Loading...
2009 (5)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. ~E~EIV OC`f ~ 7 2009 ''C)ti1-E~ CLERGY ACORD 25 (2001/08) A CORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) TM 1/7/zoo9 PRODUCER phone: 315-451-1500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Freyer & Coon, Inc. Haylor ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE , HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 231 Salina Meadows Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. 4743 Syracuse NY 13221 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:SeleCtlVe Wa Insurance Com an P & D Electric of Hudson Valley, Inc. INSURERB:National Benefit Life Pie Development Co., Inc. INSURER C: 53 Eliza St. NY 12508 B INSURER D: eacon INSURER E: nnvoonnoc 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 DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS j~ GENERAL LIABILITY 517 6 8 715 1/ 1/ 2 0 0 9 1/ 1/ 2 010 EACH OCCURRENCE $ 1 0 0 0 0 0 0 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 5 0 0 0 0 0 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5 Q 0 0 PERSONAL & ADV INJURY $ 10 O Q Q O Q GENERAL AGGREGATE $ 3 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG $ 3 Q 0 Q 0 ~ 0 POLICY PROT LOC . jj AUT OMOBILE LIABILITY S 17 6 8 715 1/ 1/ 2 0 0 9 1/ 1/ 2 010 COMBINED SINGLE LIMIT $ 1 0 0 0 0 0 0 ANY AUTO (Ea accident) ALLOWNEDAUTOS 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 OTHERTHAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLALIABILITY 51768715 1/1/2009 1/1/2010 EACH OCCURRENCE $j000000 j~ OCCUR ~ CLAIMS MADE AGGREGATE $ 5 0 0 0 0 0 0 DEDUCTIBLE $ X RETENTION $ 10 0 0 0 WC STATU- OTH- WORKERSCOMPENSATION AND T Y IMI R , EMPLOYERS' LIABILITY E. L. EACH ACCIDENT $ __ ANY PROPRIETOR/PARTNER/EXEGUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONSbelaw E. L. DISEASE-POLICY LIMIT $ A OTHER 51768715 1/1/2009 1/1/2010 $1,000,000 Lmt/ $214,250Limit Install Fltr/Equip. Fltr 89100163435 1/1/2009 1/1/2010 ented/LeasedEquip $100K Limit B $500 Deductible NYS Disability Statutory DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS roject: Amundson 73 Losee Road ~/ t r e G` C® ~~ `` // CAIJCFI I ATInNZ/l ^d_/HN!\' !_iLCT-'.- t+~.n r rrwr~ i c. r rvw~ri - - 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 Road CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Wappingers Falls NY 12590 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE , .., I ~" / ~ i ACORD Yb (ZOO1/OB) U /i~+vn~ t.vnrvnn r rvr• i aw 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) ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID A DATE (MM/DD/YYYY) ,M - CHAZOIN O1 05 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Singer Nelson Charlmers ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P O Box 16 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1086 Teaneck Road, 5th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Teaneck NJ 07666-0016 Phone: 201-837-1100 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Liberty Insurance Underwriters INSURER B: The Chazen Engineerin & Land Surveyin Company P . ~ . INSURER C , 21 FOX S~reet P hk i NY 12601 INSURER D oug eeps e 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 DATE MM/DD/YY E PDATE MM/DDm N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $ CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ POLICY PRO LOC JECT AUT OMOBILE LIABILITY ,r-~ p,,,~ ~ COMBINED SINGLE LIMIT $ ANY AUTO Y g (Ea accident) ALL OWNED AUTOS g p ~ ~ ~ ~~~ BODILY INJURY SCHEDULED AUTOS Jf1 (Per person) $ HIRED AUTOS ^, . Ip (^ rry~ ' BODILY INJURY $ NON-OWNED AUTOS ~ A .rub/ I\ l.i G ~ 1 (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 ~ CLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY RIPARTNER/EXECUTIVE PRIET E.L. EACH ACCIDENT $ ANY PRO O OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ A OTHER Professional Liabilit AEE196946-0108 12/31/08 12/31/09 5,000,000 each claim 5,000,000 annual a r DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TOWWAPl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO 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 REPRES TATIVE ACORD 25 (2001/08) ©ACORD CORPORATION 1988 ACURD CERTIFICATE OF LIABILITY INSURANCE OPID 6PAT DATE(MMfDDNY1'Y) UALI-4 01/08/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CLG Financial HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 172 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Nanuet NY 10954 Phone: 845-623-3434 Fax:845-623-4332 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA American Int'1 Specialty Liras 26883 INSURER B: Harleysville Ins Co of NY 33235 Quality Environmental Solutions & Technologies ,Inc . INSURER C: 1376 Route 9 INSURERD Wa in ers Falls NY 12590 pp g 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 DATE (MMlDD1YY) DATE (MM/DDlY1' LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 0 0 0 0 0 0 A X X COMMERCIAL GENERAL LIABILITY PROP1383812 12/30/08 12/30/09 PREMISES (Eaoccurence) $ 100000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10 0 0 0 X Professional Liab PERSONAL&ADVIIVJURY $],000000 X Pollution GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 1 O O O O O O POLICY X PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 B X ANY AUTO BA 6J1732 12/30/08 12/30/09 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X 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 $ 5 0 0 0 0 0 0 A X OCCUR ^ CLAIMSMADE PROU791181 12/30/08 12/30/09 AGGREGATE $ 5000000 DEDUCTIBLE $ X RETEIJTION $1 O O O O $ WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 12222758-REQ FROM STATE 12 / 16 / 0 8 12 / 16 / 0 9 E.L. EACH ACCIDENT $ 10 0 0 0 0 OFFICER/MEMBER EXCLUDED'! FUND E.L. DISEASE - EA EMPLOYEE $ 1 O O O O O If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE I 00 OTHER ~ qq~~ QQ AA '' J~lF 1 