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2009 (11)Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in box "3" on this form is certifying that it is insuring the business referenced in box "la" for disability benefits under the New York State Disability Benefits Law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box " 2". Tliis Certificate is valid for the earlier ol'one year after this form is approved by flee insurance carrier or its licenser! agent, or the policy expiration date listed in box "3c ". Please Note: Upon the cancellation of the disability benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article, and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. DB-120.1 (5-06) Reverse STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) lb. Business Telephone Number of Insured Adelhardt Construction Corporation 212.279.3700 241 West 30th Street 4th Floor lc. NYS Unemployment Insurance Employer New York, NY 10001 Registration Number of Insured 1584059 Work Location of Insured (Only required if coverage is specifically ld. Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a Wrap-Up or Social Security Number Policy) 111987591 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) Travelers Property Casualty Company of America Town of Wappingers Falls 20 Middlebush Road 3b. Policy Number of entity listed in box `°la" Wappingers Falls, NY 12590 DTJUB964K788 3c. Policy effective period 04/02/09 to 04/02/10 3d. The Proprietor, Partners or Executive Officers are © included. (Only check box if all partners/ofiicers included) ^ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also notify the above certificate holder within 10 days IFa 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 Certiftcate 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: H. Craig Treiber (Print name of authorized representative or licensed agent of insurance carrier) Approved by: ~"~~~~ 04/01 /09 (Signature) (Date) Title: CEO Telephone Number of authorized representative or licensed agent of insurance carrier: 516-745-0800 Please Note: Only insurance carriers and their licensed agents are azthorized 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 r~ucLl;VN~ CORD,M CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) PRODUCER 04/01/09 The Treiber Group,A/D/0 Arthur ONLY ANDICONFERS NO RIGHTS U ON THE CERTIFlCATE ION J Gallagher Co of NY Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 377 Oak Street - CS 601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Garden City, NY 11530-0601 INSURERS AFFORDING COVERAGE INSURED NAIC # Adelhardt Construction Corporation INSURER A: The Travelers Indemnity Co. of CT 25682 241 West 30th Street INSURER B: National Casualty Company 11991 4th Floor INSURER c: Travelers Property Casualty Co. of A 25674 New York, NY 10001 INSURER D: Travelers Surety & Casualty 36161 INSURER E COVERAGES ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH CHL HIS CERTIDFICATE MAY BE~I3SUED 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. I D LTR R TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A GE X NERAL LIABILITY DTNYC0964K7884 O4/O2/O9 04/02/10 EACH OCCURRENCE $1 OOO OOO COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $3OO OOO CLAIMS MADE a OCCUR MED EXP (Any one person) $1 O OOO P ERSONAL & ADV INJURY $1 OOO OOO ' GENERAL AGGREGATE $2 QOO OOO GEN L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS -COMP/OP AGG $2 OOO OOO POLICY X J CT LOC A AU X TOMOBILE LIABILITY ANY AUTO DT810964K7884 04/02/09 04/02/10 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X X HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESSIUMBRELLA LIABILITY UM00031743 O4/O2/O9 04/02/10 EACH OCCURRENCE $5 OOO OOO )( OCCUR ~ CLAIMS MADE AGGREGATE $5 OOO OOO DEDUCTIBLE X RETENTION_$ 10 OOO ~- _-_ ~ ~ V $ C . WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DTJUB964K7884 04/02/09 04/02/10 ~( WC STATU- OTH- G ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $5OO OOO OFFICER/MEMBER EXCLUDED9 If yes, describe under E.L. DISEASE - EA EMPLOYEE $5OO OOO SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $5OO OOO D OTHER Crime 3RD Party Covg. 104897482 03/13/09 03/13/10 $1,000,000 Emp. Theft DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ACC Job #1526 JP Morgan Chase 1460 Route 9 Wappinger Galls, NY ~ ~,L. The following are included as Additional Insureds, where required by ~'\ '~'~''+, ApR ~~ written contract: -_ ~~~, r --' JP Morgan Chase 575 Washington Blvd., Jersey City, NY 07310, Eric ;+"' (See Attached Descriptions) ~~~~~ ~%~F,as~ r'FRTIFICeTF 4nt nCG - - a.~~n ~ wry SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Wappingers Falls DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~n DAYS WRITTEN 20 Middlebush Road NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Wappingers Falls, NY 12590 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /" ernon~eronn~r~oi. -- °-------.-____-- - -- -- ~--- ••--~ . .+r ~ +r~~~ao~rnnccyan LGU ©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 farm 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. r1~.vrcu ca-a ~cuvuua/ Z Of 3 #5229827/M229821 Arthur J. Gallagher Risk Management Services, Inc. 1D Columbus Boulevard Hartford, CT 06106 USA Insurance Certificate Experts Town of Wappinger 20 Middlebush Road Wappinger Falls„ NY 12590 USA Thie document was brought to you by CertificateaNow and Arthur J. Gallagher Risk Management Services, Znc. in Hartford, CT. If you have questions regarding the content of this document, please contact the Producer/Agent listed on the certificate of insurance. The data included in this notice and in the attached document is confidential to ConfirmNet and Arthur J. Gallagher Risk Management Services, Inc. cc: MAY ~ ~ 2009 -~~,~ye~i ~LF_Rt! Caj"y The data included in this notice and in the attached document is confidential to ConfirmNet and the party responsible for bringing you this information. A~RO® CERTIFICATE OF LIABILITY INSURANCE YYYY) OS/04/09 PRODUCER 1-860-560-2766 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Riak Management services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10 Columbus Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hartford, CT 06106 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: LIBERTY MUT INS CO 23043 C R Systems, Inc. dba Canopy Roofing Systems INSURER e: 505 North State Road INSURER C: Briarcliff Manor NY 10510 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'L POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER YY 7 y LIMITS A GENERAL LIABILITY TH1-L15-007332 05/01/09 OS/O1/10 EACH OCCURRENCE $ 1, 000, 000 N ED O X COMMERCIAL GENERAL LIABILITY ~ Ea o PREM SES nce $ 300, 000 CLAIMS MADE ^X OCCUR MED EXP (qny one person) $ 10 , 0 00 PERSONAL&ADV INJURY ___ _ $ 1, 000, D00 GENERALAGGREGA7E $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 , 00 0 , 0 00 POLICY X FR~ LOC A AUT OMOBILE LIABILITY AS1-L15-007332 05/01/09 O5/O1/10 COMBINED8INGLELIMIT 000 (Ea accident) , 000 $ 1, X ANY AUTO ALL OWNED AUTOS - BODILY INJURY (Per person) $ SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY TH2-631-509127. 