Loading...
2009 (2)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 This Certificate of Insurance 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. ~ECEI VE ~~ N~~ ~ t ~~+~19 ~~wN C,~,,~~k Acord 25 (2009/011 ADDITIONAL INFORMATION CLE-002473627-02 DATEIMMIDDlY1~ 11 /06/2009 PRODUCER Marsh USA Inc. (Philadelphia) Two Logan Square Philadelphia, PA 19103 215.246.1000 fax215.246.1399 Attn: Redcross.certrequest@marsh.com 849428-SIR-CAS-09-10 NY NY CLIE MOI MAIL INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER F: NY PENN REGION AMERICAN NATIONAL RED CROSS INSURERGt 825 JOHN STREET ____ _ INSURER H: WEST HENRIETTA NY 14586 , INSURER L TEXT ATTACHING TO AND FORMING PART OF THE AMERICAN NATIONAL RED CROSS CERTIFICATE OF INSURANCE AS RESPECTS WORKERS COMPENSATION: This is to certify that all American National Red Cross units in the following states are currently self insured through the American National Red Cross: Alabama, Califomia, Florida, Georgia, Massachusetts, Michigan, Missouri, Ohio, Pennsylvania, Tennessee, and Virginia. Workers Compensation Policy #MWC11602800: Policy for all other states except the monopolistic states of North Dakota, Puerto Rico, Washington, Wyoming and U.S. Virgin Islands and the self-insured states of Alabama, Califomia, Florida, Georgia, Massachusetts, Michigan, Missouri, Ohio, Pennsylvania, Tennessee, and Virginia. Includes Employers Liability for monopolistic states of North Dakota, Puerto Rico, Washington, Wyoming, and U.S. Virgin Islands. *Specific Excess Workers Compensation Policy #MWFEX138: American National Red Cross is self-insured for Workers Compensation in the state of Florida. The Excess Liability limit is subject to a state approved Self-Insured Retention. **Specific Excess Workers Compensation Policy #MWXS867: American National Red Cross is self-insured for Workers Compensation in the following state&: Alabama, Califomia, Georgia, Massachusetts, Michigan, Missouri, Ohio, Pennsylvania, Tennessee and Virginia. The Excess Liability limits are subject to state approved Self-Insured Retentions. This certificate is issued as a matter of information only and confers no rights upon the certificate holder Fi~CEI V ~Ld N~ J t t ~J09 T~~~ ~~~~ CERTIFICATE HOLDER TOWN OF WAPPINGER ATTN: SUE ROSE 20 MIDDLEBUSH ROAD WAPPINGER, NY 12590 of Maran USA IrIC. /G, w-~C-- Roger CFell Page' 2 Joanne Melazzo Client Representative Marsh USA Inc. Two Logan Square Phlladslphia, PA 19103 215 246 1 120 Fax 215 246 1399 Joan ns. M sl azzo mars h. com www.marsh.com To Whom It May Concern: Re: Certificate of Insurance The enclosed certificate is being sent to you to respond to your recent request. Please note that the Red Gross has an online Memorandum of Insurance (MOI). The Memorandum of Insurance will provide you with a more efficient way of obtaining information about Red Cross insurance coverage and can be accessed from the following websites: www. marsh.com/moi?client=2077 www.redcross.ora (the Red Cross public website}. Left click on the heading "Working with the Red Cross" and find the MOI link at the bottom of the page at "Related Links." Should you have any questions, the contact person listed on the Memorandum website is available to assist you or you may confact a Risk Management representative from American Red Gross national headquarters at (202} 303-7290. ~E~EIVE,~ NG'.' 