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Derniglia & Swartz, 134 Academy Street, Poughkeepsie, NY, 12601 is includq~ ~~ GLE as additional insureds under the General Liability and Umbrella Liability a RK per the written agreement with regard to work performed by the named insured. Per the terms of the blanket additional insured endorsement, coverage for the additional insureds is contingent upon a written "(Cont'd)" 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 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SD 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 REPRESENTATNES. AUT IZED N E ACORD 25 {2001106) 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. NOTEPAD: NS REDS NAME Qua~ity, Environmental oPLID 6PAT PATE 01./08ID9 ,g quiring such cover.:: a regiment with the named insured re age. ACORD CERTIFICATE OF LIABILITY INSURANCE OP iD A OATE(MMfDDfYYYY) - CHAZOIN O1 05 09 PRODUCER TH15 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Singer N®lson Charlmara ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P O Box 16 BOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR lOB6 Teaneck Road, 5th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Teaneck NJ D7666,0016 Phone : 2 D 1-837-1100 INSURERS AFFORDING COVERAGE NAIC # INSURED INBURER A' Lilx~rty Ineurmoe Undcrwri tnrr. INSURER 8 The Ghazen Engineeringg & Land Surveyin Company, P.C. ~ INSURER C 21 Fox S reet Poughkeepsie NY 12601 _______ INSURER D. -•---------- INBURER E• .-. COVERAGES THE POLICIES DF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONORION OF ANY CONTRACT DR OTHER DOCUMENT WfTH RESPECT TO WHICH THIS CERTIPICATE MAY BE ISSUED OR MAV PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC7T0 ALL THE TERMS. EXCLUSIONS AND CONDIT70NS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR NSR TYPE OF INSURANCE POLICY NUMBER DALTE MM/DDIYY DATE MMIDDIYY I LIMITS GENERAL LIABILITY EACH OCCURRENCE ; COMMERCV~1. GENERAL LIABILITY PREMISES Ee oeaeence S CLAIMS MADE ~ OCCUR MED EXP S~+Y ana person] S PERSONAL d ADV INJURY S _ GENERAL AGGREGATE S GEN'L AGGREGATE I APPLIES P ~ / /~ ~ / \ PRODUCTS -COMPfOP AGG S JE C I OC POLICY ~ ~~ ~ C V AUT OMOBILE LUIBILITY CoMBiNED31NGLELIMIT ANY AUTO ~~~ ~ 20U~ (Ea eccrtknl) ; All OWNED AUTOS BODILY INJURV SCHEDULED AUTOS T(1~ CLERK (Nerperson) 3 HIRED AU705 , [iODILV INJURV NON-OWNED AUTOS IPer uGdenlj S C ~ ~ PROPERTY DAMAGE (Pe[ eecidenl) ; GARAGE LIABILITY AU70 ONLY • EAACCIDENT S ANY AUTO OTHER THAN ~ ACC S AU70 ONLY AGG S EXCESS(UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR ~ CLAIMS MADE AGGREGATE ; S DEDUCTIBLE ; j RETENTION S ; WORKERS COMPENSATION AND ' I TORY LIMITS ER EMPLOYERS LIABILITY ANY PROPRIETDRlPARTNER7EXECUTNE E L EACH ACCIDENT S DFFICER/MEMBER EXCLUDE07 E L DISEASE - EA EMPLOYE S H yes, desurbe under SPECIAL PROVISIONS below E L DISEASE • POLICY LIMIT S 1 Ai ~ OTHER Profasaional Liabilit AEE196946-0108 12/31/D8 12/31/09 5,000,000 each claim 5 000 000 annual a r DESCRIPTION OF OPERAT10N6! LOCATIONS !VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TOWWAPI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 D PAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, SLIT FAILURE TO DO SO SHALL TOwri of Wappinger 20 Middlehush Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Wappingers Fa11a NY 12590 REPRE8ENTATVEB. AUTHORI REPRES TATIVE AcoRO 25 f2DDVVBI ©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. AC1UKlJ 78 17110'1/0111 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name & Address o1' Insured (Use street address only) lb. Business Telephone Number of Insured Appolo Heating Inc.* 518-355-2296 868 Burdeck Street Schenectady NY 12306 Ic. NYS Unemployment insurance F,mployer Registration Number of insured UIER# 4769657 7 Work Location of Insured (Only reynired if coverage is snecifieally Id. Federal F,mployer Identification Number of insured limited to certain locations in Ne-n York State, i.e., a wrap-Up or Social Security Number Policy) 204369056 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) Rochdale Ins. Co. (Oryx) Town of Wappingers Falls 20 Middlebush Road 3b. Policy Number of entity listed in box "la" Wappingers Falls NY 12590 RWC3166053 3c. Policy effective period 12/31/2008 to 12/31/2009 3d. The Proprietor, Partners or Executive Officers are x inClnded. (Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box " 3" insures the business referenced above in box "la" for workers' compensation under the New Yorlc 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 In,cw~anc•e Carrier will also notify the above certificate holder within !0 days IF a policy i,+• canceled due to nonpayment of premicrm.+ or 1•vithin 30 day,+ IF there are reasons other than nonpayment of premtums that cancel the policy or eliminate floe in.+•ured fironr the c•overa~>e indicated on thi,c Certificate. (These notice,+~ may he ,cent by regarlar mail.) Otherwise, this Certificate is valid for one year offer this form is• approved by the insurance carrier or its licensed agent, or until thepolicy expiration date listed in box "3c", -vhichever• 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: Edward J. Reagan (Pint name of authorized representative or licensed agent of insuratrcecamer) Approved by: /12/2009 (Date) Title: Vice President, James P. Reagan .Agency, Inc. ` ~ _` ~' Telephone Number of authorized representative or licensed agent of insurance can-ier: 315 - 673 - 2 094 _ F„y ~• ~~ Please Note: Only insurmace carriers and their licensed agents are authorized to issue Fa•m C-105.2. In,+~urance hro r;'+•~a~ ~~~ authorised to icrue it ~~ C-105.2 (9-07) www.wcb.state.