05/01/09 O5/O1/10 EACH OCCURRENCE $ 5,000,000 X OCCUR ~ CLAIMS MADE AGGREGATE $ 5, 000, 000 DEDUCTIBLE $ X RETENTION $ 10, 000 $ A WORKERS COMPENSATION WC2-L15-007332 05/01/09 05/01/10 ~ X WCSTATT- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ 1, 000, 000 ^ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1, 000, 000 If yes, describe under - Y L 000 000 -~$ 1 SPECIAL PROVISIONS below E F. , , OTHER MAY 7 ~ ~~ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES !EXCLUSIONS ADDED BYENDORSEMENT /SPECIAL PROVISIONS o p p ^ p ~~lrllF~' is~~r-V CERTIFICATE HOLDER CANCELLATION to days notice due to non-payment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, 7HE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Town of Wappinger 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 20 Middlebuah Road REPRESENTATIVES. Wappinger Palls„ NY 12590 AU7HORIZEDREPRESENTATIVE ~ USA ~ ~~~~- ACORD 25 (2009/01) royehar 11818912 © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACOff'D,w CERTIFICATE OF LIABILITY INSURANCE OP iD DY DATE (MM/DD/YYYY) ~_-_- M&OSA-1 05 / 0 6/ 0 9 PROnucER 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 rhone:845-877-9901 Fax:845-877-6771 INSURED M & 0 Sanitation Inc 70 Fairview Ave Poughkeepsie NY 12601 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Peerless Insurance Company 24198 INSURER B: Excelsior Insurance Company 11045 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 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. I LTR NSR TYPE OF INSURANCE POLICY NUMBER POI Y E I E DATE MM/DD/YY P EXP RATIO DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ lOOOOOO A X COMMERCIAL GENERAL LIABILITY CBP9605982 05/01/09 O5/O1/1O PREMISES (Eaoccurence) $ 100000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ SOOO PERSONALBADV INJURY $ lOOOOOO GENERAL AGGREGATE $ 2000000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $2000000 POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A ANY AUTO BA9607082 05/01/09 O5/O1/1O (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: qGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 $ OCCUR ~ CLAIMSMADE CU9608182 05/01/09 O5/O1/1O AGGREGATE $ 1000000 DEDUCTIBLE $ }[ RETENTION $ 10000 $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe w ider SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT ' $ OTHER C~~v~ DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS As per policy. ~~~ Fl ~ '.°~,.,,, .. q ~:~ . °"~. ~n~NRi CLE R~ !`CQTICICATF 4lfll IIFR GA NGtLLA I IUN TOWNOFW 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 Wappingers IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 20 Middlebush Road Wappengers Falls NY 12590 REPRESENTATIVES. AU RIZE RE NATIVE ACORD 25 (2001/08) ~ - ter' V HGUKU I.VKYVKH 1 IVN 7y06 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 after the coverage afforded by the policies listed thereon. ~' ~ r ~ECEB1/E~ MAC' ~ 7 Zi~O~ ~~R~l~I ~:L~'F~~ ACORD 25 (2001/08) ACORD,. CERTIFICATE OF LIABILITY INSURANCE OP ID MO PANTE-2 DATE(MMIDD/YYYY) 04 28 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Brinckerhoff & Neuville, Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1134 Main St. , PO Box 424 ALTER THE C ERAGE AFFORDED BY THE POLICIES BELOW. Fishkill NY 12524-0424 / ~~ '' Phone:845-896-4700 Fax:845-897-5110 ~~ ~~ INSURERSAFFORDIIVfa~~ NAIC# INSURED INSURER A: Se]~i~ Iysy,Fauce Company - -. - -- ~ -~-i ~i- _ - - - 12572 -_-- ---- -- J INSURER B. 2~Q Pantel Contracting Corp. - _ - ------ ~T--- - - -_ WSURER C: _ _ ~n~°,. _ -.- --- PO Box 358 Wappingers Falls NY 12590 _ _ _ _ - __vv'1 INSURERO_ _- ~~~ _ - _- INSURER E: ~ ~ V V V tKAlatJ 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 - - -- ---- - -- - -- --- -_-_ POLICY EFFECTIVE P LICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY -- , EACH OCCURRENCE $ 1, 0 0 0, 0 0 0 A X COMMERCIAL GENERAL LIABILITY $1788083 05/01/09 05~01~10 -IIA111AGE TO RENTFi7- PREMISES (Fa occurence) - - - __ _ $ 50,000 l CLAIMS MADE X 1 OCCUR - ME D EXP (Any one person) $ 5 , 0 0 0 __ ~ _ __ PERSONA( & ADV INJURY $ 1 , Q Q Q , Q Q Q _ _ _ __ __ _ - GENERAL AGGREGATE $ 3 , Q Q Q , Q Q 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 3 , Q Q Q , Q 0 Q POLICY }[ PRO- LOC JECT AUT OMOBILE LIABILITY ~ ~ COMBINED SINGLE LIMIT $ 1 000 000 A ~ X l ANYAUTO 51788083 05/01/09 05~01~10 (Ea accident) , ~ ALL OWNED AUTOS -. ~ BODILY INJURY SCHEDULED AUTOS i (Per person) X ii HIRED AUTOS F.--_ -- - -- --~ ---- ---- ~- __.-.__.__-_. ---- i 1 -- - BODILY INJURY $ X i NON-OWNED AUTOS (Per accident) r-..I ---_ _ -- _ ' - --- ---- - ---- i ~ PROPERTYDAMAGE $ (Per accident) ~ GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ -_ _ l ! j ANY AUTO - EA ACC OTHER THAN ____ $ -- _ - - --_ AUTO ONLY. AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5 O Q Q, Q 0 0 A X OCCUR ~ CLAIMSMADE 51788083 05/01/09 05~01~10 AGGREGATE $ 5, QQQ, QQQ I -- __ $ DEDUCTIBLE _ _ $ X RETENTION $10,000 $ WORKERS COMPENSATION AND I TORY 1-IMITS~ j ER EMPLOYERS' LIABILITY _, _ __ ANY PROPRIETOR/PARTNER/EXECUTIVE E L. EACH ACCIDENT .__ -_. _..___ ~$ ,_-_- -. i OFFICER/MEMBER tXCLUDED9 ' t L. DIS~A5f. - EA EMPLGYEL _ $ If yes, describe under - -- -------- - SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ I OTHER DESCRIPTION OF OPERATIONS (LOCATIONS (VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS GtK I IhIGAI t HOLDER CANCELLATION WAPPING SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL TOWn O f Wappinger IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 20 Middlebush Road REPRESENTATIVES. Wappingers Falls NY 12590 AUTH IZEDREPRESENTA E /) ~/Y'yfiLCi ~--s{/V/ MI.VRU G.7 ~CVV 1/VOJ v ©ACORD CORPORATION 1988 ACORDM CERTIFICATE OF LIABILITY INSURANCE OP ID MO PRICE-1 DATE (MMIDD/YYYV) 04 07 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Brinckerhoff & Neuville, Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1134 Main St. , PO Box 424 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fishkill NY 12524-0424 Phone:845-896-4700 Fax:845-897-5110 INSURERS AFFORDING COVERAGE ;NAIC# INSURED INSURER A' General Casualty ~ 24414 _ wsuRER B Ma~esta.c Insurance Company I _42269 -- Ronald H. Price and Sons, Inc. wsuRERC. 