11 t~t~9 ~~~~ G~~~ DATE (MM/DDIYYYY) ~R CERTIFICATE OF LIABILITY INSURANCE DUTCH RS 10 15 09 PRODUCER Marshall & Sterling, Inc . Suite 300 ive D ti 103 E 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. ve r , xecu New Windsor NY 12553 Phone: 845-567-1000 Fax: 845-567-1030 INSURERS AFFORDING COVERAGE NAIC # F INSURED INSURER A: Ar onaut Insurance Co. ~ ~ INSURER B: County Of Dutch@38 ~ t `~ k M f i INSURER C: anagemen R s Office o 22 Market Street NQ~ I RERD: Poughkeepsie NY 12601 SURER E: ~\./~' v 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 DATE MMIDD~ DATE MMIDD~ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X X COMMERCIAL GENERAL LIABILITY 4 61157 9 10 ~ 01 ~ 0 9 10 ~ O 1 ~ 10 PREMISES (Ea occurence) $ 10 0 0 0 0 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ PERSONALBADVINJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 000000 POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A X ANY AUTO 4611579 10/01/09 10/Ol/10 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-0WNED 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 $ 10000000 _ A X OCCUR ~ ClA1MSMADE 4611579 10/01/09 10/01/10 AGGREGATE $ 10000000 DEDUCTIBLE $ ~( RETENTION $ 0 $ WOR KER S COMPENSATION ' - - TORY LIMITS ER AND EMPLOYERS LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIV E.L. EACH ACCIDENT $ ~ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ Ii yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS (LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Town of Wappinger is provided Additional Insured status, when required by written contract or agreement, with respect to County Highway Annual Snow & Ice Removal Program, as their interest may appear. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO WAPPIN2 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 Town of Wappinger REPRESENTATIVES. 20 Middlebush Road Wappingers Falls NY 12590-4004 AUTHORIZED REPRESENTATIVE ~~~ ACORD 25 (2009/01) U 79ss-zoos AcuKU cc~rtruttn I wn. au ngnts reserves. The ACORD name and logo are registered marks of ACORD 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 This Certificate of Insurance 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 (2009/01) ri a ERIE o NoURAN CE COMPo NY OTHER INTEREST COPY Erie Insurance Company CANCELLATION NOTICE Member Erie Insurance Group 100 Erie Ins. PI. Ene. PA 16530 CANCELLATION EFFECTIVE MAIL DATE 11/09/09 POLICY NUMBER Q26 5320040 NY 12/21/09 12.01 AM DUE DATE 10/03/09 POLICY EFFECTIVE DATE 02/03/09 STANDARD TIME FIVESTAR CONTRACTORS POLICY NAMED INSURED WARREN CUSTOM BUILDERS INC AP-00038 TOWN OF WAPPINGERS FALLS AQ-00028 2345 SOUTH RD STE B NN1116 20 MIDDLEBUSH RD NN1116 POUGHKEEPSIE NY 12601-5585 WAPPINGERS FALLS NY 12590-4004 WE ARE NOTIFYING YOU THAT THE ABOVE POLICY IS CANCELLED AS OF THE CANCELLATION EFFECTIVE HOUR AND DP.TE SHOWN ABOVE, UNLESS ON OR BEFORE SUCH DATE, .THE PREMIUM IS PAID TO US OR OUR AGENT (OR A BROKER AUTHORIZED TO RECEIVE SUCH PAYMENTI. IF WE HAVE BEEN ASKED TO PROTECT OTHER INTERESTS, WE ARE REQUIRED TO ADVISE THEM OF THIS CANCELLATION. THE REASON FOR THIS ACTION: NON-PAYMENT OF PREMIUM A $10.00 LATE FEE HAS BEEN ASSESSED. RECEI,V~I~ NG ~ ~ 12009 T4W(V CI~~~' 00028 NN1116 PHONE GRAP GRAPEVILLE AGENCY, INC. 1-518-966-4466 ~fic ~~ ~% ,~ ~~ !/ l P V~//lltl/~~ - ~ ~ ~~~ ~IJ .:.::~.~' 94801C 6/00 ~RO® CERTIFICATE OF LIABILITY INSURANCE OP ID SPAY DATE(MMIDD/YYYY) WAPPI-D 10/29/09 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 Phone:845-297-1700 Fax:845-297-2879 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: GraAh1C Arts Mutual Ins CO INSURER B: Wappingers Central School District INSURER C: 167 Myers Corners Rd Suite 200 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 W ITH RESPECT TO W HICH 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/YYYY POLICY EXPIRATION DATE MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 10000_00 A X X COMMERCIAL GENERAL LIABILITY CPP3725513 07/01/09 07/01/10 PREMISES (Eaoccurence) $ 1000000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5000 PERSONAL&ADVINJURY $ 1000000 GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPiOP AGG $ 300 O O O O POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT 1000000 A X ANYAUTO CPP3725513 07/01/09 07/01/10 (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 ~ ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLALIABILITV EACH OCCURRENCE $ 15000000 A X OCCUR ~ CLAIMSMADE CULP3725517 07/01/09 07/01/10 AGGREGATE $ 15000000 DEDUCTIBLE $ X RETENTION $ 10000 _ $ WORKER AND EMP S COMPENSATION LOYERS' LIABILITY A U- TH- TORY LIMITS ~_ ER YIN ANY PROPRIETOR/PARTNERIEXECUTIV~ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) O(~~ ~ O 2U E.L. DISEASE - EA EMPLOYEE $ It yes, describe under SPECIAL PROVISIONS below tt~~ E.L. DISEASE -POLICY LIMIT $ OTHER ~p~ ^ T®YYN ~J~ {'] rQ~_ - t~ ~~ ,f DESCRIPTION OF OPERATIONS I LOGA710N51 VEHICLES I EXCw51DNS nouEU [tr tnuurtStmtn 1 ~ SrtGIAL rnuvmiuna The Town of Wappinger is provided Additional Insured status when required by written contract or agreement with respect to use of Schlathaus Park for the Night of Jazz Concert on June 1, 2010. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION WAPPI-3 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 Town of Wappinger 20 Middlebush Rd Wappingers Falls NY 12590 REPRESENTATIVES. -- - - ACORD 25 (2009101) ©198 -2 09 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I ~ 1 g ACORD CERTIFICATE OF LIABI ~ DATE (MM/OD/YYYY) LITY INSURANCE -----~"----- - -- - - -- ---- - -- __ _ - __ _. 10/29/2009 -- - 1 ~ PRODUCER . THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1166 Avenue of the Americas HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR New York, NY 10036 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 105892-00000-ACORD-2009 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Flre IDS CO PlttSbUrgh PA 19445 KINGSTON OIL SUPPLY CORP. _. __ P.O. BOX 760 PORT EWEN NY 12466 ___-.---__- wsuRER e: New Hampshire Ins. Co. _______.- ______-._. 23841 , _ wsuRER c: N/q N/A i INSURER D - L - _ -- ---- --- INSURER E: _- ---_- COVERAGES _ _ _-- " _ - - _ THE POLICIES OF INSURANCE LISTED BELOW HAVE B EEN 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 E INSURANCE AFFORDED BY THE POLICI ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND _ CONDITION__S OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - --- INS LTR WADD'I INSRa ~ TYPE OF INSURANCE POLICY NUMBER rDUCVEFFECTIVE POLICY EXPIRATION LIMITS DATE IMM/DD/YYYY( DATE (MM/DD/YYYY) A GENERAL LIABILITY 4807545 11/01/2009 11/16/2009 EACH OCCURRENCE -.._._- ___. 1._000 000 X COMMERCIAL GENERAL LIABILITY _ _ DAMAGE TO RENTED PREMISES(Eaoccurrence_ ~ 1 QQ Q00 _ CLAIMS ^ I MED EXP (Any one erson) $ 1 Q QQQ - MADE ~ OCCUR P PERSONAL 8 ADV INJURY __ - ~ 1,000,000 ~ GENERAL AGGREGATE $ 1,000,0001, GENERAL AGGREGATE LIMIT APPLIES PER POLICY PRO LOC PRODUCTS -COMP/OP AG ---- 1 QQQ QQQ ~.