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. . The head of a state or municipal department, board, commission or office authorized or required by law to issue any pern~it for or in connection with any work involving the employment of employees in a hazardous employment deltned 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 fot7n 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 pari 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 chav,that compensation for all employees has been secured as provided by this chapter, :' ~: . C- 105.2 (9-(17) Reverse -ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DB DATE (MM/DD/YYYY) ANCHO-2 02 09 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Main Street America Group - Sy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Syracuse Region HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 2027 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Keene NH 03431 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: NGM Insurance Company 14788 INSURER B: Anchor Electric InC INSURER C: 38 FOX Road H ll J ti NY 12533 INSURER D: opewe unc on 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 ANV 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 MM/DD/YY E PDATE MMIDD/YY N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2 , OOO , OOO A X COMMERCIAL GENERAL LIABILITY MPV53655 08/10/08 08/10/09 PREMISES (Eaoccurence) $500,000 CLAIMS MADE ®OCCUR MED EXP (Any one person) $ 10 , 000 PERSONAL&ADV INJURY $ 2 r 000 r 000 GENERAL AGGREGATE $ 4 , OOO , OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 4 r OOO , OOO POLICY X PRO LOC JECT AU TOMOBILE 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 EA ACC OTHER THAN $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER A EMPLOYERS'LIABILITY C T E WCV53655 08/10/08 08/10/09 E.L. EACH ACCIDENT $100,000 ANY PROPRIETOR/PARTNER/EXE IV U OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1OO r OOO If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 500 , 000 OTHER ~~~~ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS All duties usual and customary to Electrical Work within Buildings ~~'~ `+ a ~p .~ ~ ~ T~-~I'~o ~L~RK CERTIFICATE HOLDER CANCELLATION 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 Town of Wappinger IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 20 Middlebush Rd. Wappinger Falls NY 12590 REPRESENTATIVES. A~ORIZE~~RES TIVE ACORD 25 (2001108) ©ACORD CORPORATION 1988 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) lb. Business Telephone Number of Insured ANCHOR ELECTRIC, INC. 38 FOX ROAD HOPEWELL JUNCTION, NY 12533 lc. NYS Unemployment Insurance Employer Registration Number of Insured ' Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, i.e., a Wrap-Up Policy) ld. Federal Employer Identification Number of Insured or Social Security Number 202774866 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) MSA GROUP/NGM INS CO TOWN OF WAPPINGER 3b. Policy Number of entity listed in box "la" 20 MIDDLEBUSH ROAD WCV53655 WAPPINGER FALLS, NY 12590 3c. Policy effective period 08/10/08 to 08/10/09 3d. The Proprietor, Partners or Executive Officers are Included. (Only check box if all partnerslofficers included) X All excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also notes the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box " 3e ", 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: _Dawn Buckley (Print name of authorized representative or licensed agent of insurance carrier) Approved by: ~ ~ ~ 02/10/09 (Signature) (Date) Title: Licensed Agent/Sr. CSR Telephone Number of authorized representative or licensed agent of insurance carrier: 866-676-3849 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) www.wcb.state.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. C-105.2 (9-07) Reverse his certtn_c_a[_e_ts executed by Uberty Mutual htsurance Group as respects such insurance as is attordetl by those companies. BMOO6R Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate is not an insurance policy and does not affirmatively or negatively mnend, extend, or alter the coverage afforded by the policies listed below. Policy limits are no less than those listed, although policies may include additional sublimity not listed below. Policy limits may be reduced by claims or other payments. This is to certify that (Name and address of Insured) Treco Corporation PO Box 310 Bridgeport, CT 06601 at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subje is not altered by anv requirement, term or condition of anv contract or other document with Ex iration T e Continuous* Extended X Policy Term 02/01/2009/02/01/2010 IWAS-IID-42 1 27 1-089 Workers Compensation _ L%bert~ - i.~~TM to all their terms, exclusions and conditions and is certificate may be issued. Limits of Liability Coverage afforded under WC law of Employers Liability the following states: Bodily Injury By Accident cT, NY $500,000 Each Accident Bodily Injury By Disease $500,000 Policy Limit Bodily Injury By Disease $500,000 Each Person General Aggregate-Other than Prod/Completed Operations General Liability Products/Completed Operations Aggregate Claims Made Occurrence Bodily Injury and Property Damage Liability Per Occurrence Retro Date Personal and Advertising Injury Per Person / Or anizatiot Other Liability Other Liability Each Accident -Single Limit - B. I. and P. D. Combined Automobile Liability Each Person Owned Non-Owned Each Accident or Occurrence Hired Each Accident or Occurrence C - :. a.+v1y~ O M ~nO~OAI ~LCRNC M E T"""~ T --~ IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) mast be endorsed. A statement on this cenificate does not confer rights to the certificate holder in lieu of such endorsement(s). 11 SUBROGATION 1S WAIVED, subject to the forms and conditions of the policy, certain policies may require en endorsement. A statement on this cenificate does not confer rights to the certi Gcate holder in lieu of such endorsements. 