8 Cochran Hi11 Rd. INSURER U Poughkeepsie NY 12603 ~ _ - -- ---- --- -- - --- ~- _- - _ INSURER E I COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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 FIEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I/1DD' LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE TDATE (MM/DD/YY POLICY EXPIRATION DATE (MMIDDIYY -~-- - _ - - - ~ - --- - - - LIMITS ~' GENERAL LIABILITY EACH OCCURRENCE $ 1, 0 0 0, O O O ~ A X X !COMMERCIAL GENERAL LIABILITY CCXO 3 714 6 8 0 8/ 14 / 0 8 0 8/ 14/ 0 9 -17AMRGE-iO-AENTED ----- PREMISES (Ea occurence) I $ 10 0, 0 0 0 I --_.~ I i I ~ CLAIMS MADE I X OCCUR --' _- MED EXP (Any one person) --- -. __- -- l i$ 5, 0 0 0 ' _ { - ~ ~ PERSONAL & AOV INJURY $ 1 , O O O , O O O ! ! J - -- -._-. __. --- ------ i GENERAL AGGREGATE -- $ 2, 0 0 0, 0 0 0 - - - I ' ! GEN'L AGGREGATE LIMIT APPLIES PER: ...---- I--_-. ~- PRODUCTS -COMP/OP AGG ----- - ----- - $ 2 , O O O , O O O - 1 I ~ ~ jE~ POLICY I LOC f ~ j ~ ~ AUTOMOBILE LIABILITY ~ I ( ' COMBINED SINGLE LIMIT $ 1, 0 0 0, 0 0 0 X ANVnUTO A ' ' CBA0371468 08/14/08 08/14/09 (Eaaccidenq ALL OWNED AUTOS BODILY INJURY $ ' SCHEDULED AUTOS I ((Per person) i _ _ _ ---------- - ---- ---- ------_... X I HIRED AUTOS ~ I I Y ~' O 4 ' X 'NON-OWNEUAUTOS ~ I DII Y B NJUR (Per acciderU) - - '. $ ! ' - --- - _ _ PROPERTY DAMAGE $ I (Per accidenq i ~. GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 1 $ -- - -- - i ~ ANY AUTO ~ I I EA ACC $ OTHER THAN ----7 - -----... - --.._...... I I I I AUTO ONt_Y AGG ! $ j ~I EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE ~ $ 3, 0 0 0, O O O A X I OCCUR l_-1 CLAIMS MADE CCU0371468 08/14/08 08/14/09 AGGREGATE $ 3, 000, 000 DEDUCTIBLE $ X RETENTION $ lO , 000 $ ' WORKERS COMPENSATION AND X TORY I.iMITS ER ~- - - - --_----- _ EMPLOYERS' LIABILITY ~ B I ANY PROPRIETOR/PARTNERIEXECUTIVE i C2OO8OS000-OZ 08/12/09 04/01/10 - EL. EACH ACCIDENT $ 1, 000, 000 OFFICERIMEMBER EXCLUDED I F.L. DISEASE - EA cMPLOYEE~ $ i , O O O , 0 G O yeS OE5GI"i bf; lindP,r ~' SPECIAL PROVISIONS below I _____....____-_-__ E.L. DISEASE. -POLICY LIMIT ____.._.__ ---_- ---_- $ 1 , 0 0 0 , 0 0 0 OTHER i ' I i UtJI:KIY I IUN Ur UYtKH I IUNJ / LUI:H I IUNJ I VtHIGLtS / tlI:LUJIUNS HUUtU tlY tNUUKStMtN I I SYtI:IHL YKUVWIUNJ The Town of Wappinger is included as an additional insured. I APR 0 ~ 209 -~r~~nr~nw ~~~~~ CERTIFICATE HOLDER WAPPING Town of Wappinger 20 Middlebush Road Wappingers Falls NY 12590 ACORD 25 (2001108) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUT~IZED REPRESENTA E L~ © ACORD CORPORATION 1988 PHILADELPHIA INDEMNITY INSURANCE COMPANY ONE BALA PLAZA SUITE 100 BALA CYNWYD PA 19004 REINSTATEMENT NOTICE Named Insured & Mailing Address: Producer: 0023404 WOODHILL GREEN CONDOMINIUM ASSOCIAT DONN GERELLI ASSOCIATES INSURANCE AGENCY, 1668 ROUTE 9 BLDG 1 INc 1 CROTON POINT AVE. WAPPINGERS FALLS NY 12590 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 03/31/2009 . This notice is to advise that the policy is being reinstated without lapse in coverage. ~ECEi~fE~ aPR ~ ~ 200 ~~~~~~: C~EI:iK :} Other Party of Interest TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 Dafe Mailed: 31st day of March, 2009 MAUREEN O'BRIEN NYCT36 FORM# CT969897NY51995 03312009SINY ODEN 3.0.08.12a Copy for Other Interests Page 1 of 1 R©~ CERTIFICATE OF LIABILITY INSURANCE OPID 1PAT DATE(MMlDDM1'Y) ~...~ UNITEDI 04 09/09 PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CLt3 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 INSURER A: $electlVe Ins CO of Amer 12572 INSURER B: 9artford IInderxriters Ina. Co. 30104 US Sports Institute, Ino. INSURER C: Markel Insurance Company 12 2~aiden Lane Bound Brook NJ 08805 INSURER D: State Insurance Fund INSURER E: Traveler's Insurance Co any 39357 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NS TYPE OF INSURANCE POLICY NUMBER DATE MMlDD1YY1'Y DATE MMlDDlYY1'Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 0 0 0 0 0 0 A X COMMERCIAL GENERAL LIABILITY S1842093 04/09/09 04/09/10 PREMISES (Eaoccurence) $ 100000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10000 PERSONAL&ADVINJURY $ 1000000 GENERAL AGGREGATE $ 3 0 0 0 0 0 0 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 3000000 POLICY PE4 LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT E id $ 1000000 A X ANY AUTO S1842093 04/09/09 04/09/10 l aacc enq ALL OWNED AUTOS BODILY INJURY P $ SCHEDULED AUTOS er person) ( HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE P id t $ ( er acc en ) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS !UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ^ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WOR AND KERS EMPL COMPENSATION OYERS' LIABILITY X TORY LIMITS ER $ ANY PROPRIETORlPARTNER/EXECUTIVE ~ OFFICER/MEMBER EXCLUDED? 6S60UB-0948055-5-0 12/07/08 12/07/09 E.L. EACHACCiDENT _ $ 500000 D (Mandatory in NH) 21427727-1 07/07/08 07/07/09 E.L. DISEASE-EA EMPLOYEE $500000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 500000 OTHER C Accident 4102AH239392 04/09/09 04/09/10 M~~~'~0 DESCRIPTION OF OPERATIONS !LOCATIONS /VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS ~ 2U~~ 4 APR Tln~nc~[ CI.FR~ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWAPPI DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Town of wappinger 20 Mi ddlebush Road REPRESENTATIVES. . Wappingers Falls NY 12590 AUTHORIZED REPRESENTATIVE AcORD 25 [2009101) GAf~d~B8~200~f~~ CORPORATION. All rights reserved. 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. ~~ ~. 9'O~P , ~/G 'j, `''~ ~~, ~~ , n~ T~ ACORDM CERTIFICATE OF LIABILITY INSURANCE 04/16/2009) PRODUCER ($45)896-2222 Kraus-Ritter Insurance 1081 Main St . FAX (845)896-4365 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 ] Fishkill , NY 12524 INSURERS AFFORDING COVERAGE NAIC # INSURED M. RICCI ELECTRIC ~ INSURER A: Preferred Mutual Ins. Co. 15024 4 ]AMES DORLAND DR. ~P~ ~ ~ ~~~~ INSURER e: First Rehabilitation Company WAPPINGERS FALLS, NY 12590 INSURER C: ~~'~~~' ~~~~'! INSURER D: "\ INSURER E: CAVFRO[;FS 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 CPP0160565087 11/22/2008 11/22/2009 EACH OCCURRENCE $ 1 ~ 000 ~ 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ loo ~ o0 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ lU , 00 A PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 3 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 3 , 000 , 000 POLICY PRO LOC JECT AUT OMOBILE LIABILITY PCA0100701665 11/22/2008 11/22/2009 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1, 000 , 000 ALL OWNED AUTOS BODILY INJURY A X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY UC 01405806 66 11/22/2008 11/22/2009 EACH OCCURRENCE $ 1, 000, 000 OCCUR ~ CLAIMS MADE AGGREGATE $ A $ DEDUCTIBLE $ X RETENTION $ 10,00 $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ EWE Y DBL136751 10/18/2008 10/18/2009 ORK STATE B ISABILITY INSURANCE DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Wappi nger BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 20 Mi ddl ebush Rd AN UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Wappingers Falls, NY 12590 AVl~HO DREPRESENTA ecnRn ~~ ~2nnvnRl / ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) ERIE INSURANCE COMPANY Erie° Insurance P.O. BOX 1699 ERIE, PA 16530 OTHER INTEREST COPY Company CANCELLATION NOTICE Member •Erie Insurance Group 100 Erie Ins. PI •Erie, PA 16530 MAIL DATE 04/16/09 CANCELLATION EFFECTIVE POLICY NUMBER Q26 5320040 NY 05/19/09 12.01 AM DUE DATE 02/03/09 POLICY EFFECTIVE DATE 02/03/09 STANDARD TIME FIVESTAR CONTRACTORS POLICY NAMED INSURED WARREN CUSTOM BUILDERS INC AP-00011 TOWN OF WAPPINGERS FALLS AQ-00012 6 RAYMOND AVE NN1116 20 MIDDLEBUSH RD NN1116 POUGHKEEPSIE NY 12603-2363 WAPPINGERS FALLS NY 12590-4004 WE ARE NOTIFYING YOU THAT THE ABOVE POLICY IS CANCELLED AS OF THE CANCELLATION EFFECTIVE HOUR AND DATE SHOWN ABOVE, UNLESS ON OR BEFORE SUCH DATE, THE PREMIUM IS PAID TO US OR OUR AGENT IOR 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. 