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2010 (3)NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISION, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE WAPPINGERS FALLS BUILDING DEPARTMENT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 `::~1?~€i1Qf3:~EC31t~R~d: f31!:~tW15:~C~f~TIK:FG;4T~~:~`:~:=`:~::~: POLICYHOLDER MICHAEL J RODELL D/B/A ATLANTIC COAST CONSTRUCTION 6 MARLORVILLE RD WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1187 857-6 DATE 11/17/2010 CERTIFICATE NUMBER 511-325 CERTIFICATE HOLDER WAPPINGERS FALLS BUILDING DEPARTMENT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 12/07/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~~~~O~ICD NOV 1 ~ ZQ~ TOWN OF VUAPPrNGER TOWN CLERK THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 497 STDCAN-2/2001 Technology Insurance Company 5800 Lombardo Center Cleveland OH 44131-2550 ~`- tt ~ ~ CERTIFICATE HOLDER NOTICE ~ ~ NEW YORK WORKERS COMPENSATION INSURANCE COVERAGE ""°''°~-~- Certificate Holder: Town of Wappinger 20 Middlebush Road Wappinger Falls, NY 12590 d G~[~C~C ~MC~D NOV 1~~~ 2p;p TOWN OE WAPPINGER TOWN CLERK Insured: Commercial Contracting Company, Inc. Policy Number: TWC3225374 Policy Period: 12/31/2009 to 12/31/2010 12:01 a.m. at the insured's mailing address Date of Notice: 11/9/2010 Notice Type: Reinstatement Endorsement No.: 4 Reason: As a Certificate Holder on the above policy, you are hereby notified that the NOTICE OF CANCELLATION effective 11111!2010 is superceded. Coverage has been reinstated without lapse for the policy period noted above. If you have any questions regarding this notice, please contact the insured. e ~~ By: Authorized Representative ,• Technology Insurance Company An AmTrust Financial Ccmpany A member of the AmTrust Financial Group A. M. Best Rating: A- New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 1 WATERVLIET AVENUE ALBANY, NEW YORK 12206-1649 Phone: (518) 437-8979 CERTIFICATE OF WORKERS' COMPENSATION ^ ^ ^ ^ ^ ^ 141603741 ~~ PENZETTA PLUMBING & HEATING INC 49 N ELM STREET ~ ~~~ ~~ F, ~ BEACO~1 NY 12508 ~"~ ~ su~~~ls~~~~ NQ`s ~ 9 2G~G TOWN C)F WAPPINGER TOWN CLERK POLICYHOLDER CERTIFICATE HOLDER PENZETTA PLUMBING & HEATING INC TOWN OF WAPPINGER 49 N ELM STREET 20 MIDDLEBUSH ROAD BEACON NY 12508 WAPPINGERS FALLS NY 12550 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE A 1338 042-3 313889 11 /01 /2010 TO 11 /01 /2011 11 /5/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1338 042-3 UNTIL 11/01/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 11/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. FRED PENZETTA-PRESIDENT OF PENZETTA PLUMBING & HEATING INC (1 OF 2) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED ~BY THE POLICY. NEW YORK STATE INSURANCE FUND G~~ ~"~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cerUcertval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 383749404 U-26.3 NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE 200 WHITE PLAINS, NEW YORK 10604-3814 (914f 701-2120 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ BUILDING DEPARTMENT TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ~:~:.:.:.i?C-€~iOF~:.EC3v~RED: ~ $Y:~~Wi~:~C~~TIs*:FG;4*f::~: ~: ~:~:~:~:.:~: ~: POLICYHOLDER CROSSCUT CONSTRUCTION PO BOX 522 PINE BUSH NY INC. 12566 POLICY NUMBER +W 1479 395-4 DATE 11/04/2010 CERTIFICATE NUMBER 397-196 CERTIFICATE HOLDER BUILDING DEPARTMENT TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS TS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1479 395-4 UNTIL .5/02/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 5/02/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~~ . ~`- ~ 1, U-26.3 AND CONFERS NO RIGHTS CERTIFICATE DOES NOT [~C~C~C~~M[~D NOV 0 8 2010 TOWN OF WAPPINGER TOWN CLERK THE STATE INSURANCE FUND ~~ DIRE R, INSURANCE FUND UNDERWRITING 2433 cERTOZ-z/zoot NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS FALLS NY 12590 :~:::~:~P~E#1f~E3::E011~RE~:~$~!:~?WISC~t~TIF:EGi~tiT~~:~:~:::~.'•'`::>: POLICYHOLDER T W F CONTRACTING INC 211 CHESTNUT STREET PORT CHESTER NY 105733122 POLICY NUMBER +G 1243 153-2 DATE 11/02/2010 CERTIFICATE NUMBER 292-653 CERTIFICATE HOLDER TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1243 153-2 UNTIL 6/29/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/29/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. I~CC~LD~C~D '~ NOV 0, 5 20.E TOWN OF WAPPINGER TOWN CLERK THE STATE INSURANCE FUND ~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING 2431 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-838-997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS FALLS NY 12590 :~:~:~A~E2iQE5:~E01l~R~l~:~~1!:~1'WIC:~E~€t1'I~:FCA7~~:~:~>:~:~:~:~:~:~: ::::::::::::~ ~:~:~~~~o~r~:::~a::::::~:tz~~:~~r:t ::::::::::::::::::::::::::: POLICYHOLDER T W F CONTRACTING INC 211 CHESTNUT STREET PORT CHESTER NY 105733122 POLICY NUMBER +G 1243 153-2 DATE 11/02/2010 CERTIFICATE NUMBER 337-133 CERTIFICATE HOLDER TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1243 153-2 UNTIL 6/29/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/29/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PO~CY. ~~~ ~ Tp ~/N ~V ~ 4 ?010 T~~I/~ ~gppl N THE U-26.3 DIRE R, INSURANCE FUND UNDERWRITING 2425 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 >:~:~ R~€tiQE3:~EOrl~REt~:~f3Y: ~ 1~WiS:~E~f~1'IFFC,;43~~:~5>:~":~.'•: ~: ::::::::::::~:~:~:s~~~~~s:::~~::::::~:fz~t:~~r~ ::::::::::::::::::::::::::: POLICYHOLDER T W F CONTRACTING INC 211 CHESTNUT STREET PORT CHESTER NY 105733122 POLICY NUMBER +G 1243 153-2 DATE 11/02/2010 CERTIFICATE NUMBER 906-691 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1243 153-2 UNTIL 6/29/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR _WORKERS'_COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/29/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~~ ~ ~~ J . ~ P A 1, ~~ // /^\~' n v ~i~ OI' n ~o,, v VSO T OWN pF ~ 4?G'~ TOE ~gppjj - ----- THE ST~Pr~UR~I~)cTtiU ~~ ~ `~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING 2371 CERT02-2/2001 New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (888) 997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 61533029 LOVELL SAFETY MGMT CO., LLC 110 W ILLIAM STREET 12TH FLR NEW YORK NY 10038 POLICYHOLDER CERTIFICATE HOLDER LISIKATOS CONSTRUCTION INC TOWN OF WAPPINGER P.O. BOX 309 20 MIDDLEBUSH RD COLD SPRING NY 10516 WAPPINGERS FALLS NY 12590 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G 1416 145-9 304122 04/01 /2010 TO 04/01 /2011 10/29/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1416145-9 UNTIL 04/01/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~. ..,~~` ~ ~~ t ~~O ~~. No ~~0 row ~o ¢ O To ~F ~ ~ ~0''~ ~IiN C APING ~FRk FR / NEW YORK STATE INSURANCE FUND G~~~ ~`~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 369580153 U-26.3 ~~ STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NY5 DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a. Legal Name and Address of Insured (Use street address only) 1 b. Business Telephone Number of Insured COMMERCIAL INST. & ALARMS, INC. 845-896-9500 2 SUMMIT COURT lc. NYS Unemployment Insurance Employer SUITE 306 ~--.~ ,, Registration Number of Insured FISHKILL, NY 12524 ~ ~ 7341995 ld. Federal Employer Identification Number of Insured or Social Security Number 141632315 2. Name and Address of the Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certif cate Holder) Zurich American Insurance Company Town of Wappingers """---- 58 South Service Road, Melville, NY 11747 20 Middlebush Road ~~ (~` (~D ~1 ~D Wappingers Falls, NY 12590 V LL~~ V 36. Policy Number of entity listed in box "la": 1992507 - 001 OCT~2 7 2010 3c. Policy effective period: TOWN OF WAppING 7/15/2010 To 7/15/2011 E TOWN C 4. Polic covers: a. ~X All of the employer's employees eligible under the New York Disability Benefits Law b. ~ Only the following class or classes of the employer's employees: Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above isability Benefits insurance coverage as described above. D and that the named insured has NYS 1 ~ 'l~t.,G~.A totz5t2oto g /~",-~ y ~ .. Date Signed (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (631) 845-2200 Title Operations Manager IMPORTANT: If box "4a" is checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier, this certificate is COMPLETE. Mail it directly to the certificate holder. [f box "4b" is checked, this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the Disability Benefits Law. It must be mailed for completion to the Workers' Compensation Board, DB Plans Acceptance Unit, 20 Park Street, Albany, New York 12207. PART 2. To be com leted b NYS Workers' Com ensation Board Onl if box "4b" of Part 1 has been checked State Of New York Workers' Compensation Board According to information maintained by the NYS Workers' Compensation Board, the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Workers' Compensation Board Employee) Telephone Number Title Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insz~rance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (5-06) Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in box "3" on this form is certifying that it is insuring the business referenced in box "la" for disability benefits under the New York State Disability Benefits Law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box " 2". This Certificate is valid for the earlier of one year after this form is approved by the insurance carrier or its licensed agent, or the policy expiration date listed in box " 3c". Please Note: Upon the cancellation of the disability benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article, and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. DB-120.1 (5-06) NEW YORK STATUTE INSURANCE FUND 1 WATERVLIET AVENUE ~518)$4~7~6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE '~"°' TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1482 281-1 DATE 10/21/2010 CERTIFICATE NUMBER 714-812 ~: ~:: `:: R~E31f3b::Et~11~R~D::$~: ~ ~'WI~ <C~E~fi'I~:ECA'{~:`........":; `: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 11/10/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTEP. THE COVERAGE AFFORDED BY THE POLICY. ~j~O~GD I OCT 2 5 Zd ~~ TOWN OF WAPPRK ER TOWN CLE _____ CANCELLATION U-26.3 THE STATE INS~Uj~RANCE FUND DIRE OR, INSURANCE FUND UNDERWRITING 575 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8~8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ~:~:~:~R~€tiQd>Ei~.rt~REb:~BY:~ tWiS`~~€t~I~:EGaT~~:~>:~:~:~>:~:~:~: ::::::::::::t:~:~:~~~~~a5::::~c~:::~y:to&~~~~r~ ::::::::::::::::::::::::::: POLICYHOLDER T W F CONTRACTING INC 211 CHESTNUT STREET PORT CHESTER NY 105733122 POLICY NUMBER +G 1243 153-2 DATE 10/19/2010 CERTIFICATE NUMBER 337-133 CERTIFICATE HOLDER TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 11/08/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. `~ CANCELLATION U-26.3 ^, J OCj ~ 5 ~ N~,ER W N a~ W Ap ERK ~o TOWN CI- ~~~O~~V ~~~ THE STATE ND INS RANCE FU U ~~~ ~ - .~ ~ /~%/Q/f%-~~lifi~ DIRE OR, INSURANCE FUND UNDERWRITING 6403 cTnraN-~i~nn~ NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54~716400ANY, NEW YORK 12206-1649 CANCELLATION OF G~f~n-~~~ICD oc ~-~~ s 200 TOWN OF WAPPINGER 20MIDDLEBtTSH RD TOWN C)F L'UAPPINGER WAPPINGERS FA ~?~590 TGWN CLERK -_-~' ~ , TION INSURANCE POLICY NUMBER +A 1482 281-1 DATE 10/21/2010 CERTIFICATE NUMBER 668-155 ~:`~:~is~tic~Ei:~Cd~REir~:~ S$'1~Wig: ~C~i~fi1~3Ca~~:~:~;:":.:.:.:.: :::::::::::;~~~fi~~~rr~:::~~:::~r:t ~~~~~r~ ::::::::::::::::::::::::::: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 11/10/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 319 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE 200 WHITE PLAINS, NEW YORK 10604-3814 (9145 701-2120 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS FALLS OCT, 2 s ZOtO BUILDING DEPARTMENT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 TQb~/iV OF WAPPINGER Tr'~W N CLERK ~.... :~:~12C-€t'1rQ./E1:~C0/~11~R~d>$Y:~TW.rI~/:~~fCq~~E/#~TjIK:IyG,{:4~'f~:~:~::~:~>:~:~:~: POLICYHOLDER RIA CONSTRUCTION INC P.O. BOX 7174 NEWBURGH NY 12550 POLICY NUMBER 'tiW 1484 087-0 DATE 10/22/2010 CERTIFICATE NUMBER 917-897 CERTIFICATE HOLDER TOWN OF WAPPINGERS FALLS BUILDING DEPARTMENT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1484 087-0 UNTIL 5/22/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 5/22/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND U-26.3 ~i~ DIRE R, INSURANCE FUND UNDERWRITING 249 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8~8-997-3863 CANCELLATION OF CERTIFIC~..~ WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER OCT~2 2 20;0 20 MIDDLEBUSH ROAD TOWN OF WgppINGER WAPPINGERS FALLS NY 12590 TOwN CLERK --~..\ :~:~:~P~€2iQE3:~Ei3V~RED:~81!:~ TWiS:~lr~f~~fil~:~C,~7~~:~`:.:.:.`:.": ::::::::::~:~:~:~:~~~~as:::~~:::t:sto~~~r~:~ ::::::::::::::::::::::::: POLICYHOLDER T W F CONTRACTING INC 211 CHESTNUT STREET PORT CHESTER NY 105733122 POLICY NUMBER +G 1243 153-2 DATE 10/19/2010 CERTIFICATE NUMBER 906-691 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 11/08/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 6457 cTnr a ni_ ~ inn i New York State Insurance Fund -- -- -------------- Workers' Compensation & Disability Benefits Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (888) 997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 141670108 KEEVILY,SPERO-WHITELAW INC. 500 MAMARONECK AVENUE HARRISON NY 10528 POLICYHOLDER SAXTON CORP T/A JUDGE SIGN CO A DIVISION P.O. BOX 163 EAST GREENBUSH NY 12061 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 10035 POLICY NUMBER ' CERTIFICATE NUMBER I, PERIOD COVERED BY THIS CERTIFICATE DATE ', G 813 625-1 ' 168794 11 /01 /2006 TO 11 /01 /2011 9/10/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 813 625-1 UNTIL 11/01/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 11/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. '~~ G°~LC~COMGD OCT 2 5 2010 TOWN OF WAPPINGER TOWN CLERK NEW YORK STATE INSURANCE FUND L~;~ ij~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cerUcertval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 682474017 U-26.3D 312/CD32844-20/554 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~1 SIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 ~ 'j ~~ LR1~V~~~V~u OCT 1 ~ 20 TOWN OF WAPPINGER .............................................................. ::::: ;1? rE21Qf 5: ~ E Oita R~C~:: BY :: ~' H I>; :: E ~Et~' I K:~C~4'Ci^ :::::::::::::::::::: POLICYHOLDER RICHARD J DELUCA UBA Al REMODELING EXPERTS BY DELUCA HOMES 18 PETERS RD HOPEWELL JCT NY 12533 POLICY NUMBER +A 1447 622-0 DATE 10/08/2010 CERTIFICATE NUMBER 429-535 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1447 622-0 UNTIL 3/23/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 3/23/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 5 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING 315 CERT02-2/2001 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE 200 WHITE PLAINS, NEW YORK 10604-3814 (914f 701-2120 CANCELLATION OF CERTIFICATE OF WORKS 'COMPENSATION INSURANCE ,. , BUILDING DEPARTMENT TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ~~~~~n/J 1111 ~D ~~T"21 20i0 TpwN OF WAPPINGE TOwN CLERK R POLICY NUMBER +W 1479 395-4 DATE 10/18/2010 CERTIFICATE NUMBER 397-196 :~:~: ~AC-€iiOE~.'•EOrI~R~I~`SY.'•?Wi~:~~~€t1~1~:EGiT~~:~: ~: ~:~>: ~:: ~: ~: POLICYHOLDER CROSSCUT CONSTRUCTION INC. PO BOX 522 PINE BUSH NY 12566 CERTIFICATE HOLDER BUILDING DEPARTMENT TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 11/07/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1409 smcaN-~i~nn i NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ~~~~ ~b~D ACT 2 ~ 2010 TOwN of wAPPjN -- ro wN~RK ER :~:~A~iQE3`GO.rt~~~d:~$Y`tWIS:~C~€~T:I~:IGatf~:~:~:~:~:~'::=': POLICYHOLDER T W F CONTRACTING INC 211 CHESTNUT STREET PORT CHESTER NY 105733122 POLICY NUMBER +G 1243 153-2 DATE 10/19/2010 CERTIFICATE NUMBER 292-653 CERTIFICATE HOLDER TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 11/08/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 6397 cTnrnni_~i~nn~ STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name and address of Insured (Use street address only) lb. Business Telephone Number of Insured Conte Electric Inc d~ John E. Conte 845-454-1833 2111 New Hackensack Road Poughkeepsie, NY 12603 lc. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, i. e. a Wrap-Up Policy) 1 d. Federal Employer Identification Number of Insured or Social Security Number 14-1737642 2. Name and Address of the Entity Requesting Proof of 3e. Name of Insurance Carrier Coverage (Entity Being Listed as t1~"Cer~cate Holder) Twin City Fire Insurance Company e 3b. Policy Number of entity listed in boz "la": Town of Wappinger OIWECJU8863 20 Middlebnsh Road PO Boz 324 NY 125 ~ ~ ~ ~ ~ ~ ~ D Wappingers Falls 3c. Policy eSective period: , 10/16/10 -10/16/11 Q ~ T I .2 2 Q ; Q 3d. The Proprietor, Partners or Ezecntive Officers are: ~~ X included. (Only check box if all pariners/officers included) TOWN O F W A P P I N G E R ezclnded or certain partners/officers ezclnded. TOWN CLERK ~, 1Demolition is: (Dej6e&lon of Demollllon on Reverse) included. ezclnded. This certifies that the insurance carrier indicated above in box " 3" insures the business referenced above in box "1 a" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certifteate. (These notices may be sent by regular mail.) Otherwise, this Certt,Jleate Ls valid jor a maxfiiwm of one year afi'er this form is approved by the Insuranct carrier or Its licensed agent Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requiremenb of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Approved by: Title: President Telephone Number of authorized representative or licensed agent of insurance carrier: 518-602-2020 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT authorized to issue it. C-105.2 (12-03) Workers' Compensation Law Section 57. Restriction on inane of permib snd the entering into contracts nnlesa compensation is secured. 1. The head of a state or municipal department, boazd, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazazdous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, boazd, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, boazd, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazazdous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Definition of Demolition (Box " 3e" on the reverse side of this form) A building wrecking or demolition is one where a building, chimney or steeple is razed, or where a floor, exterior wall or roof is removed. If the contract involves only the removal of interior walls, partitions or the facing only of any exterior wall, it is not considered demolition. Oat-of-State Companies Working in NYS - NYS Workers' Compensation and Disablllty Benefib Regairemenb for Permib, Licenses or Contracts issued by NYS Government Entities Generally, employers must have a workers' compensation policy or a combination of policies that cover each state in which they employ permanent employees to cover on-the job accidents and disabilities. As you are probably awaze, certain insurance carriers write policies that cover multiple states. "Riders" found under sections 3A and 3C on the Information Page of the policy specify the states of coverage. In addition, the operations covered in each state aze identified in attachments to the policy. In addition to any other state's workers' compensation coverages, anout-of--state employer needs to be specifically covered for NYS workers' compensation insurance when there are "sufficient contacts" between that employer and the state. While there is no single determinative factor, any of the following criteria could be the basis for finding "sufficient contacts" requiring New York coverage: • a physical location within New York State; • $50,000 in payroll during a calendar year in New York State; • one or more employees (including subcontractors) with a primary work location or hired within New York State; or • employees (including subcontractors) working in New York State for more than 90 days during a calendar yeaz. If anout-of--state employer meets any of the above criteria, it is required to cant' a New York State workers' compensation policy. When New York is listed in Item 3A on the Information Page of an employer's workers' compensation insurance policy, the employer is fully covered under the NYS Workers' Compensation Law. If insured through a private insurance carrier, the out-of--state employer must file a C-105.2 -- Certificate of Workers' Compensation Insurance (the business' insurance carrier will send this form to the government entity upon request) PLEASE NOTE: The New York State Insurance Fund provides its own version of this form, the U-26.3. If the out-of--state employer is legally, fully self-insured in New York State, the out-of-state employer must file a SI-12 -- Certificate of Workers' Compensation Self-Insurance (the business calls the Board's Self-Insurance Office at 518-402-0247). If the out-of-state employer is participating in group self-insurance, the out-of-state employer must file a GSI-105.2 -- Certificate of Participation in Worker's Compensation Group Self-Insurance (the business' Group Self-Insurance Administrator will send this form to the government entity upon request). If anout-of--state employer does not meet any of the above criteria and has New York (NY) listed in Item 3C on the Information Page of its workers' compensation insurance policy (the Other States Insurance section), NYS specific coverage is not required and the employer may be able to use its own state's workers' compensation coverage by filing a WC/DB-101 form. [The out-of--state employer's employees will be covered under NY benefits when working in New York by having NY listed in Item 3C on the Information Page of the workers' compensation insurance policy (the Other States Insurance section).) C-105.2 (12-03) Reverse NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~h_ ~~~~~~~~ TOWN OF WAPPINGER 20 MIDDLEBUSH RD oCj 1 WAPPINGERS FALLS NY 12590 2 Z~~~ T~wN OF WAPPINGE TOwN CLERK R :~::~R~€21f1E3>C(31t~REd:~$YSIWIS:~C~€~TIi=:FCA7~~:~:~>5>:~>:~:~: ::::::::::~:~z~~~a~rs:::~~:::~ofzfif:~~r~ ::::::::::::::::::::::::::: POLICYHOLDER RICHARD J DELUCA DBA Al REMODELING EXPERTS BY DELUCA HOMES 18 PETERS RD HOPEWELL JCT NY 12533 POLICY NUMBER +A 1447 622-0 DATE 10/07/2010 CERTIFICATE NUMBER 429-535 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 10/27/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 239 crnrnni_~ inn ~ NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE~200f WHiT2120AINS, NEW YORK 10604-3814 CANCELLATION OF CERTIFICA ~ wCI~~ COMPENSATION INSURANCE ~.