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2008 (3)-' .~Q.. CERTfFICA1'E OF f.1ABiLf'TY fNSURANCE ,~o~,z«s D~ ~ iNOratro~ ~~ ~Tfl~ C~gYiflClttE IS 1!S A 1A11'lTER OF N+1l~OR#MTION ttldROlt ibtlpperitea. LLC-0 OenNdr OM.Y MiD CUNFigFi6 NO Rit;~4TS tJ1PON TNH CER~'IFiC~ATfs ar,a E Upon ~Mtornii Hoc.. Ttil~ CER'ill'•IGlT6 oo>~S NUT AMiND, RXTTsNp OP 700 S i u t ~Iwercaea~n (s~osl ar~saoo cwaur~as ~c~aao cOV~AA+~ Ip61IlAB ~ R A: i0920a2 ~ La~ ~Flbad l o t ~: SL Paul F Marine Ins. C o a l FloYldi6 0080901 F7t~C MAR D: ~ C N Q ThE P4tlClBB OF MIBtIRANCB t.~TF,p 8E(.OW HAV& Bt~N :&6tlBD TO Tt16 iN5t7ASD NARtED AHWE POR THE POLICY Pt~IIOp Ni01CATER NUTWI'M9TANDlNB ANY REQUI~NIENT. TC-FUuI OR OONDI'f10N OF ANY OOPILMCT 4R OTM~ C10CU11EKT' YYR}I RESAEGT Tp WFNCH THIS CERTIFICATE NAY 8E ISBt>FD OR MAY PERTAIN. 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(8)Ptu9etty~ Sladrat Speclat Forte Indadint'!'bett (Popcy T 3t>,830I306y, Limit 132.770,2&8- L~uchasr [aunty ~ as AddlUoBSt Itlsuted ceiaedinq tRe DAy ltegortietg Cs~.tx>: iCgni~ by wriest motmct. wreRVC~n.r~ uni ~o ~ Y ~ . Plfl/`Yr 1 AMY ~~~ - - - - 5ltfllti.DAN1/UF AIE AOOYE 615lOtret~ POiJCKf triGlltlCiLLiO t1iFONR TII! fXM11ArOM CATL '1MfAt~F.7f W 1'iUflA Irrlli~{ NILL t~rJRYOR 70 f1AL JO DAYS WArifTHY .SifflEl POtphltsi(!pR NY 1260t Mi0TI0! Ta z1t! OERTIFrpAtt nar.oot aA~o m T~ tsT, our t`AKAliIE To Do ao ewa.i IMPBtifi ND fiBIIGAT1pN OR UMMUTY OR APIY tgtip UMIN t11ft INStINEtt, ti5 AG!!RS OR iilltrA7lYfa. IYRNDIIILE011tD~9BifAi WE r ~ .~ AiCORDln~$(T/87T ~a*+w~.qua„rewaewta,ao~lrawc~w~avmwaattn~rrwwa^wcwn~ea~e„nrPrweranueam~~• •w~.-VeWa,VnrVrsnrwnrrsoa P~~F~~~~-~ , JUL 2 4 2007 TOWN CLERK PE~F!~/~-~ , JUL ~ 4 2007 x .°°A i TOWN CLERK Mr.Joseph Ruggiero Supervisor July 21,2007 Town of Wappinger Falls 20 Mi RECEIVE D ` ddlebush Rd. ~~ ,~~ Wappinger Falls, N.Y.12590 JUL 2 3 2007 E Supervisor Ruggiero; SUPERVI~C3;;~S GFFICE As chairman of the Wappinger Greenway Trail Committee TOWN G~ U'vAPP~~'VGER x ~ ,- ~`~'~'~ I have completed negotiations with the new group B.L Inc. ~' - (Behavioral Interventions) and have taken them on as a replacement ~- ~` , for the Community Transition Group to implemen# our ongoing park a trail maintenance work. The organization is headed by Frances Ray ~ Program Manager of B.I. Lnc.with field workers under the direction of Mr. Eugene Atkins. This organrzation provides direction for young adults that are required to do community service as part of their probation duties. ~~ Enclosed you will find a copy of the organization's certificate . _~ of Lability insurance. This group will be starting Monday July 23, 2007 at Reese Park under the direction of our trail warden Mr. Frank Barresi. They will also be working the trail network at Carnwath Farms as par# of their commitment to the Greenway Committee. If a there are any questions or concerns please do not hesitate to call. Sin s J. nnesser Chr. Wa Qe Greenwav Comm. Cc: R.J. Holt Rec. Chr. N i ~- -E S ACORDrM CERTIFICATE OF LIABII:.ITY INS~.IRA~ICE DATEosi 6i oo ~ PROnvcER Aon Risk Services, Inc. Of New York THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 300 Jericho Quadrangle AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Suite 300 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Jericho NY 11753 USA COVERAGE AFFORDED BY THE POLICIES BELOW. PHONE- 516 342-2900 FAX- 516 342-2955 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: American Home Assurance CO. 19380 CABLEVISION OF WAPPINGERS FALLS, INC. INSURERS: New Hampshire Indemnity CO Inc 23833 1111 Stewart Avenue , Bethpage NY 11714 u5A INsvRERC: New Hampshire Ins Co 23841 INsuRERD: ACE American Insurance Company 22667 INSURER E: __ SIR Md THE POLICIES OF INSURANCE LISTID BELOW HAVE BEEN ISSUED TO THE INSURID NAMED ABOVE FOR THE POLICY PERIOD INDICATID. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDTIYON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUID OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDTI'IONS OF SUCH POLICIES. AGGREGATE LIIvIl'TS SHOWN MAY HAVE BEEN RIDUCED BY PAID CLAIMS. INSR LTR DDS INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE(MM\DD\YY) DATE(MM\DD\YY) A ERAL LIABII.ITY GL1595201 05/15/07 05/15/08 EACH occURRExcE $500 000 General Li abi 1 i ty - cabl , X COMMERCIAL GENERAL LIABD,ITY DAMAGE TO RENTED $ 500 , 000 CLAIMS MADE ® OCCUR PREMISES (Ea occurence) X Any one person SIR: 5500,000 PERSONAL & ADV INJURY 000 OOO $1 , GENERAL AGGREGATE $10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ^X POLICY ^ PRO- ^ LOC PRODUCTS-COMP/OP AGG $1,000,000 JECT A AUTOMOBII.E LIABIIdTY CA1606812 05/15/07 05/15/08 Auto -Cable COMBINED SINGLE LIIvIIT X ANY AUTO (Ea accident) $2 , 000 , 000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODII.Y INJURY NON OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABH.ITY AUTO ONLY - EA ACCIDENT 8 ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG D EXCESS /UMBRELLA LIABII.TTY x0oG23875019 05/15/07 5 15 0 EACH OCCURRENCE umbrella OCCUR ^ CLAIMS MADE AGGREGATE $5 000 000 , , DEDUCTffiLE ® $25 000 , RETENTION 8 WORKERS COMPENSATION AND EMPLOYERS'LL4BH ITY yyo rke rs Comp -Cable - n X C STATU- OTH- C , ANY PROPRIETOR/PARTNER/EXECUTIVE yyC1607838 05/I5/07 05/15/08 E.L. EACH ACCIDENT $1, 000 , 000 WOrkerS Comp -Cable - ~ OFFICER/IvtEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $1, 000 , 000 If yes, describe under SPECL4L PROVISIONS E.L. DISEASE-POLICY LIIvIIT $1, 000 , 000 below OTHER ~ i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CABLEVISION OF WAPPINGERS FALLS, INC. ADDED TO ABOVE REFERENCED POLICIES EFFECTIVE 01/05/01. CERTIFICATE HOLDER ~ INCLUDED AS ADDITIONAL INSURED AS RESPECTS LIABILITY IF REQUIRED BY AGREEMENT. RE: CAN OPERATIONS - TOWN OF ~ WAPPINGER, NY C H D ~ Town of Wappi nge r Attn : Town Supervisor SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WII,I, ENDEAVOR TO MAIl, P . O . BOX 324 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ~ Wd l n e r5 Fal ~ s NY 12 590 USA pp g BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILI'CY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATTVES. AUTHORIZED REPRESENTATIVE .~oivF~la.6-.S~isalc~es~.~na gP./Yrrw-°P/owb 1 d a w ~, d 0 x O z R V w d U _~ v ~~ '.,. ACORD CERTIFICATE OF LIABILITY INSURANCE OP 1D $ DATE (MM/DD/YYYY) TOWNO-1 03 13 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Marshall & Sterling, Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 66 Middlebush Rd. , Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wappingers Falls NY 12590-4047 Phone :845-297-1700 Fax: 845-297-2879 INSURERS AFFORDING COVERAGE NAIC # INSURED - INSURER A: Selective Wa Insurance CO 316 INSURER B: PERMA Town of Wapppinger INSURER C: Attn• Joe Ruggiero 20 MiddlebusFi Rd PO Box 324 INSURER D: Wappingers Falls NY 12590 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLI Y FFEC7IVE , DATE MMIDDIYY POLICY EXPI ATI N DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ lOOOOOO A ][ X COMMERCIAL GENERAL LIABILITY 51323145 01/22/07 01/22/08 PREMISES Eaoccurence) $ 100000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5000 PERSONALBADVINJURY $ 1000000 GENERAL AGGREGATE $ 3000000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 3000000 POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ A ~[ X ANY AUTO S1323145 01/22/07 01/22/08 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) ]{ HIRED AUTOS BODILY INJURY $ ]~ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSNMBRELLALUIBILITY EACH OCCURRENCE $ lOOOOOOO A ~[ OCCUR ~ CLAIMS MADE S1323145 01/22/07 01/22/08 AGGREGATE $ 10000000 DEDUCTIBLE $ X RETENTION $10000 $ WORKERS COMPENSATION AND X TORY LIMITS ER B EMPLOYERS'LIABILITY PE01047012 01~01~07 01~01~08 E. L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNERlEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DEJt:KIYIIVK VF UYCKAI IVrv.`! r LVl./i 11Vna / YCnn.LCa / GAa.LVa1VnJ ,urvcv v, r....v....rmr,., . v, r....-.r.......,,....... County of Dutchess is included as Additional Insured including waiver of subrogation when required by written contract or written agreement as respects contract for the moving and storage of voting machines through Dutchess County Board of Elections, 47 Cannon St, Poughkeepsie, NY 12601. CERTIFICATE HOLDER CANCELLATION County of Dutchess Attn: Barbara Keating 22 Market St Poughkeepsie NY 12601 C0~0 ~ 5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, RS AGENTS OR REPRESENTATIVES. ACORD 25 (2001/08) ©ACORD CORPORATION 1988 ACORDTM CERTIFICATE OF LIABILITY INSURANCE 3/29/2007m) PRODUCER Rea an Insurance g 8 E Main St THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Marcellus NY 13108 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: C1nClnnatl Insurance Company 10677 Thomas Gleason Inc. INSURERe:ECT NY (CRM) 22926 42 McKinley Lane INSURERC: Poughkeepsie NY 12601 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR T DD' POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION LIMBS A GENERAL LIABILITY CPP0730585 4/1/2007 4/1/2008 EACH OCCURRENCE $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY PREMISE Ea occurence 5 5 0 0, 0 0 0 CLAIMS MADE a OCCUR MED EXP ( one person) S 10.0 0 0 PERSONALBADVINJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2, 0 0 0, 0 0 0 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMPfOPAGG S 2, 000, 000 POLICY X PRO- X LOC A AUT OMOBILELIABIIJTY CAA5896749 4/1/2007 4/1/2008 COMBINED SINGLE LIMIT $ 1, 000, 000 X ANY AUTO (EascddeM) ALLOWNEDAUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY S X NON-OWNEDALROS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTOONLY-EA ACCIDENT S ANYAUTO OTHERTHAN EA ACC $ AUTOONLY: AGG S p ExcESSNMBRELLALIABILm CPP0730585 4/1/2007 4/1/2008 EACH OCCURRENCE $ 5, 000, 000 , X OCCUR ~ CLAIMS MADE AGGREGATE $ 5. 