00012 NN1116 PHONE GRAP GRAPEVILLE AGENCY, INC. 1-518-966-4466 ~ECEIVEC~ APR 7 0 200 ~"tllil/~! CLERK 94801C 6/00 ACORD CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDD/VYYY) ~, 04/09/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joy Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 639 E Main St HOLDER. THIS CERTIFICATE DOES ALTER THE COVERAGE AFFORDED NOT AMEND, EXTEND OR BY THE POLICIES BELOW. Middletown, NY 10940 INSURERS AFFORDING COVERAGE NAIC # INSURED Airflow Air Conditioning, Refrigeration & Heating, InC. tNSURERA: Efle Insurance__ _.._. P. O. Box 941 INSURER B: Highland, NY 12528 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 ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY QDK5205005 04/01/2009 04/01/2010 EACH OCCURRENCE $ 1 000 OOO COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurence $ 300 X00 CLAIMS MADE ~ OCCUR MED EXP (Any ane person) 5 _ __ 5,_00_ PERSONAL & ADV INJURY $ 1 000 Q00 GENERAL AGGREGATE $ 3 000 OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 3 000 OOO POLICY PRO LOC A AUT OMOBILE LIABILITY 0000199428 04/01 /2009 04/01 /2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1 000 000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY BCU5205005 04/01/2009 04/01/2010 EACH OCCURRENCE $ S,000,OOO A X OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- _ EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED9 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 ENDORSEM N I ~ APR ~ ~ 1008 ~~~ani ~~_~~ ~'CDTICICATF LIf11 r1FR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Wappinger Building Department 20 Middle Bush Rd ~ DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~~ 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. Wa In er, NY 12590 PP 9 -~ AUTHORIZED REPRESENTATIVE V AI:UKU I:UKYUKAI IUIV "IyiSC ACORD 25 (2001/08) b4714! lbby 14: b f ti45tiybiibl4 F~~1iNtSUW t'UUL~ f~~-ltat b~/ b~ f1PR-11-~QQ~ dlec''9P f ROMtPf2ETRI~PfIQOhE.~ IN5 1FJ954~~Q TOa896L3019 P.1,'~ ~,~ Chi ~'~'IFN~l4~"E C~~ LIABILITY (N~,r' UF~ANCE ~*~~ PROCUC~R U4J14JZ009 THIS CERTIRICATI; IS 19SUEp AS A MATTER OF INFORNIATiON Pretsk & PBgoDIeB hptsural ~ ONLY AND CONFERS Nd RIGHYS t1pON THE C~RTR=KATE 268$ South Road HOLDER. THIS C>rRTIFICATE ao~ NOT AMENO, Ex7'ENC OR Ai,YfwR THE COVERAGE A~pllpteD BY THE POLICIES BEROW. Poughkaepsle, NY 12601 Ph~6~WI80D,_ Fa~e~BA i 4lS2-Z11Q INSURERS AFFORDINQ COVERAGE NAIC tJ INSURe:o Ftralini>•ow Foal - Sa Coneitruetlon CA INa ~ lies HallUbrrn ~ C~lalu No Dlving Allc wad Ina D1BIA s: Goneral Ca.us ca 160T Route 69 dal Trades Co>te~ & Canatr Tenet Fla1NS111 II}Y 12' •24 uRHR o~ 1=11'bt Rehebdiiatlon Ltfe Ms Co pVERAGEB TMQ POLlCtE6 OF INBURANCL' LISTEp 8E1~DIM1r MtAVF BEgy i9SUlED TO TF~ INSLBiEO NAMED ABOVE PoR THE ANY REGI~NfiEMfiNT'. TERM OI ; CONDiT10N OF ANY CONTRACT' CIR DTM@tt OgCUMEJll7 WITH REBPBCf Tq MAY PERTAA~, TIiQ IN~URANG ; AFFOROEp SY TF1E POUCfES DES4`RIBED HERF]N IS SirB.IECT Tp ALL TiIE T POUCtEEi. AaGRiB8F1TE E,MW7'8 ! Hi?1AfN MAY FIAV<i 9AEN RECxICBQ BY PAIp CLAIMS, A X cowwsncwt eeNeF Lues,rnr 01 LIEN QU2102 11 101!2008 17/01/2409 CLAwis MADE I ~ OCCUR ~~ ~~ AQGR ieiA17~ p PEAS PR4 OC AYTOMOBIL9 LtABLL-TY B X ANY AUTO OBADa71048 07JOi/2008 071011Z'009 ~++aw++taAUros FCME~ULm AUT48 NIREp AUTO$ P(CN.ONINFp AUTO$ ~Ae4 uASltm ANY AUTO ~+cc~orusenar~R.A 1U100. ~Y ~p ~ C4 nAS Au1D6 DEDIlCTBLE RET ~ WOMiRR6 COeM'~IOAT~011 Ae14 C 6MPLOVBRn~L1AB9leY aD84950 M,r ~Ta+~PAR7Tr9elE7t81 UTIVE 44/01/2009 WJ07l2D10 OFFICERIMEW6ER E1tCtU0®4 II e, Uata@a y~y„ L orNe~e D NY$ Diaabinly D9L-1B984Q 01/diJ,xpo3 1-xlel`, oeaclaPT10N eF oriRAT14Nd r tour IRS / tfENICLP.s t E1(ctUmDNe Aon~i eY NNOOR~N6NT r sPecu~ pN0W91pN6 ~pD~1o116 Of iha Named In lurod. ~~~ .`'y ~ ~~.»`_ CANCELLAnoN Jri1Wl.oAl1Y OFTNAA~1eE Q~ PQ41C1W B5 C,AM(~tLl,@®!•ppITYIR ~(Ppth7AIV Town of UYappln )er oATe Ytualm~, im eeaunro resuleele wlt,t ewoeAVOR YO gA11. 1 D oAra reMrrRN Bullditlg QepsrtJ ~etlt nla~l¢TOtet6cetR~weAS~s~,,oa:RR~nm~W:Pr,BUTa~e.unetesoaeceNAU. x4 Middlebue>wh F d ARPOEE NO DeWQATTON OR iIAtINJYY QP ANY K{ND UPON TFt$ g19URtlee, na AOt3n'el OR Wapipingens Fall I, MY 72b90 N~nt~tfvRe, A4SMDIpttlp AQPIIREOITATNfl ~~ POLICY PEpN3D MiOtCRTGD_ MOTVIa7~MSTANIDIN6 41Ri1CFt THLS G'rcRTiFICATE tAAY 9E ISSUED OR ERlVI8, E%CI.U6tON$ AND CONiDITI01u3 OF 3uq{ ' ^e ~~ ~ENCE i OQO D~ ANNICeE To RQN7E 8a0 OCa _.. ~ro s 10 000 p 8ADV1 A1pY 1400dG0 + a AI. AaOR x aoa o00 PRODUeTS-ca PAGE s200D OD N.co~i~.~ ysaNC~ uutr :1,00C,OOQ ~a.YMwuRr t p001LYiKAJRr (Prr aedanq ~ PROPPROP ~DAktAOE s _ ~, p'fHP R TFNN = . AUTi3 UNL,Y- t9 i a a ~ BTATU• OTM• ~A~~ ioo,DOD _„ ~ nrl~ARF • FJUI r _ s.1D0~090 SAO Oo0 ssASS • POLICY uAm : ` , ~~ V ~~ APR ~ ~0~ ta~Y14/2t1t79 14:1x1 ~45~yb8N14 Af'~ t.4 2©07 l31 ac'~F' ~ ~"i: F'F'iETAICF'r"1faOMEi It~l,9 This ecrtificate is an t~riginat, htl~iNBUW F'UUL 16ftS~t52221~ NA~at ~'1l State ofNew York Werker's Compensatidn Hoard CERT'~F~t A~'E pF P.~~.'~ICg'ATI~IN AST WEJRI~'ER'S C~]~P'ENSATTON GRC7U~' SELF INSURANCE la. 4e~111Vnf1! emt Addrep oT8 uMes4 PARklptlit~ In Cir~pp &K flnAQn11E1cC (Use &treet nddrr ~ aqt~ td. Bnstie~t Talepl~wea Nurnbar stBostAar Reler+encsd Is "1.11". >vo 1Jlvlnp Allowlad, Inc. (845)8968320 OBA: Rainla~v Poo18 ~ Co1 structlan Cu. 1807 RoutB 52 Fishklll NY 1524 1c, iVYS UnelnpW,nnear Illsnrluce Employer Ilte~lr4rntlsn Nam4er orli~l-sirleas " " , Rafllseerad itt sax 1f , la. EtiectlvaftilltestMerlWerafllp In the Group d/1/20Ut'1 1fi205716 Iwm4 i1Mtc 4114/2ppB I xplr>disul bate 4/13(2t]10 tt lrcdmyl! f&mpbyror idrlrltlfldltlon Na~ber oFBnalnr~s AtsTerenced !n Box la The pruprletcr, t9lrhrers, or F. ;egpttve 4fi~ers wre „la„" '~ lACtodcd. (only chef T ~ All pArinere / otflcma 1n~dtal. 14'1836052 Q All arcladed or eerU in psrtncrs / olttcerR ¢xgslded. 