7hc following applies only with respect to insurance for motor carriers registered in Florida: As provided for in Fla. Slat. § 320.02(5)(e), the listed insurance policy may not be c¢ncelled on less than 30 days written notice by the insurer to the Department of Hwy Safety & Motor Vehicles, such 30 days notice to commence from date notice is received by the Dnpanment. Notice of cancellation: (not applicable unless a number of days is entered below) . Notice of Cancellation does not apply when policy(ies) are canceled due to non-payment of premium. Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policies until at least 0 days notice of such cancellation has been mailed to the below listed Certificate Holder. Office : Trumbull, CT Phone: 203-459-4411 Certificate Holder: Town of Wappinger 20 Middlebush Road Wappinger Falls, NY 12590 «- ~i~~rax{y-~, RITA MAGGI Authorized Rearesentative Date Issued: 02/09/2009 Prepared By: MH Client#: 20271 OR rrn~ GA ACORDTM CERTIFICATE OF LIABILITY INSURANCE Drcrrv) 01/30/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Treiber Group, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 377 Oak Street - CS 601 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Garden City, NY 11530-0601 516 745-0800 INSURERS AFFORDING COVERAGE NAIC # INSURED T H INSURER A: ZUrlch AmerlCan InSUranCe Company 16535 yree oldings Corp. 1 N th L INSURER B: Steadfast Insurance Co. 26387 or way ane L th NY 121 INSURER C: a am, 10 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 POLICY EFFECTIVE D TE D POLICY EXPIRATION DAT MM DD LIMITS A GENERAL LIABILITY GL0943266700 01/31/09 01/31/10 EACH OCCURRENCE $1 OOO OOO X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1 OO OOO CLAIMS MADE a OCCUR MED EXP (Any one person) $1 O OOO PERSONAL & ADV INJURY $1 OOO 000 GENERAL AGGREGATE $2 OOO 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2 OOO OOO POLICY X PRO ECT LOC A AUT OMOBILE LIABILITY BAP943267200 01/31/09 01/31/10 COMBINED SINGLE LIMIT E id t $1 000 000 X ANY AUTO a acc ( en ) , , ALL OWNED AUTOS O SCHEDULED AUTOS B DILY INJURY (Per person) $ X HIRED AUTOS BODIL X NON-OWNED AUTOS Y INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC OTHER THAN $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY SE0938090000 01/31/09 01/31/10 EACH OCCURRENCE $5 OOO OOO X OCCUR ~ CLAIMS MADE AGGREGATE $5 OOO 000 DEDUCTIBLE $ X RETENTION $ 1O OOO $ A WORKERS COMPENSATION AND WC94284301 01/31/09 01/31/10 X WC STATU- OTH- A EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 OOO OOO OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1 OOO OOO If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Town od Wappinger, 20 Middlebush Road, Wappingers Falls, NY 12590 is included as additional insured, where required by written contract with FEB ~ ? 2009 respects to job at 7-11 m 1425 Route 9, Wappingers Falls, NY 12590. ~~W~! CLCRK Town of Wappinger 20 Middlebush Road 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 ~,p_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 70 THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR .+vv~~.+ ~a t~.vv uvvi l VT L Ti1111LLOOLL LC71.1 U A~.VKU I.VKYVKAI IVN l`JtSif ACORDM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/30/2009 PRODUCER (g45)896-2222 FAX (845)896-4365 Kraus-Ritter Insurance 1081 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. Suite J Fishkill , NY 12524 INSURERS AFFORDING COVERAGE NAIC # INSURED RGH Construction, Inc. INSURERA Peerless Ins. Co. 24198 6 Old Myers Corner Road INSURER B: Wappingers Falls, NY 12590 INSURER C: 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 DD' TYpE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CCP3006796177 02/01/2009 02/01/2010 EACH OCCURRENCE $ 1 ~ 000 ~ 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50 ~ 000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5 r ~~~ A PERSONAL 8 ADV INJURY $ 1 ~ 000 ~ 000 GENERAL AGGREGATE $ 2 ~ 000 ~ 00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 ~ X00 ~ 00 X POLICY PRO LOC JECT AUTOMOBILE LIABILITY BA3006783707 02/01/2009 02/01/2010 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ A X HIRED AUTOS BODILY INJURY P id $ X NON-OWNED AUTOS er acc ent) ( PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CU3006796177 02/01/2009 02/01/2010 EACH OCCURRENCE $ 2 ~ OQQ ~ QQQ X OCCUR ~ CLAIMS MADE AGGREGATE $ A ,000,000 $ 2,000,000 DEDUCTIBLE $ X RETENTION $ 10 r 00 $ WORKERS COMPENSATION AND WC8567973 01/01/2009 01/01/2010 X WC STATU- OTH- A EMPLOVERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 100, 00 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100 , 000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 500 , 000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS p.. ^ ' ~ ~ I ERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED. L1•~~(v ~'E~ 0 ~ ~~ TAW ~ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL TOWN OF WAPPINGER 15 DAYS WR EN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUILDING DEPARTMENT BUT FAILURE T AIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY P . 0. BOX 324 , MIDDLEBUSH ROAD OF ANY KIN PON THE INSURER, ITS AGENTS OR EPRESENTATIVES. WAPPINGERS FALLS, NY 12590 AuTHORIZ El~~(c1~TA~/~~ , ~ „ , ~ // er_nRn ~h r~nn~ina- rnernon rnoonow~rtn~i eeoc ^~~--=~.M v~•~... .vr.. ~ v. ~.~v.~... . ~~~vVl~~l~V` ENVIR-1 01/28/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Donald B . Dedrick Agency Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR Mill Street, PO Box 319 , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Dover Plains NY 12522 i Phone: 845-877-9901 Fax:845-877-6771 j INSURERSAFFORDINGCOVERAGE j NAIC# INSURED INSURER A: EVanstori Insurance Company INSURER B: Central All America 20222 Envirostar Corp INSURERC Central Mutual Insurance Co 20230 P 0 BOX 365 Croton Falls NY 10519 INSURER D: INSURER E: VVVCKAUCJ 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 MAV 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. I LTR YNSR TYPE OF INSURANCE ~ POLICY NUMBER POLICY EFFEC IVE ! DATE (MM/DD/W) POLI Y EX IRATION DATE MM/DD/YY) LIMITS _ '~ GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A '', ! }~ i COMMERCIALGENERALLIABILITY ~ TBA#08PKG01629 12/11/08 12/11/O9 PREMISES(Eeoccurence) $ SOOOO I~ ~! ~ CLAIMS MADE ~~ OCCUR ~ ~ - t ~ ~ MED EXP (Any one person) $ 5000 ~ ~ - -~ PERSONAL&ADVINJURY $ 1000OQO X ! POllutlon & Prof ~ GENERAL AGGREGATE $ 2000000 ! G 'L AGGREGATE LIMIT APPLIES PER:! ~ r~' - PRODUCTS-COMP/OPAGG ~ $ 2000000 ' PRO- i ~~ ~ ~ ~ POLICY j ! JECT LOC ! 'AUTOMOBILE LIABILITY ~~ ~ COMBINED SINGLE LIMIT (Ea accident) $ lOOOOOO i ANY AUTO ; C BAP7976635 02/19/09 02/19/10 ~ ALL OWNED AUTOS BODILY INJURY '', '~~, SCHEDULED AUTOS (Per person) $ ~I $ !HIRED AUTOS ~ BODILY INJURY ~~ , i ' ~ $ }{ NON-OWNED AUTOS ~ ~-- ~ (Per accident) ~ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ I I, AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY . EACH OCCURRENCE $ ~ mil OCCUR ~~ CLAiMS MADE i r~ AGGREGATE $ I~ ~ $ ~I, DEDUCTIBLE i ~' `~ $ ~ !RETENTION $ I ~ $ WORKERS COMPENSATION AND it ~ ' ~ X TORY LIMITS ER .EMPLOYERS LIABILITY B WC7942213 I! 09/29/O8 09/29/09 E LEACHACCIDENT $ 100000 . ANY PROPRIETOR/PARTNER/EXECUTIVE . ~~ OFFICER/MEMBEREXCLUDED~ ~ ~ ~~ i E. L. DISEASE-EAEiNPLOti"EE $ 100000 If ves describe under ~ SPECIAL PROVISIONS below I E.L.DISEASE-POLICYLIMIT ~ $ SOOOOO OTHER I DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS As per policy. JAN 2 9 2009 ~OW~e CLERK CERTIFICATE HOLDER CANCELLATION TOW1dWAP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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 Wappinger Falls NY 12590 REPRESENTATIVES. AU RIZE RE ATIVE AGUKU Z5 (2001/DS) ~ "- " ~~' ©ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID SPAY DATE (MM/DD/YYYY) WAPPII6 O1 28 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: Amarioan Zurich Insurance Co. INSURER B: PERMA Town of Wappingger INSURER C: 20 Middlebush Rd Wa in ers Falls NY 12590 INSURER D: pp g 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 POLICY EFFECTIVE DATE MM/DDM! POLICY EXPIRATION DATE MMIDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X X COMMERCIAL GENERAL LIABILITY CP09063089 01/22/09 01/22/10 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- JECT Loc Em Ben. 1MIL/3MIL AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 10 ~ ~ O 0 0 A X ANY AUTO BAP9063090 01/22/09 01/22/10 (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 EA ACC OTHER THAN $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10000000 A X OCCUR ~ CLAIMSMADE LJM69063091 01/22/09 01/22/10 AGGREGATE $ 10000000 DEDUCTIBLE $ ~[ RETENTION $ 10000 $ WORKERS COMPENSATION AND ' W A U- TH- X TORY LIMITS ER B EMPLOYERS LIABILITY W0000120901 08/01/08 08/01/09 E L EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE . . OFFICER/MEMBER EXCLUDED? f d i E.L. DISEASE - EA EMPLOYEE $ yes, I escr be under SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ~~ ((~~ C The County of Dutchess is provided additional insured status with respe~~bd/ ~- the Dutchess Rail Trail Mainenance Agreement, File #G-1391-K. dAN 3 ~ 2009 ~01MN CLCRK CERTIFICATE HOLDER CANCELLATION DUTC-12 ~ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION County of Dutchess 22 Market Street Poughkeepsie NY 12601 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE 70 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AGORD 25 (Z0UI/UH) ©ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE OPID SPAY DATE(MM/DDmYY) WAPPII6 O1 28 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: American Zurich Insurance Co. INSURER B: PERMA TOwn of Wappinger INSURER C: 20 Middlebush Rd W i NY 12590 F ll INSURER D: app ngers a s 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 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 MM/DD/YY POLICY EXPIRATION DATE MMIDDlYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X X COMMERCIAL GENERAL LIABILITY CP09063089 01/22/09 01/22/10 PREMISES Eaoccurence) $ 10000 0 CLAIMS MADE a OCCUR MED EXP (Any one person) _ $ 5000 PERSONALBADVINJURY $ 1000000 GENERAL AGGREGATE $ 3000000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 3000000 POLICY PRO- JECT Loc Em Ben. 1MIL/3MIL AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT E $ 1000000 A X ANY AUTO BAP9063090 01/22/09 01/22/10 a 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: qGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10000000 A X OCCUR ~ CLAIMSMADE >;JMB9063091 01/22/09 01/22/10 AGGREGATE $ 10000000 DEDUCTIBLE $ X RETENTION $ 10000 $ WORKERS COMPENSATION AND ' X TORY LIMITS ER B EMPLOYERS LIABILITY WCOOO120901 O8/Ol/O8 08/01/09 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 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ~~ ~ ~ ` ' The County of Dutchess is provided additional insured status with res V the Dutchess Rail Trail Mainenance Agreement, File #G-1391-K. JAN ~ C 2009 Tn~n~ Ci~CRK CERTIFICATE HOLDER CANCELLATION DUTC-12 ~ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION County of Dutchess 22 Market Street Poughkeepsie NY 12601 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,IT3 AGENTS OR ACORD 25 (2001108) ©ACORD CORPORATION 1988 DATE (MMIDDIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE DUTCH RS 01 22 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE yiarsh~ll & ,Sterling, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 103 Executive Drive, Suite 300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. vew Windsor NY 12553 Phone:845-567-1000 Fax:845-567-1030 County of Dutchess Office of Risk Management 22 Market Street Poughkeepsie NY 12601 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Ar onaut Insurance Com an INSURER B: INSURER C: INSURER D: INSURER E: V V Y Lf~I'~V ~v THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. 