0 0 0. 0 0 0 DEDUCTIBLE $ X RETENTION $ 10 , 0 0 0 $ $ WORKERS COMPENSATION AND EC01061646 4/1/2007 4/1/2008 X WC STATU- OTH- LT EMPLOYERS'I.IABILITY E.L. EACH ACCIDENT s SEE ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERlMEMBER EXCLUDED? E.L DISEASE-EA EMPLOYEE $ ATTACHED Ifyes,desaibeunder SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMB $ GSI105 .2 A OTHER CPP0730585 4/1/2007 4/1/2008 $230,000 S1,ooo Ded. Leased/Rented Equipment DESCRIPTION OF OPERATIONS f LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Certificate holder is listed as an Additional Insured on the General Liability policy on a primary &non-contributory basis Project: New Hackensack Road Water Main Extension Also listed as additional insured on the Auto Liability policy is: Certificate holder (30) day written notice of cancellation or material change applies on the General Liability & Auto Liability policies Umbrella coverage follows General Liability form ----._._.~_.......~.. reuc~l I eTlnLl vcnrrr r..r,r~,..,r... ~.. --------- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER TOwn Of Wappinger WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE 20 Middlebush Rd. CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 Wappinger Falls NY 12590 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ZTS AGENTS OR REPRESENTATIVES. AUTHORRED REPRESENTATNE , I ACORD25(2001/08) VNIsVRV VVf\r"VItA11V1. 1.'!VV IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the poficy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC ADDITIONAL INSURED -WHEN REQUIRED IN CONTRACT OR AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. SECTION II -WHO IS AN INSURED, 2. is amended to include: e. Any person or organization, hereinafter referred to as ADDiTiONALINSURED: (1) Who or which is not specifically named as an additional insured un- der any other provision of, or en- dorsement added to, this Coverage Part; and (2) For whom you are required to add as an additional insured on this Cover- age Part under: (1) A written contract or agreement; or (2) An oral agreement or contract where a cert'rf'icate of insurance showing that person or organization as an additional insured has been issued; but only with respect to liability arising out of "your work" performed for that addi- tional insured by you or on your behalf. A person or organization's status as an in- sured under this endorsement continues . for only the period of time required by the written contract or agreement, but in no event beyond the expiration date of this Coverage Part. If there is no written con- tract or agreement, or ff no period of time is required by the written contract or agreement, a person or organization's status as an insured under this endorse- ment ends when your operations for that insured are completed. 2. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to in- clude: 1. Automatic Additional Insured Provision The written or oral contract or agreement must be currently in effect or become ef- fective during the term of this Coverage Part. The contract or agreement also must be executed prior to the "bodily in- jury", "property damage" or "personal and advertising injury" to which this endorse- ment pertains. 2. Conformance to Specific Written Con- tract or Agreement If a written contract or agreement be- tween you and the additional insured specifies that coverage for the additional insured: a. Be provided by the Insurance Serv- ices Office additional insured form number CG 20 10 or CG 20 37 (where edition specffied); or b. include coverage for completed op- erations; or c. Include coverage for "your work'; and where the limits or coverage pro- vided to the additional insured is more re- strictive than was specifically required in that written contract or agreement, the terms of Paragraphs 3., 4.s.(2) and 1 or 4.b., or any combination thereof, of this endorsement shall be interpreted as pro- viding the limits or coverage required by the terms of the written contract or agreement, but only to the extent that such limits or coverage is included within the terms of the Coverage Part to which this endorsement is attached. !f, how- ever, the wrtten contract or agreement specifies the Insurance Services Office additional insured form number CG 20 10 but does not specify which edition, or specifies an edition that does not exist, Paragraphs 3. and 4.a.(2) of this en- dorsement shall not apply and Paragraph 4.b. of this endorsement shall apply. 3. SECTION tll -LIMITS OF INSURANCE is amended to include: The limts applicable to the addftional insured are those specffied in the written contract or agreement or in the Declarations of this Cov- erage Part, whichever are less. If no limits are specified in the written contract or agreement, or if there is no written contract or agreement, the limits applicable to the additional insured are those specified in the Declarations of this Coverage Part. The limits of insurance are in- clusive of and not in addition to the limits of insurance shown in the Declarations. Includes copyrighted material of Insurance GA 47210 01 Services Office, Inc., with its permission. Page 1 of 2 4. The following are added to SECTION 1 - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions and SECTION I - COVERAGES, COVERAGE B. PERSONAL AND ADVERTISING INJURY LIABILITY, 2. Exclusions: The insurance provided to the additional in- sured does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the: (1) Rendering of, or failure to render, any professional architectural, engi- neering or surveying services, in- cluding: (a) The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (b) Supervisory, inspection, arohi- tectural or engineering activities; (2) Sole negligence or willful misconduct of, or for defects in design furnished by, the additional insured or its "em- ployees". b. "Bodily injury" or "property damage" aris- ing out of 'your work" included in the "products-completed operations hazard". c. "Bodily injury" or "property damage" aris- ing out of "your work" for which a consoli- dated (wrap-up) insurance program has been provided by the prime contractor ! project manager or owner of the con- struction project in which you are in- volved. 5. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDfT10NS, S. Other Insurance is amended to include: a. Where required by a written contract or agreement, this insurance is primary and / or noncontributory as respects any other insurance policy issued to the additional insured, and such other insurance policy shall be excess and / or noncontributing, whichever applies, with this insurance. b. Any insurance provided by this endorse- ment shall be primary to other insurance available to the additional insured except: (1) As otherwise provided in SECTION 1V - COMMERCIAL GENERAL LIABILITY CONDITIONS, 5. Other insurance, b. Excess Insurance; or (2) For any other valid and collectible in- surance available to the additional insured as an additional insured by attachment of an endorsement to another insurance policy that is writ- ten on an excess basis. In such case, the coverage provided under this endorsement shall also be ex- cess. Includes copyrighted material of Insurance GA 47210 01 Services Office, Inc., with its permission. Page 2 of 2 CERTIFICATE OF PARTICIPATION IN WORKERS' COMPENSATION GROUP SELF-INSURANCE la. Legal Name and Address of Business Participating in Group ld. Business Telephone Number of Business referenced in box "la" Self-Insurance (Use Street Address Only) 845-454-3730 x 101 Thomas Gleason Inc. L 42 M Ki l ane c n ey Poughkeepsie NY 12601 1 e. NYS Unemployment Insurance Employer Registration Number of Business referenced in box "la" 17-13062 lb. Effective Date of Membership in the Group 4/1/2007 lc. The Proprietor, Partners or Executive Officers are lf. Federal Employer Identification Number of Business referenced x included (Only check box if all partners/officers included) in box "la" all excluded or certain partners/officers excluded 141438793 2. Name and Address of the Entity Requesting Proof of Coverage 3. Name and Address of Group Self-Insurer Town of Wappinger ECT NY (CRM) 20 Middlebush Rd. C/O Compensation Risk Managers Wappinger Falls NY 12590 112 Delafield St. Poughkeepsie NY 12601 This certifies that the business referenced above in box "la" is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law as a participating member of the Group Self-Insurer listed above in box " 3" and participation in such group self-insurance is still in force. The Group Self-Insurer's Administrator will send this Certificate of Participation to the entity listed above as the certificate holder in box " 2". The Group Self-Insurer's Administrator will notify the above certificate holder within 10 days IF the membership of the participant listed in box "la" is terminated. (These notices maybe sent by