~_~ ~ ~ TOWN OF WAPPINGERS FALLS BUILDING DEPARTMENT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 125 G°~~C~~~M~D OCT 0 8 20~,~ TOWN OF WAPPING ER TOWN CLER ~:~:~: A~€21f1E;:~EC31l~I~(^d:~$Y:~T'WIS:~E~E2TI~:FCA'F~~:~:~>:~>:~:<~:~: POLICYHOLDER RIA CONSTRUCTION INC P.O. BOX 7174 NEWBURGH NY 12550 POLICY NUMBER +W 1484 087-0 DATE 10/06/2010 CERTIFICATE NUMBER 917-897 CERTIFICATE HOLDER TOWN OF WAPPINGERS FALLS BUILDING DEPARTMENT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 10/26/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FU ND ~~~ ~ - /~~Q/1~-~%Gf~ DIRE OR, INSURANCE FUND UNDERWRITING ~n~ NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE 200 WHITE PLAINS, NEW YORK 10604-3814 (914j 701-2120 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 G°~CC~C~ML~D OCT 0 g 20~~ POLICY NUMBER +W 1484 087-0 DATE 10/06/2010 CERTIFICATE NUMBER 918-217 TOWN OF WAPPrNGER TOWN CLERK ~: ~::::::1?C,E21QE3:~GC3V~REd$1!:~ 1Wltslr~€~TIF:(C.;43f~:~>: y::'::>: ~: POLICYHOLDER RIA CONSTRUCTION INC P.O. BOX 7174 NEWBURGH NY 12550 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 10/26/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 403 cTnr nni_~ inn NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER ATTN: SHELLY 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 :~:::.>P~ii~1E3>EC3.rl~R~d.'•$Y:~ 7Wi5:~~~f{TI~:FC;ATf~55 :.:.:.:.:.:.: :~::::::: ~:~:o~:~~~~r9.:::~~::~>fob:s~~r~ :::::::::::::::::::::::: POLICYHOLDER J. D. PARRELLA ELECTRIC, INC. 299 WASHINGTON ST NEWBURGH NY 12550 POLICY NUMBER '~G 2059 277-0 DATE 9/30/2010 CERTIFICATE NUMBER 465-768 CERTIFICATE HOLDER TOWN OF WAPPINGER ATTN: SHELLY 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 11/01/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIrE~._ D oc~ a s 2oro TOWN OF WAPPINGER TOWN CLERK CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 479 cTnrnni_~i~nn ~ Technology Insurance Company 5800 Lombardo Center Cleveland OH 44131-2550 CERTIFICATE HOLDER NOTICE NEW YORK WORKERS COMPENSATION INSURANCE COVERAA~~~ ~ Certificate Holder: ~ ~~ " ~D ~~~ Town of Wa in er OCR ~ ~ 2010 PP~ 9 20 Middlebush Road O~ w App~1vGER Wappinger Falls, NY 12590 T~wN1~NN CLER~ Insured: Commercial Contracting Company, Inc. ~. Policy Number: TWC3225374 Policy Period: 12/31/2009 to 10/12/2010 12:01 a.m. at the insured's mailing address Date of Notice: 9/28/2010 Notice Type: Cancellation Effective Date of Cancellation: 10/12/2010 12:01 a.m. at the insured's mailing address Endorsement No.: 11 Reason: Prem Due 2805.00 As a Certificate Holder on the above policy, you are hereby notified that in accordance with the terms and conditions of this policy, Workers' Compensation Insurance will cease on the date shown for the above named insured. If you have any questions regarding this notice, please contact the insured listed above. By: ~~ e ~~ Authorized Representative r~ Technology Insurance Company An AmTrust Financial Company A member of the AmTiust Financial Group A.M. Best Rating: A- NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER SEP 3 ~ 2C1o 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 TOWN QF WgpprNGER T~wN CLERK POLICY NUMBER +G 1316 863-8 DATE 9/27/2010 CERTIFICATE NUMBER 171-097 p~€tiQE3:~COr1EREd:~$Y:~1:HIS:~E~r~1:IP:ECAT$~:~:~:~::: <:: POLICYHOLDER NECKLES BUILDERS INC 47 WEST OLD FARMS ROAD HOPEWELL JUNCTION NY 12533 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 10/17/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~, ~~ CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1109 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISION, ALBANY, NEW YORK 12206-1649 518) 437-6400 CERTIFICATE OF WO "`"°`D-~"~ ION INSURANCE G°3L~C~COM[~D I TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY12.590 ~ 1 1~' j'±. ,?I »: ~ R~€tiOb:`•EOf~R~b: ~ $.y. <tWi~:~~~€fi~1~:FC;;47~~"•":~:~': POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1482 281-1 DATE 9/28/2010 CERTIFICATE NUMBER 668-155 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1482 281-1 UNTIL 6/07/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/07/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND U-26.3 ocr o i; zoo TOWN OF WgppINGER TOWN CLERK ~~ DIRE OR, INSURANCE FUND UNDERWRITING 205 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISION, ALBANY, NEW YORK 12206-1649 518) 437-6400 CERTIFICATE OF WORKE~COMPENSATION INSURANCE ~~~~~~ D ~~ TOWN OF WAPPINGER OCj ~ 1'2010 20MIDDLEBUSH RD TOWN OF wgppjNGE WAPPINGERS FALLS NY 9 T.. ~ R f~ ~ TO_ WN CLERK ::~::pE~€t1OE5>EC3il~R~C5:~f3Y:~?WIS:~~~€~TI~:EG;47~ >:~::~:~:~:~:~:~: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1482 281-1 DATE 9/28/2010 CERTIFICATE NUMBER 714-812 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1482 281-1 UNTIL 6/07/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/07/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~~ /~%l Q/l~E~lifi~ U-2C).3 DIRE OR, INSURANCE FUND UNDERWRITING 197 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 G°~~~~~~ CAD SEP; 2 4 2010 TOWN OF WAPPING ER TOWN CLER :~:~:~A~€21Qf3:~E0.ri~RED:~BY`tWi~:~C~€tTI~:EGa~~~:~:~:~:~»:~>:~: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1482 281-1 DATE 9/21/2010 CERTIFICATE NUMBER 714-812 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 10/11/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U - 26.3 THE STATE UND INS RANC E U ~~~ F ~ ~ j~ 1~/l Q/l~E%l~fi~ DIRE OR, INSURANCE FUND UNDERWRITING 955 cTnr~nni_~i~nn~ NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~iSIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 `: >P~iQa:~EOrI~R~d:~$Y'tHI~:~~~~TIF:ECaT~~:~::~:~:~:~>:~:? ::::::::::~~:o~~~~og::=~c~:::~v:f:f:~:~:~~y~ ::::::::::::::::::::::::::: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1482 281-1 DATE 9/21/2010 CERTIFICATE NUMBER 668-155 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 10/11/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NCT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. SEP' 2 3 201~J `OWN G~ WAppRK ER SOWN CLE CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 951 STDCAN- 2/2001 STATE OF NEW YORK WORKERS' COMI'ENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION 1NSURANCE COVERAGE la. Legal Name and address of Insured (Use street address only) lb. Business Telephone Number of Insured BURKE ELECTRICAL CONTRACTORS, INC. (845) 897-5033 10 Stagedoor Road lc. NYS Unemployment Insurance Employer Registration Fishkill NY 12524 Number of Insured Work Location of Insured (Only required if coverage is specifically N/A limited to certain locations in New York State, i.e. a Wrap-Up 1 d. Federal Employer Identification Number of Insured Policy) Or Social Security Number 061604205 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) AmGUARD Insurance Company Town of W er 20 Middle sh ad 3b. Policy Number of Entity listed in box "la": Wappinge Fall ~/~ L"/ ~D BUWC122045 3c Polic eff ti i d . y ec ve per o : SEP~ 2 7 2010 4/ 15/2010 4/ 15/2011 t° TOW 3d. The Proprietor, Partners or Executive Officers are: N OF WgppINGER ^ included. (Only check box if all partners/officers included) TOWN CLERK ®au excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box " 3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The ln.surance Carrier will also notify the ahove certificate holder within 10 days 1F a policy is canceled due to nonpayment of premiums nr within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy nr eliminate the insured from the coverage indicated on this Certificate. ('t'hese notices may he sent by regular mail.) Otherwise, this Certificate is valid for a maximum of one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in bax "3c'; whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, 1 certify that 1 am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Approved by: Samantha Walizer (Print n`ame-~of~authorized representative or licensed agent of insurance carrier) ~v/ 09/21/2010 (Signature) (Date) Title: Policy Services Coordinator Telephone Number of authorized representative or licensed agent of insurance carrier: 800-673-2465 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) www.wcbstat.ny.us New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 1 WATERVLIET AVEP U~ 8A5 BA4 7_e EW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION I SUFt~I~^~~ ^ ^ ^ ^ ^ ^ 141639884 ~* f~/s"°-e~ TO SEP 2 2 201 p H H R CONSTRUCTION CORP ~ ;~ fY '~' ~N OF 80 WASHINGTON STREET SUITE 100 ~r~ --~` ~ ~-Q ~N C PPINGER POUGHKEEPSIE NY 12601 / C~~ POLICYHOLDER H H R CONSTRUCTION CORP 80 WASHINGTON STREET SUITE 100 POUGHKEEPSIE NY 12601 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLLEBUSH ROAD WAPPINGERS FALLS NY 12590 POLICY NUMBER I CERTIFICATE NUMBER A 1149 664-3 255493 PERIOD COVERED BY THIS CERTIFICATE 9/ ~/20E0 06/06/2010 TO 06/06/2011 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1149 664-3 UNTIL 06/06/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OUTS DTE OF NEWHYORK,TTO THEEPO IOCYHOLDER'S REGUILARCNEW YORKOSTATE EMPLOYEESSONLY. TO OPERATIONS IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 06/06/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. HERBERT HREDL-PRESIDENT SUE AREDL-VICE PRESIDENT 2 OF 2 OWNERS/OFFICERS OF HHR CONSTRUCTION INC A 2 PERSON CORPORATION THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND ~~ ~~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 325839471 U-26.3 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la. Legal Name and Address of Insured (Use street address only) Ib. Business Telephone Number of Insured 845-485-4033 FAIRVIEW HEARTHSIDE DISTRIBUTORS LLC lc. NYS Unemployment Insurance Employer ATTN: ART ACKERT JR. Registration Number of Insured 68 VIOLET AVENUE POUGHKEEPSIE, NY ] 2601 1 d. Federal Employer Identification Number of Insured or Social Security Number 800256380 2. Name and Address of the Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Zurich American Insurance Company Town of Wappinger 58 South Service Road, Melville, NY 11747 20 Middlebush Rd Wappingers Falls, NY 12590 3b. Policy Number of entity listed in box "la": 5373081 - 001 3c. Policy effective period: ~ ~~ 10/20/2009 To 10/20/2010 ~/ ~] ~Q 4. Polic covers: y ~-O~N P l 6' ?0' a. ~X All of the employer's employees eligible under the New York Disabilit Benefits Law `V O ~ b. ~ Only the following class or classes of the employer's employees: TD ~ ~APPj Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referen ~,~~ and that the named insured has NYS Disability Benefits insurance coverage as described above. 4Pi G ~ n/ ~~e0~~ ~ ~ , . _ Date Signed sttatzoto gy J (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) ~- .~+ Telephone Number (63_1)_845-2200 _ _ _ Title Operations Manager___ _ IMPORTANT: If box "4a" is checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier, this certificate is COMPLETE. Mail it directly to the certificate holder. If box "4b" is checked, this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the Disability Benefits Law. It must be mailed for completion to the Workers' Compensation Board, DB Plans Acceptance Unit, 20 Park Street, Albany, New York 12207. PART 2. To be com leted b NYS Workers' Com ensation Board Onl if box "4b" of Part 1 has been checked State Of New York Workers' Compensation Board According to information maintained by the NYS Workers' Compensation Board, the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Workers' Compensation Board Employee) Telephone Number Title Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorised to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. ~Do ~~FR DB-120.1 (5-06) _y Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in box "3" on this form is certifying that it is insuring the business referenced in box "1 a" for disability benefits under the New York State Disability Benefits Law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box "2". This Certificate is valid for the earlier ojorre year after this form is approved by the insurance carrier or its licensed agent, or the policy expiration date listed in box "3c". Please Note: Upon the cancellation of the disability benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shalt be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article, and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. DB-120.1 (5-06) Technology Insurance Company 5800 Lombardo Center Cleveland OH 44131-2550 CERTIFICATE HOLDER NOTICE NEW YORK WORKERS COMPENSATION INSURANCE Certificate Holder: Town of Wappinger 20 Middlebush Road Wappinger Falls, NY 12590 E SEP 16 2~ IJ TOWN OF WAPPINGER TOWN CLERK Insured: Commercial Contracting Company, Inc. Policy Number: TWC3225374 Policy Period: 12/31/2009 to 12!31/2010 12:01 a.m. at the insured's mailing address g" F Date of Notice: 9/9/2010 4 ~. Notice Type: Reinstatement Endorsement No.: 7 Reason: As a Certificate Holder on the above policy, you are hereby notified that the NOTICE OF CANCELLATION effective 919/2010 is superceded. Coverage has been reinstated without lapse for the policy period noted above. If you have any questions regarding this notice, please contact the insured. C ,~~ By: Authorized Representative /• Technology Insurance Company An AmTrust Financial Company A member of the AmTrust Financial Group A. M. Best Rating: A- NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE 200 WHITE PLAINS, NEW YORK 10604-3814 (914f 701-2120 CANCELLATION OF CERTIFIC.~E-,Q_F WORKERS' COMPENSATION INSURANCE ~~~~~ ~'D TOWN OF WAPPINGER SEP 2 Y; 2010 20 MIDDLEBUSH ROAD T~ wN WAPPINGERS FALLS NY 12590 TOw wgPPrNGER IV CLERK :~:~:~>?~2iQa:~EC3.rl~~~d:~$~!:~tW15:~0~€1'~IK:EGaT~~:~:~:~:~:~:~:~:~:~: ::::::::::~~~~i~~~~a~:::~r~:::~o:fofi~:~ar~ ::::::::::::::::::::::::::: POLICYHOLDER EU-TE DESIGN LLC D/B/A EURO TECH CONSTRUCTION 181 BOYD ST MONTGOMERY NY 12549 POLICY NUMBER +W 1329 868-2 DATE 9/17/2010 CERTIFICATE NUMBER 305-010 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 10/07/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 279 STDCAN-2/2001 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name >~ Address of Insured (Use street address only) 1b. Business Telephone Number of Insured JOVAN & SONS FUEL OIL INC (845) 266-4478 354 RUSKEY LN HYDE PARK NY 12538 1c. NYS Unemployment Insurance Employer Registration Number of Insured 1690816 Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, i.e., 1 d. Federal Employer Identification Number of a Wrap-Up Policy) Insured or Social Security Number 14-1835387 2. Name and Address of the Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Federated Mutual Insurance Company TOWN OF WAPPINGERS FALLS 3b. Policy Number of entity listed in box "1 a" 20 MIDDLEBUSH RD TOWN OF WAPPINGERS FALLS NY 12590 9294644 3c. Policy effective period 10/29/2010 to 10/29/2011 3d. The Proprietor, Partners or Executive Officers are: ^~~~ n~D '( " ~ included. (Only check box if all partners/officers included) v V 0 all excluded or certain partners/officers excluded. This certifies that the ins rance carrieEn~cai`eda'bove in bo "3" insures the business referenced above in box "1 a" for workers' compensation ~ ~ FO~~i~P~-~ ompensation Law. (To use this form, New York (NY) must be listed under It m N ~ of the workers' compensation insurance policy). The Insurance Carrier or its I nsed I ~I(~I~~ertific a of Insurance to the. entity listed above as the certificate holder in box "2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box " 3c", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: by: Title: _ / (Fr a of authorized r presentative or licensed agent of in uran carrier) ~~/.~ ~d. ( ignature) ~ (Date) rp ~~~ Telephone Number of authorized representative or agent of insurance carrier: (888) 333-4949 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 Ed. 09-07 www.wcb.state.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. C-105.2 Ed. 09-07 Reverse STATE OF NEW YORK WORKERS' COMPENSATION BOARD r>~u~r-r>~r('eTF. nF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) lb. Business Telephone Number of Insured RC Harris Plumbing 8 Heating Inc. 845-635-9800 1427 Route 44 lc. NYS Unemployment Insurance Employer Pleasant Valley, NY 12569 Registration Number of insured Work Location of Insured (Only requlrerllf coverage isspec~cally Id. Federal Employer Identification Number of Insured Ilnrlted to certain lacatlons !n New York State, l.a, a ii'rap-Up or Social Security Number Parley) 16-1517030 2. Name and Address of the Entity Requesting Prootof 3a. Name of [nsurance Carrier Coverage (Entity Beiog Listed as the CertiRcate Holder) Pacific Employers Insurance Company ~ ~`` P ; " Town of Wappinger 3b. Policy Number of entity listed in box "la" a 20 Middlebush Road 046288920 Wappingers Falls 590 - 3e. Policy effective period ~~~~~~~ D D 04/12/2010 to 04112/2011 3d. The Proprietor, Partners or Executive Officers are SEP Q 9 2010 ~ included. (Only check bo: if sll psrtneratofficerslncluded) T'~wN OF WA ^ all excluded or certain partners/officers excluded. ppINGER .rOw N This certifies that the insurance carrier indicate '31 -' x ` "insures the bustness reterencea aoove rn oox is wr wo~~~~~ compensation under the Nety York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier toil/also notify the above certificate holder tvithln 10 days 1Fapolicy is canceled due 1o nonpayment ofpremiums or x~ithin 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the lruured from the coverage indicated on -his Certificate. (These notices may be sent by regular mail) Otherwise, this CertJflcate !s valid for one year after this forth !s approved by the Insurance carrier orlts !lcensed agent, or unN/ the poAcy explratlon date listed In box "3c", w/rlclrever is earlier. Pler.~e Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a clew Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that 1 am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Brooke Smith _ (Print ruune of authori~d represenative or licensed agent of insurance carrier) Approved by: Title: Renewal Underwriter Assistant Telephone Number of authori2ed representative or licensed agent of insurnnce carrier: 888-376-9633 Please Note: Only insurance carriers acrd their licensed agents are authorized to issue Form C-lOS.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9.07) www.tecbstate.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by la~v to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such smote or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal departmcrt, board, eemmission or office authorized or required by law to enter into any ccnt:act for cr in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. C-105.2 (9-07) Reverse Technology Insurance Company 5800 Lombardo Center Cleveland OH 44131-2550 CERTIFICATE HOLDER NOTICE NEW YORK WORKERS COMPENSATION INSURANCE COVERAGE Certificate Holder: Town of Wappinger 20 Middlebush Road ~ ,~~ ~ L, Wappinger Falls, NY 12590 ~ Insured: Commercial Contracting Company, Inc. Policy Number: TWC3225374 Policy Period: 12/31/2009 to 9/9/2010 12:01 a.m. at the insured's mailing address Date of Notice: 8/26/2010 Notice Type: Cancellation Effective Date of Cancellation: 9/9/2010 12:01 a.m. at the insured's mailing address Endorsement No.: 9 Reason: Prem Due 2805.00 As a Certificate Holder on the above policy, you are hereby notified that in accordance with the terms and conditions of this policy, Workers' Compensation Insurance will cease on the date shown for the above named insured. If you have any questions regarding this notice, please contact the insured listed above. C ~~ By: Authorized Representative ,• Technology Insurance Company An AmTrust Financial Company A member o/the AmTrust Financial A.M. Bast Rating: A- [~[~C~C~~MC D SEP 0 2 2010 TOWN OF WAPPINGER TOWN CLERK New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (888)997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE _~ ^ ^ ^ ^ ^ ^ 141484873 ~~.~' ~' LOVELL SAFETY MGMT CO., LLC 110 WILLIAM STREET 12TH FLR NEW YORK NY 10038 POLICYHOLDER CERTIFICATE HOLDER BLACK ELECTRIC INC TOWN OF WAPPINGER 766 FREEDOM PLAINS ROAD 20 MIDDLEBUSH RD POUGHKEEPSIE NY 12603 WAPPINGERS FALLS NY 12590 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G 2089 892-0 229530 04/01/2010 TO 04/01/2011 8/27/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2089 892-0 UNTIL 04/01/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~~~~pdC~D SEP 0 2 2010 TOWN OF WAPPINGER TOWN CLER NEW YORK STATE INSURANCE FUND e~~- '~~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 600250902 U-26.3 .. it STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) lb. Business Telephone Number of Insured 845-724-5615 DAKA PLUMBING & HEATING, LLC 2561 ROUTE 55 lc. NY5 Unemployment Insurance Employer POUGHQUAG, NY 12570 Registration Number of Insured 4843969-9 Work Location of Insured (Only required ifcoveragelsspec~ally ld. Federal Employer Identification Number of Insured limited to certain locations In New York State, r:~, a Wrap-Up or Social Security Number Policy) 050-535629-2 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) EXCELSIOR INSURANCE 3b. Policy Number of entity listed in box "la" TOWN OF WAPPINGER ~ WC 8309442 20 MIDDLEBUSH ~' ~' -" ~ Policy effective period WAPPINGERS FA LS, -0324 03/10/2010 03/10/2011 ~~ ~ to ~0 ~ ~~ 3d. The Proprietor, Partners or Executive Officers are A (J~j ^ included. (Oaly check box if all partuenlofncers included} ~' ?