2. Na1nc sad Addrers otthe Elttli~ xo~satttr~fl !'roof of Coaon~ 3, hlsama srld Address a! Group Shclnasra. (Entity Sd~ Noted se GbrtlfleH~ llalder), Taws of Weppingar SDdclal Trades, Contracting And Cotistrtlctian Truk BuAdMg t]epanment 8250 South Bay Road 20 Mtddte6ush Rd 8ylncuse, fYY 13039 Wappingers Felts, NY 1259 I Po11cy: Wt52i5b4 This cert~og that the busi7 ess ret'erottood above in box "1g" is cnmplyiltig with the mandatory coverage requir~etnents of the New York Stets 'Workers' ~ ;ompensatic-n Lave as a participat#rlg tlacmbcr of the Group Serf-Insurer listed above in box "3 and Participatialt irl such g bap self inqura>ttcc is still in force. The ~uP Salflnsut~er`s ,A,dttxinistrator will send this CerfSficatc of participation tv the entity listed above as the certiflc~te holder in box"2". The C~xoup Sclf insurer's A dminitor will notify the above cet'ti~ioate holder within 1Q days IF the rnemmbcrship of the Farticiparn listed x>1 box " 1 ~" is terminated. t~'llesc >QOtices may be sent by regular m,aiL) Qtllcrvvisc, this Certificate i,4 valid for a maximum of dlle year fr~ m the date c:erti~eed by the group self insurer.', Xf thls certi, ficate ~s rra lar~~ sr valid according to the abt~ve gs~fdelines a~ the business referenced in ba-x "1 a" contfrru~s to be Warned a,~ a permit, lic~st or contrast' issued by the c~rtificare holder, the hs~airiess ma~St provide the Certifrcate holder either with a rtew certificate or o~ 4gr authari~red pravf the busiK~ss is complying with the mar~datorp crrivvarage reguiremenls of the New York State Workers' (ompensatlon ,few. Under penalty of perjury, ]certify th at I rim an autho~rixed representative of the Group Self-insurer referenced above and that 'the business zcf~nCed iri ` Iox "1a" has the oovexagp as depicted Ott this farm. C~Tt1~1:i19y. Da~vtd~;~rfC9 iu nemo of a~~otJzod iepeesantatlve nt die tte+oup 3ett-h1~ Ct)Tt7lfa .il $y: 4/14120tJ8 (~s"mom) {~} Title; 'cruet Admi for -~` Telephcme N~ ntber; 315 Hsf~-ea73 GSI-145.2 {Z•4Z) Worker's Coimpetnsa~tlon Law ~~~o~~ V ~~' . APk ~ 5 2'00 ~insnt 1^0 ~~1. A~DRD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) TM 4 13 2009 PRODUCER phone: 315-451-1500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Haylor, Freyer & Coon, Inc. 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:Val1C' FOr e Insurance Com an 7000 Pyramid Network Services, LLC INSURERe:Underwriters at Llo ds 5786 Widewaters Pkwy 3214 0003 i INSURERC:CNA Insurance Com an 7000 - tt NY 1 Dew INSURER D: INSURER E: CnVFRAC;FS 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 PAZD CLAIMS. INSR LTR DD'L F POLICY NUMBER POLICY EFFECTIVE TE M DD POLICY EXPIRATION DATE M DD/YY LIMITS A GENERAL LIABILITY 0295961126 4/1/2009 4~1~2010 EACH OCCURRENCE $ 1 000 000 DAMAGE TO RENTED }{ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 5 0 0 0 0 0 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 1 0 0 0 0 PERSONAL 8 ADV INJURY $ 1 O O O O O O I GENERAL AGGREGATE $ 2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 0 0 0 0 0 0 POLICY X PRO ~' LOC j~ AUT OMOBILE LIABILITY 02092747094 4/1/2009 4~1~2010 COMBINED SINGLE LIMIT (Ea accident) $ 1, 0 0 0, 0 0 0 X ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY }', NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE '"° (Per accident) $ GA RAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ j~ EXCESS/UMBRELLA LIABILITY 02092747080 4/1/2009 4/1/2010 EACH OCCURRENCE $ 25 000 000 X OCCUR ~ CLAIMS MADE AGGREGATE $ 2 5 0 0 0 0 0 0 DEDUCTIBLE $ }{ RETENTION $ 10 0 0 0 $ C WORKERS COMPENSATION AND WC2094025878 1/1/2009 1/1/2010 WC STATU- OTH- X TORY IMITS R EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 5 0 0 O O O ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? , __ E.L. DISEASE - EA EMPLOYEE $ rj Q OJ_ Q 0 0-_-, If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 5 0 Q 0 0 0 B OTHER ppYR00108 10/18/2008 10/18/2009 $3M Ea. Claim/$3M Agg/ $IOOk Ded. Professional Liability ~ ^P~` ,~~` DESCRIPTION OFOPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS ~~` lL 9J +~oUv pp ~., ~~I!F ~ ~ 4..y~5 ~~ RFRTICICATF N[11 I'1FR CANCELLATION 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 Fall NY 12590 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ID7SURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~.., i r~, 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 does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ~~~I V ~~ ~-PR ~ ~ X00 „~lliill~l ~',R_F~~ c~~,y ACORD 25 (2001/08) STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name and address of Insured (Use street address only) 1 b. Business Telephone Number of Insured Pyramid Network Services, LLC 315-445-2424 5786 Widewaters Pkwy Dewitt NY 13214-0003 lc. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured (Only required if coverage is specifically ld. Federal Employer Identification Number of Insured or limited to certain locations in New York State, i. e. cr Wrap-Up Policy) Social Security Number 16-1592709 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) CNA Insurance Company Town of Wappinger 3b. Policy Number of entity listed in box "la": 20 Middlebush Road WC2094025878 Wappingers Fall NY 12590 3c. Policy effective period: 1/1/2009 t0 1/1/2010 3d. The Proprietor, Partners or Executive Officers are: x^ included. (Only check box if all partners/officers included) ^ all excluded or certain partners/officers excluded. 3e. Demolition is: (Definition of Demolition on Reverse) ^ included. x^ 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 not ~ the above certiftcate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for a maximum of one year after this form is approved by the insurance carrier or its licensed agent. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. ~~ . , p~ A rovedb James D. Freyer, Jr ~ YEC~I~ PP Y~ ~~ (Print name of authorized representative or licensed agent of insurancecarrier) t 4/13/20.09 ~P~ ~ ~ ~U~ Approved by: ,,--..