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. ani icv NUMBER DATE MMIDD~ DATE MMIDD/YY LIMITS ISR TYPE OF INSURANCE GENERAL LIABILITY X X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR A IA 4611579 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- LOC POLICY n JECT AUTOMOBILE LIABILITY }[ ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS 4611579 GARAGE LIABILITY ANY AUTO EXCESSlUMBRELLA LIABILITY OCCUR ~ CLAIMSMADE 4611579 DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below EACH OCCURRENCE $ lOOOOOO 10/01/08 10/01/09 PREMISES (Eaoccurence) $ 100000 MED EXP (Any one person) $ PERSONAL&ADVINJURY $ lOOOOOO GENERAL AGGREGATE $ 2000000 PRODUCTS-COMP/OPAGG $ 2000000 10 / 01 / 0 8 10 / 01 / 0 9 COMBINED SINGLE LIMIT (Ea accident) $ lOOOOOO BODILY INJURY (Per person) $ BODILY INJURY (Per accident) PROPERTY DAMAGE {Per accideni) $ $ AUTO ONLY - EA ACCIDENT $ OTHER THAN ~ P`CC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ lOOOOOOO 10/01/08 10/01/09 AGGREGATE $ 10000000 $ $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ~~'°` +,k ~ Town of Wappinger is provided Additional Insured status, when required by ~ ~~ ~ written contract or agreement, with respect to Insured's contract agreement `' r~~P with the Town of Wappinger for repair and maintenance of the Dutchess Rail ,' Trail. CERTIFICATE HOLDER Town of Wappinger 20 Mi.ddlebush Road Wappingers Falls NY 12590 CANCELLATION TOWAPPl 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. ©ACORD CORPORATION 1988 ACORD 25 (2001108) 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. ~, .gin, ~ 4 ~ `~~ . ACORD 25 (2001/08) PHILADELPHIA INDEMNITY INSURANCE COMPANY ONE BALA PLAZA SUITE 100 BALA CYNWYD PA 19004 REINSTATEMENT NOTICE Named Insured & Mailing Address: WOODHILL GREEN CONDOMINIUM ASSOCIAT 1668 ROUTE 9 BLDG 1 WAPPINGERS FALLS NY 12590 Producer: 0023404 DONN GERELLI ASSOCIATES INSURANCE AGENCY, INC 1 CROTON POINT AVE. CROTON-ON-HUDSON NY 10520 Policy No.: PHPK361089 Type of Policy: PACKAGE INCLUDING AUTO You recently received a notice advising this policy was being cancelled effective 02/01/2009 . This notice is to advise that the policy is being reinstated without lapse in coverage. «, Other Party of Interest TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 FORM# CT969897NY51995 Copy for Other Interests ODEN 3.0.06.t0a Date Mailed: 20t3h day of January, 2009 ~ °~ ' tv1AUREEN O'BRIEtJ NYCT36 01202009SINY Page 1 of 1 Farm Family Casualty Insurance Company ® Glenmont, New York 01 /20/09 TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FAL NY 12590-4004 POLICY REINSTATEMENT NOTICE In accordance wfth the policy terms and conditions, it is hereby agreed that the Cancellation Notice issued on policy number 31 14X0137 ,for the below named insured, to become effective 01 /20/09 , is hereby rescinded. Named insured and address: ROOM TO GROW INC 7 POTTER PL HOPEWELL JCT NY 12533-5151 Cppy DATE (MMIDD/YYYY) ACORD,. CERTIFICATE OF LIABILITY INSURANCE TE°HM i 12 09 os THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Ralph V . Ellis , Inc . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 15 Davis Ave., P.O. Box 3288 Poughkeepsie NY 12603 Phone:845-485-6300 Fax:845-485-6603 INSURED Tech Mechanical DC DBA Conklin's Tech-Mechanical Inc 5 Parker Avenue Poughkeepsie NY 12601 ~~ NAIC # INSURERS AFFORDING COVERAGE 14788 INSURER A: NATIONAL GRANGE MUTUAL ~ INSURER B: ZURICH INSURANCE COMPANY INSURER C: INSURER D: INSURER E COVERAGES ANY REQUIREMENTSTERM OR CONDIT ON OF ANY CONTRACTOR OTHER DOCUMENT W TH RESPECTOTO WH CHIT IS CEIRTIF CDAITE MADY BEOI SUED OR DING 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. POLIC EFFECTIVE POL Y EXPIRATION LIMITS IRSR~ADD' POLICY NUMBER DATE MMIDDIYY DATE MMIDD/YY LTR NSRD TYPE OF INSURANCE EACH OCCURRENCE S 1 0 0 0 O O O GENERAL LIABILITY 5 5 0 0 0 O O COMMERCIAL GENERAL LIABILITY MPV 6 8 5 3 2 12 / 13 / 0 8 12 / 13 / 0 9 PREMISES (Ea occurence) A X ~~ MED EXP (Any one person) 5 1 0 0 0 0 CLAIMS MADE ,~ X OCCUR PERSONAL & ADV INJURY S ], O O O O O O GENERAL AGGREGATE s 3 0 0 0 O O O PRODUCTS -COMP/OP AGG S 3 0 0 0 O O O GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JECT LOC COMBINED SINGLE LIMIT g 1000000 AUTOMOBILE LIABILITY 12/13/08 (Ea accident) 12/13/09 A $ i ANY AUTO B1V68532 BODILY INJURY ~ ALL OWNED AUTOS (Per person) SCHEDULED AUTOS B1V68532 12/13/08 12/13/09 gODILYINJURY $ t) id X HIRED AUTOS 12 / 13 / O 8 en 12 / 13 / 0 9 (Per acc }[ NON-OWNED AUTOS B1V68532 pROPERTYDAMAGE (Per accident) AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY EA ACC S OTHER THAN ANY AUTO AUTO ONLY: AGG 5 EACH OCCURRENCE S 3, 0 0 0, O O O EXCESSIUMBRELLA LIABILITY 12/13/08 AGGREGATE $ 3, 0 0 0, O O O 12/13/09 UR ~ CLAIMSMADE CW68532 ~ A }( OCC - DEDUCTIBLE $ $ RETENTION $ X TORY LIMITS ER WORKERS COMPENSATION AND Y ' 12 / 13 / 0 8 12 / 13 / 0 9 E.L. EACH ACCIDENT S 1 0 0 0 O O O ~' LIABILIT EMPLOYERS ANY PROPRIETOR/PARTNER/EXECUTIVE WCV 6 8 5 3 2 E.L. DISEASE - EA EMPLOYEE 5 I.O O O O O O OFFICER/MEMBER.F_XCLUDED? E.L. DISEASE -POLICY LIMIT S 1 0 0 0 O O ((yes, describe under SPECIAL PROVISIONS below OTHER 01/01/07 12/31/09 TTY Disabi statu ory B DISABILITY 5291139-001 NS (LOCATIONS (VEH ICLES /EXCLUSIONS ADDED BY ENDOR SEMENT I SPECIAL PR OVISIONS DES CRIPTION OF OPERATIO r ~ ~~ C ~~ ~ _ DEC 1 ~ ~~~' CERTIFICATE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS NY 12590 CANCELLATION `^"'""' a' - ` ,I,O~~ -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOP DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 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. CORPORATION 1988 ACORD 25 (2001108) AV V/.~! ------ PRODUCER Vr..~ ~ ~ .. ^v~~. r. v. rev •r.r~^ . . Ralph V. Ellis, Inc. 15 Davis Ave., P.O. Box 3288 Poughkeepsie NY 12603 Phone:845-485_6300 Fax_845-485-6603 INSURED Tech Mechanical DC DBA ~Conklin's Tech-Mechanical Inc 5 Parker Avenue Poughkeepsie NY 12601 ......... ~. ......~ TECHM-1 ~ 1l/U: 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. NAIC # INSURERS AFFORDING COVERAGE ___ ~_.__ I 14788 i( wsuRER A: NATIONAL GRANGE MUTUAL ~_____ II nlCl IRFR R' ZURICH INSURANCE COMPANY _ I ______ inlcuRFR C' INSURER D: INSURER E COVERAGES ANY RUEOUIREMENT,STERM ORCONDITION OF ANY CONTRACT OR OTHER DOCUMENN W TH RESPECTOTO WH CH ITHIS CERTDIF LATE MADY BEOISSIUED OR DING 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. P LICY EFFECTIVE POLI Y EXPIRATION LIMITS INSRV>,DD' POLICY NUMBER DATE MMIDDIYY DATE MM/DD/YY EACH OCCURRENCE $ 1 O O O O O O LTR pNSRO, TYPE OF INSURANCE GENERAL LIABILITY $ 5 0 0 0 O O I~ X I COMMERCIAL GENERAL LIABILITY MPV 6 8 5 3 2 12 / 13 / O 8 12 / 13 / 0 9 PREMISES (Ea occurence) A ( ~~ MED EXP lAny one person) $ 1 O O O O ~~ CLAIMS MADE L' X I OCCUR i PERSONAL & AOV INJURY $ 1 0 0 0 O O O I GENER/+L AG~:~REGATE ~ ' s 3 0 0 0 O O O I~ GEN'L AGGREGATE LIMIT APPLIES PER: set, NY 11791 F(.p. Industries, Inc. 2481 Charles court Bellmore, NY 11710 11~ ~ PRODUCTS • COMP/OP AGG I$ 3 0 0 0 O O O INSURERS AFFORDING COVERAGE wsuRER A: Travelers Indemnity Ca INSURER B: State Insurance Fund INSURER C'. INSURER D: I INSURER E: NAIC # ERAGES MENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ELOW HAVE BEEN ISSUED TO THE IN CURED NAMED ABOVE FOR THE PO SCEXC RUO NS AND CONDIT ONS OF S DCH E POLICIES OF INSURANCE LISTED B Y REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER D LIMITS ~Y PERTAIN, THE INSURANCES OWN MAY HAVE BEN RIEDUDCED BY PAID CAIMS SUBJECT TO ALL THE TE U )LILIES. AGGREGATE LIMITS POLICY EFFECTIVE P DATE MMIDDIYYON $1 OOO OO POLICV NUMBER DATE MMIDD/YY 12131109 EACH OCCURRENCE NSR TYPE OF INSURANCE 12,/31IO8 DAMAGE TO RENTED $3OO OOO ~ 680605Y0045 $5 000 GENERAL LIABILITY L GENERAL LIABILITY MED EXP (Any one person JURY X COMMERCIA OCCUR a _ pJ~RSONAL & ADV IN $~ OHO OOO CLAIMS MADE GENERAL AGGREGATE ----~- DUCTS -COMP/OP AGG $2 OOO OOO ___.._ - PRO GEN'L AGGREGATE LIMIT APPLIES PER: $ OMBINED SINGLE LIMIT PRO- LOC POLICY JEGT C (Ea accident) AUTOMOBILE LIABILITY $ BODILY INJURY ANY AUTO (Per person) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (per accident) HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS (Per accident) _~- AUTUONLY-EAAC~ID_'~~ $ cAACC $ -- GARAGE LIABILITY Ol'HER TI1AN AGG $ AUTO ONLY: $5 OOO OOO ANY AUTO 12131109 EACH OCCURRENCE $5 OOO OOO 12131108 EX291 K8213 AGGREGATE EXCESS/UMBRELLA LIABILITY $ OCCUR ~ CLAIMS MADE $ DEDUCTIBLE WC STATU- OTH- 11101109 X ~~ - RETENTION $ 12254298 $100,000 11101108 E.L. EACH P.CCIDENT WORKERS COMPENSATION AND DISEASE - EA EMPLOYEE $100+000 L E EMPLOYERS' LIABILITY _^, ,r ` ~ . . _ . __ .,.,~ irv I IMIT $500+000 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. v BAR ~ 2~~ ..~~n~n~ M^A ~~v ACORD 25 (2001/08) ACORD~, CERTIFICATE OF LIABILITY INSURANCE 3/5%2009 ~) PRODUCER (585) 546-3747 x7727, Fax (585) 424-2798 ?irst Niagara Risk Management, Inc. THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Suite 777 Canal View Boulevard 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. , 2ochester, NY 14623-2825 Attn: Louise Cook INSURERS AFFORDING COVERAGE NAIC # NSURED INSURER A:TraVelerS PC of America donro Muffler Brake, Inc. ?00 Holleder Parkway tochester NY 146150945 wsuRER B: Cincinnati Insurance Co . __ 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, 7HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. ISR ADD'L I I Y A TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYI' POLICY EXPIRATION DATE MMIDD/YY LIMITS GENERAL LIABILITY TC2~7GLSA177D8217-09 04/01/2009 04/01/2010 H R E $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED (Ea ocrurrenc F,,~ 1 , 000 , 000 $ A CLAIMS MADE ~ OCCUR „ MED EXP An one erson $ 5 , 000 P N vl $ 1,000,000 GENERAL AGGREGATE $ 5, 000 , 000 GEN'LAGGREGATE LIMIT APPLIES PER: D T - P P $ 1, 000 , 000 X POLICY PRO LOC AU TOMOBILE LIABILITY TC2JCAP281D1136-09 04/012009 04/01/2010 COMBINED SINGLE LIMIT 000 000 $ 1 X ANY AUTO (Ea accidenQ , , A ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS ACTUAL CASH VALUE BASIS : Limit : (Per accident) X Garagekeepers COMPREHENSIVE $2,000,000 PROPERTY DAMAGE $ Covera a COLLISION $2, 000, 000 (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA A $ AUTO ONLY: qGG $ EXCESS/UMBRELLA LIABILITY CCC1154790 0?1/O1/2009 04/01/2010 $ 5,000,000 X OCCUR ~CLAIMSMADE AGGREGATE $ 5,000,000 3 DEDUCTIBLE $ X RET NT N 10 000 WORKERSCOMPENSATIONAND SEE SEPARATE WC STATU- OTH- EMPLOYERS' LIABILITY C105 . 2 FORM E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPE IAL PROVI IONS el w E.L. DISEASE -POLICY LIMIT $ OTHER ~~~~~~~ ESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIALPRQVISIONS ?~' ~ Tn~nanl ~-°R rR~ Town of Wappinger 20 Middlebush Rd. Wappingers Falls, NY 12590 CORD 25 (2001/08) 5025 (0108).08a CELLATION 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 AUTHORIZED REPRESENTATIVE Joseah Teresi/LCOOK ~~~ ~ ©ACORD CORPORATION 1988 Page 1 of 2 DATE (MM/DD/YVYY) ACa~DT~; CERTIFICATE OF LIABILITY INSURANCE D2/2D/D9 PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION harsh USA, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ~omedepot.certrequestClmarsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 ?ax (212)__.948_0902_____,. INSURED dame Depot U.S.A., Inc. 3/b/a The Home Depot >455 Paces Ferry Road 3uilding C-8 \tlanta, GA 30339 rn\/FRArFC INSURERS AFFORDING COVERAGE i NAIC # _ _ __ ___ -- - --- - -- WSURERA:Steadfast Ins Co 126387 INSURER B: Zurich American Ins Co 116535 INSURERC NATIONAL UNION FIRE INS CO OF PITTS 119445 INSURERD:New Hampshire Ins Co -- _ 123841 --t- wSUREREIllinois Natl Ins Co ';23817 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINU 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 n~ nnnv un~r~ occni ^Fn1 ICFn RY PAlll RI AIMS. NSRR ( ADD' ~ D POLICY NUMBER POLICY EFFECTIVE D T M D Y POLICY EXPIRATION LIMITS LTR IPR 3757 608-02 03/01/09 03/01/10 EACHOCCURRENCE I S4,000,000_ A GEN ERAL LIABILITY DAMAGETORENTED i TY LIMITS OF POLICY ARE EXC SS PREMISES Ea occurence 51,000,000 ~ COMMERCIAL GENERAL LIABILI R "OF SIR: $1,000,000 PER ~CC" MEDEXP(Anyoneperson) SEXCLUDED I CLAIMS MADE OCCU ~ PERSONAL&ADVINJURY 54,000,000 GENERALAGGREGATE 54,000,000 I r- ' ' PRODUCTS-COMP/OPAGG 54,000,000 L AGGREGATE LIMIT APPLIES PER GEN - i X I POLICY n PRO- LOC B ~ I AUT OM081LELIABILITY BAP 2938863-06 03/01/09 03/01/10 COMBINED SINGLE LIMIT 51,000,000 X (Ea accident) - ANY AUTO ALL OWNED AUTOS BODILY INJURY 5 (Per person) I SCHEDULED AUTOS HIRED AUTOS BODILY INJURY 5 (Per accidenq NON-OWNED AUTOS I X SELF INSURED AUTO PROPERTY DAMAGE S ~--i (Per accident) ; I (PHYSICAL DAMAGE AUTO ONLY - EA ACCIDENT S GARAGE LIABILITY OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG S A IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE 5 5, 000, 000 EXCESSlUMBRELLALIABILITY E ~ X AGGREGATE S 5, 000, 000 CLAIMSMAD OCCUR DEDUCTIBLE S C RETENTION S 3566916 (CA) 03/01/09 03/01/10 WC STATU- OTH- X TORY LIMIT ER , D WORKERS COMPENSATION AND EMPLOYERS'LIABILITV 3566915(AOS) 03/01/09 03/01/10 E.L. EACH ACCIDENT 51,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED% 3566917 (FL) 03/01/09 03/01/10 E. L. DISEASE-EA EMPLOYEE 51,000,000 E II yes, describe under E.L. DISEASE -POLICY LIMIT S 1 , 0 0 D , 0 00 SPECIAL PROVISIONS below D F OTHER Workers Compensation TX Em to ers Excess 3566918 (KY, MO, NY, WI, TNSC45694422 (TX) ) 03/01/09 03/01/09 03/01/10 03/01/10 ~ 25M/2M Occurre~c,e/ ~ ~ C Workers Compensation 4601323(QSI) 03/01/09 03/O1/lA ~ ~ ,y~~ 4~ " DESCRIPTION OFOPERATIONS / LOCATIONS I VtHIGLts r excwaivrva wuucv o r ~,..+.+..~~~.~~•~ • • ~• ~~•-•- • • •~-- •-•-•-- +" ..'L;I•..;. TE HOLDER TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS, NY 12590 USA ACORD 25 (2001/08) cyoungblood_hd 11158928 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 D 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 AUTHORIZED REPRESENTATIVE ©ACORD CORPORATION 1988 ADDIr IONAL INFORMATION PRODUCER larsh USA, Inc. iomedepot.certrequest@marsh.com 3475 Piedmont Rd NE, Suite 1200 >,tlanta, GA 30305 INSURED Some Depot U.S.A., Inc. 3/b/a The Home Depot >.455 Paces Ferry Road 3uilding C-8 Atlanta, GA 30339 DATE )MM/DDfYY) 02/20/09 COMPANIES AFFORDING COVERAGE COMPANY F Illinois Union Ins Co COMPANY G COMPANV H •**HOME DEPOT INSUREDS*** Home Depot U.S.A., The Home Depot, Inc. Entity List hem-Dry Limited Harris Research, Inc. HD Direct LLC Home Depot Installation Services, Inc. Home Depot USA, Inc. DBA The Home Depot THD At Home Services, Inc. DBA The Home Depot At-Home Services THD At-Home Services, Inc. The Home Depot, Inc. The Home Depot, Znc. Home Depot USA, Inc. Your Other Warehouse, LLC The Home Depot Bath Remodeling, Inc. \ P. 1V~~1 vy..~.,. ,~.~~f!' TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS, NY 12590 USA a~~y-___ MARSH USA INC.BY Page ~2 ~ _„~ -RD,~, CERTIFICATE OF LIABILITY INSURANCE 02/20/091YVYY) PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certrequest@marsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 948-0902 INSURED Home Depot U.S.A., Inc. d/b/a The Home Depot 2455 Paces Ferry Road Building C-8 Atlanta, GA 30339 ' INSURERS AFFORDING COVERAGE ; NAIC # INSURER A: Steadfast Ins Co 126387 -- - r INSURERB:Zurich American Ins Co 16535 - INSURERC:NATIONAL UNION FIRE INS CO OF PITTS 19445 - -- -- ~ ( ~ 23841 INSURERC:New Hampshire Ins Co I WSUREREIllinois Natl Ins Co ;23817 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 and InIF.~ AC;(~F2FC;ATF I IMITS SHnWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD' LTR Rd POLICY NUMBER POLICY EFFECTIVE pT Y POLICY EXPIRATION AT MM LIMITS A I IGENERALLIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE I S4,000,000 ~ LLIABILITY COMMERCIALGENER A LIMITS OF POLICY ARE EXCI SS 1 DAMAGETORENTED PREMIS~Eaoccurence) 51, 000, 000 ~ -_ OCCUR CLAIMS MADE Lx "OF SIR: $1,000,000 PER bCC" ~ MEDEXP(Anyoneperson) SEXCLUDED_ ~ PERSONAL&ADVINJURY $4,000,000 GENERALAGGREGATE 54,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG S4, 000, 000 X I POLICY PE ~ LOC B I AUT OMOBILELIABILITY BAP 2938863-06 03/01/09 03/01/10 COMBINED SINGLE LIMIT 51 000 000 X ANY AUTO (Ea accident) , , ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per accident) X SELF INSURED AUTO PROPERTY DAMAGE 5 PHYSICAL DAMAGE (Peraccidentj GA RAGE LIABILITY AUTO ONLY - EA ACCIDENT 5 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG S A EXCESS/UMBRELLA LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE 5 5, 000, 000 X OCCUR ~ CLAIMSMADE AGGREGATE 5 5, 000, 000 5 DEDUCTIBLE 5 RETENTION S S C WORKERS COMPENSATIONANO 3566916 (CA) 03/01/09 03/01/10 X TORY LIMITS OER D EMPLOYERS'LIABILITY 3566915 (AOS) 03/01/09 03/01/10 E.L. EACH ACCIDENT 51, 000, 000 E ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 3566917 (FL) 03/01/09 03/01/10 EL. DISEASE-EAEMPLOYEE ~ S1, 000, 000 If yes. describe under SPECIAL PROVISIONS below E. L. DISEASE-POLICY LIMIT 51,000,000 D F C OTHER Workers Compensation TX Employers Excess Workers Compensation 3566918 (KY, M0, NY, WI, TNSC45694422 (TX) 4801323(QSI) ) 03/01/09 03/01/09 03/01/09 03/01/10 03/01/10 0.3/01/10 Occurrence/SIR 25M/2M -~,.=~ -°~-`, DESCRIPTION OFOPERATIONS/ LOCATIONS /VEHICLES / EXCLUSIONS AUUtu dr trvuunstnatrv i i art~iN~ rnvviawrva .. ~ lb +YY ,'~ t;' e' ~' ~~~ TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGER FALLS, NY 12590 USA ACORD 25 (2001/08) cyoungblood_hd 11158927 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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 ' ~.._ s- . ©ACORD CORPORATION 1988