___--------- JECT A AU TOMOBILE LIABILITY 9722561 11/01/2009 11/16/2009 COMBINED SINGLE LIMIT 000 QOQ $ 1 ANY AUTO IEa accident) , , ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS IPer Person) HIRED AUTOS ~r "" ~ r ~ /1E~ ~ BODILY INJURY NON-OWNED AUTOS ~`// r . Yr L (Per accident) PROPERTY DAMAGE NO1/ ~ Y (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT T _ ANY AUTO i ~ / " o• r ~ ~ - ~y OTHER THAN EA ACC lrF AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE_ OCCUR L~_I CLAIMS MADE ~ / ~ AGGREGATE ~ ~ DEDUCTIBLE $ --- $ RETENTION $ - B i B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC 1591728 WC 1591729 TX ' 11/01/2009 11/16/2009. X WC STATU- I IOTH- LiSv-LE ~ ANYPROPRIETOFUPARTNER/EXECUTIV Y!N ( ) 11/01/2009 11/16/2009 EAC _ $ 1 000 000 E OFFICER/MEMB .L HACCIDENT , , ER EXCLUDED? n L. DISEASE - EA EMPLOYE - $ 1 ,000,OOO (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS belrnv L. DISEASE -POLICY LIMIT --- $ 1 ,000,000 I OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS -- - CERTIFICATE HOLDER NYC-003295639-24 ----- -- ----- -------------..-- - - --. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Wappingers EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 Middlebush Rd 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT Wappingers Falls, NY 12590 , i BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED RA IDCgENTATIVE __ ~r~/~ A OTC of Mars US / ~G _ W .C K. Paul Martelloni r+~~.vrtu ca tcu~y/vl / ©1998-2009 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD ~~DM CERTIFICATE OF LIABILITY INSURANCE iiioiizoo ) PRODUCER ($45)647-9100 FAX (845)647-8660 Sprague & Kil l een, Inc. 116 Canal Street 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. P. 0. Box 506 El l envil l e, NY 12428 INSURERS AFFORDING COVERAGE NAIC # INSURED River Remodeling, Inc. INSURER A: NatlOnal Grange Mutual Ins Co 14788 90 Fiddlers Bridge Road INSURER B: THE STATE INSURANCE FUND State Staatsburg, NY 12580 INSURER C: INSURER D: INSURER E: /`!l\ /CO A /'! C C vTHE 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 MPV57005 12/08/2008 12/08/2009 EACH OCCURRENCE $ ],,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500 ~ 00 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10 ~ 00 A PERSONAL & ADV INJURY $ 1 r 00p ~ 00 GENERAL AGGREGATE $ 2 , OOO , OO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 ~ 000 ~ 00 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 $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND A1230 087-7 04/01/2009 04/U1/201U WC STATU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ ZOO , OO B OFFICER/MEMBER EXCLUDED? SEE ATTACl~ED E.L. P OYE $ lOO , OO If yes, describe under SPECIAL PROVISIONS below E.L. 1 L I 500 , OD OTHER Nov o ~ zoos DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS n ~ ~~~~~ roof of Insurance ` ertificate holder is listed as additional insured with regards to the General Liability policy above 'n regards to work being performed by insured at The Kungel Residne t.4--Edge Hill Rd in ~ appinger Falls NY { rcvTlGlrerc unl nl=a C~NCFI I OTIf1Nl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL , Bldg Dept Town of Wappingers 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, , Attn : Susan Deyo BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 20 Mi ddl ebush Rd OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Wappi