~~~ Tp~ X all excluded or certain partners/officers excluded. N TQ of wApP1N This certifies that the insurance ~ above ' box " 3" insures the business referenced above in box "1 a" for workers' compensation under the New York State Worker a sation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also note the above certiftcate holder within ! 0 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certif Late is valid jor one year after this form is approved by the insurance carrier or Its licensed agent, or untll thepoliry expiration date listed in box "3c", whkhever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holde* with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: rint name f au ized representative or licensed agent of inswance carrier) - ~- - - Approved by: Title: (Date) Telephone Number of authorized representative or licensed agent of insurance carrier: Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07} www.wcb.state.ny.us Workers' Compensation Law Section 57, Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. C-105.2 (9-07) Reverse NEW YORK STATE INSURANCE FUND 199 CHURCH STRiE8$8N9W YORK N.Y. 10007-1100 CANCELLATION OF CERTIFICATE OF O~ PENSATION INSURANCE ~~o~ A~ ~o G ~~ TOWN OF WAPPINGERS TpwN pF l1 ~~~~ POLICY NUMBER 20 MIDDLEBUSH ROAD Tp'A' ~/,q~p +Z 2093 204-2 WAPPINGERS FALLS NY 12590 yvN C~~ INCi~R $/09/2010 4~ ~` ~ ~~ CERTIFICATE NUMBER -' 121-558 :::::.'•::R~€t1QF3::E01l~R~d::BY: ~'tFllS: ~~~f{TI~:EGA'ff :::::::::::::::::::: POLICYHOLDER NAC INDUSTRIES INC 160 AIRPORT DRIVE WAPPINGERS FALLS NY12590 CERTIFICATE HOLDER TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 8/29/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 843 cTnrnni_~i~nn ~ NEW YORK STATE 199 CHURCH STRiET T CERTIFICATE OF WO~ INSURANCE FUND W YORK N.Y. 10007-1100 x.47-3863 ~C~D AUG 0 91010 ~~ TOWN OF WAPPINGER T~wN OF WAPPINGE 20 MIDDLEBUSH ROAD T~ WN R WAPPINGERS FALLS NY 12590 C~ER K r~\ ~ , :__ ~ t ~:::.:. R~i4d:: E C31l~R~ti:. $Y:. tWi~ E~Ettls=:~G;A'F~ .:.:.:.:.:.:.::: ~::::::::~: ~:o x ~~~a~:::~'~:::::::~:t off: ~~¢r:t ::::::::::::::::::::::::::: POLICYHOLDER WFL CONSTRUCTION INC BILL LIGUORI 8 COMMERCE STREET POUGHKEEPSIE NY 12603 POLICY NUMBER ~~Z 1363 521-4 DATE 8/04/2010 CERTIFICATE NUMBER 913-807 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1363 521-4 UNTIL 1/01/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 1/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE~F~U`ND ~Z~ 1?~G~ 2~Eiliti` U-26.3 DIRE R, INSURANCE FUND UNDERWRITING 785 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8~8-997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 :~:~:~1?~€21f7E1:~EC31l~R~D$Y>1F15:~1r~€~?IK:IGAT~~:~>:~:~:~»:~:~: :::::::::~:~:0~:~2~:~~:::~~::::::~:toy:s~i~r:t :::::::::::::~:~::::::::::: POLICYHOLDER WFL CONSTRUCTION INC BILL LIGUORI 8 COMMERCE STREET POUGHKEEPSIE NY 12603 POLICY NUMBER ~~Z 1363 521-4 DATE 8/04/2010 CERTIFICATE NUMBER 071-757 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1363 521-4 UNTIL 1/01/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 1/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDE IS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE OLIN. ~. _~ ~ ~~D ~ A Tp ~~ ~ 9 2010 T N OF WAPPI OWN C~FRNGER K THE STATE INSU'~RAIQCE.~F~U-ND U'2G.3 DIRE R, INSURANCE FUND UNDERWRITING 231 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFICA '~' TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 tl1~L5~~~ V L5V AUG 02 2010 TOWN OF WAPPINGER TOWN CLERK TION INSURANCE L ~ ~~~~ :~:.>:.A~€tiOa:.EOrt~REd:.BY:~TWI~:.C~€~T:I~:~C~a7~ ::.:.:.:.:.:.:.:.:.: POLICYHOLDER WFL CONSTRUCTION INC BILL LIGUORI 8 COMMERCE STREET POUGHKEEPSIE NY 12603 POLICY NUMBER +Z 1363 521-4 DATE 7/26/2010 CERTIFICATE NUMBER 071-757 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 8/15/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 2371 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER AUG 0 2 2010 20 MIDDLEBUSH ROAD TOWN OF WAPPII~1 ~~ WAPPINGERS FALLS NY 12590 TOWN CLERK ~. ~ ~ :~.'•:~A~€tiQt~:~EOrt~RECS:~$Y:~1H1~.'•!r~[t~IK:EGaT~~:~`:~`:~:~:~»: POLICYHOLDER WFL CONSTRUCTION INC BILL LIGUORI 8 COMMERCE STREET POUGHKEEPSIE NY 12603 POLICY NUMBER +z 1363 521-4 DATE 7/26/2010 CERTIFICATE NUMBER 913-807 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 8/15/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1045 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 i2~RiOE3:~6011~R~1~:~f3Y:~tHr~IS:1C~./€tTI~:EyCa~~~:~>:~:~:::~::~: POLICYHOLDER MAURICE E WILKINS DBA MW POOLS PO BOX 126 CLINTONDALE NY 12515 POLICY NUMBER +A 1448 745-8 DATE 7/22/2010 CERTIFICATE NUMBER 175-923 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1448 745-8 UNTIL 3/21/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 3/21/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND U-26.3 ~~~ ~Q~-~ DIRE R, INSURANCE FUND UNDERWRITING 295 CERT02-2/2001 NEW YORK STATE INSURANCE 199 CHURCH STREET NEW YORK N.Y. 1-8~8-997-3863 CERTIFICATE OF WORKERS' COMPENSATION TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 :~:~:~1?~€21QE5:~6C31/~R~d:~B~!:~CH15:~~~FtTIK:{GA~~~:~:~:~:~::~:: ~:~: POLICYHOLDER ISLAND PUMP & TANK CORP 40 DOYLE COURT EAST NORTHPORT NY 11731 POLICY NUMBER + G 796 438-0 DATE 7/21/2010 CERTIFICATE NUMBER 852-761 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 FUND iooo7-iioo INSURANCE THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 796 438-0 UNTIL 6/29/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/29/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. U-26.3 THE STATE INSURANCE FUND ~~ DIRE R, INSURANCE FUND UNDERWRITING 811 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SION, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS 20 MIDDLEBUSH RD WAPPINGERS FALLS FALLS NY 12590 >>?~iiQE3'C(~11~rBEd:~BY:~tHI~:~C~€~~IF:FGi7~~:~:~:~:~:~:~:< :~: ::::::::::~~z~~~~v~:::~r~::::::~:fzt:E:~¢r~ ::::::::::::::::::::::::::: POLICYHOLDER MAURICE E WILKINS DBA MW POOLS PO BOX 126 CLINTONDALE NY 12515 POLICY NUMBER +A 1448 745-8 DATE 7/22/2010 CERTIFICATE NUMBER 368-565 CERTIFICATE HOLDER TOWN OF WAPPINGERS 20 MIDDLEBUSH RD WAPPINGERS FALLS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1448 745-8 UNTIL 3/21/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 3/21/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND U-26.3 ~~ DIRE R, INSURANCE FUND UNDERWRITING 265 CERT02-2/2001 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name and address of Insured (Use street address only) lb. Business Telephone Number of insured Prostruction USA Corp. (845) 454-5238 199 West Road, B Suite 117 lc. NYS Unemployment Insurance Employer Registration Pleasant Valley NY 12569 Number of Insured N/A Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, i.e. a Wrap-Up ld. Federal Employer Identification Number of Insured Policy) Or Social Security Number 262647638 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) AmGUARD Insurance Company 3b. Policy Number of Entity listed in box "la": Town of Wappinger 20 Middlebush Road PRWC022072 Wappingers Falls, NY 12590 3c. Policy effective period: 6/23/2010 to 6/23/2011 3d. The Proprietor, Partners or Executive Officers are: ^ included. (Only check box if all partners/officers included) ® all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box " 3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also notify the ahove certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. ('t'hese notices may he sent by regular mail.) Otherwise, this Certficate is valid for a maximum of one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c'; whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, 1 certify that 1 am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Approved by: Title: Samantha Walizer (Print n~a~meno~f a`u~th~ori~zed representative or licensed agent of insurance carrier) ~~~Q7YU~" `~^'' ~"'" G~~~' 07/22/2010 (Signature) (Date) Policy Services Coordinator Telephone Number of authorized representative or licensed agent of insurance carrier: 800-673-2465 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) www.wcb.stat.ny.us NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~TSIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION NY 12533 12590 POLICY NUMBER ~~A 1332 146-8 DATE 7/19/2010 CERTIFICATE NUMBER 162-368 :~:~:~RE~€tiOE3'EC3rl~RED:~f3Y:~ tWiS:~C~€t~fil~:~Ca~f~:~:~:~:~:~:~:~:~: CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 8/19/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~ ~~~~Ob JUl"2 2 2010 T PTO=N`ERK ER CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 293 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY POLICYHOLDER DUTCHESS FIRE PROTECTION INC PO BOX 408 WAPPINGER FALLS NY 12590 12590 POLICY NUMBER +A 1379 524-0 DATE 7/20/2010 CERTIFICATE NUMBER 215-550 :~>R~€2iQE1:~C0l~R~D:~$Y:~?WIS:~E~i~:71~:~C;4~~ :~:~:~:~:~:~:~:~:~: ::::::::::is~:~:or:~~~~rs:::r~~::::::~:to~~:Sara ::::::::::::::::::::::::::: CERTIFICATE HOLDER TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 8/09/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. G°~~~~~Mf~D JUL~ 2 2 2010 CANCELLATION U-26.3 TOWN OF WAPPINGER TOWN CLERK THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1073 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SION, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 >: AE€i1f1D>E011SREb>$Y:THIS: CE€tTIF:~GATi'~;»>:::~:~:~: POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION NY 12533 POLICY NUMBER ~~A 1332 146-8 DATE 7/19/2010 CERTIFICATE NUMBER 874-920 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 8/19/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. G°~CC~C ~MCD JUL~ 2 2 2010 CANCELLATION U-26.3 TOWN OF WAPPINGER TOWN CLERK THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 289 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8~8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 "'i?~€iic?Ei:~EC3V~~~d.'•$Y>tWi~:~~~€tfiIF:~G~at~ ::~::~:~>::: POLICYHOLDER ISLAND PUMP & TANK CORP 40 DOYLE COURT EAST NORTHPORT NY 11731 POLICY NUMBER + G 796 438-0 DATE 7/19/2010 CERTIFICATE NUMBER 852-761 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 8/08/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFOnTU`n R_- y~HF ?OLICY. JUL-2 2 20',0 TOWN OF WAPPINGER ~VI~N CLE+~K THE STATE INSURANCE FUND CANCELLATION U-26.3 DIRE OR, INSURANCE FUND UNDERWRITING 2099 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 :~:~:~i?~€iit)Ei:~EC31t~t~Eb:~BY:~TF115:~~~€~'~IK:~C.A7f :~::~:~:~:~:~:~:~: ::::::::: s:~~:f~~~~a~:::~~::::::s:t:~~~:~ar~ ::::::::::::::::::::::::::: POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION NY 12533 POLICY NUMBER ~~A 1332 146-8 DATE 7/19/2010 CERTIFICATE NUMBER 297-081 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 8/19/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER :THE COVERAGE AFFORDED-$~t '~~~~ °-~-^~CY G~[~~C~MCD JUL" 2 2 2010 CANCELLATION U-26.3 TOWN OF WAPPINGER TOWN CLERK THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 981 STDCAN- 2/2001 STATE OAF NER' S'ORIi Vi~'OI2IC.EIZS' COPuIPENSATION BOARI} CERTffICATE C>F INSLiRA:\7CE COt~'ERAtiE tTNDFR THE ?\'1'S DISABILITZ" BENEFITS LA«' PART 1 ~ To be completed by Disc#iiity Benefits Carrier or Licensed Insurance Agent of that Carrier la. LegAl Name At-d Addre5.5 Of Itistved t'E1se strteC AddreS5 a111}°} PATIO ENCLOSURES INC 700 HIGHLAND EAST MACEDONIA, OH 44056-2112 lb. Bttsitiess Telepliatle Nlutibet of Iustu~ed (330) 467-4267 1c. N1'S Unen~la~znent Ittsitratace Etnplar~eJ~ Registratiaa Iv'tunGer of Itrsttred 7091405 ld. Federal Entpla~=er Identification Itiinnber of Itrsured or Sacial Secnrin~ Ntuuber 341-00-7831 2. Flame and Address of the Entity Reryuesting Proof of 3A. Nate of Iststuattce Cartier Coi-erage (Entin• Being Listed as the Certificate Holden NE1N YORFt STATE INSURANCE FUND Town of Wappinger 20 Middlebush Road sta. Policy IVtmiberaferttit)' listedut box "la": Wappinger Falls, NY 125 0 0 (i~ On n BL 2779 76 - 8 ~ ~ ~ D u ~~ ' =' v 3c. licy effectit*e periai: Jl':.:.; ~ ZOS~ 07/0l/201o to 07/01/2011 ~, Poiic}• cc~ve'rs. _._._. ~~~~riv--~-~•~~I1~1GER _ --- -~-.,., a. ~ :411 of the entplayet's eaiglo~~e~el~ ~f~i~cler the e1~- ~"ark Disability- Benefits Lan' b. ©CTnly the follcnt~iul; class ar classes of the e~rtpler=at' crupia~~es: Uudrr penaltt~ of perjure-. I certify that 1 aui an antlzorizze•d reprrserttati`~e or licensed anent of the uLStrrtettc~e carrier referenced alro~~e and than the named iustued 1~as N1'S Disabilih• Benefits instuance covera>;e as described abo~~e. Date Si,~tred 07/14/2010 B~~ ~- /~~~_ {5tpual o£iustvaarce Carrier's awlwQizld retaesnniaUee or Vl'S Licensed lusrnancr ~tgtrrt of d-a1 ~nyurars:e tAtnerV TeiephatteAaut,lber (866) 697-4332 Title DIRECTOR OF UNDERWRITING t~fiPaRT.4~T: If hox "~a" rs checked. arod this form is signed h3' Hre rnsnrarrer carver s ault-arized rYpvesexualn•! ur ~.'1'S Licensed Ivstrrance Awent or liu~ G1rT1lC. ItnS CC[1JfrCatl r5 COhtPI.ETE. !viatl rl drre~ctlq 10 the CemficAt! h6tdt7- libox '~tb" is theckld. This cayrFittfiG rs NOT CUMPLEFE far pltt~rnses of 5ectKw 224. Subd. 8 of the Disa~ilin' Herte€tts Law'. It roust tx rreailed Cor conrpllrion to the "4t'urklrs Cowperrsatian tiaard_ L}H Plans Arceptswc! Uni1.24 t?ar-c Strrl~_ Allwwq_ tvl4s•'4'rni: 12x4'. BART 2. TQ be cvrnpfeted iay NYS Workers' Carnpensatian board ~onhF if bax "4b" of Part 1 has en checked) State Of New York Workers' Compensation Board Arcarclittg tc~ infaentatian inatiufaiuecl irv the NYS ~l~aricers` Cautlaensation Bcurcd. the atmve-naaneci eurpla~~er ~s can~plied .s~itlt the 1~1"S I?isaUiittti~ Benefits I att• with rrs}~ect to all of ltisfher eruplovees- Date Sigatecl~ $d- lSituranrre ofA'1'S t~'orkerc' C~P411tfC7r~9Tti1n ~C1afd E1N(7~M'MI Telepitaste Alttntber Title Please Dote: t~nl}~ insttrance catziers lieetzsecl tc~ «rite I~IYS disabiht~~ i~enefits itrstu:~uce policies :uyd I~Tl'S licensed in~:utatue agexirs of those uysiuance cairiecs tyre atttliarized to isstte Form DB-130, 1, Insurance hralers ttre :VC>T` :tuthari~ed tc~ issue this farm.. DB•12t1.1 t5 nt+,~ Certificate Number 89309 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~iSIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 :~:~:~f?~21f)F3>ECS1i'~R~D:=81!>tHIS: lr~Et~'IK:~C;4~f~:~:~:~':~::~: ::::::::~~:~:~~~~~s:::~~::::::~:f:~~~:~ar~ ::::::::::::::::::::::::::: POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION NY 12533 POLICY NUMBER ~~A 1332 146-8 DATE 7/19/2010 CERTIFICATE NUMBER 616-846 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 8/19/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. G°~l~C~(~~MC~D JUL ~ 3 2010 TOWN OF WAPPINGER TOWN CLERK THEr STATE INSURANCE~F~U-ND CANCELLATION ~~~- 1~~~'~~` U-26.3 DIRE OR, INSURANCE FUND UNDERWRITING 985 sT~caN-~i~nni NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE WAPPINGERS FALLS BUILDING DEPARTMENT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY POLICYHOLDER MAURICE E WILKINS DBA MW POOLS PO BOX 126 CLINTONDALE NY 12515 12590 POLICY NUMBER +A 1448 745-8 DATE 7/06/2010 CERTIFICATE NUMBER 174-621 ~::: Pl_RiQE3:~EC31f~R~d:~$Y:~1`H15:~C~€tTIF:{CA7ir:~:~:~:~:~:~:~:~:: CERTIFICATE HOLDER WAPPINGERS FALLS BUILDING DEPARTMENT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 7/26/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. JUL 0 9 2010 TOWN OF WgppINGER TOWN CLERK THE STATE INSURANCE FUND CANCELLATION ~~~- %~~ U-2C).3 DIRE OR, INSURANCE FUND UNDERWRITING 1007 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~TSIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 :~:~:~AC-t~i~ES:~COrt~RED:~SY'TWIS>~~€~tI~:~G1i*f~;: ":~:~:~::~: POLICYHOLDER MAURICE E WILKINS DBA MW POOLS PO BOX 126 CLINTONDALE NY 12515 POLICY NUMBER +A 1448 745-8 DATE 7/06/2010 CERTIFICATE NUMBER 175-923 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 7/26/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON RTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COV AGE~fj~' ED BY THE POLICY. ~~ fob raw ~~i ~ ~O N OF ?~~o ra~~ ~~RKGFR / CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1009 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 ~: ;>A~i1bE3>E01l~R~d:~$Y:~1'HIS:~CE€~?IF:EG;47f :::::::::~: ::::::::::~:~z~~~~o~~:::~~::::::r:t2~f:~¢r~ ::::::::::::::::::::::::::: POLICYHOLDER MAURICE E WILKINS DBA MW POOLS PO BOX 126 CLINTONDALE NY 12515 POLICY NUMBER +A 1448 745-8 DATE 7/06/2010 CERTIFICATE NUMBER 368-565 CERTIFICATE HOLDER TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 7/26/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COV~~ AFFORDED BY THE POLICY. r!~ `` ~~O ra ~~ ~~ ~N ~ o,~? ~ T o~ °~o O~iN ~qp~r ~~,. ~, THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1043 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~iSION, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER BUILDING DEPT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ~::~: i?~€tiOa:~EC3~R~d`$Y:~tWiS::~~f~TIF:EGA7~~?<::~?:~:::: POLICYHOLDER MAURICE E WILKINS DBA MW POOLS PO BOX 126 CLINTONDALE NY 12515 POLICY NUMBER +A 1448 745-8 DATE 7/06/2010 CERTIFICATE NUMBER 526-941 CERTIFICATE HOLDER TOWN OF WAPPINGER BUILDING DEPT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 7/26/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Cf~I~AGE AFFORDED BY THE POLICY. ~l~ v ~~ lv~al/ rO~i /U~ o y ~~ T~ 0~ Zoro ~/~/ ~'9AiOr/' ~ ~ THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1049 STDCAN-2/2001 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) lb. Business Telephone Number of Insured 330-468-0700 Patio Enclosures, Inc. lc. NYS Unemployment Insurance Employer 700 East Highland Road Registration Number of Insured Macedonia, OH 44056 70-91405 1 Work Location of Insured (Only required if coverage is specifically ld. Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a Wrap-Up or Social Security Number Policy) 341007831 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) Commerce & Industry Insurance Company TOWN OF WAPPINGER 3b. Policy Number of entity listed in box "la" 20 Middlebus ---- WC067712436 Wappinger Fal s, NY v ~ C~ i ti d li ff P l~ V ~:/ L~ ve per o cy e ec 3c. o ` 7/5/10 to 7/5/11 JUL 0 6 2010 3d. The Proprietor, Partners or Executive Officers are TOWN OF WAPPINGER ^X included. (Only check box if all partners/officers included) TOWN CLERK ^ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box " 3" insures the business referenced above in box "1 a" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NIA must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c'; whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Sulane Lawhead (Print name of authorized representative or licensed agent of insurance carrier) Approved by: -v~_ 1_a....~-.~~ (Signature) (Date) Title: Senior Client Manager astanag (LO-6) Z' SO I -~ STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier _~ 1a. Legal Name and Address of Insured (Use street address only) 1b. Business Telephone Number of Insured CRAIG M KURLANDER SR. DBA EXPLICIT 845-283-0390 EXTERIORS i 1c. NYS Unemployment Insurance Employer Registration 262 TOAD PASTURE ROAD Number of Insured MIDDLETOWN, NY 10940 1d. Federal Employer Identification Number of Insured or Social Security Number 073682701 2. Name and Address of the Entity requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity being listed as the Certificate Holder) The First Rehabilitation Life Insurance Town of Wappingers Company of America " " 1a : 3b. Policy Number of Entity listed in box 20 Middlebush Rd DBL293320 i Wappingers Falls, NY 12590 3c. Policy effective period: 03/21 /2010 to 03/20(2011 4. Policy covers: i a. ~ All of the employer's employees eligible under the New York Disability Benefits Law i b. Only the following class or classes of the employer's employees: Under penalty of perjury, I certify that 1 am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. Date Signed_ 7/1 /2010 By u (Signature of insurance carrier's authorized representative or YS Lic ed Insurance Agent of that insurance carrier) TelephoneNumber_ _516-829-8100 _ Title Sr. Vice President IMPORTANT: If box "4a" is checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent _ ~ of that carrier, this certificate is COMPLETE. Mail it directly to the certificate holder. j If box "4b" is checked, this certificate is NOT COMPLETE for the purposes of Section 220, Subd. 8 of the Disability Benefits Law. It must be mailed for completion to the Worker's Compensation Board, DB Plans Acceptance Unit, 20 Park Street, Albany, NY 12207. PART 2. To be completed by NYS Worker's Compensation Board (Only if box "4b" of Part 1 has been checked) ~ State of New York Worker's Compensation Board According to information maintained by the NYS Worker's Compensation Board, the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. ~~ I Date Signed By (Signature of NYS Worker's Compensation Board Employee) ~~ Telephone Number Title i I Please Note: Only insurance carriers licensed to write NYS Disability Benefits insurance policies and NYS Licensed Insurance Agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (5-06) Technology Insurance Company 5800 Lombardo Center Cleveland OH 44131-2550 CERTIFICATE HOLDER NOTICE NEW YORK WORKERS COMPENSATION INSURANCE COVERAGE Certificate Holder: ~~~ -_' Town of Wappinger ~~ V ~D 20 Middlebush Road ' ~u~ o s 200 Wappinger Falls, NY 12590 ~wN,,~`Fn,WAPPINGER Insured: Commercial Contracting Company, Inc.~O Vy' V CL~RK Policy Number: TWC3225374 Policy Period: 12/31/2009 to 7/12/2010 12:01 a.m. at the insured's mailing address Date of Notice: Notice Type: Effective Date of Cancellation Endorsement No.: Reason: 6/28!2010 Cancellation 7/12/2010 12:01 a.m. at the insured's mailing address 7 Prem Due 2780.00 As a Certificate Holder on the above policy, you are hereby notified that in accordance with the terms and conditions of this policy, Workers' Compensation Insurance will cease on the date shown for the above named insured. If you have any questions regarding this notice, please contact the insured listed above. e ~~ By: __ _ _. Authorized Representative I• Technology Insurance Company An AmTrust Financial Company A member of the AmTrust Financial Group A.M. Best Rating: A- STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) lb. Business Telephone Number of Insured 330-468-0700 Patio Enclosures, Inc. lc. NYS Unemployment Insurance Employer 700 East Highland Road Registration Number of Insured Macedonia, OH 44056 70-91405 1 Work Location of Insured (Only required if coverage is specifically ld. Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a Wrap-Up or Social Security Number Policy) 341007831 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) Commerce & Industry Insurance Company VILLAGE OF WAPPINGER FALLS 3b. Policy Number of entity listed in box "1 a" 20 Middlebu WC067712436 Wappinger ]ls, l~~j (~9 (~ ~~J (n] ~--,C L~-, O \J ~ D 3c. Policy effective period 7/5/10 to 7/5/11 JUL 0 6 20f0 3d. The Proprietor, Partners or Executive Officers are TOWN OF WgppINGER ^X 1nCluded. (Only check box if all partners/officers included) TOWN CLERK ^ all excluded or certain partners/of£cers excluded. This certifies that the insurance carrier indicated above in box " 3" insures the business referenced above in box "1 a" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also notes the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c ", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Sulane Lawhead (Print name of authorized representative or licensed agent of insurance carrier) Approved by: (Signature) (Date) Title: Senior Client Manager astanag ~LO-6) Z' SO I -~ NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE L-:~ TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY125900324 JUL 0 Y 2fJ TOWN OF WAPPrNOE~ T~wN CL~E~K :::~1?E~€t1f}E3:~COI~R~d>$Y:~ THIS:~~~f~?I~:~GAT~~:~::~:~:~:~>:~: :::::::::::t f:~or~~~a~:::~~:::~y:fog:s~or~ ::::::::::::::::::::::::::: POLICYHOLDER NATIONAL MAINTENANCE INC T/A NATIONAL SIGN & LIGHTING 185 SWEET HOLLOW ROAD OLD BETHPAGE NY 11804 POLICY NUMBER +Z 1327 758-7 DATE 6/29/2010 CERTIFICATE NUMBER 166-800 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY125900324 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1327 758-7 UNTIL 11/01/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 11/01/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE DOES NOT APPLY TO THOSE JOB SITES WHICH ARE COVERED BY OTHER INSURANCE AND ARE SPECIFICALLY EXCLUDED BY ENDORSEMENT. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND U-26.3 ~~ DIRE R, INSURANCE FUND UNDERWRITING 1739 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8~8-997-3863 CANCELLATION OF CERTIF~CA-TFtOF WORKERS' COMPENSATION INSURANCE ~3L~~[~p~~~ TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY1259003 JUL 01 2010 TOWN pP WAPPINGER TOWN CLERK >::~P~€2iQEi:~CC3.rt~REb: ~$Y:~ tH15:~C~1~'EIF:{GATP~:~:~::~:~:~:~:~:~: POLICYHOLDER NATIONAL MAINTENANCE INC T/A NATIONAL SIGN & LIGHTING 185 SWEET HOLLOW ROAD OLD BETHPAGE NY 11804 POLICY NUMBER +z 1327 758-7 DATE 6/28/2010 CERTIFICATE NUMBER 166-800 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY125900324 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 7/18/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 4163 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CERTIFICATE [~[~C~[~~MCD JUN 2'~ ~r•~ TOWN OF WAPPINGERS MIDDLEBUSH RD TOWN OF WAPPINGER WAPPINGER FALLS NY 125 0 TOWN CLERK •:~:•:•p~1QE3:~E01l~R~b:~SY:~'t'WIS:~C~t~1'I~:FC~4TP~:~:~:~:~:~:~:~:~:~: :::::::::::~z~:~~~~~lo-~::::~:~:::~~:f;~~f~~r~ ::::::::::::::::::::::::::: POLICYHOLDER HERRING SANITATION SERVICE INC 1072 RTE 9 ~~1 FISHKILL NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 6/22/2010 CERTIFICATE NUMBER 368-122 CERTIFICATE HOLDER TION INSURANCE TOWN OF WAPPINGERS MIDDLEBUSH RD WAPPINGER FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1267 807-4 UNTIL 12/30/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 12/30/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~~ ~~'-~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING 301 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CERTIFICATE OF W JUN $~~ >?010 TOWN OF WAPPINGERS TOWN OF BUSH RD WAPPINGER WAPPINGER FALLS NY 12590 TOWN C~,ERK •:•:•:•i?~i~ti:~EO.V~R~Ci:~i~Y:~..T.WISSC~t#fi1~:ECI>i'f~~:~:~:~:~:~:~5:~: ~: :::::::::::~z~:~~~~~,~r:::art:::~~:t;~~f~~r~ ::::::::::::::::::::::::::: POLICYHOLDER HERRING SANITATION 1072 RTE 9 ~~1 FISHKILL SERVICE INC NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 6/22/2010 CERTIFICATE NUMBER 362-328 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUSH RD WAPPINGER FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1267 807-4 UNTIL 12/30/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 12/30/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND U-26.3 DIRE R, INSURANCE FUND UNDERWRITING 303 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ATE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CERTIFICATE OF y~~I~tS' COMPENSATION INSURANCE TOWN OF WAPPINGERS DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS BUILDING NY 12590 / ~~~~ ~~N TO~.yN ~ 410)p T owl c~FRKG~R, ........................................................................ :~:~:~p~iiQEs:~E~35t~R~15:~8~l:~1'WIB'EEF~i'I~:~GA'Ci=~: ~: ~:~:~:~:~:~:~:< POLICYHOLDER HERRING SANITATION 1072 RTE 9 ~~1 FISHKILL SERVICE INC NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 6/22/2010 CERTIFICATE NUMBER 893-493 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUILDING DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1267 807-4 UNTIL 12/30/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 12/30/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~ ~~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING 279 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS BUILDING DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 1259 / ~~~~ TOwNOFN~41010 T~wN ~CFRK FR .......................................................................... «~:~P.~ti~:~E~3.r1~~~1~:~$Y:~'1'WIB:~E~EY1'IFfC~a'CP~>:~:~:~:~>:~:~: ~: POLICYHOLDER HERRING SANITATION SERVICE INC 1072 RTE 9 ~~1 FISHKILL NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 6/21/2010 CERTIFICATE NUMBER 893-493 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUILDING DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 7/11/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1767 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SION, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS BUILDING DE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 I a~~~o JUN g 41010 TOTO~ W~RK ER :•:•:•P.L~2i11QEs:~E~C/3.rt~R~I~:~SY:~I~W~jIB{:~C#~+T~.IK:yG~4~~:~:~:~:~:~:~:~:~:~: POLICYHOLDER HERRING SANITATION SERVICE INC 1072 RTE 9 ~~1 FISHKILL NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 6/21/2010 CERTIFICATE NUMBER 072-315 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUILDING DE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 7/11/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ ~~~~~ DIRE OR, INSURANCE FUND UNDERWRITING 1803 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE G°~CGC~MC~D TOWN OF WAPPINGERS BUILDING DE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 JUN 2 4 20;0 TOWN OF WAPPINGER TOWN CLERK ......................................................................... ~: ~:~>Pt;E#fQE3:~E~3V~R~CS:~BY:~~'WIS: ~ CE;E~1'i><:~C,i4~~:~:~:~:~:~: ~:~:~: ~: POLICYHOLDER HERRING SANITATION SERVICE INC 1072 RTE 9 ~~1 FISHKILL NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 6/22/2010 CERTIFICATE NUMBER 072-315 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUILDING DE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1267 807-4 UNTIL 12/30/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 12/30/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSU//R~ANCE FUND C/~~I~ VIII" l• U-2f).3 DIRE R, INSURANCE FUND UNDERWRITING 243 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE %TE SION, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~~~d~~ ~~ TOWN OF WAPPINGERS JUN 2 4 20'0 MIDDLEBUSH RD WAPPINGER FALLS NY 12590 TOWN OF WAppINGER TOWN CLERK .~. :~:.:~:~PL~iiQE`Et7~RJ~CS:.SY:.Wig:.E~F~1'1~:EGA"'~ ::.:.:.:.:.:.:::.: :::::::::::~~;<:~~~~~o.:~::::~~::::::~:t:f:t:~~r~r~ ::::::::::::::::::::::::::: POLICYHOLDER HERRING SANITATION SERVICE INC 1072 RTE 9 ~~1 FISHKILL NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 6/21/2010 CERTIFICATE NUMBER 368-122 CERTIFICATE HOLDER TOWN OF WAPPINGERS MIDDLEBUSH RD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 7/11/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND l~~ DIRE OR, INSURANCE FUND UNDERWRITING 1785 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE BTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CANCELLATION OF ~~~ TOWN OF WAPPINGERS BUSH RD WAPPINGER FALLS NY 12590 JUN 2 4 2010 TOWN OF WAPPINGER TOWN CLERK TION INSURANCE POLICY NUMBER +A 1267 807-4 DATE 6/21/2010 CERTIFICATE NUMBER 362-328 ~':.`'1?L~21fkE3: ~6R~t~:.~Y`fiWll~:.E~~fiI~:ECaTJ' ::.:.:.:.:.:.:.:.:.: :::_:::::::~;~~:~~~~~or:::~~::::~:f~:t:E.~~r~ ::::::::::::::::::::::::::: POLICYHOLDER HERRING SANITATION SERVICE INC 1072 RTE 9 ~~1 FISHKILL NY 125242547 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUSH RD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 7/11/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMER'D, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE UND E INSURANC ~~ F p ~~~%~ DIRE OR, INSURANCE FUND UNDERWRITING 1783 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 G°~[~C~C~OdI~D JUN 2 2 2010 POLICY NUMBER +z 1172 271-7 DATE 6/17/2010 CERTIFICATE NUMBER 657-367 TOWN OF WAPP~NGER TOWN CLERK ~:~:: PC~€2iQd: GOV~~Ed:~BY: tWiS::~~€tTI~:~C~*~~::~::::::: POLICYHOLDER HUDSON VALLEY CHIMNEY SERVICE INC 3647 ALBANY POST ROAD POUGHKEEPSIE NY 12601 CERTIFICATE HOLDER TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 7/07/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 299 STDCAN-2/2001 - ---, i ~.~New York State Insurance Tund N'rarkexc ` Crahtpen.wc[tloir r~'r Dr~uGxbty~ Befxc~ts 5r~ecialisFC :4i~ree 1914 199 CHURCH STREET, NEW YORK. N.Y. 1.0007-1100 Phone: (.888) 997.3863 CERTIFICATE aF WtyRKERS' CrJMPENSATION INSURANCE G°~CC~C~~ICD h A A A h h HYDROVAC EXCAVATING INC 52>j8 ROUTE 9W JUN 21.2010 NEW BURGH NY 1255U TOWN OF WAPPINGER POLICYHOLDER HYDROVAC EXCAVATING INC 5288 ROUTE 9W NEW BURGH NY 12550 TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD VVAPPINGERS FALLS NY 12590 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G 1414 439-8 140144 I 06/29(2009 TO 06(292011 ~ 6/1712010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY N0. 1414 439-8 UNTIL Ofi129/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER F{7R UJORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAIN WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEVU YORK. EXCEPT A5 INDICATED BELOW. IF SAID POLICY IS CANCELLED. OR CHANGED PRIOR TOU62912(?11 IN SUCH MANNER RS (O AFFECT THIS CLRI IFICATE, 1U DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDEP. ABOVE. NOTICE 6Y REGULAR h1AIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEIN YORK STATE INSURANCE= FUND DOL=S NOT ASSUME= ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THC- CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE= POLICY. NEW YDRK STATE INSURANCE FUND ~~~iyt.. ~~1.1,~eiL~f.-~ ~` DIRECTOR,INSURANCE FUND UNDERWRITING _~``-,This certificate can be validated on our web site at httpsJlwww.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 732981744 _N_e_w_York Stat_e_Ins_uran_ce Fund Workers' Compensation & Disability Benefrts Specialists Since 1914 1 WATERVLIET AVENUE ALBANY, NEW YORK 12206-1649 Phone: (518) 437-8976 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~~~~ TISHADAM CONSTRUCTION LLC 139 SOUTH CROSS ROAD STAATSBURG NY 12580 POLICYHOLDER 1 CERTIFICATE HOLDER l TISHADAM CONSTRUCTION LLC i TOWN OF WAPPINGERS FALLS 139 SOUTH CROSS ROAD BUILDING DEPT. STAATSBURG NY 12580 20 MIDDLEBUSH RE. WAPPINGERS FALLS NY 12590 POLICY NUMBER ~ CERTIFICATE NUMBER _~ PERIOD COVERED BY THIS CERTIFICATE DATE A 1306 628-7 144157 10/10/2009 TO 10/10/2010 6/21/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1306 628-7 UNTIL 10/10/2010, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 10/10/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS, PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND G~;~~ ~!~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 571920762 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la. Legal Name and Address of Insured ~.}.- ess Telephone Number of Insured ABLE MIKE ELECTRIC CORP. (~ ~(~ (~ ~~ (~j45-54 -4432 J 17 LAKE RD ~] l~Ji ~C ~ c. NY Unemployment Insurance Employer HOPEWELL JUNCTION, NY 12533 Registry ion Number of Insured JUN 2 3 2010 TOWN OF WAPP N~e al Employer Identification Number of r Social Security Number TOWN CLE X042608 8 2. Name and Address of the Entity Requesting roo o Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Zurich American Insurance Company Town of Wappinger 58 South Service Road, Melville, NY 11747 20 Middlebush Road Wappinger Falls, NY 12590 3b. Policy Number of entity listed in box "la": 5364945 - 001 3c. Policy effective period: 3/1/2010 To 3/1/2011 4. Pol~ic covers: a. L^J All of the employer's employees eligible under the New York Disability Benefits Law b. ~ Only the following class or classes of the employer's employees: Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. d 6iz2i2oto ~~~.~ .~~A--~ D Si gy . ate gne (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (631) 845-2200 Title Operations Manager IMPORTANT: If box "4a" is checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier, this certificate is COMPLETE. Mail it directly to the certificate holder. If box "4b" is checked, this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the Disability Benefits Law. ]t must be mailed for completion to the Workers' Compensation Board, DB Plans Acceptance Unit, 20 Park Street, Albany, New York 12207. PART 2. To be coin leted b NYS Workers' Com ensation Board Onl if box "4b" of Part 1 has been checked State Of New York Workers' Compensation Board According to information maintained by the NYS Workers' Compensation Board, the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Workers' Compensation Board Employee) Telephone Number Title Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorised to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (5-06) Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in box " 3" on this form is certifying that it is insuring the business referenced in box "la" for disability benefits under the New York State Disability Benefits Law. The [nsurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box " 2". This Certificate is valid for the earlier of one year after this form is approved by the insurance carrier or its licensed age~tt, or the policy expiration date listed in box "3c". Please Note: Upon the cancellation of the disability benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article, and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. DB-120.1 (5-06) NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE 200 WHITE PLAINS, NEW YORK 10604-3814 (9145 701-2120 CANCELLATION OF CERTIFICATE/~QRKERS' COMPENSATION INSURANCE ~~~ ~~~~a J~ D TOWN OF WAPPINGER T N 15;~p+~ 20 MIDDLEBUSH ROAD OWN OF WAPPINGERS FALLS NY 12590 TpWN wAPPIN~FR c~FRK ~:: R~€2iOd:~EO~R~b:~$Y: tH15:~0E€1TIF:~GATi'~:~:~:~::::~:~:~: POLICYHOLDER TOTAL GREEN LLC 371 ORCHARD DRIVE MONROE NY 10950 POLICY NUMBER +W 2073 309-3 DATE 6/10/2010 CERTIFICATE NUMBER 920-558 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/30/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 871 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 CANCELLATION OF TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD WAPPINGER FALLS NY ~~ JUN 11 20'~ TOWN OF WAPPINGER TOWN CLERK MPENSATION INSURANCE POLICY NUMBER ~~G 1225 085-8 DATE 6/08/2010 CERTIFICATE NUMBER 054-923 :~:~:1?C~€21f}ES:~EdifEF~Ed:~f3~!: ?HIS:~C~R:TIP:~CA7P~:~:~:~:~::~::~: POLICYHOLDER CADY LANE HOMES INC 19 CADY LANE WAPPINGERS FALLS NY 12590 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/28/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. R E G I S TER E D M A I L CANCELLATION U-26.3 TIIE STATE INS U RANC E F UND G~~ .~ j~ , ~ ~ 1?%l Q/1~~~iti` DIRE OR, INSURANCE FUND UNDERWRITING 495 STDCAN- 2/2001 New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 1 WATERVLIET AVENUE ALBANY, NEW YORK 12206-1649 Phone: (518) 437-8976 ~~~~~~ CERTIFICATE OF WORKERS' COMP PIPE DREAMS CONSTRUCTION INC 12 STUYVESANT ST APT 1 KINGSTON NY 12401 INSURANCE ~CC~C O~f~D JUN p 4 2010 TOWN OF WAPPINGER TOWN CLERK POLICYHOLDER CERTIFICATE HOLDER PIPE DREAMS CONSTRUCTION INC TOWN OF WAPPINGERS 12 STUYVESANT ST APT 1 20 MIDDLEBUSH RD KINGSTON NY 12401 WAPPINGERS FALLS NY 12590 POLICY NUMBER A 2102 032-6 CERTIFICATE NUMBER 120065 PERIOD COVERED BY THIS CERTIFICATE 05/21 /2010 TO 05/21 /2011 DATE 6/3/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2102 032-6 UNTIL 05/21/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 05/21/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND ~~ ~~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 612839311 U-26.3 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CERTIFICATE OF Wi~S' COMPENSATION INSURANCE ~~~ ~~~ ~~ ~O TOWN OF WAPPINGER ~` N O 8 20 MIDDLEBUSH ROAD DINj~ OF ?~~~ WAPPINGERS FALLS NY 125 T ~~N C ppIN~F C~Rk R ~:~:~:~i2C~€tiQEi:~EC~Sl~REd: $Y: tWi~:~lr~t~Tl~:{G;43~ :':~:~";:~: :::::::::~:~o~~~~:a.~:::~~::::::y:fob:s~~r:t :::::::::::::::::::::: POLICYHOLDER WFL CONSTRUCTION INC BILL LIGUORI 8 COMMERCE STREET POUGHKEEPSIE NY 12603 POLICY NUMBER +Z 1363 521-4 DATE 6/04/2010 CERTIFICATE NUMBER 913-807 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1363 521-4 UNTIL 1/01/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 1/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND U-26.3 ~~ DIRE R, INSURANCE FUND UNDERWRITING 655 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8~8-997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ ~~ TOWN OF WAPPINGER ~/ ~~~ 20 MIDDLEBUSH ROAD TO /UN WAPPINGERS FALLS NY 12590 ~/~/ 08? ~' ~F O~N ~~AA c~FR`N~FR '1 ................................................ :~::::::P.L~tiQEi::GC35l~R~L?::SY:~1'WIS:~C~RT.IF:E : ~~.~.. ~~~~:~~ .~:~~~:~:~ :~:::::::::~:ti~~~~~y~:::t~~::::r:tat:f:~~r~ :::::::::::.:::::::::::: POLICYHOLDER WFL CONSTRUCTION INC BILL LIGUORI 8 COMMERCE STREET POUGHKEEPSIE NY 12603 POLICY NUMBER +Z 1363 521-4 DATE 6/04/2010 CERTIFICATE NUMBER 071-757 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1363 521-4 UNTIL 1/01/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 1/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INS?U~RANCE FUND U-26.3 DIRE R, INSURANCE FUND UNDERWRITING 227 CERT02-2/2001 NEW YORK STATE. INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE I~C~~OML~D JUN p 3 2010 ~~ TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD TOWN OF WAPPINGER WAPPINGERS FALLS NY 12590 TOWN CLERK ............................................................... ~:~:~: ~ R~2iQEi:~E~31fEE~[~:~SY:~TWIB>C~E~'1~:4GA'{~~: ~: ~: ~: ~;:~:~}:~: :~::::::::::~:~:o~~~~rr~:::~~::::::~:t:~~f~r~r~ ::::::::::::::::::::::::::: POLICYHOLDER WFL CONSTRUCTION INC BILL LIGUORI 8 COMMERCE STREET POUGHKEEPSIE NY 12603 POLICY NUMBER +Z 1363 521-4 DATE 5/28/2010 CERTIFICATE NUMBER 913-807 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS` COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/17/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~~ /~%J DIRE OR, INSURANCE FUND UNDERWRITING 1203 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 CANCELLATION OF CERTIFIC TE ~ (r~'~ }PEN ATION INSURANCE JUN 0 3 2010 ~~ TOWN OF WAPPINGER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD TpWN CLERK WAPPINGERS FALLS NY 12590 >::::::]?~t]~:.EC31[~R~1~::$Y:~1'HI~::C~[~TI~:~GA~:: ~ ::::::::::::::::: ::::::::::::~:~o~:~~~~~:::~':~:::~:f:~~f~~rd ::::::::::::::::::::::::: POLICYHOLDER WFL CONSTRUCTION INC BILL LIGUORI 8 COMMERCE STREET POUGHKEEPSIE NY 12603 POLICY NUMBER +Z 1363 521-4 DATE 5/28/2010 CERTIFICATE NUMBER 071-757 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/17/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 637 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE 200 WHITE PLAINS, NEW YORK 10604-3814 (914f 701-2120 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER FALLS 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 ~~~~~ G~ MAY 2$2010 TOWN OF WAPPINGER TAW N CLERK :~i?~€ti~1E3: CC3rt~REd:~i3~!:~tWlS:~IrE€ttl~:fGati= :~::~:~:~:~:~:~:~: POLICYHOLDER JOHN FALVELLA INC 47 UNION SCHOOL RD MONTGOMERY NY 12549 POLICY NUMBER +W 1369 249-6 DATE 5/24/2010 CERTIFICATE NUMBER 900-821 CERTIFICATE HOLDER TOWN OF WAPPINGER FALLS 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/14/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1671 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISION, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE G°~CC~C~~~ICD TOWN OF WAPPINGERS BUILDING DEPT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 MAY 2 8 200 TOWN OF WAFPINGER TOWN CLERK `P~€tii~Ei: EO~REd:~f3Y`•tWiS:~C~€tTI~:EGAt~ :~">:: ;:: ~:~:~5~:0~:1~~~9:~: ~"[~:~::~f~f:dal:~Q1~:~:~:~:~:~:~::~:~::~:~:~: POLICYHOLDER ERIC D BENGEL DBA TRADEMARK CONTRACTING 28 HAMPSHIRE RD FISHKILL NY 12524 POLICY NUMBER +A 1452 332-8 DATE 5/24/2010 CERTIFICATE NUMBER 074-787 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUILDING DEPT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/14/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 725 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD WAPPINGERS FALLS NY 12590 MAY 2 8 2010 TOWN OF WAP~'~~ EIS TOWN Cl.