regular mail.) Otherwise, this Certificate is valid for a maximum of one year from the date certified by the group self-insurer. If this certificate is no longer valid according to the above guidelines and the business referenced in box "la " continues to be named on a permit, license or contract issued by the certifzcate holder, the business must provide the certificate holder either with a new certificate or other authorized proof 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 of the Group Self-Insurer referenced above and that the business referenced in bog °Gla" has the coverage as depicted on this form. Certified by: J Michael Reagan (Print name of authorized representative of the Group Self-Insurer) Certified by: (Signature) 3/29/2007 (Date) Title: President Telephone Number: 315-673-2094 GSI-105-2 (2-02) WORKERS' COMPENSATION LAW 03-17-08;12; 01 PM; ;516-795-F1C1 ~ ~ DATE(MM/DDlYYYY)~ _ CERTIFICATE OF LIABILITY INSURANCE o3/17/loos PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I HUBSINETTE-COWELL ASSOC INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1003 Park Byrd, #3 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Massapequa Park, NY 11762-2777 ALTER THE COVERAGE AFFORDED BY THE POLICfLS SNOW. (516)795-1330 MSURERS AFFORDING COVERAGE ! NAIC# INSURED INSURER A; ""'""`~""'' ..,"LaxireazivE 2NS. CORD. HUGI~SONVILLE FIRE DISTRICT INSURER B: P.O. BOX 545 INSURER C: ~- HUGHSONVILLE, NY 12537 INSURER D; 845-403-3439 INSURER E; .OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND coNmm~u.c nc ci rr~u I PQLICI@$, AGGREGATE 1 IMITS SWC]WIU Mev uevr orris orn, , J9R 7R DD'L NERD - PO C . N RAN POLICY NUMBER LI Y EXPIRATI N DATE MMlDOlYY LIMITS GE X NERAL LIABILITY COMMERCIAL GEN EACH~~ U RR ENCE S 1 0 0 0 O Q O ERAL LIABILITY CLAIMS CI ~ E~ PREMISES Eaoccurence $ 1 OOO OOO A MADE OCCUR VFI MED EXP (Any ona pQrson) 3 1 O O O O STR2062288-0 03/01/08 03/O1/p9 PERSONALaADVINJURY s 1 000 0001 GE N'L AGGREGAT GENERAL AGGREGATE $ 3 D O Q Q Q D E LIMIT APPLIES PER POLICY j ~ ; PRODUCTS . COMPlOP AGG S 3 O O O O O O ; LOC AU TOMOBILE LIABILITY X ANYAUTO Ea eccltleD~ INGLE LIMIT $ 1 r ooO r OQQ X ALLOWNEOAUTOS SCHEDULEDAU708 BODILYINJURV (Por poron) 3 A X , X HIRED AUTOS NON-OWNEDAUTOS vFISTRZ062288-0 03/01/08 O3/01/09 gODILYINJURY (PereccVCenq g PROPERTY DAMAGE (Persccitlent) - $ ' GARAGE LIABILITY AurOONI,v.EAACCIDENT S ANVAUTO OTHER THAN EAACC $ AUTO ONLY' AGG 5 -~ EXCESSIVMBRELLA LIABILITY EACH OCCURRENCE S 5 OOO , OOO OCCUR ~I CLAIMS MADE AGGREGATE S 1 O , OOO , OOO VFISCU5056222-0 03/01/08 03/01/09 $ Q DEDUCTIBLE $ I RETENTION S S WORKER$COMPENSATIONAND EMPLOYERS' LIABILITY ~ TORY LIMITS ~ ER ~ ANV PROFRIE'TONPARYNEwEXECUnvE OFFICERMIEMB __~ E.L. EACH ACCIDENT g ~R PXCLUDED7 Ifyyas dascrlbeunder ~ E.L. DISEASE • GA EMPLOYE 3 SPEG IAL PROVISIONS below E.L. DISEASE • POLIGV LIMIT S OTHER -- ------ ~,-.~......,.,,~....,,~...,.,...~.,,v~,_v.,_....~u.a,,.,,..ar.vuGV O1 G14V VR8CMCn11/3YCl:IHL VKVVI.1'IVNS 'ROOF OF INSURANCE FOR USE OF PREMISES LOCATED AT CARNWATH FARMS, THE OLD ~RAYSTONE BUYLDING, CARNWATH ROAD, WAPPINGERS FALLS, NY 12590, FOR TRAINING. 'HE CERTI)»'xCATE HOLDER IS NAP~D AS AN ADDITIONAL INSURED A$ PER FORM #VGL101. :RTIFICATE HOLDER re~.r.~. , .~..... TOWi3 OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPTNGERS FALLS, NY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ExPIRATION A GATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAO DAYS WRITTEN 12590 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, eUT ALLURE TO DO SO SHALL REPRESENTATeVES.~ OR LI`BILI7~OF ANYwINO UPON- I SURER, ITS AGENTS OR ORD25(2009/08) -- 'OAGORD ORPORATION 1988 03-17-08;12: 01 PM; ;516-795-5101 # _, _ I e IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subJect to the terms and conditions of the policy, certain policies may require an endorsemEnt. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. i j • CORD25(2001/OB) hts certificate is executed by Libert Mutual Inswance Crroup as respects such inswance as is afforded by those companies BM0068 Certrficate of Insurance Chia certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an inswance policy and does not amend, extend, or alter the coverage tfforded by the policies listed below. f'h.c .~ t....o,.rtF , al.... iwr....._ ~ ____ ~ _...... ..............~~ .,. ~,.~u. u~ Treco Corporation PO Box 310 Bridgeport, CT 06601 is, at the issue date of this certificate, inswed by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject .~ .,,, ,t.o_e,~ z,.. ,_.. _..,...._____..--- F.x ~iration T e Continuous* Extended X Policy Tenn Workers Compensation General Liability Claims Made Occurrence Retro Date Automobile Liability Owned Non-Owned Hired C O M M E N T S Bodily Injury By Disease $500,000 Policy Limit Bodily Injury By Disease $500,000 Each Person General Aggregate-Other than Prod/Completed Operations Products/Completed Operations Aggregate Bodily Injury and Property Damage Liability Per Occurrence Personal and Advertising Injury Per Person / Other Liability Other Liability Each Accident -Single Limit - B. I. and P. D. Combined Each Person Each Accident or Occurrence Each Accident or Occurrence nouce of canceuanon: 1 not appucabte unless a number of days is entered below) . Hetore the stated expirauon date the company wlll nut cancel or reduce the insurance afforded under the above polities until at least 0 days notice of such cancellation has been mailed tu: Office : Trumbull, CT Phone: 203-459-4411 Certificate Holder: Town of Wappinger 20 Middlebush Road Wappinger Falls, NY 12590 «~ to all their terms, exclusions and conditions and ~ ciuiuu~uu m an conffacc or omer document wttri res ed [o which this eertitieate ma be issued. Eff/E .Date(s) Polic Number(s) Limits of Liabili 02/01/2008 / 02/01/2009 WAS-11D-421271-088 Coverage afforded under WC law of Employers Liability the following states: Bodily Injury By Accident CT, NY $500 000 Each Accident .,~. ,_ ;.~ .S~ PATTI MARTIN Date Issued: 02/15/2008 Prepared By: RD THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDIT , IONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/ODIYY POLICY EXPIRATION DATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $ j CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ I GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ PRO- POLICY JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ j I ALL OWNED AUTOS BODILY INJURY ~ SCHEDULED AUTOS (Per person) i ~ j !HIRED AUTOS a j - BODILY INJURY $ ' ~ NON-OWNED AUTOS (Per accident) --- I PROPERTY DAMAGE $ (Per accident) i GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ I ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ ~ ~ $ DEDUCTIBLE ' I $ RETENTION $ $ WORKERS COMPENSATION AND ' TORY LIMITS ER ` EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT ~ --- $ OFFICER/MEMBER EXCLUDED? r E L DISEASE EA EMPLOYEE $ . . - -- If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER A Professional AEE196946-0107 12/31/07 12/31/08 5,000,000 each claim Liabilit 5,000,000 annual a r DESCRIPTION OFOPERATIONS /LOCATIONS 1 VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TOWWAPl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Town of Wappinger 20 Middlebush Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Wappingers Falls NY 12590 REPRESENTATIVES. AUTHO EPRES TATIVE ACORD 25 (2001/08) ©ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID CHP.ZOIN DATE(MMIDDm/YY) O1 02 08 PRODUCER Singer Nelson Charlmers P O Box 16 5th Floor k R d THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. oa , 1086 Teanec Teaneck NJ 07666-0016 Phone: 201-837-1100 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Liberty Insurance Underwriters INSURER B: The Chazen Engineeringg & Land INSURER C: Surveyin Company, P.C. 21 FOX S~reet INSURER D: Poughkeepsie NY 12601 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W ITN RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER OATEYMMIDD~ E POATEY MMIDDIYYON LIMITS LTR NSR TYPE OF INSURANCE EACH OCCURRENCE $ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence $ CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMPlOP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JECOT n LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OW NED AUTOS GARAGE LIABILITY ANY AUTO EXCESSIUMBRELLA LIABILITY OCCUR ~ CLAIMS MADE DEDUCTIBLE ~ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERlMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER A Professional Liabilit DESCRIPTION OF OPERATIONS 1 LOCATIONS I COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ R THAN EA ACC $ OTHE AUTO ONLY: AGG $ EACH OCCURRENCE $ AGGREGATE $ $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ AEE196946-0107 I 12/31/071 12/31/081 5,000,000 each claim 5,000_,000 annual agg ADDED BY ENDORSEMENT CERTIFICATE HOLDER Town of Wappinger 20 Middlebush Road Wappingers Falls NY 12590 ACORD 25 (2001108) CANCELLATION TOWWAPl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE exriwa ~ iv DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ©ACORD CORPORATION 19E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEYMM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ lOOOOOO A }{ COMMERCIAL GENERAL LIABILITY MPV78197 O8/15/O7 08/15/08 PREMISES (Eaoccurence) $ SOOOOO CLAIMS MADE ~] OCCUR MED EXP A _ _ ( ny one person) $ 10000 -_ PERSONAL&ADVINJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'LAGGREGATELIMITAPPLIESPER: PRO PRODUCTS-COMP/OPAGG $ 2000000 - POLICY ~{ JECT LOC AU TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ lOOOOOO ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ A }[ SCHEDULED AUTOS B1V7$197 O8/15/O7 O8/15/O8 (Per person) A X HIRED AUTOS - BODILY INJURY $ A }~ NON-OWNED AUTOS (Per accident) - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC OTHER THAN $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~_~ CLAIMS MADE AGGREGATE $ _ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND ' X TORY LIMITS ER A EMPLOYERS LIABILITY WCV7$197 O8/15/O7 O8/15/O8 E L EACH ACCIDENT $ 100000 ANY PROPRIETOR/PARTNEPJFXErUTIVE ~ . . -_-_-_.