~~-~ °~i %~~u.;u , ,~ (Signature) (Date) Title: Senior Vice President Telephone Number of authorized representative or licensed agent of insurance carrier: 315 -451-1500 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT authorized to issue it. C-105.2 (12-03) ~ - Workers' Compensation Law Section 57. Restriction on 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 carver 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. Definition of Demolition (Box " 3e." on the reverse side of this form) A building wrecking or demolition is one where a building, chimney or steeple is razed, or where a floor, exterior wall or roof is removed. If the contract involves only the removal of interior walls, partitions or the facing only of any exterior wall, it is not considered demolition. Out-of--State Companies Working in NYS --NYS Workers' Compensation and Disability Benefits Requirements for Permits, Licenses or Contracts issued by NYS Government Entities Generally, employers must have a workers' compensation policy or a combination of policies that cover each state in which they employ permanent employees to cover on-the job accidents and disabilities. As you are probably aware, certain insurance carriers write policies that cover multiple states. "Riders" found under sections 3A and 3C on the Information Page of the policy specify the states of coverage. In addition, the operations covered in each state are identified in attachments to the policy. In addition to any other state's workers' compensation coverages, an out-of--state employer needs to be specifically covered for NYS workers' compensation insurance when there are "sufficient contacts" between that employer and the state. While there is no single determinative factor, any of the following criteria could be the basis for finding "sufficient contacts" requiring New York coverage: • a physical location within New York State; • $50,000 in payroll during a calendar year in New York State; • one or more employees (including subcontractors) with a primary work location or hired within New York State; or • employees (including subcontractors) working in New York State for more than 90 days during a calendar year. If an out-of--state employer meets any of the above criteria, it is required to carry a New York State workers' compensation policy. When New York is listed in Item 3A on the Information Page of an employer's workers' compensation insurance policy, the employer is fully covered under the NYS Workers' Compensation Law. If insured through a private insurance carrier, the out-of--state employer must file a C-105.2 -- Certificate of Workers' Compensation Insurance (the business' insurance carrier will send this form to the government entity upon request) PLEASE NOTE: The New York State Insurance Fund provides its own version of this form, the U-26.3. If the out-of--state employer is legally, fully self-insured in New York State, the out-of-state employer must file a SI-12 -- Certificate of Workers' Compensation Self-Insurance (the business calls the Board's Self-Insurance Office at 518-402-0247). If the out-of-state employer is participating in group self-insurance, the out-of-state employer must file a GSI-105.2 -- Certificate of Participation in Worker's Compensation Group Self-Insurance (the business' Group Self-Insurance Administrator will send this form to the government entity upon request). If an out-of--state employer does not meet any of the above criteria and has New York (NY) listed in Item 3C on the Information Page of its workers' compensation insurance policy (the Other States Insurance section), NYS specific coverage is not required and the employer may be able to use its own state's workers' compensation coverage by filing a WC/DB-101 form. [The out-of--state employer's employees will be covered under NY benefits when working in New York by having NY listed in Item 3C on the In#~pr~yax~~workers' compensation insurance policy (the Other States Insurance section).] 66.J/ C-105.2 (12-03) Reverse ~ ~P~ ~ ~ ~~~~ _ ~..~~. ...,~.__... _..._... DATE(MM~DD~YYYY) CERTIFICATE OF LIABILITY INSUItAtVrCE oa~ol~2009 A CORD ,M raonucER Aon Risk Services South, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Richmond VA Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 7325 Beaufont Springs Drive CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 300 i h d 23225 COVERAGE AFFORDED BY THE POLICIES BELOW. R c mon vA u5A INSURERS AFFORDING COVERAGE NAIC # PHONE 866 283-7122 FAX- 847 953-5390 INSURED INSURER A: National Union Fire Ins Co of Pittsburgh 19445 u.s. Remodelers, Inc. INSURERB commerce & industry Ins Co 19410 Attn: Stephen Thompson 405 State Highway 121 Bypass Buildin A Suite 250 INSURERC Illinois National Insurance Co 23817 g , Lewisville TX 75067 u5A INSUREaD. INSURER E: szR:a yes er teams an can ~t~ons o t e o acy THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIItEMENT, 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. LIMITS SHOWN ARE AS REQUESTED INSR LTR AllD' INS TYPE OP INSURANCE POLICI' NUMBER POLICY EFFECTIVE POLICI' EXPIRATION LBNTTS DATE(MM\DD\YY) DATE(MM\DD\YY) A NERALLIABILITI' GL1774139 04/02/09 04/02/10. EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 2 50 , 000 PREMISES (Ea occurence) CLAIMS MADE X^ OCCUR D IAnv one person) PERSONAL & ADV INJURY $1 ~ 000 ~ O00 GENERAL AGGREGATE $ 2 000 000 ' , , GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 , OOO , OOO POLICY © PRO- ~ LOC JECT A AUTOMOBILELiABII,ITY CA 8262349 04/02/09 04/02/10 COMBINED SINGLE LIMIT - ANY AUTO (Ea accident) $1, 000 , 000 )( ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) X HULED AUTOS BODII.Y INJURY )( NON OWNED AUTOS (Per accident) PROPERTY DAMAGE P id er acc ( ent) GARAGE LIABH.ITY AUTO ONLY - EA ACCIDENT 8 ANY AUTO OTHER THAN EA ACC AUTO ONLY AGG C EXCESS /UMBRELLA LIABILITY BE2023728 04/02/09 04 02 10 EACH OCCURRENCE , OCCUR ^ CLAIMS MADE AGGREGATE $10,000,000 DEDUCTU4LE ® RETENTION $10,000 8 WC 1 14 4 X WC STATU- OTH- WORKERS COMPENSATION AND yyC - AO$ T }' T B EMPLOYERS' LIABll,ITY ' WC7171491 04/02/09 04/02/10 E.L. EACH ACCIDENT $1, 000 , 000 AN} PROPRIETOR/PARTNER/ExFCUTIVE WC - ~ ~ e OFF]CER/MEMBER EXCLUDED? ' WC7171493 04/02/09 04/02/10 E.L. DISEASE-EA EMPLOYEE $1, 000 , 000 ~ - Ifyes, describe under SPECIAL PROVISIONS WC_ ~ E.L. DISEASE-POLICY LIMIT $1, 000, 000 ~ below OTHER ~ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ~ Town of wappinger is included as an Additional Insured with respect to the General Liability policy. Cancellation Provision shown herein is subject to shorter or longer time periods depending on the jurisdiction of and reason ~ for the cancellation. CERTIFICATE HOLDER CANCELLATION Town Of Wappl n g e r p SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ~ 20 Mi ddl ebush Road ~1~R ~ ~ ~~~~ DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL wappi nge rs Fal 1 s NY 12 590 USA 30 DAYS WRIT-I-EN 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. ,~ ~ ~ i- ~ - ~ f ^ AUTHORIZED REPRESENTATIVE ,-, i1 C-O~~ ~1J , p~~ v s s ~ A ~ ATT 1 L d w c .o 0 O rv n m O O n 0 z d R U cw ++ L U !~ v Fj ~y ~F ~J r L~L r7-ti METZG-2 04 O1 09 ACORN CERTIFICATE OF LIABILITY INSURANCE OP ID DGRA 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 110 Main Street Poughkeepsie NY 12601 Phone:845-454-0800 Fax:845-485-7804 INSURED Metzger Const Corp & Glenn P Metz er dba Metzger Construction Metzger, dba Metz er Construct 3 Van Wyck Ian Sui~e 1 Wappingers Falls NY 12590 COVERAGES INSURERS AFFORDING COVERAGE I NAIC # wsuRERA: Technology Insurance Co ~ ____ INSURER B: INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I Nt ruucr renw~ u~un.n, ~~. ,.., , .....,......._.