~ :~:~:~i?~€tif)E1:~E011~REd:~f3~:~tWiS:~~~F2TI~:FGA7~ :'::::~::~: POLICYHOLDER ERIC D BENGEL DBA TRADEMARK CONTRACTING 28 HAMPSHIRE RD FISHKILL NY 12524 POLICY NUMBER +A 1452 332-8 DATE 5/24/2010 CERTIFICATE NUMBER 074-903 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/14/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 727 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE 200 WHITE PLAINS, NEW YORK 10604-3814 (9145 701-2120 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 .............................................................. ~: ~:.:.:.P.~ti1~Ei:~ ECS1t~R~ES:.BY>TWIS:; C~[~fi1~:~C,a~i^.:~:.:.:.:.:~:.:.:.: :::::::::::g~;~~~~~~a~:::~:~::::::~:fz~E~r~r~ ::::::::::::::::::::::::::: POLICYHOLDER CONTEMPORARY ENVIRONMENTAL MGMT INC T/A CONTEMPORARY CONSTRUCTION 190 GOLDENSBRIDGE CT NORTH WING KATONAH NY 10536 POLICY NUMBER * W 921 016-2 DATE 5/19/2010 CERTIFICATE NUMBER 997-699 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY ].2590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 921 016-2 UNTIL 9/29/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 9/29/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. U-26.3 I a~c~~oe MAY 2 11010 ToTO=_Rk ER THE STATE INSURANCE FUND ~~ DIRE R, INSURANCE FUND UNDERWRITING 4571 _V CERT02-2/2001 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name and address of Insured (Use street address only) lb. Business Telephone Number of Insured Swanson Consulting Inc 845-549-8271 PO Box 395 Salisbury Mills, NY 12577 lc. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured (Only required if coverage is specifically ld. Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e a Wrap-Up Policy) or Social Security Number 134164776 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) Town of Wappingers 20 Middlebush Rd~ Wappingers Falls 1259A1 L~ V ~ ~ ~"l ~ D MAY 2 0 2010 TOWN OF WAPPINGER This certifies .that the. hncurano~ ~rltiltrt ~4,~ah'Plt~ ~1lltilP ,,, t.,,4 " 3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also note the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c'; whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Timothy E. Dean (Print name of authorized representative or licensed agent of insurance carrier) Approved by: ~./.:~.~~ /' n ~f (Signature) ~-~J~--`--.- 3a. Name of Insurance Carrier Hartford Insurance Co 3b. Policy Number of entity listed in box "la": 16WECRQ2712 3c. Policy effective period: 05/25/10 to 05/25/11 3d. The Proprietor, Partners or Executive Officers are: ® included. (Only check box if all partners/officers included) ^ail excluded or certain partners/officers excluded. 5/7/10 (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 845-567-1000 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. (.~~.--11~,, if u~v~a~~~ MAY 2 ~ 2010 TOWN OP WAPPINGER TOWN CLERK C-105.2 (9-07) Reverse NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE G°~CC~C OMCD '~' TOWN OF WAPPINGERS BUILDING DEPT MAY 18 2010 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12 9~OWN OF WAppINGER TOWN CLERK ~:: ;RC-€2iQD: COII~RED:~$Y: 7WIS: E~f{I IF:FG;4tf : >::::::~:~: POLICYHOLDER HERRING SANITATION SERVICE INC 1072 RTE 9 ~~1 FISHKILL NY 125242547 POLICY NUMBER +A 1267.807-4 DATE 5/14/2010 CERTIFICATE NUMBER 893-493 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUILDING DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/03/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1011 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SION, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CANCELLATION OF CERTIFICATE OF ~$~ERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS BUILDING DE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 / a~~~ MAY 1gP010 T o ~wN CIERK FR POLICY NUMBER +A 1267 807-4 DATE 5/14/2010 CERTIFICATE NUMBER 072-315 ::: R~€tiQE3:~EC3V~i~Eb:~$Y:~tWiS::~~F~'fI~:EGA3f ::~':~:~:~:~:: :::=:~>:::iz~:~~~~~a9::~1~c~:~::~~~fo3:J:~t~x~:~:~:~:~: `::::~::::~: POLICYHOLDER HERRING SANITATION SERVICE INC 1072 RTE 9 ~~1 FISHKILL NY 125242547 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/03/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUILDING DE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THE STATE RANC E UND INS U ~~~ F ~ ~ , ~~/1 G~ ~~~'~v" DIRE OR, INSURANCE FUND UNDERWRITING 293 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE G~~C~COMLD TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD MAY 1 9 2010 WAPPINGERS FALLS NY 12 90 TOWN OF WgppINGER TOWN CLERK ~:~::~1?~€21QE3:~E01lER~d:~~Y:~ TWIs~:~~~€~TI1;:EG;47~~::~:~::~:~:~:~: POLICYHOLDER JNR RESTORATION SERVICES LLC P 0 BOX 164 HOPEWELL JUNCTION NY 12533 POLICY NUMBER ''~A 1340 823-2 DATE 5/17/2010 CERTIFICATE NUMBER 013-531 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/29/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND CANCELLATION U-26.3 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 183 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISION, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE VILLAGE OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 G~C~C~C OMC~D MAY 19 2010 POLICY NUMBER ~~A 1340 823-2 DATE 5/17/2010 CERTIFICATE NUMBER 050-953 TOWN OF WAPPINGER TOWN CLERK :~:~:~i?~iQE3:~CO.ri~REb:~~Y:~TFI1~:~lr~f{TIK:1G;47~ :~:~`'>:~>:: POLICYHOLDER JNR'RESTORATION SERVICES LLC P 0 BOX 164 HOPEWELL JUNCTION NY 12533 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/29/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. R E G I S T E R E D M A I L THE STATE INSURANCE FUND CANCELLATION U-26.3 CERTIFICATE HOLDER VILLAGE OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 ~~ DIRE OR, INSURANCE FUND UNDERWRITING 605 STDCAN- 2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE f~GC~COM~D TOWN OF WAPPINGERS MAY 19 2010 BUSH RD WAPPINGER FALLS NY 12590 TOWN OF WAPPINGER TOWN CLERK ~:~:: P~2iQa?EO~i~~d:=$1!:tFIiS::~~€~'~I~:-C~43~~:~::~:~`:~:~:~`: POLICYHOLDER HERRING SANITATION SERVICE INC 1072 RTE 9 ~~l FISHKILL NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 5/14/2010 CERTIFICATE NUMBER 362-328 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUSH RD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/03/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1035 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICA TION INSURANCE G°~CC~C~nMCD MAY 1 9 2010 TOWN OF WAPPINGERS MIDDLEBUSH RD WAPPINGER FALLS NY 12590 TOWN OF WAPPINGER TOWN CLERK ;>: AGRIQE3:~E01f~RFd;SY:~:T:H15:~CEf{T:IFFG~47P :~>:~:~>:::~: POLICYHOLDER HERRING SANITATION SERVICE INC 1072 RTE 9 ~~l FISHKILL NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 5/14/2010 CERTIFICATE NUMBER 368-122 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/03/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 12590 CERTIFICATE HOLDER TOWN OF WAPPINGERS MIDDLEBUSH RD WAPPINGER FALLS NY THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1033 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISIGN, ALBANY, NEW YORK 12206-1649 518) 437-5400 CERTIFICATE OF WORKERS' COMPENS~.T-I$1~1 INSURANCE TOWN OF WAPPINGERS BUILDING DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 ~~~° ~ a ,9tioo MPS W PPPZ~GER jo ~o~~ ~~ERK ~: ~::~f'~EiiQt~:~ EC31t~i~~p~: ~ $Y: ~ TWsI~.S: ~~~€~1'1F:FGi7~~:~»:~:~: ~: ~: ~: ~: POLICYHOLDER HERRING SANITATION SERVICE INC 1072 RTE 9 ~~1 FISHKILL NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 5/17/2010 CERTIFICATE NUMBER 893-493 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUILDING DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1267 807-4 UNTIL 12/30/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 12/30/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND U-26.3 ~~ DIRE R, INSURANCE FUND UNDERWRITING 615 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS BUILDING DE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 :~:~:~A~€tiQE3:~60~R~d:~~Y:~tWIS:~C~f~Ti~:~Gat~~:~:~:~:~:~:~:~: ~: POLICYHOLDER HERRING SANITATION 1072 RTE 9 ~~1 FISHKILL SERVICE INC NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 5/17/2010 CERTIFICATE NUMBER 072-315 CERTIFICATE HOLDER TOWN OF WAPPINGERS BUILDING DE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1267 807-4 UNTIL 12/30/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 12/30/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~ U-2G.3 DIRE R, INSURANCE FUND UNDERWRITING 295 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISIGN, ALBANY, 518) 437-6400 NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATjA~i INSURANCE o~~o o ~~~ TOWN OF WAPPINGERS ~ 0~'LO~~ MIDDLEBUSH RD Mp`l 1 GER WAPPINGER FALLS NY 12590 ~~ `A~ PQp ~~ ~owN ~N GCE O :~:~:~AC€21fJid:~CC31t~R~d:~$Y:~?W15:~E~~1I~:FGAT~ ::~:~:~:~:~:~:~: ::::::::::tz~:~n~~~~rT:::~c~:::~~:t~~~:~r~r~ ::::::::::::::::::::::::::: POLICYHOLDER HERRING SANITATION 1072 RTE 9 ~~1 FISHKILL SERVICE INC NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 5/17/2010 CERTIFICATE NUMBER 368-122 CERTIFICATE HOLDER TOWN OF WAPPINGERS MIDDLEBUSH RD WAPPINGER FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1267 807-4 UNTIL 12/30/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 12/30/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND U-26.3 ~~ DIRE R, INSURANCE FUND UNDERWRITING 637 CERT02-2/2001 NEW YORK STATE INSURAN FUND 1 WATERVLIET AVENUE XTE SION, Y, NEW YORK 12206-1649 '~ 51 s~' ~,3- CERTIFICATE OF D~ Uv ` MAC 19 ~~10 GER `^f PpPZN BIISH RD WAPPINGERS O`A'N Q~ vv~~~R~ WAPPINGER FALLS NY 12590 ~ V~-~O~t~\ :~:~:~~C~€iiQa:~6C3V~RE~.'•f3Y:~TFIIS:~Ir~€~1I~:FCR~~~:~;:~:::~:'~: .:::::::::::~z~:~n~~~a.~:::~c~:::~;~:f~~~:~or~ :::::::::::::::::::::::::: POLICYHOLDER HERRING SANITATION 1072 RTE 9 ~~1 FISHKILL SERVICE INC NY 125242547 POLICY NUMBER +A 1267 807-4 DATE 5/17/2010 CERTIFICATE NUMBER 362-328 CERTIFICATE HOLDER INSURANCE TOWN OF WAPPINGERS BUSH RD WAPPINGER FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1267 807-4 UNTIL 12/30/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 12/30/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND U-26.3 ~~ DIRE R, INSURANCE FUND UNDERWRITING 639 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE 200 WHITE PLAINS, NEW YORK 10604-3814 (9145 701-2120 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 :~:~>R~€2iQE3:~EO~~Ed:~~Y: 1W15:~~~F2:?I~:FGA7~ :~::~::~::~:~:~: POLICYHOLDER CONTEMPORARY ENVIRONMENTAL MGMT INC T/A CONTEMPORARY CONSTRUCTION 190 GOLDENSBRIDGE CT NORTH WING KATONAH NY 10536 POLICY NUMBER + W 921 016-2 DATE 5/13/2010 CERTIFICATE NUMBER 997-699 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 6/02/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY G°~[~~~~~ICD MAY 17 20t0 CANCELLATION U-26.3 TOWN OF WAPPINGER TOWN CLERK THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 2125 STDCAN-2/2001 Technology Insurance Company 5800 Lombardo Center Cleveland OH 44131-2550 CERTIFICATE HOLDER NOTICE NEW YORK WORKERS COMPENSATION INSURANCE COVERAGE Certificate Holder: ,.~~~ Town of Wappinger 20 Middlebush Road MaY ~ 7 2~~~ Wappinger Falls, NY 12590 TOWN,nOF WAPPINGER Insured: Commercial Contracting Company, Inc. TO V v' V C~ERK Policy Number: TWC3225374 Policy Period: 12/31/2009 to 12/31/2010 12:01 a.m. at the insured's mailing address Date of Notice: 5/11/2010 Notice Type: Reinstatement Endorsement No.: 4 Reason: Payment received As a Certificate Holder on the above policy, you are hereby notified that the NOTICE OF CANCELLATION effective 5/9/2010 is superseded. Coverage has been reinstated without lapse for the policy period noted above. If you have any questions regarding this notice, please contact the insured. By: Authorized Representative ,• Technology Insurance Company An AmTrust Financial Company A member of the AmTrust Financial Group A. M. Best Rating: A- ' STATE OF NEW YORI{ WORKERS' COMPENSATION BOARD ~ CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name & Address of Insured (Use street address only) 1 b. Business Telephone Number of Insured 845-628-3610 Dutchess Environmental 936 Route 6 ]c. NYS Unemployment Insurance Employer Mahopac, NY 10541 Registration Number of Insured 32-91758 ]d. Federal Employer Identification Number of Insured Worlc Location of Insured (Orely r•equirerl rf coverage is or Social Security Number specifically limited to certain locations in New York State, i.e., a l6-]533676 Wrap-Up Policy) 2. Name and Addt•ess of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed ~ ificate Holder) Peerless Insurance Company ~,•`__~_ ~ ~ ~ 3b. Policy Number of entity listed in box "l a" WC8445359 Town of Wappinger 20 Middlebush Rd 3c. Policy effective period Wappinger Falls, NY 12590 ~D ~~~ 05/20/10 to 05/20/11 V C 3d. The Proprietor, Partners or Executive Officers are ~~~~ X included. (Only check box if all partners/officers MAY 12 included) NGER PI P WA all excluded or certain partners/officers excluded. • CC tt p This certifies that the insurance carrier 17~t(c~J{~~vR.~0..6e~ the husiness referenced ~hnvP in hnv •`1:," f .• ,..,.•i,or~~ compensation under the New Yot - npensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Cartier or its licensed agent will send this Certificate of Insurance to the entit)~ listed above as the certificate holder in box " 2". The lns:u•nnce Carrier will also notify the above certificate holder rovithin /0 Clays IF a policy is canceled due to nonpayment of premiums or within 30 dcivs /F there are reasons other than nonpayment of premixmss that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is v«!id for one year after tlris••forne is «pproved by the insur«nce c«rrier «r its licenser! «gent, or anti/ the policy expirati«n date lister! in box "3c", whichever is e«r•lier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if tl~e business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, 1 certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: ,Tay H Dedricl< Donald B Dedriclc A~ency Inc (Print namerof(au~thorize~d representative or licensed agent of insurance carrier) Approved by: \~" `-~ 5/10/10 (Signature) (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier: 54~-877-3333 Ple«se Note: Only ins•urnnce cnrrier•.c crud their licensed agents m•e nuthori_ed to issue Fnr•m ~'-105.2. lrtsurance brokers nr•e NOT nnthori_ed to issue it. C-105.2 (9-07) www.wcb.state.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. l . The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in comnection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. r.•. :.:. _: ~ Nip; ~~ r 2 .'.:.0 TOWN G~= Wk~,r~PINGER Ty1lVlV CLERK Technology Insurance Company 5800 Lombardo Center Cleveland OH 44131-2550 ;~ . `~/' 'i .' },:> CERTIFICATE HOLDER NOTICE NEW YORK WORKERS COMPENSATION INSURANCE COVERAGE Certificate Holder: O "--------.. ~~~~o~~~ Town of Wappinger 20 Middlebush Road MAY 0 3 2010 Wappinger Falls, NY 12590 TOwN OF WAPPINGER TOWN CLERK Insured: Commercial Contracting Company, Inc. -~ Policy Number: TWC3225374 Policy Period: 12/31/2009 to 5/9/2010 12:01 a.m. at the insured's mailing address Date of Notice: 4/28/2010 Notice Type: Cancellation Effective Date of Cancellation: 5/9/2010 12:01 a.m. at the insured's mailing address Endorsement No.: 3 Reason: Prem Due 2805.00 As a Certificate Holder on the above policy, you are hereby notified that in accordance with the terms and conditions of this policy, Workers' Compensation Insurance will cease on the date shown for the above named insured. If you have any questions regarding this notice, please contact the insured listed above. By: Authorized Representative ,• Technology Insurance Company An AmTrust Financial Company A member of the AmTrust Financial Group A.M. Best Rating: A- NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~s4~~!6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE G~~C~C~ML~D '~~ TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD WAPPINGER FALLS NY P \Y V `~ ~~. APR 2 9 2010 12590 TOWN OF WAppINGER TOWN CLERK ::.:.:. i?~€ti~a:. EOSfi`REd:.$Y:.~:Wi5:;~~R:7`IF:FGAf~ ::.::::::::::::: .:.: POLICYHOLDER ROSCHA CONTRACTING CORP T/A AMERICAN POOL BUILDERS 7 WEST CEDAR ST POUGHKEEPSIE NY 12601 POLICY NUMBER +A 1380 928-0 DATE 4/26/2010 CERTIFICATE NUMBER 007-397 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 5/16/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD WAPPINGER FALLS NY 12590 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING ~ i, o n NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFI TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY G°~CC~[~~MGD APR 2 9 2010 TOWN OF WAPPRK ER 12590 TpWN CLE TION INSURANCE POLICY NUMBER +G 1316 863-8 DATE 4/26/2010 CERTIFICATE NUMBER 171-097 C~P~,' :~A~tiQEi:~CC~1l~R~b:~$Y:~TFi~:~E~€~?IF:IG;47~~"':~:::~: `: ~:~:~:: ~~:orb;~~~r8:~:~~c~:~:~:~5:f:~6:~:~ar~:~:~:~:~:~:~:~:~::~:~:~:~: POLICYHOLDER NECKLES BUILDERS INC 47 WEST OLD FARMS ROAD HOPEWELL JUNCTION NY 12533 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 5/16/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING OCK NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD WAPPINGER FALLS NY 12590 (~/~ y~~~ MAY ~ 6 2a -~ TOWN OF wp,p~ING~R TOwN CLERK-- ............................................................... ~:~: ~: ~A.~iiclEi: ~Edv~R~b:~i~V:~'i'Wlts:~E~Ft7'IFEC;4'f~~:~:~:~: ~:~:~:~:~:~: POLICYHOLDER ROSCHA CONTRACTING CORP T/A AMERICAN POOL BUILDERS 7 WEST CEDAR ST POUGHKEEPSIE NY 12601 POLICY NUMBER +A 1380 928-0 DATE 5/03/2010 CERTIFICATE NUMBER 007-397 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1380 928-0 UNTIL 3/10/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 3/10/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE DOES NOT APP~.~" TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND C~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING ~Fi7 ~FRTn~-~i~nn i NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8~8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER ' 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 :~::~i2L~tiQE3>6'0.1f~6t~D:~f3Y:~1~Hi~:~~~E3:tIF:FG;47f :~>:~::~::~:~: POLICYHOLDER LCS PROPERTY MAINTENANCE INC 36 COTTAGE STREET, 3RD FLOOR POUGHKEEPSIE NY 12601 POLICY NUMBER ''~Z 1448 631-0 DATE 4/13/2010 CERTIFICATE NUMBER 852-988 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 5/08/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. G~C~c~~OM[~D C APR 16 2010 TOWN C1M i~r~~~~'NGER TOWN CLERK THE STATE INSURANCE FUND CANCELLATION U-26.3 DIRE OR, INSURANCE FUND UNDERWRITING zQ~ NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 :~:~:~AE~i1QE>:~EC31t~F~E~>81!>?WIS:~~~F2TIK:FG;47~~:~::~:~:~>:~:~:~: POLICYHOLDER ETTS PLUMBING & HEATING INC 3 NEPTUNE ROAD, SUITE M8 POUGHKEEPSIE NY 12601 POLICY NUMBER +G 1358 503-9 DATE 4/12/2010 CERTIFICATE NUMBER 593-075 CERTIFICATE HOLDER TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 5/02/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~~0~~~ ~~~...~ APR 1 5 2p1~ ~ vv A~'p~N~'~R .~ OW N ~ N C~~RK T~ THE STATE INSURANCE FUND CANCELLATION U-26.3 DIRE OR, INSURANCE FUND UNDERWRITING 337 STDCAN-2/2001 ~ ' r STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name and address of insured (Use street address only) 1 l b. Business Telephone Number of Insured Thomas Gleason, Inc. 42 McKinley Lane Poughkeepsie NY 12601 Additional Named Insureds: Northside Supplies, LLC Work Location of Insured (Only required if coverage is specifically limited to certain locations in New 3'ork Stale, i.e. a Wrap-Up Policy) 845-454-3730 le. NYS Unemployment btsurance Employer Registration Number of Insured 1713062 P ld. Federal Employer Identification Number o1'Ltsured or Social Security Numbe~~ 141438793 ~ ~~C~C~~MC~ 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Haider) Town of Wappinger 20 Middlebush Road Wappings Falls NY 12580 3a. Name of Insurance C r~rU~~//~~// Technology Insu anceV~dr 3b: Policy Number of ent TWC3238887 3c, Palicy effective period: 4/1/2010 to 4/1/2011 WAPPINGE CLERK 3d. The Proprietor, Partners or Executive Officers are: fnCluded. (only check hox ifall partnersiotlicers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box " 3" insures the business referenced about in box "la" 1'or workers' compensation under the New York State Workers' Compensation Law. (To use this form, Ncw York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will sand this Certilicate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also natify the above certifrcate holder wit{tirt !0 days IF a policy is canceled due to tronpaymerrt oJ'premiums or within 30 days /Flhere are reasons other thm~ nonpayment of premiums that cancel the policy or eliminate the i-tsured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, /his Certificate is valid jor one year after this form is approved by the insurance carrier or its licensed agent, or urtti! the policy expiration dale listed in box " 3c ", whichever is earlier. Please Note: Upon the cancellation of the. workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorised proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law, Under penalh• of perjury, I certll~ that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Henry C. Sibley - (Print name of authorized representative or liconsed agent ol~insurance carver) A roved b : ~P`"fir ~ .ir~ 4/6/2010 PP Y _ (Signature) (Dale) Title: Underwriting Manager Telephone Number of authorized representative or licensed agent of insurance carrier 607-724-0173 Please Note: Only insurance carriers and d~eir licensed agents are authorized to issue the C-705.2 form. Insurance brokers are NOT authorized ro issue it. C-105.2 (9-07) NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE 200 WHITE PLAINS, NEW YORK 10604-3814 (914f 701-2120 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ::~:~AE€#1Qd:~EOiI~fBEd:~$Y:~?H15:~EEE#TIF:4C:4Ti'~:~:~:~:~:~:~::~:~: :~::::~: d~2fi~12~~9~:~~~:~:~::4:f;2fif:~~~~t:~:~:~:::~:~:::~:::~: POLICYHOLDER TOTAL GREEN LLC 371 ORCHARD DRIVE MONROE NY 10950 POLICY NUMBER '`W 2073 309-3 DATE 4/09/2010 CERTIFICATE NUMBER 920-558 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 2590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 2073 309-3 UNTIL 4/27/2011 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 4/27/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. G°~C Gc C~~MC D APR 15 2010 TOWN OF WAPPINGER TOUVN CLERK U-26.3 THE STATE INSURANCE FUND ~~ DIRE R, INSURANCE FUND UNDERWRITING 699 CERT02-2/2001 Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chrd tcommission or office~o pay anyacompensaUonio any such mployeel f so~emplo dof such state or municipal department, boa , 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contrail for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such cortract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the cl-air, that compensation for all employees has been secured as provided by this chapter. C-105.2 (9-07) Reverse STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name & Address of Insured (Use street address 1b. Business Telephone Number of Insured only) 845-452-5400 1c. NYS Unemployment Insurance Employer Hudson Valley Heating Co., Inc Registration Number of Insured 6 South Clinton Street 53-11341 Poughkeepsie, NY 12601 1d. Federal Employer Identification Number of Work Location of Insured (Only required if coverage is Insured or Social Security Number specifically limited to certain locations in New York State, 14-1466015 i.e., a Wrap-Up Policy) 2. Name and Address of the Entity Requesting Proof 3a. Name of Insurance Carrier of Coverage (Entity Being Listed as the Certificate Majestic Insurance Company Holder) 3b. Policy Number of entity listed in box "1a" 0200805018-03 TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD r ~ 3c. Policy effective period WAPPINGERS FALLS, NY 12590 ~~~~~ rd ~ 04/01/10 to 04/01/11 MAR 3 01010 ~ r ® 3d. The Proprietor, Partners or Executive Officers are v ~ ~~^~ At r'`I C X included. (Only check box if all partners/officers included) i t~• all excluded or certain partners/officers Excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "1a" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box "2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there ore reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices maybe sent by regular mail. Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent or until the policy expiration date listed in box "3c", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Daniel Hickey 5r (Print name o orize~i s~n~ativelor licensed agent of insurance carrier) Approved by: (Signature) Title (Date) Telephone Number of authorized representative or licensed agent of insurance carrier: 845-471-6200 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. C-105.2 (9-07) Reverse --~''~ STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) lb. Business Telephone Number of Insured U.S. Remodelers, Inc. 214-488-6300 405 State Highway 121 Bypass lc. NYS Unemployment Insurance Employer Bldg. A, Suite 250 Registration Number of Insured Lewisville, TX 75067 ~O P~ 44117554 ld. Federal Employer Identification Number of Insured Work Location of Insured (Only required if coverage is specifically or Social Security Number limited to certain locations in New York State, i.e., a Wrap-Up 75-2922239 Policy) 2. Name and Address of the Entit 3a. Name of Insurance Carrier Coverage (Entity Being. sted ~~ New Hampshire Insurance Co. ~ ~ ~"J b. Policy Number of entity listed in box Kla" Town of Wappinger WC 7171490 20 Middlebush Road PR 01 2010 c. Policy effective period A Wappinger Falls, NY 125 0 _04/02/2010_ to _04/02/2011 p{~INGE w'; d. The Proprietor, Partners or Executive Officers are .-, OF TOWN `A r n' CLERK TO y v' V X included. (Only check box if all partners/officers included) ^ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box " 3" insures the business referenced above in box "1 a" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c ", w ichever is e r' Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: -Laura B. Vetter (Print name of authorized representative or licensed agent of insurance carrier) Approved by: (Signature) Title: Account Specialist Telephone Number of authorized representative or licensed agent of insurance carrier: _804-560-2230, Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-IOS.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) www.wcb.state.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. C-105.2 (9-07) Reverse o STATE FARM INSURANCE COMPANIES® ~~ DATE OF NOTICE: MAR 29 2010 One State Farm Dr Concorclvllle PA 19339 CODE: 362 AT1 28 A 002881 TOWN OF WAPPENGER TOWN HALL NOTE: PLEASE NOTIFY STATE FARM AT TtiE 20 MIDDLEBUSH RD ADDRESS LIaTED AT THE TOP, LEF'P CORNE~3 WAPPINGERS FL NY 12580-4004 vf= THIS PAGE REGARDING ANY CHA;NCI" OF ~~~~~~ 4tIQt3,~SS INFORMATION. LSD APP p 1 2010 TI~wN oF~,... ~oPY TO`JVN ..PpzNGER C~FRK NOTICE OF INSURANCE COVERAGE sate Farm Mutual Automobile Insuirance Company 7315-F871-G FAMED INSURED: POLICY NO: 103 2769-F12-52F COVERAGE: ''r" " 'ERFECT COMFORT INC YRlMAKE/MODEL: 2006 FORD VAN BI AND PD LIABILITY LAKE RD VINlCAMPER: 1 FTNE24WX6DB13957 ~ tALISBURY MLS NY 12577-5000 AGENT NAME: PHIL WILLIAMS AGENT PHONE: (846)563-7100 POLICY REINSTATED EFFECTIVE DEC 10 2009 UNTIL TERMINATED 'OLICY MESSAGES: he third party will be gluon 10 day3 natice if the policy is terrninatuci. Unt±l such notice is provided, it shall be presumed that the required ~newal premiums have been paid. The third party must notify ue withsn 10 days of any change3 of interest nr aHnership coming to their ttention. Failure to do so will render this policy null and vaid. FflT NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~540~!6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE '~~~ TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 ~: ~:.:.:.A.C~2iOa>EC~~RED:,$Y:.~tWli:.C~t~t1F:tC~ti= ::.:.:.:.:::.:.:.:.: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 POLICY NUMBER '~A 1482 281-1 DATE 3/31/2010 CERTIFICATE NUMBER 668-155 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 4/20/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. o ~~~a~~~ ~C Rp52010 ._o AP TNGER TC3w'N OF w' ,?P ~.~~~ CLERK THE STATE INSURANCE FUND CANCELLATION ~'~~ %G~ DIRE OR, INSURANCE FUND UNDERWRITING U-26.3 837 STDCAN-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54037~6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ WAPPINGERS FALLS BUILDING DEPA 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ~:~:.:.:.~~€tiQEi:.GC3R~b:. f1Y>~WiS:.~~FtfiIK:{GA~~ .:.:.:.::::::::::: POLICYHOLDER CHARLES D BURGER DBA FOXX POOLS 3730 ROUTE 9W HIGHLAND NY 12528 POLICY NUMBER +A 1367 035-1 DATE 3/31/2010 CERTIFICATE NUMBER 012-959 CERTIFICATE HOLDER WAPPINGERS FALLS BUILDING DEPA 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 4/20/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. Cpf, ~ . CANCELLATION U-26.3 G°~C~L,~'`'~~~ APR C 5 2~,0 TOWN OF U1 ":'FINGER TOWI~~ C~..ERK THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 263 STnr.nni-~i~nn ~ NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE F~518~540~!6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~'~ TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 ~: ~:.:.:.R~€iiQ~:;EC3~RE~:.$Y:.~WIC:.CE€~TIF:~Ga~tf ::.:.:.:.:.:.:.:.:.: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 POLICY NUMBER '~A 1482 281-1 DATE 3/31/2010 CERTIFICATE NUMBER 714-812 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 4/20/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. C ~® -.. _ ~~~~~ V ~V APR C 5 '~'~ CANCELLATION U-26.3 TOWN OF V'v - PINCER TOWN ~~.~RK THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 841 cTnrnni_~ inn ~ NATIONWIDE INSURANCE P.O. BOX 182194 COLUMBUS, OH 43218-2194 I~~~II~~l~l~l~l~l~l~~ll~~~~l~~lil~~~ll~~~~l~~l~~l~lll~~~~~ll~l TOWN OF WAPPINGERS BUILDING DEPT 20 MtDDLEBUSH RD WAPPINGERS FL NY 12590-4004 MARCH 30, 2010 co~~ ~L C~~C aPR o ~ ~~: Insured: HNCRING SANITATION SERVICE 1072 ROUTE 9 FISHKILL NY 12524-2547 Policy: 66 PR 206 - 305 - 0001 H TOWN OF Vlr.' ~'PIN~ER TOWN CLERK Our records indicate that you have an interest in the above insurance policy. The policy premium is past due and this is advance notice that the policy will cancel for non-payment of premium on 12:01 A.M. APRIL 13, 2010. We will notify you if the policy is cancelled for non-payment of premium. If payment is received, coverage will continue and you WILL NOT receive a final notice of cancellation. NATIONWIDE MUTUAL INSURANCE COMPANY Agent: J.S. MCLEAN Telephone: 845-471-2660 156 STATE OF NEW YORK ' ~ WORKERS' COMPENS ATION BOARD CERTIFICATE OF NYS WORKERS' COMPE NSATION INSURANCE COVERAGE 1a. Legal Name & Address of Insured (Use street address 1b. Business Telephone Number of Insured 845.471-9494 only) 1c. NYS Unemployment Insurance Employer D. Wilson Electric Inc. Registration Number of Insured 188 Cottage Street 11-504873 Poughkeepsie, NY 12601 1d. Federal Employer Identification Number of Work Location of Insured (Only required if coverage is Insured or Social Security Number specifically limited to certain locations in New York State, 14-1631868 i.e., a Wrap-Up Policy) 2, Name and Address of the Entity Requesting Proof 3a. Name of Insurance Carrier of Coverage (Entity Being Listed as the Certificate Hartford Insurance 3b. Policy Number of entity listed in box "1a" Holder) 16W EC1Y2661 Town of Wappingers 3c. Policy effective period 20 Middlebush Road 04/01/10 to 04/01/11 Wappingers Falls, NY 12590 3d. The Proprietor, Partners or Executive Officers are X inClUded. (Only check box if all partners/officers included) all excluded or certain partners/officers Excluded. _ ~_., ~.~..~~ t..r...,r4nre~ rmm~ancatinn This certifies that the insurance carrier indicated above in box "3" insures the ousmess rererencea auuvc ... u~~ ~a •~~ ••~• ~--•- --~~~r- -- -- under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity -isted above as the certificate holder in box "2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices maybe sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent or until the policy expiration date listed in box "3c", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certifiic o~Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements oft Ne t rke Compensation Law. 7' he insurance carrier refere d ove ar it that Under penalty of perjury, I certify that 1 am an authorized representative or licensed agent of t the named insured has the coverage as depicted on this form. _.,,~, Approved by: (Print na o~ Approved by: (Signature) Title: Telephone Number of authorized representative or licensed agent of insurance carrier: ..-.."---~j I APR 0 b "' ~-~'.~ To YEN ~~',1~~~- Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) or licensed agent (Date) nce carrier) (~ Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. G°~L GC~~i"~' APR Q5 7^'7 TOWN OF VV~PPINGER Towns cLER~ C-105.2 (9-07) Reverse NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE 200 WHITE PLAINS, NEW YORK 10604-3814 (914f 701-2120 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~ TOWN OF WAPPINGER FALLS 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 ~_o [~C C~CD~I~© APR 0 d 2QiJ POLICY NUMBER '~W 1369 249-6 DATE 4/01/2010 CERTIFICATE NUMBER 900-821 TOWN OF WAPPINGER ,LTOWN CLERK ~: ~:::::: AC-€#1f~E5:; ~C31l~R~b:: $Y::1?Hlts:: ~~t~71K:fGR7~ ::::::::::::::::::: ::::::::::.f l ~:O~.l ~~0:9.::: ~~'~:;::::4:f z~: J~~~X ~ :::::::::::::::::::::::::: POLICYHOLDER JOHN FALVELLA INC 47 UNION SCHOOL RD MONTGOMERY NY 12549 CERTIFICATE HOLDER TOWN OF WAPPINGER FALLS 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 4/21/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE RANC E UND INS U ~~~ F ~ ~ , 1?/ (Q/I~E''~v" DIRE OR, INSURANCE FUND UNDERWRITING hh9 NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE~9~4~ 701T212pAIN5, NEW YORK 10604-3814 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER FALLS 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 COPY APR 0 9 2010 TOWN OF WgPPI K ER TOWN CLER POLICY NUMBER +W 1369 249-6 DATE 4/05/2010 CERTIFICATE NUMBER 900-821 ~:_::::»~€ti~ti EO'11~R~L°i::fiY::?WI~::ir~t~1'I~:GCA'tf::::::::`: `::'::: POLICYHOLDER JOHN FALVELLA INC 47 UNION SCHOOL RD MONTGOMERY NY 12549 CERTIFICATE HOLDER TOWN OF WAPPINGER FALLS 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1369 249-6 UNTIL 10/03/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 10/03/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND U-26,3 DIRE OR, INSURANCE FUND UNDERWRITING Intl NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK ~518~ 437-6400 CERTIFICATE OF WORKERS' C I URAr o ~~~0~~0 APR 0 g 2010 ~~ WAPPINGERS FALLS BUILDING DEPA 20 MIDDLEBUSH ROAD 7.OW N OF W APPINGE WAPPINGERS FALLS NY 12590 .r~WN CLERK SOP Y ::::::PC€21Qf1::C01t~I~~D:`•f3Y: ~?Wlts::~~E~71~:{CA7:E::::::::::: `::::::: POLICYHOLDER CHARLES D BURGER DBA FOXX POOLS' 3730 ROUTE 9W HIGHLAND NY 12528 12206-1649 POLICY NUMBER +A 1367 035-1 DATE 4/05/2010 CERTIFICATE NUMBER 012-959 CERTIFICATE HOLDER WAPPINGERS FALLS BUILDING DEPA 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1367 035-1 UNTIL 9/17/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 9/17/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER .ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING 467 rcoTn~_~i~nn~ N_ew York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (888)997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~~~~ GEMSTAR CONSTRUCTION CORP 83 JEWETT AVENUE STATEN ISLAND NY 10302 POLICYHOLDER i ' CERTIFICATE HOLDER GEMSTAR CONSTRUCTION CORP TOWN OF WAPPINGER 83 JEW ETT AVENUE ~ 20 MIDDLEBUSH ROAD STATEN ISLAND NY 10302 ~ WAPPINGERS FALLS NY 12590 ~ POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G 1170 627-2 848346 04/01 /2009 TO 04/01 /2011 1 /5/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1170 627-2 UNTIL 04/01/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. Cppy ~I~~~I`~~~. MAR z 9 201p ~~~rA~ n 1 f; r, NEW YORK STATE INSURANCE FUND ~~~ ~~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www•nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 974570319 nan/r~nnni i n nnino ii nc~ NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~s4~~!6400ANY, NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~I~~E'Irl`~~ ~~ TOWN OF WAPPINGER MAR 2 9 20~p 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 ~+nr~, n~ Fn C o~~ ~: ~:;:.:.RC~€2iQt~:.EOrt~R~Ci:.$Y:, tWi~>iEi~1~I~:ECi~t~ ::.:.:.:.:.:.:.:::.: ..... ~:~:~::::::;5'~:0~;1~~~r9.::::~~::::::~:toff;l.:~~7i~ :::::::::::::::::::::::~::: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1482 281-1 DATE 3/24/2010 CERTIFICATE NUMBER 714-812 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS 'INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1482 281-1 UNTIL 6/07/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/07/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. U-26.3 THE STATE INSURANCE FUND 6~ DIRE OR, INSURANCE FUND UNDERWRITING STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name and address of Insured (Use street address only) lb. Business Telephone Number of Insured Sun Up Enterprises Inc 845-462-1800 1607 Rt 376 Wappingers Falls, NY 12590 lc. NYS Unemployment Insurance Employer Registration Number of Insured 41755135 Work Location of Insured (Only required if coverage is specifically ld. Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e n Wrap-Up Policy) or Social Security Number 141626397 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) Town of Wappinger 20 Middlebush Rd Wappingers Falls, NY 12590 ,~~('~~'~-~~ Mai a. g zo~n COP MAt ~,- F„r 3a. Name of Insurance Carrier Wausau Business Ins Co 36. Policy Number of entity listed in box "1a": WCKZ91451600019 3c. Policy effective period: 04/01/10 to 04/01/11 3d. The Proprietor, Partners or Executive Officers are: ® included. (Only check box if all partners/officers included) ^all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "1a" for workers' compensation under the New York State Workers' Compensation Law. (To use tlus form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Currier will also notify the above certificate holder- within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment ofpremiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be seat by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c'; whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Timoth E. Dean (Print name of authorized representative or licensed agent of insurance Cartier) Approved by: ~~~~ ~~ n 3/26/10 (Signature) tuaie~ Title: Authorized Re resentative Telephone Number of authorized representative or licensed agent of insurance carrier: 845-297-1700 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54~37~6400ANY, NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~'ECEIV`~,~ ~~ TOWN OF WAPPINGER MAR Z 61010 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 '~~~~^~ n~ ~~ ~~ Op ~>:::::: PC,€21QE1::ECl1t~R~D::BY::'TWIG::CE~t~1'I~:EGA'~f;::::::::::>::::::: ::~:::s~:o~:l~~~r8::::~:~:~:~::fi:foci.~~r~ ::::::::::::::::::::::::: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1482 281-1 DATE 3/24/2010 CERTIFICATE NUMBER 668-155 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1482 281-1 UNTIL 6/07/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/07/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND C~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING r~oTn~_~i~nn+ 7Q5 NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE~904f 701T212QAIN5, NEW YORK 10604-3814 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE - P WAPPINGER O TOWN OF G ~ECEI 9/ ~I,,, 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 MAR 15 2010 '~I~~AI ~`! FGA" :::>:.:.AC-~tiirtE~:.EC3~RE=D:. $Y:.fiWis:.~~f~1~1~:(C.aT~::; 5:.:,:.:::.: :::::::~d~z~~~~a..g:::~c~::::::d.f:~:~:~ar~ ::::::::::::::::::::::::::: POLICYHOLDER TOTAL GREEN LLC 371 ORCHARD DRIVE MONROE NY 10950 POLICY NUMBER +W 2073 309-3 DATE 3/22/2010 CERTIFICATE NUMBER 920-558 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 4/11/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE •AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING ~.,, NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54~716400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF ~~~~~~~~ PENSATION INSURANCE MAR 2 ~ 1010 ~~ TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 O ~~ ::::.:.:.PC-~ifQE>CO~R~I?:.BY:: tWi~:.~~€~1I~EGatf ::.:.:.:::.:.:.: :::::::::~s~:o~:1;~~f~8::::~'~::::a:f:f:~:~:~Qy~O ::::::::::::::::::::::::::: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1482 281-1 DATE 3/22/2010 CERTIFICATE NUMBER 668-155 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 4/11/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 1957 NEW YORK STAT~~tiE INSURANCE FUND 1 WATERVLIET AVENUE ~518)54~7~6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~E~~~~ MAR 2 5 7010 POLICY NUMBER +A 1482 281-1 DATE 3/22/2010 CERTIFICATE NUMBER 714-812 ~'~' TOWN OF WAPPINGER 20MIDDLEBUSH RD ~1^~~~ '~~ ~~'" WAPPINGERS FALLS NY 12590 P O :~::::::P~iQF3::CC3'~REb::BY:;tWi5:.~~t~~fil~:~Gi~t~ :::::::::::::::::::: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 4/11/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INS~U~RANCE~FU~ND ~i l~ ~~% l Q/l~~ilifi` DIRE OR, INSURANCE FUND UNDERWRITING oon NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE F~XTE SIGN ALBAN 518 437'6400 Y' NEW YORK 12206-1649 CERTIFICATE OF WO~~~ COMPENSATION INSURANCE ~CCEO~~~ TOWN OF WAPPINGERS MAR 2 4 2010 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590CO P~iAa ~~.~{~~ POLICY NUMBER +A 2037 632-3 o,arE 3/19/2010 CERTIFICATE NUMBER 576-865 ~~~~:~::~.C,€i1Qd:~E'0.11~R~[~~~:BY ~'fFIIS:~iC~t~~'!~~{CA7'~:>:::~:::~:<~:~: POLICYHOLDER CHRISTOPHER T HUNT DBA CERTIFICATE HOLDER CT HUNT & SONS TOWN OF WAPPINGERS 7 ALPERT DR 20 MIDDLEBUSH ROAD WAPPINGERS FALLS WAPPINGERS FALLS Ny NY 12590 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WI INSURANCE FUND UNDER POLICY N0. 2037 632-3 UNTIL 7 15 2010 OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER TH TH THE STATE ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN T ~ COVERING THE ENTIRE EXCEPT AS INDICATED BELOW, AND E NEW YORK WORK- TO THE POLICYHOLDER'S REGULAR NEWIyORKESTATE EMPOOYEESIONS OUTSIDETOF NEWEYORKRK, LY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 7/15/2010 IN SU TO AFFECT THIS CERTIFICATE, WILL BE GIVEN TO THE CERTIFICATED HOLDERITggOVENOTICE OF SUCH CH MANNER AS ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISIOONCE TY REGULARCEPSAILISO FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TOHGIVEATE INSURANCE THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFE NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFI AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY, RS NO RIGHTS CATS DOES NOT THE STATE INSURANCE FU'N DIRE R, INSURANCE FUND UNDEr New York State Insurance Fund_ Workers' Compensation & Disability Be~tefits Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (888) 997.3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~~~~ LOVELL SAFETY MGMT CO., LLC 110 WILLIAM STREET 12TH FLR NEW YORK NY 10038 POLICYHOLDER CERTIFICATE HOLDER ~ ~ ~ FOLKES HEATING, COOLING & BURNER TOWN OF WAPPINGER SERVICE INC 20 MIDDLEBUSH ROAD 850 ROUTE 9 WAPPINGERS FALLS NY 12590 FISHKILL NY 12524 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G 2046 911-0 698990 04/01 /2009 TO 04/01 /2011 1 /5/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2046 911-0 UNTIL 04/01/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. Co{oY ~`~'~~ C,~` ono ;~~ ` ~ ~ti ~~~ r~ ~~, ..^+'` NEW YORK STATE INSURANCE FUND I 1-9R.3 G~;~~ ~`~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 1010072546 ~an~r.nooi ~a_~nii sae New York State Insurance Fund -- - Workers' Cnnipensation & Disability Benefits Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (888) 997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~~~~ LOVELL SAFETY MGMT CO., LLC 110 WILLIAM STREET 12TH FLR NEW YORK NY 10038 POLICYHOLDER CERTIFICATE HOLDER NECKLES BUILDERS INC 47 WEST OLD FARMS ROAD HOPEWELL JUNCTION NY 12533 TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 POLICY NUMBER ~ ~ G 1316 863-8 CERTIFICATE NUMBER 171097 PERIOD COVERED BY THIS CERTIFICATE 04/01 /2008 TO 04/01 /2011 DATE 1 /5/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND .UNDER POLICY NO. 1316 863-8 UNTIL 04/01/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~~~ ~~~ ~o~o ~~ ~~ ~aR ~'~F~ .~~~~ COPY NEW YORK STATE INSURANCE FUND ~~~ ~~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://voww.nysif.com/cerUcertval.asp or by calling (888) 875-5790 - VALIDATION NUMBER: 206860517 ~Fnir.n~a~ 1 ~_~niF~4 i i-~F New_ York State Insurance Fund Workers' Compensatio~a & Disability Benefits Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (888) 997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~~~~ LOVELL SAFETY MGMT CO., LLC 110 WILLIAM STREET 12TH FLR NEW YORK NY 10038 POLICYHOLDER CERTIFICATE HOLDER JASTINE CONTRACTING CORP 8 APPLE SUMMIT LANE LAGRANGEVILLE NY 12540 TOWN OF WAPPINGERS FALLS BUILDING DEPARTMENT 20 MIDDLE BUSH ROAD WAPPINGERS FALLS NY 12590 POLICY NUMBER G 1479 618-9 CERTIFICATE NUMBER 850030 PERIOD COVERED BY THIS CERTIFICATE 04/01 /2009 TO 04/01 /2011 DATE 1 /5/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1479618-9 UNTIL 04/01/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. r°~PY ~~~~ G~ ~®~® ~~ ~.3 ~~~ > Fp NEW YORK STATE INSURANCE FUND ~~~~~ ~~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 332548590 ~Fnir.n~ai~a_~ni~~4 _New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1919 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (888) 997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~~~~ LOVELL SAFETY MGMT CO., LLC 110 W-LLIAM STREET 12TH FLR NEW YORK NY 10038 POLICYHOLDER CERTIFICATE HOLDER BARON UTILITIES CORP TOWN OF WAPPINGER 14 PETRA LANE BUILDING DEPARTMENT ALBANY NY 12205 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G 2027 250-6 182512 05/01 /2008 TO 04/01 /2011 1 /5/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2027 250-6 UNTIL 04/01/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~~PY `~~'v ~~ ~o~® ~ ,^~^~ r~ NEW YORK STATE INSURANCE FUND i i-~a ~~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 -VALIDATION NUMBER: 496331200 ~anir~n~oi ~n_onii ~~n NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~TSIGN, ALBANY, NEW YORK 12206-1649 518) 437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 ~:~: ~: ~RC~€2iQd {EOI~R~I~: ~f3~: ~~Wi~: ~ E~EtT1~:FGRtf~: ~: ~>::~:~:~: ~: ~: POLICYHOLDER SBI CONSTRUCTION SERVICES INC 7 VETERANS PLACE WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1424 417-2 DATE 3/12/2010 CERTIFICATE NUMBER 348-067 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1424 417-2 UNTIL 6/20/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/20/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. '''~~~~~10~L Cp MAR 15 PY 20~® THE STATE INSURANCE FUND U-26.3 ~~ DIRE R, INSURANCE FUND UNDERWRITING 7 L. 5 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name & Address of Insured (Use street address 1b. Business Telephone Number of Insured only) 845-454-3650 1c. NYS Unemployment Insurance Employer Avello Brothers Contractors, Inc. Registration Number of Insured 60 Fulton Street 16-10853 Poughkeepsie, NY 12601 1d. Federal Employer Identification Number of Work Location of Insured (Only required if coverage is Insured or Social Security Number specifically limited to certain locations in New York State, 14-1537061 i.e., a Wrap-Up Policy) 2. Name and Address of the Entity Requesting Proof 3a. Name of Insurance Carrier of Coverage (Entity Being Listed as the Certificate Majestic Insurance Company Holder) ~ 3b. Policy Number of entity listed in box "1a" @@ ~'' ~, i ~ ~.. 0200805150-03 Town of Wappinger ~ , , ., ~Q ~ 3c. Policy effective period 11 iw 20 Middlebush Road 04/01/10 to 04/01/ Wappingers Falls, NY 12590 r,,~,tl~ibt e ~o ~.j ~.c 3d. The Proprietor, Partners or Executive Officers are t,,. _ ^ inClUded. (Only check box if all partners/officers included) L- -- ~( all excluded or certain partners/officers Excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "1a" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box "2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box '3c'; whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: (Print Approved by: (Signature) Title or licensed agent of insurancee carrier) '( l (~ (Date) Telephone Number of authorized representative or licensed agent of insurance carrier: 845-471-6200 Pleose Note; Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) Workers' Compensation law Section 5 estriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commoisment of employees in a haza douseemployment defined permit for or in connection with any work involving the emp y by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insuov ded brrthissch ptereNothing herein'showever~ shall chair, that compensation for all employees has been secured as pr Y be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commissi to mend of employees in a haz'ardouslemploymentnto any contract for or in connection with any work involving the emp y defined by this chapter, notwithstanding any general or special statunsurarc'elcarorierus porodu ednn a form sat sfactory not enter into any such contract unless proof duly subscribed by an to the chair, that compensation for all employees has been secured as provided by this chapter. C-105.2 (9-07) Reverse ~ STATE OF NEW YORK ~ WORKERS' COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la. Legal Name and Address of Insured (Use street address only) 84SB-656-65 Zelephone Number of Insured HOFFMAN HOMES AND REMODELING SPECIALISTS, INC. lc. NYS Unemployment Insurance Employer 15 SACHSON PLACE Registration Number of Insured WAPPINGERS FALLS, NY 12590 ld. Federal Employer Identification Number of Insured or Social Security Number 141831464 ,~._ ._ 2. Name and Address of the Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Zurich American Insurance Company , Town of Wappinger 58 South Service Road, Melville, NY 11747 ~„ Building Department 20 Middlebush Road 3b. Policy Number of entity listed in box "' C~~ Wappingers Falls, NY 12590-0324 5289171 - 001 3c. Policy effective period: ~~~ r ~ 2010 9/25/2009 To 9/25/2010 ,,,1/11/ ~~ gyp. 4. Polic covers: a. ~X All of the employer's employees eligible under the New York Disability Benefits Law b. ~ Only the following class or classes of the employer's employees: Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. Date Signed 3t9t2o~o gy ~~~~ (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (631) 845-2200 Title Operations Manager IMPORTANT: If box "4a" is checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier, this certificate is COMPLETE. Mail it directly to the certificate holder. If box "4b" is checked, this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the Disability Benefits Law. It must be mailed for completion to the Workers' Compensation Board, DB Plans Acceptance Unit, 20 Park Street, Albany, New York 12207. PART 2. To be com leted b NYS Workers' Com ensation Board Onl if box "4b" of Part 1 has been checked State Of New York Workers' Compensation Board According to information maintained by the NYS Workers' Compensation Board, the above-named employer has complied with the NYS Disability Benefits Law with respect to al] of his/her employees. Date Signed gY (Signature of NYS Workers' Compensation Board Employee) Telephone Number Title Please Note: Only incur°ance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (5-06) Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in box " 3" on this form is certifying that it is insuring the business referenced in box "la" for disability benefits under the New York State Disability Benefits Law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box " 2". This Certificate is valid for the earlier ojone year after this form is approved by the insurance carrier or its licensed agent, or the policy expiration date listed in box "3c". Please Note: Upon the cancellation of the disability benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article, and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. DB-120.1 (5-06) New York Sta_te_I_nsurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 1 WATERVLIET AVENUE ALBANY, NEW YORK 12206-1649 Phone: (518)437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~~~~ HOFFMAN HOMES & REMODELING SPECIALISTS INC 15 SACHSON PLACE WAPPINGERS FALLS NY 12590 r ~~~~ .~ _,~ ~~ qR j~ - M ~~L~t, 1l~rq~ ?~10 ~'~~~A. CERTIFICATE HOLDER POLICYHOLDER HOFFMAN HOMES & REMODELING TOWN OF WAPPINGERS BUILDING DEPARTMENT SPECIALISTS INC 20 MIDDLEBUSH ROAD 15 SACHSON PLACE WAPPINGERS FALLS NY 12590-0324 WAPPINGERS FALLS NY 12590 POLICY NUMBER CERTIFICATE NUMBER PERIOD 04004E 009 TO 04/104/20 OTIFICATE 3/9/D2010 ~ A 1465 188-9 997535 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSUKAIVC:t FUND UNDER POLICY NO. 1465188-9 UNTIL 04/04/2010, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OUTS DEIOOF NEWHYORKTTO THEEPOLICOYRHOLDER'STREGULAR NEW YOR OSTATE EMPLOYEESSONLY. TO OPERATIONS IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04104/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND e~~ '~~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 295974024 U-26.3 New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 1 WATERVLIET AVENUE ALBANY, NEW YORK 12206-1649 Phone: (518)437-8979 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~~~~ ~EC~~v~~ SK ELECTRIC LLC 271 ROUTE 9D BEACON NY 12508 ~OPy MAR ~ 2 2010 POLICYHOLDER CERTIFICATE HOLDER SK ELECTRIC LLC TOWN OF WAPPINGERS 271 ROUTE 9D BLDING DEPT BEACON NY 12508 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE A 1456 134-4 817340 06/14/2009 TO 06/14/2010 3/10/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1456134-4 UNTIL 06/14/2010, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 06/14/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND G~;/ j~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 627380437 U-26.3 NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE~9~4j 701T212QAIN5, NEW YORK 10604-3814 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~~1~ ~~ MAR y ~ 2o~a ~~ TOWN OF WAPPINGERS FALLS BER BUILDING DEPARTMENT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 y,~- y ~j POLICY NUM +W 1484 087-0 DATE 3/08/2010 CERTIFICATE NUMBER 917-897 >:.:.i?~€2iQEti:.EOal~~~D:. ~Y:.~tHifs:.sr~E2"rIF:tGati'::.>:.:.:.:.>:.:.: POLICYHOLDER RIA CONSTRUCTION INC P.O. BOX 7174 NEWBURGH NY 12550 CERTIFICATE HOLDER TOWN OF WAPPINGERS FALLS BUILDING DEPARTMENT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/28/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING ~nn~ NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE~904S 7p1T212QAINS, NEW YORK 10604-3814 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE '~~ TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY POLICYHOLDER RIA CONSTRUCTION INC P.O. BOX 7174 NEWBURGH NY 12550 POLICY NUMBER +w 1484 087-0 DATE 3/08/2010 CERTIFICATE NUMBER 918-217 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/28/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING oQa NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54~37~6400ANY, NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ~ECEI~'~~ MAR t 1 2010 POLICY NUMBER +A 1379 524-0 DATE 3/08/2010 CERTIFICATE NUMBER 215-550 ~~~ntM ~t'`~_~p" __=~ (~ ::5:_:.PC-~iQt~:.EOV~R~E?:.BY::~WIl:.E~R7~I~:EGatf ::.:.:.:.:.:.:.:.: :::::::«:~:f:~~o~:1~~~rG~::~:c~:~:~y:fob:l:~~r~ :::::.::::::::::::::::::::: POLICYHOLDER DUTCHESS FIRE PROTECTION INC PO BOX 408 WAPPINGER FALLS NY 12590 CERTIFICATE HOLDER TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH -THE STATE INSURANCE FUND UNDER POLICY N0. 1379 524-0 UNTIL 11/01/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 11/01/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 5 DAYS WRITTEN NOTICE OF .SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSU~RANCE~FU~N"D U~~ 1~%(Q/l~E%tili` U-26.3 DIRE R, INSURANCE FUND UNDERWRITING ~rnTn~ ~~~~~+ SAS NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54037~6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE r~ TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 t r ;. __-- ~ECEI V;~ L MAR 1 12010 ~'/1 /^~ ~J ~p- POLICY NUMBER +A 1424 417-2 DATE 3/08/2010 CERTIFICATE NUMBER 348-067 ~:~:::::: fi~€iiOE'GC3~R~b::B~!:~ 1'Wig:.it~t~~`1~:{G,Q7f::.::>:.:.:.:.::: ........~::~:~:~:~6~~;2n~1~~D:8.::~~'1~:::~:f2.8:1;~Q~~ :::::::::::::::::::::::::: POLICYHOLDER SBI CONSTRUCTION SERVICES INC 7 VETERANS PLACE WAPPINGERS FALLS NY 12590 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/28/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING i.nc NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISION, ALBANY, NEW YORK 12206-1649 518) 437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE -~~ TOWN OF WAPPINGER BUILDING DEPARTMENT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 :~::::::PC€21QE::C011~F2(=~:;fiY::1WIC::C~t~1'IF:{GA7~ :::::::::::::::::::: :::::::::s~:~.¢~~~~:~:::~c~::::::s:t:~~~:~~r~ ::::::::::::::::::::::::::: POLICYHOLDER SK ELECTRIC LLC 271 ROUTE 9D BEACON NY 12508 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1456 134-4 UNTIL 6/14/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/14/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~E~EIVE~ ("1 MAR 12 2010 oP ~, Y ^'~~ ~~ map U-26.3 POLICY NUMBER +A 1456 134-4 DATE 3/09/2010 CERTIFICATE NUMBER 488-765 CERTIFICATE HOLDER TOWN OF WAPPINGER BUILDING DEPARTMENT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGERS BLDING DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1456 134-4 DATE 3/09/2010 CERTIFICATE NUMBER 817-340 ~'`::PC~iiQd SCOSi~RED:; 8`!:~'i`Wt~:;ir~r~TIF:~GA`ff<:::::: `::::::::: POLICYHOLDER SK ELECTRIC LLC 271 ROUTE 9D BEACON NY 12508 CERTIFICATE HOLDER TOWN OF WAPPINGERS BLDING DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1456 134-4 UNTIL 6/14/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/14/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. MAR 1 2 2x90 "~1Alf~~ ~i1 ~A" l _o P Y THE STATE INSURANCE FUND ~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISION, ALBANY, NEW YORK 12206-1649 518) 437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 ~':,:.:.AC~tiQE3:. GC3:~l~~~b:.8~!:`•1~WI~>~~t~1~I~:IGa7~ ::.:.:.:.:.:.:.:.:.: POLICYHOLDER SK ELECTRIC LLC 271 ROUTE 9D BEACON NY 12508 POLICY NUMBER +A 1456 134-4 DATE 3/09/2010 CERTIFICATE NUMBER 708-035 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1456 134-4 UNTIL 6/14/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/14/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~ ~~ A ~ Y ~C~IV,~~ MAR 112010 ~°~~~IrM,{~~~~~ U-26.3 THE STATE INSURANCE FUND ~~ DIRE R, INSURANCE FUND UNDERWRITING STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name & Address of Insured (Use street 1b. Business Telephone Number of Insured address only) (585) 647-6400 Monro Muffler Brake, Inc. 200 Holleder Parkway 1c. NYS Unemployment Insurance Employer Rochester, NY 14615-3808 Registration Number of Insured 43403512 Work Location of Insured (Only required if 1d. Federal Employer Identification Number of coverage is specifically limited to certain locations Insured or Social Security Number in New York State, i.e., a Wrap-Up Policy) 16-0838627 2. Name and Address of the Entity Requesting 3a. Name of Insurance Carrier Proof of Coverage (Entity Being Listed as the The Phoenix Insurance Company Certificate Holder) 3b. Policy Number of entity listed in box "1 a" Town of Wappinger TC2N-UB-177D815-0-10 20 Middlebush Road Wappingers Falls, NY 12590 ~~C'~ /~L 3c. Policy effective period ~ G V 04-01-2010 to 04-01-2011 r MAR 1 1 2010 3d. The Proprietor, Partners or Executive Officers are ~~ ® InClUded. (Only check box if all partners/officers included) ` #"~~N~ ~CLFP~' ^ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "1 a" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box "2". The Insurance Carrier will also notify the above ce-fiticate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices maybe sent by regular mail). Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Dee Belleville .(Print name otauthorized representative or licensed agent of insurance Approved by: (Signature) 9110 Title: Account Representative Telephone Number of authorized representative or licensed agent of insurance carrier: (860) 277-6542 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) www.web.state.ny.us W31 F3J07 riECEIlfE~ MAR - 9 2010 New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 ~~~^1M (;~~~~ 1 WATERVLIET AVENUE ALBANY, NEW YORK 12206-1649 Phone: (518)437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ,~ ~_. %, { ~~~~~~ LORI WAREING D/BIA LORJEN ELECTRICAL SYSTEMS 109 STAGECOACH PASS STORMVILLE NY 12582 POLICYHOLDER LORI WAREING D/B/A LORJEN ELECTRICAL SYSTEMS 109 STAGECOACH PASS STORMVILLE NY 12582 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE A 1107 779-9 712203 03/05/2006 TO 03/05/2011 2/22/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1107 779-9 UNTIL 03/05/2011, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 03/05/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 5 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND ~~ ~~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 445085254 U-26.3 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54~716400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 <:::: P~€2iQb:. EOV~R~b:. ~~l~fiH15::lr~t~TIF:(GAt~::::::::;>::>::::: POLICYHOLDER CHRISTOPHER T HUNT DBA CT HUNT & SONS 7 ALPERT DR WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 2037 632-3 DATE 3/02/2010 CERTIFICATE NUMBER 576-865 CERTIFICATE HOLDER TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/22/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~ r ` MAR - 5 2010 °-~~nrnt ~f;l_FP- CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING ~n~~ NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~ISION, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 ...................................:.:...:........:............. >:: A.E€21QE1:~CO.itEREb:~8Y:~1'WI5:~irS€~TIK:FCAtB~:~:~:~:~:?~:~:~:~: POLICYHOLDER SK ELECTRIC LLC 271 ROUTE 9D BEACON NY 12508 POLICY NUMBER +A 1456 134-4 DATE 3/02/2010 CERTIFICATE NUMBER 708-035 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/22/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. r' ~~ ~' ~~G~1~ _- MaR " 5 201 `. --•,nrc~~ ~`~ ~P~ CANCELLATION U-26.3 THE STATE E F UND INSURANC , ~ ~ DIRE OR, INSURANCE FUND UNDERWRITING ~~~~ NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~1 SION, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER BUILDING DEPARTMENT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ::::.:.:. i?C-€€~iQa:. EC7rt~R~b:. $1!:: ~TW 15:. ~~€2~1~ (GRtf ::.:.:.:::.:.:.:.:.: POLICYHOLDER SK ELECTRIC LLC 271 ROUTE 9D BEACON NY 12508 POLICY NUMBER +A 1456 134-4 DATE 3/02/2010 CERTIFICATE NUMBER 488-765 CERTIFICATE HOLDER TOWN OF WAPPINGER BUILDING DEPARTMENT 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/22/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~EC~~~ ~~ MAR _ 5 2010 E . --.~n-r~i ~I FPS ~' CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING ~zii NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54~7~6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGERS BLDING DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1456 134-4 DATE 3/02/2010 CERTIFICATE NUMBER 817-340 :`:.5>R~€2iQE:.GC31l~R~Ci>BY:. TFII~:.lr~€~1~I~:EGaTi^ ::.:.:::::.:.::::: . :::::::::: i5 ~:f:~::1 ~~ag :::~~#:::::: ~:f z~ l,~ar ~ ::::::::::::::::::::::::::: POLICYHOLDER SK ELECTRIC LLC 271 ROUTE 9D BEACON NY 12508 CERTIFICATE HOLDER TOWN OF WAPPINGERS BLDING DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/22/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~ECE`~ ~~ MAR ° ~ 2010 ~~nr~.i C;1 FP' CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING ~~i,n 436 Farm Policy Cancellation Notice - New York Famil Agent : 3045 r~ EC E I V E L Casualty Insurance Company ® Glenmont, New York MAR - 31010 ',V NI {r:%"`:1.~':'v`i':i::''•:{•i>::itii5+::::::.:?.:.~::isi:::::i:}isi::ii:i'•i:•i::iti}{•i'S::i:~ii: ::: :'.:1: •' ..:::'.Ciiii% •i:::{::::irii::i.{•.?:iiii: iiiYii:<:i '•'r :1 '•;L':?iiti:i, `•ii:{;:iii:::::•::::i::i::ii:. iiiii ::: -LOSS PAYEE/ADDITIONAL INSURED ~l ~P- . . , . . .;.:.,.......,...,:...:.. ................:.:..:.....,........................................... - CONTRACTORS ADVANTAGE TOWN OF WAPPINGER ,r- -. ::: ~>.~.~.<.:::.n~:,:.>~.:'"~.;~'''•`.;#~~i'~ryr~~:~~131 ~:. ~'~ ~ 20 MIDDLEBUSH RD \:`;;~~~ 3114X0137 02/20/10 03/02/10 WAPPINGERS FALLS NY 12590-4004 ~ "~ ,.: Your olio >`F'•~~'w~""``''"''"'~~""''""" ~ ~'~ ~"'' ' ' N_:_•.:.:.:. will be „ f::N;:,.:<:;%•?::;:.~::::~::~::r..~ .~~~':.~..'. .,.::.:. •. ..: .... ........ I canceled on Mo. -Day - Yr. ~ Standard time this date .~ 03/22/10 i 12:01 AM IMPORTANT: Special regulations that apply to this notice You are hereby notified in accordance with the terms and conditions of the above stated policy, and in accordance with New York law, that your insurance will cease at and from the hour and date mentioned above. Reason for Cancellation: Nonpayment of Premium. A bill for the premium earned to the time of cancellation will be forwarded in due course. Payment of overdue premium to us, or your agent or broker will be considered timely if made within 15 days after mailing of this notice. To make such payment, contact us or your agent immediately. LOSS INFORMATION: Upon written request from you or your agent, we will mail or deliver loss information covering a period of years specified by the Superintendent of the Insurance Department by regulation or the period of time coverage has been provided by us, which ever is less, within 10 days of such request. Loss information consists of information on closed claims, open claims and notices of occurrences, including date and description of occurrence and any payments. Notice to Loss Payee -~ You are hereby notified that the agreement under the Loss Payable Clause payable to you as Lienholder, which is part of the above policy, issued to the above insured, is hereby nonrenewed in accordance with the conditions of the policy. This nonrenewal is to be effective on the date stated above. NAME AND ADDRESS OF INSURED: ROOM TO GROW INC 7 POTTER PL HOPEWELL JCT X-2881 0806 NY 12533-5151 By AUTHORIZED REPRESENTATIVE Page 1 of 2 Farm Family Casualty Insurance Company Technology Insurance Company 5800 Lombardo Center Cleveland OH 44131-2550 CERTIFICATE HOLDER NOTICE NEW YORK WORKERS COMPENSATION INSURANCE COVERAGE Certificate Holder: Town of Wappinger 20 Middlebush Road Wappinger Falls, NY 12590 Insured: Policy Number: Policy Period: Date of Notice: Notice Type: Effective Date of Cancellation: Endorsement No.: Reason: t ~ECEIi/EI~ MAR - 4 2010 '~t1U1~1 ~(;:C.F~r Commercial Contracting Company, Inc. TW C3225374 12/31/2009 to 3/9/2010 12:01 a.m. at the insured's mailing address 2/25/2010 Cancellation 3/9/2010 12:01 a.m. at the insured's mailing address 1 Prem Due 2780.00 As a Certificate Holder on the above policy, you are hereby notified that in accordance with the terms and conditions of this policy, Workers' Compensation Insurance will cease on the date shown for the above named insured. If you have any questions regarding this notice, please contact the insured listed above. e ,~~ By: Authorized Representative ,• Technology Insurance Company An AmTrust Financial Company A member of the AmTrust Financial Group A.M. Best Rating: A- NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-386$ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE '~' TOWN OF WAPPINGER ~ECEIVEI~ 20 MIDDLEBUSH RD. WAPPINGERS FALLS NY 12590 MAR 0 1 2010 ' RP'' ~ ~'~1A/~~ C`L star ~,~'' ~; ;t x :: ~::::::A~€21QE?::Ed1t~I~~d::~3Y::'CWI~::~~€~T.IF:{G;4~'~:`>::::::::'::::: POLICYHOLDER ROCK-ALL CONSTRUCTION INC 1365 RUSTIC RIDGE CT. YORKTOWN HEIGHTS NY 10598 POLICY NUMBER ''~G 1087 080-6 DATE 2/25/2010 CERTIFICATE NUMBER 938-950 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH RD. WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1087 080-6 UNTIL 6/29/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/29/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING 147 CFRT(1~-~/~(ln 1 NEW YORK STATE INSURANCE FUND 199 CHURCH STRiE8~8N997Y086~ N.Y. 10007-1100 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~~~~ ~~ TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD ~Ap O' z~~k WAPPINGER FALLS NY 12590 /'11111 N ~~~ ~ ~ :~:.:.:,~?EEti<)iE3:~EC3.rt~~~1?:.SY:~mWi~:;C~~I~:ECik~::.> :::.:::.:.:.::: POLICYHOLDER CADY LANE HOMES INC 19 CADY LANE WAPPINGERS FALLS NY 12590 POLICY NUMBER +G 1225 085-8 DATE 2/25/2010 CERTIFICATE NUMBER 054-923 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1225 085-8 UNTIL 6/29/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/29/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE.. NOTICE BY REGISTERED MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSU~~RANCE~~F~U`ND ~~~ 1~%lQ/~C~ili` U-2G.3 DIRE R, INSURANCE FUND UNDERWRITING 205 CERT02-2/2001 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54~7-6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ~E~EIV ~Ly FEB ~ ~ zoo POLICY NUMBER +A 1379 524-0 DATE 2/22/2010 CERTIFICATE NUMBER 215-550 ,.,,~W~1(°:L~R~,, +~; ~ ~ ~ :::.'•`•::P~1QE~::EC31l~R~[?'•$Y:: tWlfs:;~Et~7'IF:{CAT~::::`• ::::::::::::::: POLICYHOLDER DUTCHESS FIRE PROTECTION INC PO BOX 408 WAPPINGER FALLS NY 12590 CERTIFICATE HOLDER TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/14/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INS~U~JRANCE FUND DIRE OR, INSURANCE FUND UNDERWRITING 717 STDCAN-2/2001 NEW YORK STATU~TTE INSURANCE FUND 1 WATERVLIET AVENUE ~518)g4~7~6400ANY, NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE E~~w~~ ~ >~ 2a,~ ~~ TOWN OF WAPPINGERS ~EB 20 MIDDLEBUSH ROAD Tn~MN ~1 ~~~ WAPPINGERS FALLS NY 12590 ~' J ~ t, POLICY NUMBER +A 1363 304-5 DATE 2/22/2010 CERTIFICATE NUMBER 098-423 ~: ~:.:.:.1?~E2jQE3:.E~31lSR~C?:.SY:, ~Wi>:.~~F~'IF~CA'~ .:.:::.:.:.:.:.:.:.: POLICYHOLDER BALANCED BUILDERS INC 20 GARDEN PLACE BEACON NY 12508 CERTIFICATE HOLDER TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1363 304-5 UNTIL 8/05/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 8/05/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING CERT02-2/2001 3119 NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE~9~4~ 701T212pAINS, NEW YORK 10604-3814 CANCELLATION OF CERTIFICATE OF WORKE~tS' COMPENSATION INSURANCE ~~~1 k ~~ TOWN OF WAPPINGER FALLS 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 ~~~ ',~9 r--,. POLICY NUMBER +w 1369 249-6 DATE 2/17/2010 CERTIFICATE NUMBER 900-821 ~: ~:.:.:.P~€2iQ~:.C~.~REd:.$Y::~Wi~:.~~~~IF:4Ca~~ .:.:.:.:.:.:.:.:.: ~:::::::: ~ a ~:o~ 1 ~~09:::~'~:::::;~:f o~ l;~a r ~ ::::::::::::::::::::::::::: POLICYHOLDER JOHN FALVELLA INC 47 UNION SCHOOL RD MONTGOMERY NY 12549 CERTIFICATE HOLDER TOWN OF WAPPINGER FALLS 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/09/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE .~ ~. ,~ TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 -~ ~~ ~" ~ ~ ~I~. SEE ^~10 ~, r,,A r~ ~: ~:;::::A~€ti17iE1>C(3V~R~D::SY::1`WIC::~IEtTI~:~CA7~:>::<:;:::;::::>: POLICYHOLDER HUDSON VALLEY CHIMNEY SERVICE INC 3647 ALBANY POST ROAD POUGHKEEPSIE NY 12601 POLICY NUMBER +Z 1172 271-7 DATE 2/17/2010 CERTIFICATE NUMBER 657-367 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/09/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 CERTIFICATE HOLDER TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING Erie ,j~ Insurance Group ,ooE~~emS.Pi FEBRUARY 16, 2010 Erie, PA 1fi530 ADDITIONAL INSURED AND/OR a~~~~~ ~~ ~~ CERTIFICATE HOLDER• NAMED INSURED AND ADDRESS: ~E~ ~ o Z~~a ~q r..~ TOWN OF WAPPINGER GREAT AMERICAN AWNING 20 MIDDLEBUSH RD •~ ,, & ENDT #1 WAPPINGER FALLS NY 1259 (`~L _' j~ 43 ROUND LAKE RD BALLSTON LAKE NY 12019 TYPE OF POLICY: POLICY NUMBER: COMPANY: BUSINESS CATASTROPHE POLICY Q255170103NY ERIE INSURANCE COMPANY YOUR NAME APPEARS ON THE ABOVE POLICY AS AN ADDITIONAL INSURED AND/OR CERTIFICATE HOLDER. THIS IS YOUR NOTICE THAT YOUR INTEREST AND ANY COVERAGE AFFORDED TO YOU BY THE POLICY IS BEING CANCELLED EFFECTIVE 12:01 A.M. - JANUARY O1, 2010. NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54037~6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE RECEIVE ~~ TOWN OF WAPPINGERS FED 2 3 Zuiu 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 AWN ~~~ ,7 ~~~`, ~ ~ :~~ _ !' POLICY NUMBER +A 1363 304-5 DATE 2/19/2010 CERTIFICATE NUMBER 098-423 ~:~:,:.:.f?~€'ti<)iE3:. C~.r1~RED>$Y:.fiWI~`E~€~T.IF:EGa~f.S:.:.:.>:.:.: :~~~~:~:~~~~~:Oar.~~G~l~?:~:~fl~:~:~:~~.f:f:~:1,~1~7~ ::::::::::::::::::::::::::: POLICYHOLDER BALANCED BUILDERS INC 20 GARDEN PLACE BEACON NY 12508 CERTIFICATE HOLDER TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/11/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE '~~'TOWN OF WAPPINGER 20 MIDDLEBUSH RD. WAPPINGERS FALLS NY 12590 ~..., ~E~ ~ " 2010 ^4r-~, POLICY NUMBER +G 1087 080-6 DATE 2/18/2010 CERTIFICATE NUMBER 938-950 ::`::]?C~Fi1QE3::E01l~R~[?:BY: ~'1•Fill:;sr~EtTIF:{CA7~:>:<::`•::::::': :::::::::: ~ ~ z:~:l;~~09 :::~:~: ~ ::: ~: f :f ~ ! ~Q r ~ ::::::::::::::::::::::::::: POLICYHOLDER ROCK-ALL CONSTRUCTION INC 1365 RUSTIC RIDGE CT. YORKTOWN HEIGHTS NY 10598 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH RD. WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/10/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 7R(,4 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING ~Tnr.n~i-~i~nn~ NEW YORK STATE INSURANCE FUND 199 CHURCH STREET NEW YORK N.Y. 10007-1100 1-8$8-997-3863 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD WAPPINGER FALLS NY ~t~ ~.~ ~, ~~~' F~D ~` ~' 200 12590 ,. . ,~~ ,.-.~ :.:,1?C~€tiQa`Cd~RECi:.BY:.~TWI~:.~~FttI~:IGa~f ::.:.:.:.:.:.:.>:.: POLICYHOLDER CADY LANE HOMES INC 19 CADY LANE WAPPINGERS FALLS NY 12590 POLICY NUMBER +G 1225 085-8 DATE 2/18/2010 CERTIFICATE NUMBER 054-923 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLE BUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/10/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. R E G I S T E R E D M A I L CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 97 cTnreni-~i~nn~ NEW YORK STATE INSURANCE FUND 105 CORPORATE PARK DR, STE~904S WHOiT212QAINS, NEW YORK 10604-3814 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~- TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY FEB 1 7 2010 12590 -~~nr',r~~ r`1 r.F..,, POLICYHOLDER CONTEMPORARY ENVIRONMENTAL MGMT INC T/A CONTEMPORARY CONSTRUCTION 190 GOLDENSBRIDGE CT NORTH WING KATONAH NY 10536 POLICY NUMBER + W 921 016-2 DATE 2/12/2010 CERTIFICATE NUMBER 997-699 :~:.:.:.R~€2i~7Es:.6C3t~R~b:.B~: ~:T:W15:.~~€~T:IF:FGQt~::.:.:.5:.:.:.:.: CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 3/04/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54~7~6400ANY, NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER ~EB ~ ~~ 2010 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ( ~ ''~'~+ ~~ ~,~ ...,,. ~. ~, 1° ~':.:.>~,r~~,ic~ti:.cep:~i~~d>$v:.:rwi~:;e~~ri~:FC.~a~~::.:;:;.:.:.:::.:.: POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION NY 12533 POLICY NUMBER *A 1332 146-8 DATE 2/11/2010 CERTIFICATE NUMBER 162-368 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1332 146-8 UNTIL 8/19/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 8/19/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~ U-26,3 DIRE OR, INSURANCE FUND UNDERWRITING ,.~~T..., ., ,.,,,., , ~QQ NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE (518~S403N=6400ANY, NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY FEB 1 ~ 2(~BU 12590 "1sq, ,^J ~,_. f~ ' -/' ~ ,, POLICY NUMBER '~A 1332 146-8 DATE 2/11/2010 CERTIFICATE NUMBER 616-846 AC,€iiQd:.EC3V~REd:. BY:.?W15:.~~€~1°I~:EGAT~ POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 NY 12533 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1332 146-8 UNTIL 8/19/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 8/19/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~ U-26,3 DIRE OR, INSURANCE FUND UNDERWRITING i.ni ..-,.T .... .. ... .. ... NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SION ALBANY NEW YORK 12206-1649 ~518~ 4376400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~ r ._. i TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD ~EB t ~ 2010 WAPPINGER FALLS NY 12590 ~~~~~' ^1 /^-. ::~::::::A~1QE)::C01t~R~b:: f3Y::'fWIS::~~€~1'IK:{G1:t7~:`.'•::::>:`•::::::: POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION NY 12533 POLICY NUMBER ''~A 1332 146-8 DATE 2/11/2010 CERTIFICATE NUMBER 874-920 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1332 146-8 UNTIL 8/19/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 8/19/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~ U-2G.3 DIRE R, INSURANCE FUND UNDERWRITING o n o ^--- .... ..... .... . NEW YORK STAT~~I1E INSURANCE FUND 1 WATERVLIET AVENUE ~518)g4~7~6400ANY, NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER ~~~~~~~~~, 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 FEB 1 6 2p10 ~:~:.:.:. PC~tiQd>Ed11~RED:.SY.'•:TWIG:.it~Et?I~:(Gatf .:.:.:.:.:.:.:.:.: POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION NY 12533 POLICY NUMBER ''~A 1332 146-8 DATE 2/11/2010 CERTIFICATE NUMBER 297-081 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1332 146-8 UNTIL 8/19/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 8/19/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSUjR~ANCE,~FU~ND U~2~ ~~%(QJl~~ilili` U-2G.3 DIRE OR, INSURANCE FUND UNDERWRITING r rnTnn ., ,.,.,,. , X05 NEW YORK STATE INSURANCE FUND ALBANY NEW YORK 12206-1649 1 WATERVLIET AVENUE XTE~ISION, 518) 437-6400 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~!,~, a ~' ~~~~ `~ ~t" POLICY NUMBER '~~ TOWN OF WAPPINGER ~'~A 1329 868-2 20 MIDDLEBUSH ROAD ~Eg 1 P, 2014 DATE WAPPINGERS FALLS NY 12590 2/09/2010 rA + r9 fr' ~' CERTIFICATE NUMBER 305-010 ::: <::::1?C~2f0~:: E(3t~R~d; $Y: ~ 1'WI ~:: C~F~1°IF:tC.At~ :::::::::::::::::::: CERTIFICATE HOLDER POLICYHOLDER EU-TE CORPORATION T/A EURO-TECH TOWN OF WAPPINGER GENERAL CONSTRUCTION 20 MIDDLEBUSH ROAD 18C SCARBOROUGH LANE WAPPINGERS FALLS NY 12590 WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1329 868-2 UNTIL 8/03/2010 COVERING THE ENTIRE OBLIGATION OFATION LAWICWIOHDRESPECTWOOKALL'OPERATIONSIOINUTHER STATEEOFYNEW YORK, ERS' COMPENS EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 8/03/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 5 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING CERT02-2/2001 ., NEW YORK STAT~~ttE INSURANCE FUND 1 WATERVLIET AVENUE ~518)54~7-6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~ TOWN OF WAPPINGER BLDG DEPT MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 ~::::1?C,EiiOd:; EC3St~t~~d>fiY: ~ 1Wi~::~~f~TI~:EGA~~;.`•:::;:; `:::;": ::::::::::~~z~:~~~rr.:~:::~c~:::::;~:tz~~~~r~ ::::::::::::::::::::::::::: POLICYHOLDER SEAN KELLY CONTRACTING INC 365 ROUTE 376 HOPEWELL JUNCTION NY 12533 POLICY NUMBER +A 1481 727-4 DATE 2/08/2010 CERTIFICATE NUMBER 879-748 CERTIFICATE HOLDER TOWN OF WAPPINGER BLDG DEPT MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 2/28/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~ ~ ~ ~,~~ - ~, DEB t s 2010 CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING ~.~~ NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE F~518~54~~!6400ANY, NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE '~~' TOWN OF WAPP INGER BUILDING DEPARTMENT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 _._ ~, AFB 0 ~ 2010 ~,,~~~, n .,/ /~/~ POLICYHOLDER LIPUMA CONTRACTORS, 9 BIRD ST RED HOOK :::;:.:_f~C-~ii~E3:_CC~~RECi:.fiY:~~HI~:.C~i~TI~:EGa7f ::.:.:.:.:.:::.:.: CERTIFICATE HOLDER INC. NY 12571 POLICY NUMBER +A 2075 343-0 DATE 2/05/2010 CERTIFICATE NUMBER 657-518 TOWN OF WAPPINGER BUILDING DEPARTMENT 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 2075 343-0 UNTIL 8/06/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 8/06/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE~FU~N"D ~~~ ~~~~/~1P~7ili` U-26.3 DIRE OR, INSURANCE FUND UNDERWRITING L7A NEW YORK STATE INSURANCE FUND N ALBANY NEW YORK 12206-1649 1 WATERVLIET AVENUE XTE~ISIO 518) 4376400 CERTIFICATE OF WORKERS' COMPENS .ION INSURANCE ~^ ~.•~, '~'~~ TOWN OF WAPPINGERS WAPPINGERSUFALLS~ NY 12590 _~~~'~ 92010 ./ ~~, ~: ~:::::: R~EifQd:: CC31C~R~d::BY:: tWlf ~~f~I'I~:(GA7f :::::::::::::::: POLICYHOLDER CHRISTOPHER T HUNT DBA CT HUNT & SONS 7 ALPERT DR WAPPINGERS FALLS NY 12590 CERTIFICATE HOLDER POLICY NUMBER +A 2037 632-3 DATE 2/05/2010 CERTIFICATE NUMBER 576-865 TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 2037 632-3 UNTIL 7/15/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 7/15/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THE STATE INSURANCE FUND ~~~ ~~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING Inc NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~S4037~6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE '~~~ TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ~: ~:.:.> RC~€2iQE3:. GC3V~R~1~:; ~Y ~:Wi~lr~t~l`1~:1CA'f~ ~:.:.:.:.>:.:.:.> POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION NY 12533 POLICY NUMBER +A 1332 146-8 DATE 2/02/2010 CERTIFICATE NUMBER 162-368 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 2/22/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CEI~-T~ DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~,~ FEB ~' 2010 CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 47'3 NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~S4~37~6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE '~'~~ TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 POLICY NUMBER +A 1332 146-8 DATE 2/02/2010 CERTIFICATE NUMBER 874-920 >:.>:.PC~€tiaE3:. CO.rI~R~d:.$Y`~:WI~>~~€t?~IK:IGa3~::.:.>:.:_:.:.:.: POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION NY 12533 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 2/22/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIF TE DOES NOT '. ~~° AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~E~ 0 ~ 2010 CANCELLATION U-26.3 THE STATE INSURANCE FUND l~~ DIRE OR, INSURANCE FUND UNDERWRITING ilia NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54~~~6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~ TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1332 146-8 DATE 2/02/2010 CERTIFICATE NUMBER 297-081 ::::`• <P C,€i1QE3:: C C3'11~ Rid:: BY:`• ~ W 15:: it~E~t1 ~:1CA1'f:>:`• ::::::::: `:::: POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION NY 12533 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 2/22/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIF TE_DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~ r. DEB Q `~ 2Q10 CANCELLATION U-26.3 R~n F ~~ { ~ THE STATE INSI,/nU//ARANCE FUND DIRE OR, INSURANCE FUND UNDERWRITING ~.~~ NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~S40~_6400ANY, NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~'TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 ~':.>:. i?~€tiQd :. EOV~~Ed:, f3Y:; tHi s: ~ CIR~IF:tC.artf ::.:.:.: .:.:::.: POLICYHOLDER ODONNELLS INC 62 CARPENTER RD HOPEWELL JUNCTION NY 12533 POLICY NUMBER +A 1332 146-8 DATE 2/02/2010 CERTIFICATE NUMBER 616-846 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 2/22/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~~ ~. .,,. ti FEBUw2010 ~EB~~~~~~ Mn ~ r`i ~~' °~/qA n~ a^~ - CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE~iSION, ALBANY, NEW YORK 12206-1649 518) 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE __~~~ ~ ~~ TOWN OF WAPPINGERS ~i~~~'~~~L 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 FEg 0 '~ 2010 ~~ nrn,~ n~ ~~ POLICY NUMBER +A 2037 632-3 DATE 1/29/2010 CERTIFICATE NUMBER 576-865 `:.::.i?~#iQE3:.6C3.rt~R~d:: $Y:, tWi~:: E~E~TI~$CA3~:::::::'':::; `: POLICYHOLDER CHRISTOPHER T HUNT DBA CT HUNT & SONS 7 ALPERT DR WAPPINGERS FALLS NY 12590 CERTIFICATE HOLDER TOWN OF WAPPINGERS 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 2/18/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING 581 STDCAN-2/2001 NEW YORK STATUTE INSURANCE FUND 1 WATERVLIET AVENUE ~518)54~7~6400ANY' NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER ZOMIDDLEBUSH RD WAPPINGERS FALLS NY 12590 POLICY NUMBER ''~A 1482 281-1 DATE 1/26/2010 CERTIFICATE NUMBER 714-812 ~::.:. PC~€2i0E3:.60~ R~d:.BY: ~ ~TWI~:. ~~EttI~:EGat~ ::.:.:.:.:::.:::.: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1482 281-1 UNTIL 6/07/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/07/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~' '"~ 1 , ^ ~~ P ~ I V ~. _ ~ ' "`~ N'~1 !a f` r THE STATE INSURANCE FUND ~~ U-2C).3 DIRE R, INSURANCE FUND UNDERWRITING NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~54~~!6400ANY, NEW YORK 12206-1649 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 ~: ~.'•>::R~€i1QE5:`•E01f~REd>$Y::1'WI~`•E~EtfiI~:ICA'f~:`•:::::;:::::`•:.:.: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 POLICY NUMBER ''~A 1482 281-1 DATE 1/26/2010 CERTIFICATE NUMBER 668-155 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY N0. 1482 281-1 UNTIL 6/07/2010 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 6/07/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~ ~ . ,~~~~ ,pN Z ~ ~,,~14 THE STATE INSURANCE FUND ~~ U-26.3 DIRE R, INSURANCE FUND UNDERWRITING ~o~ NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE ~518~S4~37~6400ANY' NEW YORK 12206-1649 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~ TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 ~:~:;::::R~€21QE3 `GC31l~RLb:; SY:~'TWIS::IrEE~tiF:ECA~~ :::::::::::::::::::: POLICYHOLDER EU-TE CORPORATION T/A EURO-TECH GENERAL CONSTRUCTION 18C SCARBOROUGH LANE WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1329 868-2 DATE 1/25/2010 CERTIFICATE NUMBER 305-010 CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 2/14/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~~~~~~~L JAN 2 ~ 2090 ~~~~~~~ ~,1 ~r-a. Ir' CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ ~~~ DIRE OR, INSURANCE FUND UNDERWRITING 1~AS NEW YORK STATE INSURANCE FUND 1 WATERVLIET AVENUE XTE SIGN, ALBANY, NEW YORK 12206-1649 ~518~ 437-6400 CANCELLATION OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~~~ TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 ::::.:.:.P~€tiQa:.EOV~REt?::BY:: tWi~.`•itLFt1'IF:FGR7~::.:.:;>:.:.:.:.:.: POLICYHOLDER BRYAN MURPHY CONSTRUCTION INC 24 DOWNEY AVE WAPPINGERS FALLS NY 12590 POLICY NUMBER +A 1482 281-1 DATE 1/21/2010 CERTIFICATE NUMBER 714-812 CERTIFICATE HOLDER TOWN OF WAPPINGER 20MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 THIS IS TO ADVISE THAT THE WORKERS' COMPENSATION POLICY ISSUED TO THE POLICYHOLDER NAMED ABOVE HAS BEEN CANCELLED EFFECTIVE 2/10/2010. THIS INFORMATION IS FURNISHED YOU IN COMPLIANCE WITH TERMS OF THE CERTIFICATE OF INSURANCE NUMBERED AS ABOVE AND ANY OTHER CERTIFICATE OF INSURANCE PREVIOUSLY ISSUED TO YOU AT THE POLICYHOLDER'S REQUEST UNDER THE ABOVE POLICY NUMBER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. .~ } y~ 'i ~ ~U it1 ~::= ~ ~ ~~Al~~ ~R Fes' CANCELLATION U-26.3 THE STATE INSURANCE FUND ~~ DIRE OR, INSURANCE FUND UNDERWRITING z~~