___-_______ ____-._ _ OFFICER/MEMBER EXCLUDED? ~ E.L. DISEASE - EA EMPLOYEE $ 1 OOOOO 1f yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 500000 OTHER 8 NYS Disability 1772213-3 01/01/07 12/31/07 DBL Statutory DESCRIPTION OF OPERATIONS (LOCATIONS (VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Workers Compensation Certificate Form #C105.2 attached. CERTIFICATE HOLDER CANCELLATION WAPPING SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Town of Wappinger 20 Middlebush Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Wappingers Falls NY 12590-0324 REPRESENTATIVES. AU (ZED EPRES A E AGUKU 15 i,ZOUT/US) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. HI.VKV L~ (GVVI/UiS~ Erie Insurance 100 Erie Ins. PI. Erie, PA 16530 CERTIFICATE OF INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY - CERTIFICATE HOLDER C~PV NAME AND NUMBER OF AGENCY DATE ISSUED 1 1 /27/2007 RONALD FRAGOMENI ASSOC., INC. NN 1 197 NAME AND ADDRESS OF CERTIFICATE HOLDER OR OTHER NAME AND ADDRESS OF NAMED INSURED TOWN OF WAPPINGER GREAT AMERICAN AWNING 20 MIDDLEBUSH RD & ENDT #1 WAPPINGER FALLS NY 12590- 43 ROUND LAKE RD BALLSTON LAKE NY 12019-1 146 This is to certify that policies, as indicated by Policy Number below, are in force for the Named Insured at the time that the certificate is being issued. TYPE OF iNSUAAAICE PDLiCY NW4BffR ~~ POL14`',Y EFF~TFYE.t3kTE P011GY ~kP#tAT10N DA't~ _.._ {.tfdfTS Of INSt1RANCE GENERAL LIABILITY 0255120079 01 /01 /2008 O 1 /O 1 /2009 EACH OCCURRENCE $ COMPREHENSIVE FORM INCLUDING 1 OOCO00 PREMISES-OPERATIONS FIRE DAMAGE INDEPENDENT CONTRACTORS (Any one premises) $ l 000000 PERSONAL INJURY OPERATIONS HAZARD MED EXP (Any one person) $ 5000 CONTRACTUALINSURANCE BROAD FORM PROPERTY DAMAGE EXPLOSION HAZARD C PERSONAL 8 ADV INJURY $ 1000000 OLLAPSE HAZARD UNDERGROUNDHAZARD GENERAL AGGREGATE $ 2000000 ADVERTISING INJURY FIRE LEGAL PRODUCTS-COMPIOP AGG $ 2000000 ADDITIONAL INSURED AUTOMOBILE LIABILITY 0015130298 01 /01 /2008 01 /01 /2009 BODILY INJURY (EACH PERSON) $ ANY AUTO (OWNED, HIRED, BODILY INJURY NON-OWNED) (EACH ACCIDEN $ PROPERTY DAMAGE $ BODILY INJURY AND PROPERTY DAMAGE $ 1 000000 COMBINED EXCESS LIABILITY 0255170103 01 /01 /2007 01 /01 /2008 OCCURRENCE FORM EACH OCCURRENCE 1000000 RETENTION $10000 AGGREGATE 1000000 STATUTORY BODILY ACCIDENT $ EACH ACCIDENT INJURY DISEASE $ POLICY LIMIT BV DISEASE $ EACH EMPLOYEE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ~Hrv~t~~ I Irv rvH NuN-rvYMtN I , c;AUSt UH NAMED INSURED'S REQUEST: When an automobile policy is cancelled, written notice will be mailed to the Certificate Holder. When any of the above described policies (other than automobile) are cancelled before the expiration date thereof, The ERIE will endeavor to mail written notice to the Certificate Holder after the decision to cancel. Failure to mail such notice shall impose no obligation or liability of any kind upon The ERIE, its Agents or representatives. ® CANCELLATION FOR SPECIAL CONTRACTS: (If the box is checked, this certificate involves a special contract and the following cancellation provisions apply.) When an automobile policy is cancelled, written notice w~lbbe mailed to the Certificate holder. When any of the above described policies (other than automobile) are cancelled before the expiration thereof, The ERIE will endeavor to mail days written notice to the Certificate Holder after the decision to cancel. Failure to mail such notice shall impose no obligation or liability of any kind upon The ERIE, its Agents or representatives. ERIE INSURANCE GROUP This certificate is issued for information purposes only. It does not list, amend, extend, or otherwise alter the terms and conditions of insurance coverage contained in the Policy(ies) indicated above issued by The ERIE. The terms and conditions of the Policy(ies) govern the insurance coverage as applied to any given situation. Any party can request a policy and/or Declaration by asking the insured or the Agent. Limits shown may have been reduced by claims paid. OF-1568 2(02 (E) CIF SEE REVERSE SIDE AUTHORIZED ~~ REPRESENTATIVE Erie e Insurance 100 Erie Ins. PI. Erie, PA 16530 CERTIFICATE OF INSURANCE - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY - Ct=RTIFICATC unl noo nnov NAME AND NUMBER OF AGENCY --......~.~.~ ....~..~., vvr. DATE ISSUED 1 1 /26/2007 HRENKO INS AGENCY, INC. AA4332 NAME AND ADDRESS OF CERTIFICATE HOLDER OR OTHER NAME AND ADDRESS OF NAMED INSURED TOWN OF WAPPINGERS VANVLACK ELECTRIC 20 MIDDLEBUSH ROAD DOUGLAS VANVLACK D/B/A 243 JIMMIES HL WAPPINGERS FALLS NY 12590- MADERA PA 16661-8807 This is to certify that policies, as indicated by Policy Number below, are in force for the Named Insured at the time that the certificate is being issued. TYPE flP INSUAANC& POLICY NUA[BER ~`~ £FF£~T11f~EDATf PI~LfCY 'EXPffiik710N tNFf~'` LIMIT$ QF INSt1RANCE ; GENERAL LIABILITY Q363120508 12/31 /2007 12/31 /2008 EACH occuRRENCE $ , , COMMERCIAL GENERAL LIAf31LITY 1000000 OCCURRENCE FORM GEN'LAGGREGATE LIMIT APPLIES FIRE DAMAGE (Any one premises) $ 1000000 PER: POLICY MED EXP (Any one person) $ SOOO PERSONAL & ADV INJURY $ 1 OOOOOO GENERAL AGGREGATE $ 2000000 PRODUCTS-COMP~OPAGG $ 2000000 BODILY INJURY $ (EACH PERSON) BODILY INJURY $ (EACH ACCIDENT PROPERTY DAMAGE $ BODILY INJURY AND $ PROPERTY DAMAGE COMBINED EACH OCCURRENCE AGGREGATE STATUTORY BODILY ACCIDENT $ EACH ACCIDENT INJURY DISEASE $ POLICY LIMIT BY DISEASE $ EACH EMPLOYEE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CANCELLATION FOR NON-PAYMENT, CAUSE OR NAMED INSURED'S REQUEST: When an automobile policy is cancelled, written notice will be mailed to the Certificate Holder. When any of the above described policies (other than automobile) are cancelled before the expiration date thereof, The ERIE will endeavor to mail written notice to the Certificate Holder after the decision to cancel. Failure to mail such notice shall impose no obligation or liability of any kind upon The ERIE, its Agents or representatives. ® CANCELLATION FOR SPECIAL CONTRACTS: (If the box is checked, this certificate involves a special contract and the following cancellation provisions apply.) When an automobile policy is cancelled, written notice w~l6be mailed to the Certificate holder. When any of the above described policies (other than automobile) are cancelled before the expiration thereof, The ERIE will endeavor to mail days written notice to the Certificate Holder after the decision to cancel. Failure to mail such notice shall impose no obligation or liability of any kind upon The ERIE, its Agents or representatives. ERIE INSl1RANCE GRIDl1P This certificate is issued for information purposes only. It does not list, amend, extend, or otherwise alter the terms and conditions of insurance coverage contained in the Policy(ies) indicated above issued by The ERIE. The terms and conditions of the Policy(ies) govern the insurance coverage as applied to any given situation. Any party can request a policy and/or Declaration by asking the insured or the Agent. Limits shown may have been reduced by claims paid. OF-1566 2f02 (E) CIF SEE REVERSE SIDE AUTHORIZED ~~ REPRESENTATIVE ACORD CERTIFICATE OF LIABILITY INSURANCE OPID H DATE (MM/DDmm) CAMOP-1 12 04 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Marshall & Sterling, Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 66 Middlebush Rd. , Suite 200 , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wappingers Falls NY 12590-4047 Phone:845-297-1700 Fax:845-297-2879 INSURERS AFFORDING COVERAGE NAIC# ~ INSURED INSURER A: selective Ins Co o£ Fvnerica 315 INSURER B: Camo Pollution Control Inc INSURER C: 1610 Rt 376 Wappingers Falls NY 12590 INSURER D: INSURER E: COVEP THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X COMMERCIAL GENERAL Li BIL672272 12/08/07 12/08/08 I a ocau ei _ 00000 CLAIMS MA~ OCCU MED EXP (Any one per l61~000 PERSONAL & ADV INJ bIY000000 GENERAL AGGREGAT 2000000 ' GEN L AGGREGATE LIMIT APP IES PER: PRODUCTS -COMP/0 $-B(300000 POLIC j~ LOC AUT OMOBILE LIABILITY A X ANY AUTO 51672272 12/08/07 12/08/08 ~OMBIN~D SINGLE LI a acct ent ~T1000000 ALL OWNED AUTOS SCHEDULED AUTOS ODILY INJURY er person) $ HIRED AUTOS NON-OWNED AUTOS ~ODILY JNJU)2Y er accldent)) $ P~20PEF~TY DAMAGE l( eracclddent $ GARAGE LIABILITY A U TO N O L Y - EA ACCT ANT ANY AUTO p H ER ~ ~ g U N E A TO ONLY AG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MA E AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WGRKERS COMPENSATION AND EM P LO Y ER S L IA BI LI TY X T L I S A NN yy RR pp ~~ PP RR EE TT pp ~~// qq~~TT EERR//EEX ,X EC OFFICERIMEMBE P U 200840 ~~ O1 O1 08 / / O1 O1 09 / / E.L. EACH ACCIDENT _ $100000 t R EXCL DED gg ddg bbg~ qdd@~ ~~ ' S~~I E.L. DISEASE - EA EM X000 EG IAL OV~IONS below OTHER E.L. DISEASE - POLIC $161Q0000 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER r•_nNr•.FI I erlnti Town of Wappinger Attn: Comptroller PO Box 324 Wappingers Falls NY 12590 TOWNOOI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI01~ DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL l O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. " """ "' `" ``"" """~ ©ACORD CORPORATION 1988 ACORD,~ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/29/2007 PRODUCER FAx (410) 465-0759 Atlantic Risk Management Corp. 5850 Waterloo Road, Suite 240 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Columbia MD 21045 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Natl Fire Ins CO Of Hart A XV Global Tower, LLC INSURER B:Transcontinental Ins Co A, XV Global Tower Partners, Inc. INSURERC:Valle For a Ins. Co. A XV 1801 Clint Moore Road, Suite INSURERD:Hanover Ins. Co. A- XIII Boca Raton FL 33487 INSURERE:Evanston thru All Risks V V Y LRM\ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES . AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MM/DD/YY LIMITS A GENERAL LIABILITY TCP20877B2219 10/31/2007 10/31/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILI7Y DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 CLAIMS MADE ~ OCCUR MED EXP A one erson $ 5 , 000 X Employee Benefits PERSONAL& ADV INJURY 000 000 $ 1 , , Liability GENERAL AGGREGATE 000 000 $ 2 , , GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 , 000 , 000 POLICY X JECOT LOC $1 , 000 , 000 B AU TOMOBILE LIABILITY BUA2087782169 10/31/2007 10/31/2008 COMBINE X ANV AUTO D SINGLE LIMIT (Ea accident) $ 1 , 000 , 000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS B X NON-0WNED AUTOS ODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: qGG $ B EXCESS/UMBRELLALIABILITV CUP2087782267 10/31/2007 10/31/2008 EACH OCCURRENCE $ 1$,000,000 X OCCUR ~ CLAIMS MADE AGGREGATE $ 15, 000, 000 DEDUCTIBLE $ X RETENTION $ 10 , 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC2087782303 10/31/2007 10/31/2008 Y W(,SiATU- OTH- TORY LIMITS Y ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 , 000, 000 OFFICER/MEMBEREXCLUDED? If yes describe under E.L. DISEASE-EA EMPLOYEE $ 1, 000, 000 , SPECIAL PROVISIONS below E. L. DISEASE-POLICY LIMIT $ 1,000,000 D OTHER Builder's Risk IxQ003601000 5/9/2007 5/9/2008 $100,000 per location E Professional Liab ~-813395 06/01/2007 6/1/2008 $1,000,000 limit $5,000 deduct DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXC WSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Insurance Verification Re. GTP Site Name 6 ID No.: NY-5185 / Wappinger Falls. Town of Wappinger is Additional Insured on all policies except Workers Compensation, subject to policy provisions. GEKIIFIGAIE HOLDER CeNrtFI I eTlnNl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town Clerk Town Of Wappinger 20 Middlebush Rd. EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Wappinger Falls , NY 12590 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, iTS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE David Saul/MMS ~-~~ HI.VKU L.7 (LUUI/UO) ©ACORD CORPORATION 1988 iuenne ......... .... w ~~~ ,...., .._...._..,, o_.. ...___ ~.... ~o~~,o~~ ~~.~ .,..__ , _.~ ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID sF DATE (MM/DD/YYYY) PRODUCER DUTCH-4 09 30 08 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marshall & Sterling, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 103 Executive Drive, Suite 300 , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW New Windsor NY 12553-5531 . Phone :845-567-1000 Fax :845-567-1030 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Ar Onaut Insurance COm an Count of Dutchess INSURER B: y Office of Risk Management INSURER C: 22 Market 8tre@t Poughkeepsie NY 12601 INSURER D: nw~n ~ we-e. INSURER E: V V • GRMV C~7 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X X COMMERCIAL GENERAL LIABILITY 4611579 10/01/08 10/01/09 PREMISES (Eaoccurence) $ 100000 CLAIMS MADE a OCCUR MED EXP (Any one person) $ PERSONAL&ADVINJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $2000000 POLICY PRO JECT LOC AUT OMOBILE LIABILITY A X ANY AUTO 4611579 10/01/08 10/01/09 COMBINED SINGLE LIMIT (Ea accident) $ 100QQQQ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAG E $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC OTHER THAN $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 10000000 A X OCCUR ~ CLAIMSMADE 4611579 10/01/08 10/01/09 AGGREGATE $ 10000000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' TORY LIMITS ER LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If ib d d E.L. DISEASE - EA EMPLOYEE $ yes, escr e un er SPECIAL PROVISIONS below E.L. DI L OTHER OCT Q ~ 2~~~ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECUIL PROVISIONS Town of Wappingers is provided Additional Insured status, when required SOWN CLERK written contract or agreement, with respect to County Highway Annual Snow & Ice Removal Program, as their interest may appear. CERTIFICATE HOLDER CANCELLATION Town of Wappingers Town Hall, Mill Street P O Box 324 Wappingers Falls NY 12590-0324 ACORD 25 (2001108) WAPPIN3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ©ACORD CORPORA IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AI.VKU L~,2UUlNtl) AC4RD CERTIFICATE OF LIABILITY INSURANCE OPID 4PAT DATE(MMlDD/YYYY) CL(3 Financial 172 Main Street Nanuet NY 10954 Phone:845-623-3434 Fax:845-623-4332 Commercial Contracting Co. Inc 358 Saw Mill River Road Millwood NY 10546 COVERAGES THE PC)I ICIER rlc Inlc~ io enirr i icrrn or...~.. ~ ~.. ..- .. ~......__..__ __ _.._ COMt~-4 09/22/08 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE ~ NAIC # INSURERA Harleysville Worcester 26182 INSURER B Contractors Comp Trust INSURERC The First Rehabilitation INSURER D INSURER E NDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT IOD O I WITH RESPECT TO WHICH TH S CER ICATE MAY BE ISSU ED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJE CT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/W LIMITS GENERAL LIABILITY A }~ COMMER I ' EACH OCCURRENCE $ lOOOOOO C AL GENERAL LIABILITY ((~,20 9g79 1O/O1/O8 10/01/09 PREMISES (Eaoccurence) $ 100000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5Q O O PERSONAL &ADV INJURY 10 $ 00000 GENERAL AGGREGATE $ 2000 ' 000 GEN LAGGREGATELIMITAPPLIESPER. PRO- PRODUCTS-COMP/OPAGG $IOOOQOO POLICY }{ JECT LOC ALfT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANV AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLHIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LiABILiTY X TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE 351487108 O1/O1/O8 O1/O1/O9 E.L. EACH ACCIDENT _ $ lOOOOO OFFICER/MEMBEREXCLUDED~ If yes describe under E.L. DISEASE-EA EMPLOYEE $100000 , SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT $ SOOOOO OTHER C NYS Disablity DBL245712 01/01/06 Statutory CONTU UNTIL CANC ED DESCRIPTION OF OPERATIONS /LOCATIONS 1 VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS SEP 2 5 2008 TOWN CLERK CERTIFICATE HOLDER CANCELLATION TOWAPPI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN TOWn of Wappiager NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 20 Middlebush Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Wappingers Falls NY 12590 REPRESENTATIVES. AUT IZED E .,I.VRV GJ ~cvv ~rvo1 C~J ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Erie Insurance 100 Erie Ins. PI. Erie, PA 16530 CERTIFICATE OF INSURANCE - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY - CERTIFICATE HOLDER COPv NAMt AND NUMBER OF AGENCY DATE ISSUED 09/ 18/2008 GRAPEVILLE AGENCY, INC. NN 1 1 17 NAME AND ADDRESS OF CERTIFICATE HOLDER OR OTHER NAME AND ADDRESS OF NAMED INSURED JBR CONSTRUCTION CORP TOWN OF WAPPINGERS 1061 ROUTE 376 20 MIDDLE BUSH RD WAPPINGER FALLS NY 12590-6346 WAPPINGERS FALLS NY 12590- This is to certify that policies, as indicated by Policy Number below, are in force for the Named Insured at the time that the certificate is being issued. TYPE OF M15UAANCE POLICY NUMBEA POLICY SFFECT:FY:E ©ATf: POLICY EXPtflAT10N DATE ~IrdiT3 OF ItiS#1RANGE '' GENERAL LIABILITY Q467350040 10/23/2008 10/23/2009 COMMERCIAL GENERAL LIABILITY OCCURR EACIloccuRRENCE $ 1000000 ENCE FORM GEN'LAGGREGATELIMITAPPLIES FIRE DAMAGE (Any one premises) $ 1000000 PER: POLICY MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 PRODUCTS-COMP/OP AGG $ 200~00~ BODILY INJURY $ (EACH PERSON) BODILY INJURY $ (EACH ACCIDEN PROPERTY DAMAGE $ BODILY INJURY AND $ PROPERTY DAMAGE COMBINED EXCESS LIABILITY Q347370011 10/23/2008 10/23/2009 OCCURRENCE FORM EACH OCCURRENCE 2000000 RETENTION $10000 AGGREGATE 2000000 STATUTORY BODILY ACCIDENT $ EACH ACCIDENT INJURY DISEASE $ POLICY LIMIT i I BY DISEASE $ EACH EMPLOYEE , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RECEIVED SEP 2 4 2008 rn~wu~ ~r .~.-,.. CANCELLATION FOR NON-PAYMENT, CAUSE OR NAMED INSURED'S REQUEST: When an aut c ,written notice will be mailed to the Certificate Holder. When any of the above described policies (other than automobile) are cancelled before the expiration date thereof, The ERIE will endeavor to mail written notice to the Certificate Holder after the decision to cancel. Failure to mail such notice shall impose no obligation or liability of any kind upon The ERIE, its Agents or representatives. ® CANCELLATION FOR SPECIAL CONTRACTS: (If the box is checked, this certificate involves a special contract and the following cancellation provisions apply.) When an automobile policy is cancelled, written notice w~lbbe mailed to the Certificate holder. When any of the above described policies (other than automobile) are cancelled before the expiration thereof, The ERIE will endeavor to mail days written notice to the Certificate Holder after the decision to cancel. Failure to mail such notice shall impose no obligation or liability of any kind upon The ERIE, its Agents or representatives. ERIE INSURANCE GROUP This certificate is issued for information purposes only. It does not list, amend, extend, or otherwise alter the terms and conditions of insurance coverage contained in the Policy(ies) indicated above issued by The ERIE. The terms and conditions of the Policy(ies) govern the insurance coverage as applied to any given situation. Any party can request a policy and/or Declaration by asking the insured or the Agent. Limits shown may have been reduced by claims paid. OF-1566 2/02 (E) CIF SEE REVERSE SIDE AUTHORIZED ~~ REPRESENTATIVE A oRDTM CERTIFICATE OF LIABILITY INSURANCE 01 982 PRODUCER PH (260) 467-5690 FAR: (2b0) 467-5691 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION STAR Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Fort tia HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR yne Office ' , ALTER 1 NE COVERAGE AFFORDEp BY THE POLICIES BELOW . 2130 Dupont Road Fort i1a s IN 4 6825 INSURERS AFFORDING COVERAGE NAIC ~ waUREO ROAD RUtatERB INS(~RER A: NATIONAL CASUALTY COMPANY CLUB OF AMERICUi INSURER s: NATIONKIDE LIFE AND IT8 MEMBER C LUBS 19550 ii PIN INSURER C: . E >aipOD DRIVE N87i BERLIN ( Q WI 53146 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSLIItED NAMED ABOVE FOR THE P OLICY PERIOD INDICATED. NOTWITHSTANDING A REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH ICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSI~ANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB ~CT TO ALL THE TERM . S, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. NI81T TYPE OF MIBINdVH;E POLICY NtIA~ER ~-' EFFECTIVE L1ABTi GENERAL l1ABEJTY ' S 1,000,000 X COMMERCIAL QENERAL L IABILITY DAMAGE T RENTED t 300 , 000 A CLIJMSMAOE ~X OCCUR lOi00o00000172600 12/31/2007 12/31/2008 P met,,, = 5,000 X LBG1L LLTiB TO ?]IRT 12:01 A.M. 12:01 A.M i . I = , 000, 000 $1,000,000 N GENL ACaGREOATE LIMIT APPLIES PER: ONE i t 1, 000, 000 Ml T01WBIL.E LIAWTY ANY AUTO COMBINED BINDLE LIMIT (Ee aaJdurt) S 1, 000, 000 A ALLOWNEDAUTOS >I~oooo000D172600 12/31/2007 12/31/2008 BODILY INJURY sc*IEDULEDALrtos 12:01 A.M. 12:01 A.M. lP~v«>oan) ~ X HIRED AUTOS X NON-01MrED AUTOS BODILY INJURY (Px ecddenq S PROPERTY DAMAGE S (Pr acddatn) GARAGE LIAM{JTY AUTO ON Y - A (DENT S ANY AUTO OTHER THAN t AUTO ONLY: s EXCEESAIM~tLA tJABIIJTY = OCCUR ~ CLAIMS MADE S t DEDUCTIBLE S VYORKERB CONIPENtA710N AND EYPIOYMti' LIMEJTY T OT - ANY PROPRIETORIPARTNERIE7CECUTIVE E.L. H A CI .NT Z OFFlCERAIEMBER EXCLUDED? K yet da~6e urn DI M YE S , ~ T S B OTHER EXCE88 ACCIDENT s sPX0000003149700 12/31/2007 12/31/2008 >~S8 1®ICAL: $10,00 MI~DICAL 12:01 A.M. 12:01 A.M. S2so nso>ircrxsrs: PER w c srscirzc Loss: $2 500 oEeauPnoN of o-ERATwNaLOCAnoNanleloa.ES~oca.UaaNS Aooeo sY emoRS~ENTtaPEaAL PROvnIOa: CRRTIlIGTS 80LDHA Is N71ltD 11$ ]1M 71DDITIOlU-L I!f$URLD 71$ RleBPlCT$ TBEIR IDiTiRt$! IU TBS OP;Ri1TIOEIS OF T9! >ti>tlRD INSt1RSD . D7-T$ i lVEIiT: 09/2110$ DU1~B8 COUNT= CL71$$IC - H$Lt !OR*TECN, SK, 1 l/ZLt 1CID$ RUN INSUR=D CLUB: NID-HUD$ON RQ11D RtAIIQRB CLUB, ,TTN: VINCi VibTRR; 7 11RRRICR AGi1D; DLP$IL, NY 12603 09/21/08 TO`iN OF NAPPINGEIt3 FALLS ATTN: CONSTANCE SMITH 20 MIDDLEBOSH ROAD - ; -° f4?1PPING~RB FALLS, NY 12590~~~~~'V IL BNOULD ANY OF THE ABOVE OEBCRIBED FOLX~b BE CANCELtJ;D BEFORE THE EXPIfAT10N OATS TIlREOF, THE NtsuMei WstIRER YYp.i. ENDEAVOR To MAIL 3O D11Y8 VBiRTEN NOTK7E TO TILE CERTIFICATE HOLDER NAND TO THE LEFT, BUT FAILURE TO DO s0 SHALL IMPOBE NO OBUpAT1ON OR LVIWIJTY OF ANY KIND UPON THE AUTFIORI~ REPIBi3ENTATIIlE John Lefever/JRM __ 28 (2001/08) {~ ®ACORD CORPORATION 1813 IYQAlt rmne~ ne.. "r~b ~ •'" r ~' _.r. ~,! \ Dens ~ M 7 ACORD ~ ~ CA ~ ~ I ~ ~' ~ DATEIMM/DDIYY) ' ~ rM ERTI ~ T L~ :: ~~Lt -:: 1~~~~> ~ ,; o4i2sio8 __ PRODUCER REVISED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Home Office: P.O. Box 328 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Owatonna, MN 55060 COMPANIES AFFORDING COVERAGE Phone: 1-888-333-4949 __ __ COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR A FEDERATED SERVICE INSURANCE COMPANY INSURED MCMILLEN BROTHERS INC ZZ1-666-1 COMPANY B 20 EAST MAIN STREET BEACON NY 12508 COMPANY C COMPANY D co~>~~~s THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTE D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE DATE (MM/DDIYY) POUCY EXPIRATION DATE (MMIDD/YY) LIMITS GEN ERAL LIABILITY GENERAL AGGREGATE S 2,O O 0,000 X COMMERCIAL GENERAL LIABILITY _ PRODUCTS -COMP/OP AGG _ _ _ _ _ S 2_z000,O00__ A CLAIMS MADE X^ OCCUR 9322432 07/21/07 07/21/08 PERSONAL & ADV INJURY s 1 000 000 _ OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE S 1 OOO OOO ____ FIRE DAMAGE (Any one fire) S 1 OO OOO MED EXP (Any one person) S AUT OMOBILE UABiLITY S COMBINED SINGLE LIMIT 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY S A SCHEDULED AUTOS 9322432 07/21/07 07/21/08 IPer person) X HIRED AUTOS BODILY INJURY S X NON-OWNED AUTOS IPer accident) -- -----------_---- PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S 1 OOO OOO ._ A X UMBRELLA FORM 9322433 07/21 /07 07/21 /08 AGGREGATE s 1,000,000 _ OTHER THAN UMBRELLA FORM S WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMITS R ---- EMPLOYERS' UABILITY CEI~ ® E EL EACH ACCIDENT S ---- ~ THE PROPRIETOR/ INCL E ------ _ _ _ EL DISEASE -POLICY LIMIT S ! PARTNERSlEXECUTIVE OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE S OTHER TOWN C ERK DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESISPECIAL ITEMS . C~'~'t~IGATE HOLffER . CANCEi;t,ATION zz,BSS} TOWN OF WAPPINGER 9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 20 MIDDLEBUSH RD RATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL EX P I WAPPINGERS FALLS NY 12590 ~ / ~ ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMP ITS AG TS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIV ~ 1#CCllif ~~-5 t1l3 PR~~rI ~+1T" Qt#Gt1t~t7 Ct?KP!QRATIaN 9988 ACORD CERTIFICATE OF LIABI PRODUCER pH (260) 467-5690 FAX: (260) 467-5691 STAR Insurance Agency Fort Wayne Office 2130 Dupont Road Fort Wa a IN 46825 INSURED ROAD RUNNERS CLUB OF AMERICA AND ITS MEMBER CLUBS 19550 W. PINE WOOD DRIVE NEW BERLIN WI 53146 I DATE (MMIDDIrrrr, INSURANCE 6/3/2006 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR .~ rco ruc rnvFRef,F AFFORDED BY THE POLICIES BELOW. S AFFORDING COVERAGE NAIC # NATIONAL CASUALTY COMPANY NATIONWIDE LIFE c: INSURER E E BEEN ISSUED TO THE INSUR ED NAMED ABOV E FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY AY PERTAIN THE POLIC IES OF INSURANCE LISTED BELOW M OR CONDITION OF ANY HAV CONTRACT OR OTHER DOCUMENT WITH RESPECT T O WHICH THIS CE , RTIFICATE MAY BE ISSUED OR M IONS AND CONDITIONS OF SUCH POLICIES. REQ UIREM ENT, TER HEREIN IS SUBJE CT TO ALL THE TERMS, EXCLUS E INSU RANCE AFFORDED BY THE POLIC IES DESCRIBED TH A RE A T IMIT H WN MAY AVE BEEN RE E BY PAID LAIM ~ P OLICY EFFECTIVE P OLICY EXPIRATION LIMITS INSR A DD'L TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MMIDD/YY S 1, 000' 000 EACH OCCURRENCE GENERAL LIABILITY DAMAGE TO RENTED 300 , 000 $ PREMISES Ea occurrence X COMMERCIAL GENERAL LIABILITY 12/31/2007 12/31/2008 MED EXP An one arson 5 , 000 $ A CLAIMS MADE OCCUR KR00000000172600 000 000 1 12:01 A.M. 12:01 A.M. PERSONAL 8 ADV INJURY , , $ X LEGAL LIAR TO PART GREGATE NONE $ $1,000,000 GENERAL AG COMPIOP AGG TS 1,000,000 ~ GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUC PRO- POLICY T LOC COMBINED SINGLE LIMIT $ 1 , 000 , 000 AUTOMOBILE LIABILITY (Ea accident) ANY AUTO 31/2007 12/31/2008 ILYINJURY KR00000000172600 12/ gOD $ A ALL OWNED AUTOS M 12:01 A 12:01 A.M. (Per person) SCHEDULED AUTOS . . NJURY BODILY I $ X HIRED AUTOS (Per accident) X OWNED AUTOS NON ~~ E D I , - Y PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY OTHER THAN EA ACC _ $ ANY AUTO TOW AUTO ONLY: AGG $ RR N $ EXCESS/UMBRELLA LIABILITY $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE e $ RETENTION WC STATU- OTH- T RY IT WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE -POLICY LIMIT S SPECIAL PROVISIONS below 12/31/2007 12/31/200$ EXCESS MEDICAL: $10,000 B OTHER EXCESS ACCIDENT & SPX0000003149700 PER CLAIM 12:01 A.M. 12:01 A.M. $250 DEDUCTIBLE: MEDICAL AD & SPECIFIC LOSS: $2,500 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS IR INTEREST IN THE OPERATIONS OF THE NAMED CERTZFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS THE INSURED. DATE & EVENT: 07/12/08 SENIOR CITIZEN 4K RUN/WALK PETE SANFILIPPO; 8 CARMINE DRIVE, N p7APPINGERS FALLS, NY 12590 : INSURED CLUB: MID HUDSON ROAD RUNNERS CLUB ATT CERTIFICATE rlvL.utrc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 07/12/0$ TOWN OF WAPPINGER EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ATTN: CHRIS MASTERSON 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 2 0 MIDDLE BUSH RD FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE WAPPINGER, NY 12590 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE John Lefever/EM ©ACORD CORPORATION 1988 ACORD 25 (2001108) Page 1 of 2 INS025 (of o6).oea ~~pM CERTIFICATE OF LIABILITY INSURANCE 04/09/20 8) PRODUCER (914) 738-0100 FAX (914) 738-4568 Milbrandt & Co. , Inc. 159 Main Street THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 2nd Floor New Rochelle, NY 10801 INSURERS AFFORDING COVERAGE NAIC # INSURED Asbestos Corporation of America INSURER A: Commerce & Industry Ins. Co. 791 Nepperhan Avenue INSURER B: Yonkers, NY 10703-2012 tNSURERC: INSURER D: INSURER E: R(1VFRArFS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TypE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY PROP 4158852 04/06/2008 04/06/2009 EACH OCCURRENCE $ 1 ~ 000 ~ 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100 ~ 000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10 ~ QQ~ /~ PERSONAL & ADV INJURY $ 1 ~ 000 ~ ~~~ X Asbestos- Lead-Mold GENERAL AGGREGATE $ 1 ~ 000 ~ 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 1 ~ 000 ~ ~QQ POLICY X PRO- LOC JECT AUT OMOBILE LIABILITY CA 934-35-08 04/06/2008 04/06/2009 COMBINED SINGLE LIMIT $ X ANY AUTO (Ea accident) 1 , OOO ,UUU ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) A HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY PROU 4159099 04/06/2008 04/06/2009 EACH OCCURRENCE $ 9, UUU, OOO X OCCUR ~ CLAIMS MADE AGGREGATE $ 9 ~ 000 ~ 000 A $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC5313967 08/24/2007 08/24/2008 X WC sTATU- oTH- EMPLOYERS' LIABILITY ROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1, OOO, OOO A ANY P OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ I ,UUU ,UUU If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1 , 000 , 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS For any and all projects performed at the Carnworth Farms, Greystone Road, Wappingers Falls, NY, for the coverage period. Certificate Holder, Carnworth Farms, QuES&T. Inc. and William Manfredi Construction Corp. are included as Additional Insureds, as their interest may appear, as required by written contract, with respect to General Liability. r~~Tinrn~ro uni nco CANRFI I AT1l1N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of Wappi nger Falls 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn : Mr . Joseph Ruggiero, Town Supervisor BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 20 Mi ddl ebush Road OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Wappingers Falls, NY 12590 AUTHORIZED REPRESENTATIVE ~ ~ n ~ V John Cofini/BUR1 ACORD 25 (2001108) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) OP ID DATE DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE ACORD „ RCOS-ol 11 13 oe PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lawley-Richwood, LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 565 Taxter Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Elmsford NY 10523 Phone:914-345-7000 Fax:914-345-7050 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A' Natlorial Grange INSURER 8: IriC Costa Electric R INSURERC . , . 15 Appleblossom Lane 533 INSURER D: - Hopewell Junction NY 12 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POL C F C IVE DATE MMlDD/YY POL CY EX TION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2000000 A }{ COMMERCIAL GENERAL LIABILITY MPV67 552 11 ~ 12 ~ 0 B 11 ~ 12 ~ 0 9 PREMISES (Ea occurence) $ 10 0 0 0 GLAIMSMADE ~ OCCUR MEDEXP(Anyoneperson) $ 500000 X Business Owners PERSONAL&ADVINJURY $ GENERAL AGGREGATE $ 4000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER Commercial Applica PROPERTY 20000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Certificate Holder is included as additional insured with respects to liability arising out of the operations of R Costa Electric Inc. as per ~®~ '9 ~ ~QQ~ policy terms, conditions, and exclusions. TOVI!(~ CLCRK i CERTIFICATE HOLDER TOWN-12 Town of Wappinger 20 Middlebush Road Wappinger Falls NY 12590 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. NTATIVE ACORD 25 (2001/08) ©ACORD CORPORATION Federated Mutual Insurance Company .Federated Service Insurance Company P.O. Box 328 CST 404 Owatonna, MN 55060 ~E~~I Fp ~~ o~~ ~ ~ zoaa TOVIIfV CLERK certificateholder Insured TOWN OF WAPPINGER 270-595-2 6 JOHN OSSENKOP & SON PLUMBING & 20 MIDDLEBUSH RD HEATING INC WAPPINGERS FALLS NY 12590 288 CREAMERY RD HOPEWELL JUNCTION NY 12533 CANCELLATION NOTICE CANCELLATION of each policy listed below was requested by the insured . We will continue to protect your interest as a mortgagee, certificateholder, additional insu red, or loss payee through the date and time of day shown below. Policy certificateholder Time of Policy Cancellation Cancellation Policy Number Coverage Date Date Cancellation 9293967 BUSINESS OWNERS PACKAGE 09/25/08 09/25/08 12:01 A.M. 9293966 COMMERCIAL PACKAGE POLICY 09/25/08 09/25/08 12:01 A.M. 9293969 UMBRELLA 09/25/08 09/25/08 12:01 A.M. 9293968 WORKERS COMPENSATION 09/25!08 09/25/08 12:01 A.M. * Standard time at the designated business premises. This Notice was mailed on October 22, 2008. nnFn an iii-a~ r:~ J V Client: 9629 9CORNEI ACORD,M CERTIFICATE OF LIABILITY INSURANCE 11/10/08D""") PRODUCER THE VALLEY GROUP, INC.. 2537 Route 52, Suite #6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hopewell Junction, NY 12533 845 221-2071 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: General CaSUBIty Company Cornerstone Excavating, Ir1C. INSURER B: 22 Lake Drive INSURER C: Wappingers Falls , NY 12590 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER U LICY EFFECTIVE PpLAICY MM (RATION LIMITS A GENERAL LIABILITY CCX0371583 08/22/08 08/22/09 EACH OCCURRENCE $50Q 000 X COMMERCIAL GEN'cRAL LIABILITY DAMAGE TO RENTED $1 QO 000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $5 000 PERSONAL & ADV INJURY $50Q 000 GENERAL AGGREGATE $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $1 000 000 POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ - DEDUCTIBLE $ RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AND - T^ EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER ~ ~~~' ~ ` LL DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BYENDORSEMENT /SPECIAL PROVISIONS ~00Q "IMPORTANT NOTICE: THE NEW YORK STATE INSURANCE DEPARTMENT HAS STATED QQ THAT (1 )THIS CERTIFICATE OF INSURANCE PROVIDES EVIDENCE OF COVERAGE IN ~~WN LIEU OF AN ACTUAL COPY OF THE INSURANCE POLICY; (2)THIS CERTIFICATE DOES CLERK NOT AMEND, EXPAND OR ALTER ANY OF THE TERMS OF THE INSURANCE POLICIES (See Attached Descriptions) CERTIFICATE HOLDER {.rAnI..CLLAI IVIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Wappinger DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~~ DAYS WRITTEN 20 Middlebush Road NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Wappinger Falls , NY 12590 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25 (2001/08) 1 of 3 #S18534/M18287 ACW ©AGUKU GUKYVKA I WN lyiSiS ~~ IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-5 (2001/08) 2 of 3 #S18534/M18287 ,. ~-_ DESCRIPTIONS (Continued from Page.1) ADDRESSED BY THIS CERTIFICATE; AND (3)THE WORDING OF THE REFERENCED INSURANCE POLICIES, AND NOT THIS CERTIFICATE, WILL CONTROL IN THE EVENT OF ANY INCONSISTENCY OR CONFLICT BETWEEN THIS CERTIFICATE AND THE APPLICABLE POLICIES OF INSURANCE. A COPY OF THE APPLICABLE POLICIES OF INSURANCE WILL BE PROVIDED FOR INSPECTION UPON WRITTEN REQUEST." AMS 25.3 (2001/08) 3 of 3 #S18534/M18287 ACORD,~ CERTIFICATE OF LIABILITY INSURANCE ~ DATE,MM/°°/YYYY) 10/23/2008 (PRODUCER Marsh USA, Inc. 1166 Avenue of the Americas New York, NY 10036 (~ -- --------- -- --- ~~ G ~a I INSURED KINGSTON OIL SUPPLY CORPQC~ ~ ~ ~~AiI-~ PORTOEWEN NY 12466 wi G~~.R~` ®~!`~ --- --- ----- ---- - J - -------- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE ~ NAIC # wsuRERA National Union Fire Ins Co Pittsburgh PA - --_ __ 119445 INSURER e: New Hampshire Ins. Co. ; 23841 INSURER C: N/p, I N/A INSURER D: INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSr LTR y AvU y ~ INSRt TYPE OF INSURANCE ] POLICY NUMBER YULIGY trrtG I Ivt DATE (MM/DDNY) PULIGY tXPIKAI ZUNI LIMITS DATE (MM/DDIYY) I GENERAL LIABILITY ~EACH OCCURRENCE _ ~ 1 A )( COMMERCIAL GENE RA L LIABILITY 4807545 11 1/01/08 11/01/09 I DAMAGE ro RENrED ~ PREMISESIEa occurence $ ~00,000~ ( ~ '~~ CLAIMS MADE '~ OCCUR ~MED EXP (Any one person) _ $ 1 Q,000 PERSONAL & ADV INJURY $ 1 QQ .GENERAL AGGREGATE $ 1,000,000 _ GENERAL AGGREGATPRLIOMIT APPLIES PER PRODUCTS -COMP/OP AGC~ $ 1 QOQ QOQ POLICY JECT ~ LOC I A ~ I AUT X - I OMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS -- 8722561 1 1/01!08 11/01/09 COMBINED SINGLE LIMIT IEa accident) BODILY INJURY IPerperson) BODILY INJURY (Per accident) PROPERTY DAMAGE P id ~ $ 1 ,000,00 $ $ ( eracc enQ ( GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ~ $ ANY AUTO OTHER THAN EA ACC $ i i AUTOONLY qGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ B WORKERSCOMPENSATIONAND ' WC 1591728 11/01/08 11/01/09 )( I WCSTATU- ~OTH- TnRY I I B LIABILITY EMPLOYERS ECUTIVE WC 1591729 (TX) 11/01/08 11/01/09 L. EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? L. DISEASE - EA EMPLOYEQ $ 1 ,000,00 If yes. describe under SPECIAL PROVISIONS below .L. DISEASE - POLIC`! LIMIT I $ 1 ,000,00 OTHER DESCRIPTION OF OPERATIONS/LOGATIONSNEHIGLES/EXCLUSIONS AUUEU BY tNUVKSEMtN IlSPtGIAL PKVVISIUNS CERTIFICATE HOLDER NYC-002949959-19 CANCELLATION Town of Wappingers 20 Middlebush Rd Wappingers Falls, NY 12590 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. iUT ORIZED REPRESENTATIVE of arch USA Inc. Owl Paul Martelloni ACORD 25 (2001108) O ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. I ACOrd 25 (2001/081 Rn~inrcc of Panc ~ ~coRD~ -_ CERTIFICATE OF LIABILITY INSURANCE OP ID MO DATE (MM/DD/YYYY) JOHNC-1 10 20 08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Commercial Coverage - Ballston HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box, 5060 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Sar t S - a oga prangs NY 12866 Phone:518-602-2020 Fax:518-602-0236 INSURED John Conte Electric, Inc. Conte Electric Inc& J E Conte 2111 New Hackensack Rd Poughkeepsie NY 12603 INSURERS AFFORDING COVERAGE I NAIC # INSURER A: Harleysville Insur of NY ~ INSURER B: Tower Insurance company of Ny INSURER C: The Hartford Insurance Company '1235'] INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR TYPE OF INSURANCE POLICY NUMBER P Y EF E DATE MM/DD/YY POLI EXPI TI N DATE (MMIDD/Y`( LIMITS GENERAL LIABILITY EACH OCCURRENCE $ lOOOOOO X COMMERCIAL GENERAL LIABILITY C$ 6J7 933 PREMISES (Ea occurence) $ 1 OOOOO ` ' CLAIMS MADE ~~ OCCUR MED EXP (Any one person) $ 5000 A n BuS121bS5 Owners 04/12/08 04/12/09 PERSONAL&ADVINJURY $ 100000 0 GENERAL AGGREGATE 2QQ00 ' $ 00 GEN LAGGREGATELIMITAPPLIESPER: ~ PRO- i PRODUCTS-COMP/OP AGG $ 2000000 X POLICY JECT I~ LOC ~ AU TOMOBILE LIABILITY ANY AUTO BAP2650272 03/18/08 03/18/09 COMBINED SINGLE LIMIT (Ea accident) $ lOOOOOO B X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X X HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GAR AGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $1,000000 A OCCUR ~ CLAIMSMADE BE6J933 04/12/08 04/12/09 AGGREGATE $ lOOOOOO DEDUCTIBLE X RETENTION $ 10 Q Q O $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X TORY LIMITS ER C ANY PROPRIETOR/PARTNER/E.XECUTIVE OFFICER/MEMB OIWECJU8863 10/16/08 10/16/09 E. L. EACH ACCIDENT $1,00000 ER EXCLUDED? If yes, describe under E. L. DISEASE-EA EMPLOYEE $lOOOOO SPECIAL PROVISIONS below OTHER E. L. DISEASE-POLICY LIMIT $SOOOOO DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS (° ®6s / ~ A ~'t N' 1'®~~ CLERK ~`CDTICI(`ATC L1f11 nCn _ . _ - _ __- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN Town of Wappinger NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 2 0 Middlebush Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR PO BOX 324 REPRESENTAzIVES. Wappingers Falls NY 12590 A ED-REP N'FATiVE-` 'mss'-G~~ ~~.~ . GCCIRI'1 75 l9M4/nR1 vAt,uKU GVKF'VKATIVN 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. n~.vrcu co ~cuu uva) STATE OF NEW YORK xDR WORKERS' COMPENSATION BOARD Uo22 CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name and address of Insured (Use street address only) 1 b. Business Telephone Number of Insured JOHN CONTE ELECTRIC, INC 1c. NYS Unemployment Insurance Employer Registration 250 NEW HACKENSACK RD . Number of Insured POUGHKEEPSIE NY 12603 Work Location of Insured (Only required if coverage is 1 d. Federal Employer Identification Number of Insured or specifically limited to certain locations in New York State, i.e. a Social Security Number Wrap-Up Policy) 141737642 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) Twin City Fire Ins Co 3b. Policy Number of entity listed in box "1 a": 01 WEC JU8863 Town of Wappinger 3c. Policy effective period: PO BOX 324 WAPPINGERS FALLS, NY,1?.590 _ 10/16/2008 tp 10/16/2009 __ 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 "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 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 a maximum of one year after this form is approved by the insurance 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 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: Kathi Golowski (Print name of authorized representative or licensed agent of insurance carrier) Approved by: l0-2o-loos re) (Date) Title: Operations Manager (, , n Telephone Number of authorized representative or licensed agent of insurance carrier D ~ tlt..~a '~Ci 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) ~• 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) Revised ACORD~, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/22/2008 PRODUCER FAx (410) 465-0759 Atlantic Risk Mana ement Co g ~ • 5850 Waterloo Road, Suite 240 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES -NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Columbia MD 21045 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Natl Fire Ins CO Of Hart A XV Global Tower, LLC, its subsidiaries INSUREReTranscontinental Ins Co A, XV and/or assigns INSURER C: Valle For a Ins . Co . A XV 1801 Clint Moore Road INSURERD:New Ham shire/All Risks A XIV BOCa Raton FL 33487 INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS A GENERALUABILITY TCP2087762219 10/31/200.8 10/31/2009 EACHOCCURRGNCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence 300 000 $ ~ a 5 000 CLAIMS MADE OCCUR MED EXP (An one arson , $ X Employee Benefits PERSONAL & ADV INJURY $ 1 , 000 , 000 Liability GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 , 000 , 000 POLICY JE ~ X LOC $1 , 000 , 000 B AU TOMOBILE LIABILITY BUA2087782169 10/31/2008 10/31/2009 COMBINED SINGLE LIMIT $ 1, 000, 000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY L2099604006 10/31/2008 10/31/2009 EACH OCCURRENCE $ 25 , 000 , 000 X OCCUR ~ CLAIMS MADE AGGREGATE $ 25 , 000 , 000 DEDUCTIBLE $ X RETENTION $ 10 , 000 $ C WORKERS COMPENSATION AND ' WC294362518 10/31/2006 10/31/2009 Y TORY LIMITS Y OER EMPLOYERS LIABILITY 1 000 000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT , , $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1 , 000 , 000 OTHER D Professional Liab 43922818 07/01/2008 7/01/2009 $2,000,000 limit $5,000 deduct DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Insurance Verification Re. GTP Site Name 6 ID No.: NY-5185 / Wappinger Falls. Town of Wappinger is Additional Insured on all policies except Wor subject to policy provisions. CERTIFICATE HOLDER ~lf°T ~ 7 ,nn~ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town Clerk ~OWIV CLER EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL K Town of Wappinger 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 20 NL-LddlebuSh Rd. FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Wappinger Falls, NY 12590 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE David Saul/MMS ~-~~ ACORD 25 (2001/08) ©ACORD CORPORATION 1988 INS025 (o~oe>.os AMS VMP Mortgage Solutions, Inc. (800)327-0545 Page 1 of 2 ACORD CERTIFICATE OF LIABILITY INSURANCE cSR riw DATE (MM/DD/YYYY) CONKL-2 10 15 08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Whitmore Group, Ltd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 370 Old Country Road Ste.200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Garden City NY 11530 Phone: 516-746-4141 Fax:516-746-7875 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: American xnta~l Specialty Co. C kli S 1 INSURER B: coerce and zaduatry ias co 087 on n erV Ce8 and Construction, Inc. INSURER C: Stat@ Insurance Fund 94 Stewart Avenue Newburgh NY 12550 INSURER D: Zurich American Ins. Co 379 INSURER E: GVVtKAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER LI Y EF E I DATE MM/DD/YY P L EX I N DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, Q Q Q, Q Q Q A i X X COMMERCIAL GENERALLIABILITV PROP2719818 10/17/08 10/17/09 PREMISES (Eaoccurence) $ 300,000 X CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 2 5 , Q Q Q PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 ,QQQ , Q Q Q POLICY X PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT E id t $ 1 QQQ QQQ i i B X ANY AUTO CA 9343685 10/17/08 10/17/09 ( a acc en ) ALL OWNED AUTOS BODILY INJURY i SCHEDULED AUTOS (Per person) $ X ~ HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GA RAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC OTHER THAN $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ Q ~ 000 ~ 000 A X OCCUR ~ CLAIMSMADE PROU2719293 10/17/08 10/17/09 AGGREGATE $ tj ~ QQQ ~ QQQ DEDUCTIBLE $ X RETENTION $ 1 Q ,QQQ $ WORKERS COMPENSATION AND ' TORY LIMITS ER C ~ EMPLOYERS LIABILITY A~ti`rFRJPRIETOfiJ?;,RTtd~fL'cXECUTIVE ~ G1465857-9 04/01/08 04/01/09 E.L. EACH ACCIDENT $1, QQQ, QQQ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1 ,QQQ , Q Q Q If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1 ,QQQ , QQ Q OTHER D NYS Disability 5289724-001 10/26/08 10/26/09 Limits: Statutory DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ^ /~ ` , ' ~ ~ ~ Town of Wappingers Falls is included as an additional insured with respec rV `V/ to work performed by the named insured as required by written contract. OCT ~ 02(10 TOWN CLE K GERTIFIGATE HOLDER CANCELLATION TOWNWAP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Town Of Wappingers Falls IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 20 Middlebush Road REPRESENTATIVES. Wappingers Fa118 NY 12590 H R EDREPRE IV C AGVRD 25 (Z001/O8) ©ACORD CORPORATION 1988