•-- DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER IBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH C R MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DES POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY LIMITS LTR NSR TYPE OF INSURANCE EACH OCCURRENCE $ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence) $_ CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS -COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY erson) (Per $ T S _p SCHEDULED AU O HIRED AUTOS BODILY INJURY (Per accident) $ TOS NON-OWNED AU PROPERTY DAMAGE id t $ en (Per acc ) IABILITY AUTO ONLY - EA ACCIDENT $ GA RAGE L OTHER THAN ~+ ACC $ ANY AUTO AUTO ONLY: AGG $ UMBRELLA LIABILITY EACH OCCURRENCE $ EXCESS/ R ~ CLAIMS MADE AGGREGATE $ OCCU TIBLE DEDUC $ RETENTION $ MPENSATION AND _ X TORY LIMITS ER WORKERS CO EMPLOYERS' LIABILITY TWC3199830 04/01/09 04/01/10 E.L. EACH ACCIDENT $ lOOOOO p' ANY PROPRIETOR/PARTNERIEXECUTIVE EA EMPLOYEE $ lOOOOO OFFICER/MEMBEREXCLUDED? E.L. DISEASE- If yes, describe under E.L. DISEASE -POLICY LIMIT $ S O O O O O SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS i,"y r~ (~ ~ ~ /~ t r. „ ? r ~~'~ APR 0 2 20 ~ 0 ~'+nlNl~i CLARK ..~..~,~,......- ..... '.tee CANCELLATION Town of Wappinger Attn: Building Dept. P O Box 324 Wappingers Falls NY 12590 TOWNOWF 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 n cannon /~n~nr'1o ATInAI 10AA 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. ACORD 25 (2001108) DATE (MM/DD/YYYY) ACORD,M CERTIFICATE OF LIABILITY INSURANCE 6/30/2010 6/26/2009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER LOCKTON COMPANIES, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5847 San Felipe, Suite 320 THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HOLDER Houston TX 77057 . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED ~ TranSCare COr Et al OfatlOn INSURER A : Allied World Assurance (US) Inc. 19489 p , 1304733 1 Metrotech Center, 20th Floor INSURER B : Wesco Insurance Com any 25011 Brooklyn NY 11201 INSURER C : Technology Insurance Company, Inc. 42376 INSURER D : Continued on attached INSURER E THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING TRACOIO AO T P N V C T CE T C TE R. COVERAGES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING THE POLICIES TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR EMENT , ANY REQUIR CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH SURA N MAY PERTAIN, THE IN POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADO'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS EACH OCCURRENCE $ 2 OOO OOO A GE X NERAL LIABILITY AL GENERAL LIABILITY R 0304-7423 6/30/2009 6/30/2010 DAMAGE TO RENTED PREMISES Ea occurence $ 100 000 CI COMME AIMS MADE ~ OCCUR MED EXP (Any one person) $ XXXXXXX CL PERSONAL & ADV INJURY $ 2 000 000 GENERAL AGGREGATE $ 6 OOO OOO ATE LIMIT APPLIES PER: ' PRODUCTS -COMP/OP AGG $ 2 OOO OOO L AGGREG GEN PRO- POLICY JECT LOC $ AUT OMOBILE LIABILITY WPP1002042-02 (NY, PA) 6/30/2009 6/30/2010 COMBINED SINGLE LIMIT $ 1,000,000 X MD 26 02 6/30/2009 6/30/2010 (Ea accident) C ANY AUTO ) - ( TPP10001 ALL OWNED AUTOS BODILY INJURY $ XXXXXXX (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ XXXXXXX X (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ XXXXXXX (Per accident) I ILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX GA RAGE L AB NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX ANY AUTO AUTO ONLY: AGG $ XXXXXXX EACH OCCURRENCE $ 9 OOO,OOO EXCESS/UMBRELLA LIABILITY 0304-7426 6/30/2009 6/30/2010 9 000 000 A A X~ X AGGREGATE $ CLAIMS M DE OCCUR $ XXXXXXX UMBRELLA XXXXXXX FORM $ DEDUCTIBLE $ XXXXXXX RETENTION $ O p N AND See Attached ER ORY LIMITS WORKERS COMPENSATIO EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ XXXXXXX ANY PROPRIETOR/PARTNER/EXECUTIVE oPFicewMEMSER ExcLUOeo~ E.L. DISEASE - EA EMPLOYEE V V V V VXX $ Al1/1!1!1 If yes, descrf6e untler SPECIAL PROV1310NS below NO E.L. DISEASE -POLICY LIMIT $ XXXX A OTHER 0304-7423 6/30/2009 6/30/2010 $2,000,000 Each Medical Incident Professional Liability $6,000,000 Aggregate (Claims Made) DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS TransCare Corporation, et. al. includes TransCare New York, Inc., TC Ambulance Corporation, TCBA Ambulance, Inc., TC Hudson Valleyy Ambulance Corp., TransCare ` ' TransCare ML, Inc. Umbrell Inc. TC Ambulance Group Inc TC Ambulance North I h t W ~~ ~~ , , ., , er, nc., estc es Pennsylvania, Inc., TransCare Maryland, Inc., TransCare and is on an Occurrence basis for the General Liability and is excess over General Liability, Professional Lia V for Professional Liabilit 7426 i Cl i M d 0304 y a ms a e - s Employers Liability only. See attached for additional coverages. Cancellation: 30 Days as noted below except for 10 days notice for non-p t iu~.:-- Ali '~; ~ ~ ~ ~ 0 7.200g' ~~ . wTrn.r R O1/1/R! n1 Cw GEKIIFIGAIt F1VLUtK 2821063 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Wappinger DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN 2O MlddlebUSh Road NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Wappingers Falls NY 12590-0000 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIV ~~/ ~1 !., ... .. nr~or~ncw-rin.i Aeoo A(°f 1Drl 7C f7f1f1~IflR1 e.,....................w......~... .....~..... ..........w. .... .,.....w,-.w.o.......,... .....~,... .....,.. ...... ...__. Insurer D: WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY: Named Insured includes TransCare Maryland, Inc. Policy No. WC189-0680 (MD) Effective Dates: 09/26/2008 - 09/26/2009 Carrier: Commerce & Industry Insurance Company Workers' Compensation: Statutory Employer's Liability Limits: Each Accident/Each Employee/Policy Limit $1,000,000 Insurer E: WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY: Named Insured includes TransCare New York, Inc./TransCare Pennsylvania, Inc./TransCare ML, Inc. Policy No. WCS 112587-00 (NY/PA) Effective Dates: 12/31 /2008 - 12/31 /2009 Carrier: Ullico Casualty Company Workers' Compensation: Statutory Employer's Liability Limits: Each Accident/Each Employee/Policy Limit $500,000 Insurer F: EXCESS EMPLOYER'S LIABILITY: Named Insured includes TransCare New York, Inc./TransCare Pennsylvania, Inc./TransCare ML, Inc. Policy No. WEL 112587-00 (NY/PA) Effective Dates: 12/31!2008 - 12/31/2009 Carrier: Ullico Casualty Company Excess Employer's Liability Limits: Each Accident/Each Employee/Policy Limit $1,000,000 Insurer G: WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY: Named Insured includes TransCare ML, Inc. Policy No. R2WC912587 (DE) Effective Dates: 11/15/2008 - 11/15/2009 Carrier: AmGuard Insurance Company Workers' Compensation: Statutory Employer's Liability Limits: Y-lECE~VE~ Each Accident/Each Employee/Policy Limit $1,000,000 ~~L Q ~ Z~ Insurer H: EXCESS AUTOMOBILE LIABILITY: ~'C~VUI~.CLERK Policy No. 021404552 ~ r- Miscellaneous Attachment : M448760 Master ID: 1304733 Effective Dates: 06/30/2009 - 06/30/2010 Carrier: Lexington Insurance Company - Limit: $9,000,000 Each Occurrence is excess of Policy Nos. WPP1002042-02 & TPP1000126-02 only A CO RO® CERTIFICAT.