nger Falls , NY 12590 AUTHORIZED REPRESENTATIVE /1 / / J ~ Dwi ht Coombe, CIC/ALS l },' / ACORD 25 (2001/08) ©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.doesvot 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. ECEIVE~ ~Q!! 0 ~ 2009 ~n~N CLC~~ ACORD 25 (2001/08) A CORDrM DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 10/29/2009 'RODUCER (845) 223-8107 FAX: (845) 227-8816 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ~F Northeast Brokerage 2nc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ?7 High Ridge Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 11 Junction NY 12533 NSURED Storey Electric, Inc 37 Oswego Road ?leasant Valley NY 12569 INSURERS AFFORDING COVERAGE NAIC # wsuRER A American States Ins Co . INSURER B: F1rst Cardinal 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. A R AT I fT O AY AV E N DU Y P AI ISR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY H R $ 1 , 000 , 000 DAMAGE TO RENTED 200 000 X COMMERCIAL GENERAL LIABILITY R MI ccurrence $ ~ A S MADE ~ CCP8085537 10/25/2009 10/25/2010 MED EXP An one erson $ 10 , 000 CLAIM OCCUR PER AL & A V INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PR D CT -COMP/ P AGG $ 2 , 000 , 000 PRO- X POLICY T LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1, 000 , 000 X TO (Ea accident) A ANY AU ED AUTOS BA8089095 10/25/2009 10/252010 BODILY INJURY ALL OWN $ ED AUTOS (Per person) SCHEDUL X HIRED AUTOS BODILY INJURY $ X (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ NY AUTO OTHER THAN EA ACC $ A AUTO ONLY: qGG $ EXCESS/UMBRELLA LIABILITY $ CCUR ~ CLAIMS MADE AGGREGATE $ O DEDUCTIBLE ' $ RETENTION $ WC STATU- OTH- $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT 100 000 $ i ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 006000045134106 1~1~2009 1/12010 E.L. DISEASE- EA EMPLOYEE $ 100 , 000 If yes, describe under DISEASE -POLICY LIMIT L E 500 , 000 $ SPECIAL PROVISIONS below . . OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXC LUSIUNS Auutu [tr tnuunatmcrv uarc~u+~ rnvv~a,vrva Provided it is required by written contract the following are included as addtitional in o general Liability and in regards to work being performed by the insured; The Town of Wappingers. _ ~, ~ ~~~~iov a 4 zoos CERTIFICA Town of Wappingers 20 Middlebush Road Wappingers Falls, NY 12590 aCORD 25 (2001/08) NS025 rofoa).oaa CANCELLATION ' ~ ~~'~'~ ~~ FR6~~ SHOULD ANY-OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL lO 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. AUTHORIZED REPRESENTATIVE Stephanie Baez/SBAEZ ~"'-~'~~`'~~~ ©ACORD CORPORATION 1988 Page 1 of 2 DATE (MM/DD/YYYY) -o/ZO® CERTIFICATE OF LIABILITY INSURANCE L=~ 02 11/02/09 David Kusel Associates, Inc. 190 Moore St. Hackensack NJ 07601 Phone:201-489-6366 Fax:201-489-0174 INSURED Liam Construction Inc 287 Rt 94, Suite 311 Vernon NJ 07462 l:AVFR~C~FS 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. Ohio Casualt Insurance Co 466 INSURER B: AIG CENTENNIAL INS . CO . INSURER C: bleat Amarioan Zneuranoe co. 466 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 urc cun~nrta enev unvF aFFN RFDI ICFD RY PAID CLAIMS. ' I ~ LTR _ V NSR TYPE OF INSURANCE POLICY NUMBER P L Y EFFE TIVE DATE MM/DDIYYYY POLICY EXPIRATI N DATE MM/DD/YYYY LIMITS AL LIABILITY EACH OCCURRENCE $ lOOOOOO GEN ER L GENERAL LIABILITY BKW53010226 05/18/09 05/18/10 PREMISES (Eaoccurence> $ 100000 A X X COMMERCIA CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ lOOOO PERSONALBADVINJURY $ 100000 GENERAL AGGREGATE $ 2000000 AGGREGATELIMITAPPLIESPER: N' PRODUCTS-COMP/OPAGG $ 2000000 GE L POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT cident) E $ lOOOOOO C X ANY AUTO BAA53010226 05/18/09 05/18/10 ( a ac ALL OWNED AUTOS BODILY INJURY P $ SCHEDULED AUTOS er person) ( HIRED AUTOS BODILY INJURY ident) P $ NON-OWNED AUTOS er acc ( PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ lOOOOOO A OCCUR ~ CLAIMSMADE US053390171 05/18/09 05/18/10 AGGREGATE $ 1000000 DEDUCTIBLE $ }[ RETENTION $lOOOO $ WORKERS COMPENSATION _ X TORY LIMITS ER $ AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE W0003531670 03/11/09 O3/11/lO E.L. EACH ACCIDENT $lOOOOOO ~ OFFICER/MEMBEREXCLUDED? N in NH) dato M E. L. DISEASE-EA EMPLOYEE $ZOOOOOO ry ( an If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $ IOOOOOO A A OTHER Equipment Floater Pro ert Section BKW53010226 BKW53010226 05/18/09 05/18/09 05/18/10. 05/18/10 sched equ 367750 b 2 DESGRIP nun tir ~renN nvn~i w~.r+uv,wivcn,..~~.,,~....~ .............~----'-•---•---~-'-~--~-'---_---- - {r'~~~„/1a~~ s ~- cwert holder is add'1 insd w/respect to general liability & policy contracs~ for job loc: Hughsonville Fire District '~1,~ ~•_'~ •~ NoV 0 _y ~~ ,• 4 2009 __ r' rA\If^CI 1 ATIr-N V CR I Ir'11.A 1 G nvwu~ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 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 TOWn of Wappinger REPRESENTATIVES. ~~ Bldg Dept AUTHORIZED REPRESENTl~rIVE % ~ 20 Middlebush Rd Dave Kusel n ~~ ~~ ~ Wa in ers Falls NY 12590 ~ ~ ~ 1-' r.r~ennowTln61 All ... L.M r .nrl ACORD 25 (2009101) .. ~~ ..............,,,.,,... ,...... _......_.-.. --~ --~ -- The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (IJse street address only) one Number of Insured 184Bus98 LIAM CONSTRUCTION INC 6 7553 ~ ~ 287 ROUTE 94 lc. NYS Unemployment Insurance Employer 11311 VERNON, NJ 07462-0000 Registration Number of Insured Work Location of Insured (Only required if coverage is specifically ertain locations in New York State, i.e., a Wrap-Up d t i li 223071634000 ld. Federal Employer Identification Number of Insured o c te m Policy) or Social Security Number 223071634 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) GRANITE STATE INSURANCE COMPANY TOWN OF WAPPINGER 3b. Policy Number of entity listed in box "la" BLDG DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS, NY 12590 WC 003531670 3c. Policy effective period 311112009 TO 311112010 3d. The Proprietor, Partners or Executive Officers are X included. (Only check box if all partnerslofficers included) all excluded or certain partnerslofficers excluded. _a _t._..,. :., 1..,.. "1 a ' fnr wr~rkPrs' This certifies that the insurance carrier indicated above m box '3° insures me ousmc~s tcrcicuwu wv.,... ~__ ~~~' "' --- ------- compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c ", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent.of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Approved by: Title: NICHOLAS DALESSIO (Print name of autho ' ed representative or licensed agent of insurance carrier) ~, .l 11 /02/2009 ( ature) (Date) SENIOR UNDERWRITER Telephone Number of authorized representative or licensed agent of insurance carrier: 1-800-645-2259 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. ~EGEI~E~ C-105.2 (9-07) www.wcb.state.ny.us NOV 0 4 2009 ~~iNN GLE~~