~~ OF LIABILITY INSURANCE DATE (MMIDDIYYYY) ` ~ 07,0„2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LoVuilo Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6450 Transit Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Depew, NY 14043 INSURERS AFFORDING COVERAGE NAIC # INSURED pJ Exteriors, Inc. and Lampi Holding Co and Jim Lampi INSURER A: FIRST MERCURY INSURANCE CO. 10657 1589 Rt 376 INSURER B: Wappingers Fails, 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 T DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY FMMA002600 03/15/2009 03/1512010 EACH OCCURRENCE $ 1,000,000 A DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence 50,000 $ CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ EXCIUded PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY X PRO LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ~ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Par person) _ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Peraccidenl) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO `~ ~~~ OTHER THAN EA ACC $ i .__~ ~, AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE_ $ OCCUR ~ CLAIMSMADE AGGREGATE $ R ~~~~~ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE E.L. EACH ACCIDENT $ ^ OFFICERIMEMBER EXCLUDED'? ` ~ ~ ~ (Mandatory In NH) ~ 1 i Rfi E.L. DISEASE - EA EMPLOYE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE • POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BYENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOV E DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town of Wappinger Bidg Dept 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 20 Middlebush Road REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~ ~ (~~ ~ Wa In ers Falis, NY 12590-0324 PP~ 9 J,, D ~V_ gLtrY-eV,rJ~(Js ~i/UJ ACORD 25 (2009101) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD For more information contact: Marshall & Sterling Inc at 845-454-0800. 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. ~~~' V ~L. .~UL ~ 6 Z00~ ~~~~1 Ci± EF3S~ ACORD 25 (2009!01) ACORD CERTIFICATE ®F LIABILITY INSURANCE OP ID SPAY DATE(MMIDD , WAPPI-D 07 O1 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 M9-ddlebush 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: Gra h1C Arts Mutual Ins CO INSURER B: Wappingers Central INSURER C: School District 167 Myers Corners Rd Suite ZOO 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 WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 6Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH n,ee nr_r_ocr_eT^ ~ un~TS SHnWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. E I Y DA 1~N EY MM PD LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER MMIDD/YY DAT E /D /Y AT GENERAL LIABILITY EACH OCCURRENCE $ 1000000 I A X X COMMERCIAL GENERAL LIABILITY CPP3725513 07/01/09 07/01/10 PREMISES (Eaoccurence) $ 1000000 I CLAIMS MADE OCCUR MEDEXP(Anyoneperson) $5000 PERSONALBADVINJURY $ 1000000 GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - GOMP/OP AGG $ 3 O O O OOO POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A X ANY AUTO 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 EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 15000000 A X OCCUR ~ CLAIMSMADE CULP3725517 07/01/09 07/01/10 AGGREGATE $ 15000000 DEDUCTIBLE $ }{ RETENTION $ 10000 $ W ATU- - WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY _ _ E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. DISEASE • EA EMPLOYEE $ If yes, describe under DISEASE • POLICY LIMIT E L $ SPECIAL PROVISIONS below . . OTHER ~~C DESGRIPTIVN Ur UYCKA ~ was r w~.w~ was i v~nw~w . cn.. ~.~ ......... ......~..., , ..,..,.,....~... _.... -. --.. -- ..-- ------- The Town of Wappinger is provided Additional Insured status as respects Wappingers Jr High School and Van Wyck Jr High Schoo ' use of Robinson baseball fields for Spring Season. ~~ Y J(1(, 0 ? 200 Lane ~~~~~~~~ CERTIFICATE HOLDER CANCELLATION . WAPPI-3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL l O DAYS WRITTEN Town of Wappinger NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Eileen IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR 20 Middlebush Rd Wappingers Falls NY 12590 wREPRESE TATIVES. , no en oeo ecureslt/R' ACORD 25 (2001/08) © ACORD CORPORATION 1988 PATIENC-09 KOKA '4~_°,-RO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 717/2009 PRODUCER (216) 622-7400 The James B. Oswald Company 1360 East 9th Street, #600 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. Cleveland, OH 44114-1730 INSURERS AFFORDING COVERAGE NAIC # INSURED Patio Enclosures, InC. INSURER A: Nat'l Union Fire Ins Co of Pittsburgh PA 19445 ALL LOCATIONS INSURER B: Charter Oak Fire Ins Co 5615 700 East Highland Road INSURERC:Commerce & Industry Insurance Compan 19410 Macedonia, OH 44056 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 TR DD'L F I POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 4573017 7/512009 7/5/2010 P 500 000 REMISes Ea occu ence , $ ~ 10 000 CLAIMS MADE OCCUR MED EXP (Any one person) . $ I PERSONAL & ADV INJURY $ 1,000,000 I GENERAL AGGREGATE $ 2AOOr000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000 X POLICY PR~ LOC AUT OMOBILE LIABILITY COMBINED SING E I 1 000 000 B ~~ X ANY AUTO GOCAP291 D0359COF09 715/2009 7/512010 L L MIT (Ea accident) $ , , ~' ALL OW NED AUTOS BODILY INJURY SCHEDULED AUTOS Per erson ( P ) $ ~ ~ ' ~~ HIRED AUTOS i BODILY INJURY I I NON-OWNED AUTOS $ (Per accident) PROPERTY DAMAGE $ (Per accident) i GA RAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC OTHER THAN $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ^ CLAIMS MADE AGGREGATE $ DEDUCTIBLE g RETENTION $ $ WORKERS COMPENSATION X W C STATU- OTH- AND EMPLOYERS' LIABILITY Y ~ TORY LIMITS..___ ER ________ ___,_ _. _. _ __ C ANY PROPRIETOFUPARTNER/EXECUTIVE OFFICER/MEMBER EX L D? ~ 67712436 7/512009 7/5/2010 E.L. EACH ACCIDENT ~~ $ 1,000,000 C UDE (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT 1,000,000 $ OTHER DESCRIPTION OF OPERATIONS (LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER r_AN(_FI 1 ATI(1N SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN Village of Wappinger Falls NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 20 Middlebush Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Wappingers Falls, NY 12590- REPRESENTATIVES. AUTHORIZED REPRESENTATIVE I ~ ~~-`~- ~-~ AGUKUL5 (ZUUB/Ul) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD