No preview available
2009 (12), ® coRO CERTIFICATE OF LIABILITY INSURANCE NAT N DATE (MMIDD/YYYY) -1 IO v 06/12/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bagatta Associates , Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 823 W Jericho Turnpike Ste lA ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Smithtown NY 11787 Phone : 631-864-1111 Fax: 631-864-8274 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Woraaatar inauranoa Compsny 2 6182 INSURER B: standard 6aourity Lifa In^ Co Iational Maintenance InC . DBA National Sign & fighting INSURER C: AIG Insurance CO an 185 .Sweet AOllow Road INSURER D: Old Bethpage NY 11804 INSURER E: [`f1VFRer~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. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YYYY DATE MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A R COMMERCIAL GENERAL LIABILITY MPA6G6029 07/02/09 07/02/10 PREMISES(Eeoccurence $ 100000 CLAIMS MADE ®OCCUR MED EXP (Any one person) $ 5000 % Brd Form/All Risk PERSONAL 8 ADV INJURY $ 1000000 R COntraCt1181 Liisb GENERAL AGGREGATE $ 2000000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $2000000 POLICY $ PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $1000000 A R ANY AUTO BA9G2871 05/12/09 05/12/10 (Eaeccident) 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 E!+ ACC $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ 5000000 C ][ OCCUR ~ CLAIMSMADE BE4766669 07/02/09 07/02/10 AGGREGATE $ 5000000 $ DEDUCTIBLE $ ~[ RETENTION $10000 $ WORKERS COMPENSATION ITY ' TORY LIMITS ER AND EMPLOYERS LIABIL Y / N P.NV PROPRIETOP./PARTNERJEXECUTIV E.L. EACHACCIDENT S ~ OFFICER/MEMBER EXCLUDED9 (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, tlescribe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER B Disability D93966-000 10/01/08 10/01/09 ~~ ~50, 000 A Pro art MPA6G6029 07/02/09 07/02/10 ~~ Y~ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT !SPECIAL PROVISIONS As pertains to insureds operations . '~~~ ~ fl ~OQ~ F. - ,. L \ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION WAPPING 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. TOwn of Wappinger 20 Middlebush Rd. AU SENT ~ IWa in er Falls NY 12590-0324 ACORD 25 (2009/01) U 99SS-ZUU9 AGUKU GUKYVKAI IUN. All rlgtliS reSerV@O. The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF PARTICIPATION IN WORKERS' COMPENSATION GROUP SELF-INSURANCE la. Legal Name and Address of Business Participating in Group ld. Corporate Contact Name of Business referenced in box "la" Selt Insurance (Use Street Address Only) Business Telephone Number of Business referenced in box "la" Town of Wappinger Joseph Ruggiero, Supervisor 20 Middlebush Road (84s) 297 - 5771 Wappingers Falls, TeTY 12590 le. NYS Unemployment Insurance Employer Registration Number of business referenced in box "la" 1 b. Effective Date of Membership in the Group si2i2oo7 lc. The Proprietor, Partners, or Executive Officers are lf. Federal Employer Identification Number of Business referenced in Box "la". 0 included (only check box if all partners/officers included) ~ all excluded or certain partners/officers excluded 146002488 2. Name and Address of the Entity Requesting Proof of Coverage (Entity 3. Name and Address of Group Self-Insurer Being Listed as Certificate Holder) Town of Wappinger Recreation Department Attn: Eileen Manning Public Employer Risk Management Association 20 Middlebush Rd. PO Box 12250 Wappinger, NY 12s90 Albany, NY 12212-2250 RE: Proof of Workers' Compensation Coverage; This certifies that the business referenced above in box "1 a" is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law as a participating member of the Group Self-Insurer listed above in box "3" and participation in such group self-insurance is still in force. The Group Self-Insurer's Administrator will send this Certificate of Participation to the entity listed above as the certificate holder in "box 2". The Group Self-Insurer's Administrator will notify the above certificate holder within 10 days IF the membership of the participant listed in box "la" is terminated. (these notices maybe sent by regular mail.) Otherwise, this Certificate is valid for a maximum of one year from the date certified by the group self-insurer. If this certificate is no longer valid according to the above guidelines and the business referenced in box "l a"continues to be named on a permit, license or contract issued by the certificate holder, the business must provide the certificate holder either with a new certificate or other authorized proof of the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative of the Group Self-Insurer referenced above and that the business referenced in box "la" has the coverage as depicted on this form. Certified by: CO~°Y~ trnn[ name or aumonzea repres~ [ne group aeu-msuroq Certified by: ~ 6/17/2009 rgnature (Date) Title: President Telephone Number: 1-888-737-6269 Gsl-1 os.2 (2-02) .~Jt~ :' ~ ~00~ per r aver r-.F r•-r-^~ > INSURED;C,OPY . , DATE (MM/DD/YY) ~CORD~ CERTIFICATE OF LIABILITY INSURANCE C if se 9 D ert i a D 15403 PRO UCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Aon Risk Services, Inc. of FL CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 1001 Brickell Bay Drive, Suite #1100 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Miami FL 33131-4937 , INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Illinois National Insurance Co 23817 ADP TotalSource MI XXX, Inc. INSURER B: 10200 Sunset Drive Miami, FL 33173 INSURER C: ALTERNATE EMPLOYER T Webber Plumbing & Ht Inc INSURER D: g 28 Jackson Road INSURER E: Pou h k ee s ie. NY 12603 ~ / C p /~ - i~ ;~`,'1` e -~d f,r',~iti ` .~4- ~Q~~Y Cf~h1~~~~~~: .~" x~t! -'~,~ , -.... - . c.^t ~t x ~- ~a£ r >~S"~ . ~ ,~ Z ~ , ..- - .. 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 RESPECTTO 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 AREAS REQUESTED. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE tMMIDD/YYYY) POLICY E%PIRATION DATE (MMIDDIVYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ^COMMERCIAL GENERAL LIABILITY ^ CLAIMS MADE ^ DCCUR ~ DAMAGE TO RENTED $ PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLI R S : E PE ^ POLICV ^ PROJECT ^ Loc GENERAL AGGREGATE $ PRODUCTS -COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ^ ANY AUTO (Ea accident) $ ^ ALL OWNED AUTOS ^ scHEDULEDAUTOS BODILY INJURY $ ^ HIRED AUTOS (Per person) ^ NON OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ^ ANY AUTO OTHER THAN ACC A T $ U O ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ ^ OCCUR ^ CLAIMS MADE AGGREGATE $ ^DEDUCTIBLE $ ^RETENTION $ A WORKERS' COMPENSATION AND ' WC 015080527 NY 07/01/09 O7/O1/1O ®WC STATU- ^ OTHER EMPLOYERS LIABILITY Y 1 N 70RY uM17S ~ - ANV PROPRIETOR I PARTNER I EXECUTIVE OFFICERIMEMBEREXCLUDED~ E.L. EACH ACCIDENT $ $2,000,D00 (Mandatory in NH) II Yes describe under E.L. DISEASE - EA EMPLOYEE $ $2,000,000 , SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ $2,000,000 OTHER Y~~~~~~~L.i DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS All worksite employees working for the above named client company, paid und ' , T .., er ADP TOTALSAURGE,JpIC,'s p>, are covered and t ~,at bove s licy. The above named client is an alternafe employer under this policy. i ''~\ RE: SAGE GALLAGHER JOB ~; ~! .,. c ..L -... ... - ~ `CERTIFICATE HOLDER ; CANCELLATION - ;. '' _ ~ g _ , _ - TOWN OF WAPPINGERS BLDG. DEPT. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE ATTN: MICHELLE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE 20 MIDDLE BUSH ROAD CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION WAPPINGERS, NY 12590 OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE V `~ ~3k ~GA~LCG3, +Z n.C. o f ~ fL ACORD 25 (2009/01) - -. • : - '-~ p1'988:2009 ACORD CORPORATION: Ali Tlghts reservetl. The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID CR DATE (MM/DD/YYYY) ., AMERI-1 06 17 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 A i-T h L d D l t INSURER A Mt . Hawley Insurance Co . eve mer ec an opmen Inc., dba Ameri-tech Construct INSURER e: Merchants Insurance Group 23329 ion Sheafe Wooda Realty LLC Fis~ikill Landing LTD INSURER C: 1136 Route 9 in er Fall NY 12590 W INSURER D: g app s 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 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 DATEYMMIDD~ E PDATE MM/DDS LIMITS GENERAL LIABILITY EACH OCCURRENCE $ Z 0 0 0 0 0 0 A X COMMERCIAL GENERAL LIABILITY MCF0003496 05/20/09 05/20/10 PREMISES (Eaoccurence) $50,000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ PERSONAL&ADVINJURY $ 1000000 GENERAL AGGREGATE $ 2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ l O O O O O O POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT 1 0 0 0 O O B X ANY AUTO CAP9262462 05/20/09 05/20/10 (Ea accident) $ , , O ALL OWNED AUTOS 80DILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ AUTO ONLY: qGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER _ EMPLOYERS' LIABILITY R ET R P RTNER/EXECUTIVE E.L. EACH ACCIDENT $ ANY PROP I / A O OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ I( yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER 7t Dl.K1Y 1 NN UY V YtKH I IUIVJ / LVI.H I IVIVJ / V CI'71l.LCJ / CA1iLUJ1 V NJ N V VC V O T CIV V V RJCm CIV I I Jf'C~. W L r'rtV V IJIVIYJ operations in the State of New York s ~... ~_ i' P~4~~R! ~''a -~~~,. :ERTIFICATE HOLDER WAPPING Town of Wappinger 20 Middlebush Road Wappingers Falls NY 12590 CORD 25 (2001/08) 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, eUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ©ACORD CORPORATION 1988 DATE (MM/DD/YY) ~+~R"~ CERTIFICATE OF LIABILITY INSURANCE C rtifi 1D 104082 t e a e PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Aon Risk Services, Inc. of FL CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 1001 Brickell Bay Drive, Suile #1100 4937 Mi i FL 33131 POLICIES BELOW. am , - INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Illinois National Insurance Co 23817 ADP TotalSource MI XXX, Inc. 10200 S t D i INSURER B: unse r ve Miami, FL 33173 INSURER C: ALTERNATE EMPLOYER INSURER D: T Webber Plumbing & Htg Inc 28 Jackson Road INSURER E: Pou hkee sie, NY 12603 co~eRA~Es 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 T HE 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 AREAS REQUESTED. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER ~ POLICY EFFECTIVE DATE tMMIDDIYYYY) POLICY EXPIRATION DATE (MMIDDlYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ^ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ^ CLAIMS MADE ^ OCCUR ~ PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLfES PER: ^ POLICY ^ PROJECT ^ Loc GENERAL AGGREGATE $ PRODUCTS -COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ^ ANY AUTO (Ea accident) ^ ALL OWNED AUTOS ^ SCHEDULED AUTOS BODILY INJURY $ (Per person) ^ HIRED AUTOS ^ NON OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ^ ANY AUTO $ OTHER THAN ACC AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ ^ OCCUR ^ CLAIMS MADE AGGREGATE $ ^DEDUCTIBLE $ $ ^RETENTION $ q WORKERS' COMPENSATION AND WC 015080527 NY 07/01/09 07/01/10 ®wc sTATU- ^ orHER EMPLOYERS' LIABILITY YIN TORY LIMITS ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ $2 000 000 OFFICER/MEMBER EXCLUDED? , , (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE 2,000,000 If Yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ $2,000,000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDOR MENT./*SPEGIAL PROVISIONS All worksite employees working for the above named client company, paid under ADP TOTALSOUR , INN~,'s payroll, are cgveredwnder the above stated policy. The above named client is an alternate employer under this policy. ~ .~ ~r ~ JUI~ 7 I" 7no~ -- CERTIFICATE HOLDER ' CANCELLATION TOWN OF WAPPINGERS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE BUILDING DEPARTMENT THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE 20 MIDDLEBUSH ROAD CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION WAPPINGERS FALLS, NY 12590 OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (MM/DD/YYYY) ,. NWSIG-1 06 09 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Addis Group, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2500 Renaissance Blvd. Ste 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. King of Prussia PA 19406-2772 Phone: 610-279-8550 Fax: 610-279-8543 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Zurich American Insurance co. 16535 INSURER B: Hartford Steam Boiler 03961 NW Si n Industries Mr. S~ephen Rolf INSURER C: CNA Insurance Com anies 20443 360 Crider Avenue INSURER D: Moorestown NJ 08057 INSURER E: GUVERAGES 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 DATE MM/DD/YY N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, OOO, OOO A X COMMERCIAL GENERAL LIABILITY GL08196416 06/04/09 03/01/10 PREMISES (Eaoccurence) $500,000 CLAIMS MADE X^ OCCUR MED EXP (Any one person) $ 10 , 0 0 0 PERSONAL 8 ADV INJURY $ 1, 0 0 0, 0 0 0 GENERAL AGGREGATE $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 , 000 , 000 POLICY PRO LOC JECT AU TOMOBILE LIABILITY COMBINED SINGLE LIMIT E id t $ 1 , 000 , 000 A X ANY AUTO BAP8196415 0.6/04/09 03/01/10 ( a acc en ) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X $25O COmp PROPERTY DAMAGE $ X $500 Coll (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 25 , 000 , 000 C X OCCUR ~ CLAIMS MADE 4017397510 06/04/09 03/01/10 AGGREGATE $ 25, 000 , 000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND ' TORY LIMITS ER A EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WC8196417 06/04/09 03/01/10 E.L. EACH ACCIDENT $ 1, 000, 000 OFFICER/MEMBER EXCLUDED? N d E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000 yes, escribe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1 , 000 , 000 OTHER B Property SRI5646518 06/04/09 Ol/O1/10 Blanket 29,051,670 educt. 25,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ~+=i ~-iii~:a l.C nU lClet- :LS 115 Leo a5 liaQ1 L10na1 1nsi1reC1 uIlCler LIIe CapLl Onea -- policies if required by written contract. ~ ~-~.., JUN ~ ~ 2008 ~~1/~'~f ~9 r-r_9es CERTIFICATE HOLDER CANCELLATION WAPPING SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Town of Wappinger 2 0 Middlebush Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Wappingers Falls NY 12590 REPRESENTATIVES. AUT ORIZED REPRESENT/1TIVE 0~ OtiL~ ~/ CORD 25 (2001/08) ©ACORD CORPORATION 1988 AUSTPOW-07 SAME ACORD~, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/OD/YYYY) 6/11!2009 PRODUCER (216) 622-7400 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The James B. Oswald Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1360 East 9th Street, #600 v y~ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Cleveland, OH 44114-1730 ~~~~~~~ ~ p...~ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. as ICI ~ .. ~8~ INSURED Austin Powder Company North American Quarry and Construction Services, Inc. -a-rgan~9E~" ~+~ r~°!^^,`~ 149 Fyke Road PO Box 379 INSURERS AFFORDING COVERAGE NAIC # INSURER A: LANCER INSURANCE COMPANY 6077 INSURER B: Ins Co of The State of PA 19429 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 W ITH RESPECT TO W HICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR LTR DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2+000+000 A X COMMERCIAL GENERAL LIABILITY GL803261 6/1/2009 6/1/2010 PREMISES Ea occurence $ 2.000+000 CLAIMS MADE a OCCUR MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 2+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 2 000 QQQ A X ANY AUTO BA803260 6/1/2009 6/1 /2010 (Ea accident) $ ~ , ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 3,000,000 A X OCCUR ~ CLAIMSMADE XS803262 611/2009 6/1/2010 AGGREGATE $ 4,000+000 DEDUCTIBLE $ X RETENTION $ Nil $ WORKERS COMPENSATION AND X ORY LIMITS OER B EMPLOYERS' LIABILITY WC1591438 6/1/2009 6/1/2010 E.L. EACH ACCIDENT $ 2,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBF_R EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 2,000+000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 2,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS i VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS X11 operations within the territorial limits of the policies. :ertificate holder is included as additional insured per general liability form CG 2012 ~~~ ~ ~ ~ CERTIFICATE HOLDER The Town of Wappinger 20 Middlebush Rd. Wappingers Falls, NY 12590-4004 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - n ~ ~--~~ ~~-*~`~ ACORD 25 (2001108) ©ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANC DA ) ~, E 6/1/2010 6/1/2009 PROnucER Lockton Companies, LLC Denver THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION i 8110 E Union Avenue ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Suite 700 HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR Denver 80237 , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (303) 414-6000 INSURERS AFFORDING COVERAGE NAIC # INSURED Apartment Investment and Management Company INSURER A : ACE American Insurance Com an 22667 1040189 (AIMCO) 4582 S. Ulster Street Parkway INSURER 8 : St. Paul Fire and Marine Insurance Company 24767 Suite 1100 INSURER C Denver CO 80237 INSURER D I INSURER E COVERAGES AIMCO01 RO 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. 4Gr-0RFGATF I IMITR CNnWiJ Mev uevF a~ctd went Iran ov oetn rr ewe INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 OOO OOO A X COMMERCIAL GENERAL LIABILITY XSL 624932278 6/1/2009 6/1/2010 DAMAGE TO RENTED $ 1 000 000 ClA1MS MADE ~ OCCUR MED EXP (Any one person) $ Excluded X SIR $500,000 PERSONAL & ADV INJURY $ 1 OOO OOO X Policy Aggregate-IOM GENERAL AGGREGATE $ 2. OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 000 OOO PRO- POLICY JECT X LOC AU TOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ XXX7~~3CX ALL OWNED AUTOS BODILY INJURY $ XXXXXXX SCHEDULED AUTOS NOT APPLICABLE (Per person) HIRED AUTOS BODILY INJURY $ XXXXXXX NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accideni) $ XXXXXXX GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX NOT APPLICABLE ANY AUTO OTHER THAN EA ACC $ XXX7~?~XX AUTO ONLY: AGG $ XXXXXXX EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 2S OOO OOO A X00624900137 6/1/2009 6/1/2010 X OCCUR ~ CLAIMS MADE AGGREGATE $ 25 000 000 UMBRELLA $ XXXXXXX DEDUCTIBLE X FORM $ XXXXXXX X RETENTION $ SO OOO $ XXXXXXX WC STATU- OTH- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE ICABI NOT APPL E E.L. EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED9 , -, E.L. DISEASE - EA EMPLOYEE $ XXJCX~CXX If yes, descdbe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ XXXXXXX OTHER B Excess Liability Q108300320 6/1/2009 6/1/2010 $25mxs,$25m DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Terrorism included per TRIA. #041456. RE: Chelsea Ridge Apts. - 1 Chelsea Ridge Mall, Wappingers Falls, NY 12590. cc~%Y 2042029 Town of Wappinger 20 MiddleEush Road Wappingers Falls NY 12590 Y l 6..O.J 1.. ~ v tlr. ^r ~uN o ~ zoos "~e~l~!! ~'o,r'~I,. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~Q_ 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 ACORD 25 (2001/08) For questions regarding this cartiTicate, contact the number listed in ihe'Protlucar'saetion above and specify he client code'AIM0001'. ACORD CORPORATION 1988 OP ID DATE (MM/DDIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE PaooucER -- - - -- cnrrOrr-3 06 0l 09 - -- ----- ---- - ---- __-- __ -THIS.CERTIFICATE IS ISSUED ASIA-MATTER OF INFORMATION _ __ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DeForest Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 120 Wood Road P . O. Box 32 70 , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Kingston NY 12402 . Phone:845-339-2114 Fax:845-340-1406 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Selective Way Insurance Co. Town of Unionvale INSURER B: Lisette Hitsman dba INSURER C: 249 Duncan Road LaGrangeville NY 12540 INSURER D: INSURER E: V VYCRI THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER P EFFE E DATE MM/DD/YY P L EX N DATE MMIDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000OQO A X COMMERCIAL GENERAL LIABILITY 51789615 08/11/08 08/11/09 PREMISES (Eaoccurence $ lOOOOO CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5000 PERSONALBADVINJURY $1,000000 GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 3000000 POLICY PRO- JECT LOC AU TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 OOO OOO A X ANY AUTO 51789615 08/11/08 08/11/09 (Ea accident) r ~ 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 $ EXCESSIUMBRELLALlABILITY EACH OCCURRENCE $ lO ~ OOO r OOO A X OCCUR ~ CLAIMSMADE S1769615 08/11/08 08/11/09 AGGREGATE $ 20, OOO ~ OOO DEDUCTIBLE $ X RETENTION $ l O , OOO $ WORKERSCOMPENSATION AND ' ~ - TORY LIMITS ER EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder is additional insured. -, ~ JUN ~ ~ 200 r CERTIFICATE HOLDER CANCELLATION TOWNWAP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O pAYS 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 Wappinger Falls NY 12590 REPRESENTATIVES. ACORD 25 (2001108) v Huur<u uvRPORATION 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. ~~~BV~ .SUN ~ '~ 2~~~' JUI~ .~~ ,•~,y ~ ~ AGORD 25 (2001/08) ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD/YYYY) PRODUCER 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ENERGY INSURANCE BROKERS, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 BOX 1729 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ALBANY, NY 22201-1729 INSURERS AFFORDING COVERAGE NAIC~1 INSURED MORGAN FUEL & HEATING CO. INC. INSURER A: GRANITE STATE INSURANCE CO DBA BOTTINI FUEL INSURER B: NSW FIAMPSHIRS INSURANCE CO 2785 W. MAIN STREET INSURER C: EVEREST NATIONAL INSURANCE CO WAPPINGSRS FALLS, NY 12590 INSURER D: BOTT00 INSURER E: r~nvco n r_c~ 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 WHI H C THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EX , CLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR R DD' N L POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION V LIMITS B GENERAL LIABILITY GL480-73-38 05/30/2009 05/30/2010 EACH OCCURRENCE S 1, DOO, OOO X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurence S lOO, OOO CLAIMSMADE ~ OCCUR MED EXP (Any one person) 5 5, OOO PERSONAL & ADV INJURY S I OO D OOO , , GENERAL AGGREGATE S 2 OOO OOO , , GEN'L AGGREGATE LIMIT APPLIES PER: P PRODUCTS -COMP/OP AGG S 2, OOO, OOO RO- POLICY F T LOC A AU TOMOBILE LIABILITY CA480-70-77 05/30/2009 05~3O~2OIO X ANY AUTO COMBINED SINGLE LIMIT IEaaccident) S 1,000,000 ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS IPer person) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS IPer accident) PROPERTY DAMAGE S IPer accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANYAUTO OTHER THAN EA ACC S AUTO ONLY: AGG S C EXCESSIUMBRELLA LIABILITY 7168000136-09 05/30/2009 05/30/2010 EACH OCCURRENCE S 5, OOO, OOO X OCCUR ~ CLAIMSMADE AGGREGATE S 5, OOO, OOO S DEDUCTIBLE S RETENTION S S B WORKERS COMPENSATION AND E O ' 437-58-26 O5 3O 2009 O5 3O 201,0 X WCSTATU- OTH- ORYLIMITS - - _ MPL YERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ I, OOD, OOO OFFICERIMEMBER EXCLUDED? t E.L. DISEASE - EA EMPLOYEE S I, OOO, OOO I yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT S 1 , OOO, OOO OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ~ ~~ i ('~ ~~ FAX ®845-297-0579. ~ ~ ~~~~~ ~ e~. .: ~i, .:i'i a.. CERTIFICAl TOWN OF WAPPINGSRS FALLS ATTN: SAL 20 MIDDLSBUSH ROAD WAPPINGSRS FALLS, NY 12590 CANCELLATION SHDULD 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 REPRESEN T E ~ A/),ne~ /~//Xl / l ~ HJ ACORD 25 (2001 /08) ®ACORD CORPORATION 1988 ACORDrw ;CERTIFICATE OF LL413ILIT1'INSURANCE oATEo5jz2izoo9Y~ ~ ~ ~ ~ ~ ' PRODUCER ~ "' ~ Aon Risk Servi ces Northeast , Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY fka Aon Risk Servi ces , Inc. of New York AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 300 Jericho Quadrangle CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 300 COVERAGE AFFORDED BY THE POLICIES BELOW Jericho NY 11753 USA . PHONE- 516 342-2900 FAx- 516 342-2955 INSURERS AFFORDING COVERAGE NAIC#t wsuRED INSURER A: National union Fire Ins Co of Pittsburgh 19445 ~ Cablevision of wappinger Falls, Inc. 1111 Stewart Avenue INSURER 6: New Hampshire Ins Co 23841 Bethpage NY 11714-3581 USA INSURER C: ACE American Insurance Company 22667 ,~ INSURER D: 3 R INSURER E: ~ '~ 'V ~ - SIR sa 7 1e5 erterm5 anU COO l'11l.OnS O- 1 t' O lC ~~ 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 WPI7I 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 LIMTTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . LIMITS SHOWN ARE AS REQUESTED INSR LTR ADD' INSRD TYPE OF INSURANCE POLICY NOMBER POLICY EFFECTIVE POLICY EXPIRATION LIMiTS DATE(MM\DD\YY) DATE(MM\DD\YY) A ENEItALLIABILITY GL0907264 05/15/09 05/15/10 EACH OCCURRENCE $500,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ SOO , 000 CLAIMS MADE OCCUR ~ PREMISES (Ee occurence) ® (Anv one aersoN EXC U e X SIR: $500,000 PERSONAL & ADV INJURY $1 OOO 000 ~ , , cp GENERAL AGGREGATE $10,000,000 ~ GEN'L AGGREGATE LIM]T APPLIES PER '~ : ^X POLICY ^ ~~ ^ LOC PRODUCTS-COMP/OP AGG $1,000,000 rv'i O A AUTOMOBQ.ELIABH.ITY AL0907466 05/15/09 OS/15/10 COMBDJED SINGLE LIMIT Z X ANY AUTO (Ea accident) $~ , 000 , OOO i ALL OWNED AUTOS a 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 8 ANY AUTO - OTHERTHAN EA ACC AUTO ONLY: AGG C EXCESS /UMBRELLA LIABILITY XOOG24$9S9S6 05/15/09 OS 15 10 EACH OCCURRENCE , b ll OCCUR ^ CLAIMS MADE um re a AGGREGATE $5,000,000 DEDUCTIBLE B 000 $25 , RETENTION B WORKERS COMPENSATION AND WC 7 5 1 X WC STATU- OTH- ' NY T Y R B EMPLOYERS LIABILITY NY P wC3567043 05/15/09 OS/15/10 E.L. EACH ACCIDENT $1 , OOO , 000 A ROPRIETOR/PARTNER/EXECUTNE NJ CT OFFICER/MEMBER EXCLUDED? , E. .~D Y $1 , OOO , OOO .j If yes, describe under SPECIAL PROVISIONS E. - L I $1, 000 , O00 below f Ip+cc",. OTHER ., r~ ~~ ~ JUN 0 ~ ~00~ '' DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ~:' RAil~~ D ( ~" ~ e.~ ti CABLEVISION OF WAPPINGERS FALLS, INC. ADDED TO ABOVE REFERENCED POLICIES EFFECTIVE 01/05/01. CERTIFICATE HOLDER INCLUDED AS ADDITIONAL INSURED AS RESPECTS LIABILITY IF REQUIRED BY AGREEMENT. RE: CAN OPERATIONS -TOWN OF ~~ WAPPINGER, NY r ERTIFI A LDTR ` CANCE ZATTt~N' Town of wappinger SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION _ Attn : Town Supervisor DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL P . 0 . Box 324 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, wappi nge rs Falls NY 12590 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Y AUTHORIZED REPRESENTATIVE ../~ ~O'G6~~ !/ ~~ cS~o» J / Y A RD I _ AC ORD +COR P ORATION `i 98'8 '~c®RQ CERTIFICATE QF ~I ~SI~fTY II~ v) N r SE~I~~Ir@~E 5/19/2009 PRODUCER (260) 467-5690 FAX: (260) 467-5651 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION STAR Insurance - Fort Wayne Office ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2130 East DuPont Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fort Wa ne IN 46625 INSURERS AFFORDING COVERAGE NA-C # INSURED INSURER N.: NATIONAL CASUALTY COMPAZ\TY 11991 ROAD RUNNERS CLUB OF AMERICA wsuREReNATIONWIDE LIFE 66869 AND ITS MEMBER CLUBS INSURER C' 6434 POUND APPLE COURT INSURER D: COLUMBIA MD 21045 INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICI' PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANl' CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR (NAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. IT Y A F FN Y P S. INS R ADD'L I - (POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY) DATE MMIDDIYY LIMITS GENERAL LIABILITY EACH O^CURREN^E S 1- r 000 ~ OOD X COMMERCIAL GENERAL LIABILITI' DAMAGE TO RENTED PREMISES Ea occurrence) 300 000 S A CLAIMS MADE OCCUR KR00000000172601 12/31/2008 12/31/2009 MEDEXPfAnvone ersonl S 5,000 X LEGAL LIAB. TO PART. 12: O1 A.M. 12: O1 A.M. PERSONAL t; ADV INJURI' S ~- ~ ODD ~ 000 $1,000,000 GENERAL AGGREGATE S NONE GEML AGGREGHTE LIMIT APPLIES PER: PRODU^TS -COMP/OP AGG ~ 1 r 000 i 000 PRO- POLIC~' JECT LOC AU TOMOBILE LIABILITY COMBINED SINGLE LIMIT ~ 1 000 000 ANY AUTO (Ea accident) A ALL OWNED AUTOS KR00000000172601 12/31/2006 12/31/2009 gODILY INJURY SCHEDULED AUTOS 12:01 A.M. 12:01 A.M. (Per person) ~ X HIRED AUTOS BODILY INJURI' S y, NON-OWNED AUTOS (Per accident] PROPERTY DAMAGE (Per accident] 5 GARAGE LIABILITY ~^~' AUTO ONLY - EA ACCIDENT S ANY AUTO ,'~~~~ OTHER THAN FA A^ S ~, tltltl~~~+++ ~ AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY 7, r~, '~~ EACH URR=N^E c ( OCCUR ~ CLAIMSMADE , r/ HGGREGATE S ~„r , ' e~e ~~s ~ ~ : ~r DEDUCTIBLE c. RETENTION 5 c I WORKERS COMPENSATION AND m, ~" pfi - WCY 7ATU- OTR - EMPLOYERS' LIABILITY AN" PROPRIETOR/PARTNER/EY ECUTIVE E.L. EACH ACCIDENT S , OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EAfM°LOYEE S It yes, describe untler . S°ECIAL PROVISIONS beloH• E.L. DISEASE -POLICY LIMIT 5 B OTHER EXCESS ACCIDENT & SPX0000003566300 12/31/2006 12/31/2009 ExcESS MEDICAL $10,000 MEDICAL 12:01 A. M. 12:01 A.M. $250 DEDUCTIBLE PER CLP.I AD S SPECIFIC LOSS $2,500 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER SS NAMED AS AN ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED INSURED. DATE S EVENT: 07/11/09 MAMA 6 PAPA'S SENIOR CITIZEN RUN/WALK 'INSURED CLUB: MID HUDSON ROAD RUNNERS CLUB, ATTN: PETE SANFILIPPO; B CARMINE DR.; WAPPINGERS FALLS, NY 12590 R 07/11/09 TOWN OF WAPPINGER P.TTN: CHRIS MASTERSON 20 MIDDLEBUSH ROAD WAPPINGER, NY 12590 ACORD 25 (2001108) u~cn~s ,,,,no, „~. INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ~fonn Le~eve_-/JF. 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 G ACORD CORPORATION 1988 Done ~ of 7 Erie° Insurance Group 100 6ielns.Pl. Erie, PA 16530 MAIL DATE AGENT'S NAME AGT N0. POLICY N0. 05/21/2009 GRAPEVILLE AGENC NN1116 Q26 5320040 WARREN CUSTOM BUILDERS INC 6 RAYMOND AVE POUGHKEEPSIE NY 12603-2363 OTHER INTEREST TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590-4004 IN CONSIDERATION OF THE ABOVE PAYMENT WE TAKE THE FOLLOWING ACTION: THIS POLICY WHICH WAS CANCELLED AS OF 12.01 AM STANDARD TIME MAY 19, 2009 IS HEREBY REINSTATED IN FULL FORCE AS OF 03:37 PM STANDARD TIME MAY 19, 2009. SINCE THIS POLICY WAS OUT OF FORCE FOR 0 DAYS, 15 HOURS, 37 MINUTES, WE ARE REDUCING THE PREMIUM DEPOSIT BY $ .00. A REINSTATEMENT FEE OF $25.00 APPLIES TO THIS SERVICE AND HAS BEEN ADDED TO THE BALANCE ON YOUR POLICY. THE ADJUSTED BALANCE IS SHOWN ABOVE. v ~~ ~ ~; C~~'Y 00675 THIS NOTICE SHALL BE EFFECTIVE ONLY IF YOUR PAYMENT IS HONORED BY YOUR FINANCIAL INSTITUTION 9061E (R) 8/97 ~ 1~ ~VRO CERTIFICATE OF LIABILITY INSURANCE OP ID ,ns DATE(MMIDD/YYYY) NATIO-1 05/12/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bagatta Associates , Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 823 W Jericho Turnpike Ste lA ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Smithtown NY 11787 Phone: 631-864-1111 Fax: 631-864-8274 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Worcester Insurance Company 26182 N ti l M i t INSURER B: Standard Security Life Ins Co ona a n enance Inc. T A National Sign & fighting INSURER C: AIG Insurance CO mean 1 5 Sweet HOllOW Road Old Bethpage NY 11804 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 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 NSR TYPE OF INSURANCE POLICY NUMBER DATE (MM DD/YYW DATE MM/DDS LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A R COMMERCIAL GENERAL LIABILITY MPA6G6029 07/02/08 07/02/09 PREMISES (Eaoccurence) $ 100000 CLAIMS MADE ®OCCUR MED EXP (Any one person) $ 500 0 X Brd Form/All Risk PERSONALBADVINJURY $ 1000000 X Contractual L1ab GENERAL AGGREGATE $ 2000000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $2000000 POLICY $ PRO• LOC JECT AU TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A % ANY AUTO BA9G2871 05/12/09 05/12/10 (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY A NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE P $ ( er accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: qGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ SODOOOO C A OCCUR ~ CLAIMSMADE BE4766669 07/02/08 07/02/09 AGGREGATE $ 5000000 DEDUCTIBLE $ R RETENTION $10000 $ WORK ERS COMPENSATION - AND E MPL OYERS' LIABILITY TORY LIMITS ER y / N ANY PROPRIETOR/PARTNER/EXECUTIVE^ OFFICER/MEM C ? E.L. EACH ACCIDENT $ BER EX LUDED (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER B Disability D93966-000 10/01/08 10/01/09 Property $150,000 A Pro ert MPA6G6029 07/02/08 07/02/09 - DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS As pertains to insureds operations. I~I~Y 2 ~~ 2009 °'sl~elaAl~! iff'~ r'FAt,r CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION WAPPING 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. Town of Wappinger Au s~z t~ SENT 20 Middlebush Rd. ~--~"~ 1Wal~pinger Falls NY 12590-0324 ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID CW ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) ENVIR-4 05 19 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agar-Ford-Jarmon & Muldrow HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P 0 Box 790 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Norman OK 73070 Phone:405-321-2700 Fax:405-360-8892 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: American xatl Specialty Linea 2 6 8 8 3 INSURER B: COmmerCe & Industry Ins CO 19410 Enviro Clean Services, LLC Ken R Murpphxy INSURER C: . P . O . BOX 721D 90 2 1090 i INSURER D: ty OK 7317 - Oklahoma C 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 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 NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY E PDATE MM/DDAYY N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1~ 0 0 0~ O O O A X COMMERCIAL GENERAL LIABILITY PROP18736801 05/17/09 05/17/10 PREMISES (Eaoccurenca) $ 300, 000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10 ~ D 0 0 A X POLLUTION LIAR $5, 000 DEDUCTIBLE PERSONAL&ADVINJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2, OOO~ OOO GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $2~000~000 POLICY X JECOT LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT 000 000 $ 1 B X ANY AUTO CA5295469 05/17/09 05/17/10 (Ea accident) , , ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS - (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANYAUTO OTHER THAN ~ ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 4~ 0 0 0~ O O O A X occuR ~ CLAIMSMADE PROU18736831 05/17/09 05/17/10 AGGREGATE $ 4, 000, 000 $ DEDUCTIBLE $ X RETENTION $ l O~ O O O $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PAR.TNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ A OTHER PROFESSIONAL LIABILITY PROP18736801 RETRO DATE 04-30-96 05/17/09 05/17/10 PER CLAIM 1,000,000 D 20,000 utscnirnun ur urercwn~rvar LVVNIIVnJi vcrn..~~„ ~....~.,.,~..~..,.+........ ~, ..,.....,...-...-.... _. __..-_..--- LIMITS SHOWN ARE THOSE IN FORCE AS OF PO CEPTION. L, „ ~~ ~~~,...o ~iAY ~ ~ 200 -;-~@~~f!! ~lTr~~~ CERTIFICATE HOLDER CANCELLATION TOWNWAP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7HE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL lO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL TOwn Of Wappinger IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 20 Middlebush Rd Wappingers Falls NY 12590-0234 REPRESENTATIVES. UT D REPRESENTATIVE ACORD 25 (2001108) © ACORD CORPORATION 1988 acoRO~' CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDIYYYY) ~- 05/18/2009 'RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION EMERY & WEBS INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE C/O H. R. KELLER & CO., INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1520 SHERIDAN DRIVE BUFFALO, NY 14217 INSURERS AFFORDING COVERAGE NAIC # JSURED INSURER A: FIRST MERCURY 10657 ARCO PROTECTION SYSTEM INC INSURER B: 1593 ROUTE 376 INSURER C: WAPPINGER FALLS NY 12590 INSURER D 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. SR TR DD'L POLICY NUMBER POLICY EFFECTNE DATE MMfDD1YYYY POLICY E%PIRATION DATE MMIDDIYYYY LIMITS q GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FMM1019674 05/19!2009 05!19/2010 PREMISES Ea occurrence $ 50,000 CL AIMS MADE ~ OCCUR MEDEXP (Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS -COMP/OP AGG $ 1 ,000,000 POLICY PROT- LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY fNJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE {Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS! UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 X OCCUR ~ CLAIMSMADE CUM1000643 05/19/2009 05!19/2010 AGGREGATE $ 5,000,000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION ' WC STATU- OTH- TORY LIMITS ER ANDEMPLOYERS LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ ^ OFFICER/M EMBER EXCIUDED~ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONSbelow E.L. DISEASE -POLICY LIMIT $ OTHER ~~'°~/ ~C~Ii~~V ESCRIPTIDN OF OPERATIONS! LOCATIONS 1 VEHICLESI EXCLUSIONS ADDED I3Y ENUUKSEMtNI r SrtaAl. PKt7vraru `~~ MAr" 2 9 20Q~ ROJECT: TOWN OF WAPPINGER ~ Y ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DE SCRIBE D POLICIES BE CANCELLED BEF 0 RE THE EXPI RATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN TOWN OF WAPPINGER 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 WAPPINGER FALLS, NY 12590 REPRESENTATIVES. ESENTAT VE CORD 25 (2009101) AUTHORIZEDREPR I ~~~ ©1988-2009 ACORD CORPORATION The ACORD name and loco are realstered marks of ACORD All rights reserved. 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 cert~cate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ~- ~~~~~~ ~~ ~MA°~ E ": 2©0~ -~~~~~i ~~ r~'~ ACORD 25 (2001108) STATE (=1F NEti~' YCrkIi ~~'C>khEkS' C;C)1~4YENSATION BC)AkI) C:`ERTIFIC_'~TE OF NI'S «'ORhERS' COMPENSATION INSURaNC.~ CO~'ER.~GE la. Legal Name and address of LZSUred Use street address onlyl 1b. Business Telephone Number of L7sured Kirchhoff-C onsigli 8~4S-63S-180(1 Construction 1\lanagement LLC 199 «'est Road Ste lUU lc. NYS Unemployment Insurance Employer Pleasant Valley, NI. 12169 kegistration Number of Lzsured ~~'arlc Location of Instued (Onlr required if cos~erage is s~rccificalh• !d. Federal Employer Identification Number of Insured limited to certirin loccrfions in :\'err 1'or•!c b'tirte, i. e cr i•I'r•crp-l.-jr Anlic~•) ar Social Security Number 27U-tU21U0 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) Town of ~'b'appinger 20 l~iiddlebush Road «'appingers Falls, NY 12S9U 3a. Name of Insurance Carrier Libertt- Insurance Corp 3b. Polio- Number of entity listed in boy "la": NC7Z112599~45019 3c. Police effective period: U7/U1/U9 to U7/U1/lU 3d. The Proprietor, Partners or Executive Officers are: ® included. (Cnil~ check boy if all p:unier~-i~Yficers nicludeil) ball excluded or certain partners/officers excluded. Tlis certifies that t11e insurance carrier ildicated above in box "3" insures the business referenced above in box "la" for ss~orkers' compensation under the Nest York State l~~ orkers' (::ompensatirni Last. (To use this form, New I'oric (NY) must be listed under Item 3A on the INFC)R11•L~TION PA(.rE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent still send this (;ertificate of LLSUrance to the enttts~ listed above as the certificate holder in box ""' The Inrur•irnce Ccrr7•icr mill also notifi' the uhos•e cer•tiftcate holder tir~itlzin Ill dins IF cr polict• is canceled drre to norzpcmment ofpr•emiums or x~ithin ,p dcn•s IF there are reasons other thirty nonpcn~ment r»`pr•ernirrms that ccrnce/ the polic~t• or elirrtiturte the insurcd.f •orn the cvs>erzrge indicated on this Cer•tif cafe. (These notices mcr}• he sent hr regnlin• mcrilJ Clthen+~is•e, tb.i,s C.'er•tificate is ra.lid for nne J•ear after tJxi,s fOr•I1Z TS a~7~1'Ot'ell vl• tl2e tY1Sll1'aNCC' Ca19'dC'1' Ol' ttS' I1Ce1RSC'!t agent, Ol" uH.tdl t12e ~701rC1' C'xp71'atlpll dple IISteCl in box " 3c", l,'11iC18 c'1'er' es earli.ca•. Please Note: Upon the cancellation of the w•orlcers' compensation polic}~ indicated on this form, if the business continues to be named on a permit, license or contract issued b~~ a certificate holder, the business must provide that certificate holder with a new C:er-tificate of «'orlcers' Compensation Coverage or other authorized proof that the business is comphring with the mandator•t• coverage requirements of the New York Suite ~'4'orkers' Compensation Law. under penalty of perjw•~•, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insw•ed has the coverage as depicted on this form. Approved by: John P. (>'Shea (PrnV ru~me of authorized representatite or lice~ised :igetd oY instu':uice c:nrier) Approved by: 3;`~r O9 (Si~rkature) Title: Authorized Re Telephone Number of authorized representative or licensed agent of insurance carrier. 44~-~~4-OS00 Please,~'ate: Onh• insurance can-iers cnzd tfzeir licensed agents arc uutl~ori~ed to issue the l_'-1 ~~.?•{orm. rnrthori~ed to issue it. C-10>.~(~~-071 ~~~~~~~~ auG o ~ zoos T~ll~-R! CLEF'=' (irnt.e) Insrrrcrnce hroker.e crr•e:~'OT ststst stcb.state.nv.us Wo><•l:ers' Co><npensation La~i~ Section S7. Restriction on issue of permits and the entering into contraci~~ unless compensation is secured. 1. The head of a state or municipal department, hoard, commission or office authorized or required by l:nt~ to issue an~• permit for or in comlection ~~~itl1 any ~corl, involvitlg the employment of employees it1 a hazardous employment defined by t11is chapter, and not~vitllstiulding :n1y general or special sti~tirte requiring or authorizilg the issue of such hermits, shall not Issue such permit unless proof dul}- subscribed by :v1 inslu-ance carrier is produced in a form satisfacton' to the chair, tl1:~t compensation for all employees has been secured as provided bZ• dlis chapter. Nothvlg hereitl, however. shall he crnlstn~ed as creatnlg any liability on the part of such state or mulicipal department, board, commission or office to pay amp crnupensatiml to an}• such employee if so employed. 2. The head of it Stilte or n111111C1pa1 depflrt111e11t, boil-d, l:O1111111.S~S1011 OI office authorized or required by la«~ to enter into any crnltract for or n1 cotnlection with an}' ~varlc nrvolvitlg the employment of employees u1 a hazardous employment defined hS• this chapter, not~vitllst<vlding :u1y general or special stahtte requirilg or authorizing any such contract. shall not enter into ally such contract wiles proof duly subscribed by an insurance carrier is produced u1 a form satisfactory to the ch<ru-, that compensation for all employees has been secured as provided b1~ this chapter. ECEI~iE au~ a ~ ~oa~ T~l~s~! CL~~-", C-10:i.~ (9-07)Reverse ACO OR ® DATE(MM/DD/YYYY) ~~ CERTIFICATE OF LIABILITY INSURANCE 07/29/2009 raooucER Aon Risk services Central, Inc. TffiS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Chicago IL Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER TffiS 200 East Randolph CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE (; Chicago IL 60601 USA COVERAGE AFFORDED BY THE POLICIES BELOW ~ . PRONE- 866 283-7122 Fnx- g47 953-5390 INSURERS AFFORDING COVERAGE NAIC# ~ INSURED INSURERn: ACE American Insurance Company 22667 Sears Holdings Corporation INSURER B: Indemnity Insurance Co of North America 43575 d dba Sears Home Improvement Products, Inc Attn: Risk Management E3-219A INSURER C: National union Fire Ins Co of Pittsburgh 19445 3333 Beverly Road e Hoffman Estates IL 60179 USA INSURER D: w ar INSURER E: 'fl C COVERAGES SIR annlies ner terms and rnnditinns of the nnlirv ~ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIItEMENT, TERM OR CONDTI'ION 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 ADD' LTR INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE(MM/DD/YYYY DATE(MM/DD/YYYY A ERALLIABILITY HDOG24933398 08/01/2009 0$/01/2010 EACH OCCURRENCE $$,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ S , OOO , 000 PREMISES (Ea occurrence) CLAIMS MADE ~ OCCUR MED E P (Anv one person) EXC u e PERSONAL & ADV INJURY $ 5 , 000 , 000 GENERAL AGGREGATE $5 000 000 ' , , GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ S , OOO , OOO ^X POLICY ^ PRO- ^ LOC JECI A AUTOMOBILE LIABILITY ISAH08579S7A 08/01/2009 08/01/2010 A ANY AUTO ISAH08579568 08/01/2009 08/01/2010 COMBINED SINGLE LIMIT (Ea accident) $5 , 000, 000 X ALL OWNED AUTOS SCHEDULED AUTOS ~~ ~ ((ipce~ ~ ~~ ~ I ` g~ {, C 9 111,,,~~~~~~ BODILY INJURY (Per person) X HIRED AUTOS BODILY INJURY X NON OWNED AUTOS A ~^ y O h H u L O~ (Per accident) PROPERTY DAMAGE (Per accident) A ~ F GARAGE LIABILITY ~ - ~ AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY AGG C EXCESS /UMBRELLA LIABILITY BE27471375 08/01/2009 08 O1 2010 EACH OCCURRENCE OCCUR ^ CLAIMS MADE AGGREGATE $2,000, 000 BDEDUCTIBLE RETENTION A WLRC45701 19 O1 0 X WC STA11J- OTH- WORKERS COMPENSATION AND C'4 T E A EMPLOYERS' LIABILITY ~/ N IN 1 5cFC45701220 08/01/2009 08/01/2010 E•L.EACH AccIDENT $1,000,000 ANY PROPRIETOR /PARTNER /EXECUTIVE l~l B (GMandatorv in NHj EXCLUDED? WLRC45701207 08/01/2009 08/01/2010 E.L. DISEASE-EA EMPLOYEE $1, 000 , 000 . All other States E.L. DISEASE-POLICY LIMIT $1,000,000 If s, describe under SPECIAL PROVISIONS below ~ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS rn rn O V tD m O O n O Z d y t0 U l: G W U ~_ i H J J t.. F CERTIFICATE HOLDER CANCELLATION TOWN DF WAPPINGER FALLS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED DEFORE THE EXPIRATION 20 MIDDLEBUSH ROAD DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL WAPPINGER FALLS NY 12590 USA 30 DAYS WRITTEN NOTICE TO TFDi 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 REPRESENTATTVES. = AUTHORIZED REPRESENTATIVE a.~On ~~.a/~E c-7krtiaa~ ~~~~'~ Y ACORD 25 (2009/01) p1988 2009 ACORD CORPORATION. All rights reserved= The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) TM 8 5 2009 PRODUCER Phone: 858-481-8692 Fax: 858-481-7953 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION G.S. Levine Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10505 Sorrento Valley Rd. Suite 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Diego CA 92121 INSURERS AFFORDING COVERAGE NAIL # INSURED INSURERA:HartfOrd Fire Insurance Co 19682 Blue Haven Pools Northeast, Inc INSURERB:Ins. Co. of State of Penns lv 19429 dba Blue Haven Pools & Spa 37 Elk i it 51 D S INSURER C: r ve e ay u Chester NY 10918 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 NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ,Z~ GENERAL LIABILITY 7 2 UENQY2 0 8 7 8/ 1/ 2 0 0 9 8~ 1~ 2 010 EACH OCCURRENCE $ 1 QQQ Q Q Q DAMAGETORENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 3 0 0 Q Q Q CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 1 Q Q Q Q ,~`" ~ - .a PERSONAL 8 ADV INJURY $ ], QQQ Q Q Q GENERAL AGGREGATE $ 2 QQQ Q Q Q GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 2 QQQ QQQ POLICY PRO LOC 4 AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO A ~~ ~ ~ ~ 0~ ALL OWNED AUTOS " " BODILY INJURY $ (Per person) SCHEDULED AUTOS `~'°~~~a~aq ~~ err HIRED AUTOS - t=q ,~~ BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGELIA8ILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WC3429691 8~1~2009 8~1~2010 X WCSTATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ], QQQ Q Q Q ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1 QQQ Q Q Q If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1 Q Q Q Q Q OTHER DESCRIPTION OF OPERATIONS (LOCATIONS / VEHICLES I EXCLUSIONS ADDED BYENDORSEMENT /SPECIAL PROVISIONS *10 day notice of cancellation for non-payment of premium. he attached endorsements apply only as required by written contract. E: All Operations of the Named Insured Proof of Insurance CERTIFICATE HOLDER Town of Wappinger 20 Middlebush Rd Wappinger Falls NY 12590 ACORD 25 (2001108) 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 REPRESENTA ©ACORD CORPORATION 1988 ACORO~ DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE o7/2o/zoo9 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Aon Risk Services Central , Inc. AIVD CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THLS Chicago IL Office N 200 East Randolph CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE ,,, Chicago IL 60601 USA COVERAGE AFFORDED BY THE POLICIES BELOW. m n INSURERS AFFORDING COVERAGE NAIC # rv PHONE• 866 283-7122 FAx- 847 953-5390 INSURED nvsuRERA ACE American Insurance Company 22667 Sears Holdings Corporation INSURERS Indemnity insurance Co of North America 43575 w dba Sears Home Improvement Products, Inc - Attn: Risk Management E3-219A INSURER C: 3333 Beverly Road Hoffman Estates IL 60179 USA wsURERD: INSURER E: crv annliec ner terms a c 0 ons of the policv x l.V V 1~.KAl1L' .7 POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIIE POLICY PERIOD INDICATED. NOTWITHSTANDING THE ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY ' IONS OF SUCH POLICIES. EXCLUSIONS AND CONDTI POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS , PERTAIN, THE INSURANCE AFFORDED BY THE AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED INSR LTR ADD' INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPHtATION ' LIMITS DATE MM/DD/YYYY YW DATE MM/DD/] A HDOG24933398 08/01/2009 08/01/2010 EACH OCCURRENCE $5;000,000 N X ERALLIABILITY DAMAGE TO RENTED $ 5 , 000 , 000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurtence) CLAIMS MADE ® OCCUR XP (Anv one person EXC U e PERSONAL & ADV INJURY $ 5 , 000 , 000 GENERAL AGGREGATE $ 5 , OOO , 000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 5 , 000 , 000 ^X POLICY ^ ~ ~ ^ LOC A gUTOMOBH.ELIABILITY ISAH0857957A 08/01/2009 08/01/2010 COMBINED SINGLE LIMIT A ISAH08579568 08/01/2009 08/01/2010 (Ea accident) $5,000,000 ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY (Per accident) X NON OWNED AUTOS PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT GARAGE LIABII.ITY ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE ^ OCCUR ^ CLAIMS MADE AGG'REG'ATE DEDUCTIBLE RETENTION A WORKERS COMPENSATION AND WLRC 1 )( WC STATU- OTH- ' t ~ ~ A EMPLOYERS' LIABH.rrY ~~.L~ SCFC45701220 08/01/2009 08/01/2010 E.L. EACH ACCIDENT $1, 000 , 000 ANY PROPRIETOR /PARTNER /EXECUTIVE U EXCLUDED? O F WI E.L. DISEASE-EA EMPLOYEE $1, 000 , 000 B iandatory in NH) ( i~ WLRC45701207 08/01/2009 08/01/2010 E.L. DISEASE-POLICY LIMIT $1,000,000 If es, describe under SPECIAL PRO VISIONS below All other states OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONSRDDED BY ENDORSEMENT/SPECIAL PROVISIONS 2? l0 00 m O O n O z •~ A v 4'. d U ~_ ~i rFF-e LJ ly J L CERTIFICATE HULllEK ~-~~~-~.+r~ 11v1` TOWN OF WAPPINGER FALLS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EJtTIRP.TION - 20 MIDDLEBUSH ROAD DATE THEREOF, THE ISSUMG INSURER WII,L ENDEAVOR TO MAIL WAPPINGER FALLS NY 12590 USA 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 ~y ~~ ~sSL?aG ~ysa Y ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved= The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DGRA DATE (MM/DDmYY) BRIDG-6 07 29 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Marshall & Sterling, Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 110 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Poughkeepsie NY 12601 Phone: 845-454-0800 Fax: 845-485-7804 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Indamni ty Co of ,unar 344 INSURER B: Bridge View Excavation InC INSURER C: 3 Van Wyck I.n Su7.te 1 Wappingers Falls NY 12590 INSURER D: INSURER E: GUVEKAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YY POLICY EXPIRATION DATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ~, O Q Q O Q O A }[ COMMERCIAL GENERAL LIABILITY DTC07734A349 07/15/09 07/15/10 PREMISES (Eaoccurence $ 30000D CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10000 PERSONALBADVINJURY $ 100D000 ~ GENERAL AGGREGATE' $ 3000000 GEN'LAGGREGATELIMITAPPLIESPER: '~~ ~' ,,,...((( .__~ PRODUCTS-COMP/OPAGG $ 3000OQ0 PRO• POLICY JECT LOC ~ Em Ben . 100000 AUT OMOBILE LIABILITY M ANY AUTO BINED SINGLE LIMIT CO (Ea accident) $ ALL OWNED AUTOS ® ~ BODILY INJ RY SCHEDULED AUTOS ~~E U (Per person) $ HIRED AUTOS ~ 9 ~oo D NON-OWNED AUTOS 1 ~ q1 J acc tlent)RY (Per $ ~ ~ ,J ~~~ AMA E GL~ G (Pea cRdent) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC OTHER THAN $ AUTO ONLY: qGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ g WORKERS COMPENSATION AND ' A - TORY LIMITS ER EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E,L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If d i E.L. DISEASE - EA EMPLOYEE $ yes, escr be under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS GEKI IFIGATE HOLDER CANCELLATION Town of Wappingers Middlebush Road Wappingers Falls NY 12590 TOWN03 6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AtGUKU Z5 (2001108) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). - DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. G`~ ~~ ~~~ ,~ ~ ~p09 ,~~ ACORD 25 (2001108) !, r ACORD~, CERTIFICATE OF LIABILITY INSURANCE DATE(MhVODiYYYY) 7/15/2009 PRODUCER ASL VA Richmond THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Atlantic Specialty Lines, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O eox 35723 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Richmond VA 23235 _ _ INSURERS AFFORDING COVERAGE NAIC # INSURED Swanson Consulting Inc INSURER a: CERTAIN UNDERWRITERS AT LLOYD'S P.tJ Box 395 INSURER B: _ Salisbury Mills NY (2557 INSURER C: INSURER D: INSURER E: vv r cr I nt f'ouclES of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR COND1710N OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH TH15 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR JJ8_ 00' dS13 _,]lPE9FJNSURANl:E POLICY NUMBER -. POLICY EFFECTIVE A'fE.(MMIRDL100 POLICY EXPIRATION A7E.lMMlDJt1_YYJ ~ - LIMI78 GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY FR ~ ~b~Rl:flT~- ~€ g ~ CLAIMS MADE C~ OCCUR _ __, MED EXP ( one arson) S - PERSONAL 8 AOV INJURY S _ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG _S _ POLICY PRO_ (~ LOC dEC L .~~ AU TOMOBILE LUIBILJTY ~ E E! V E - COMSINED 61NGLE LIMIT ANY AUTO (Es aceidenl) S ALL OWNED AUTOS ~~ z o ~0~~ DPe { ~ RY S SCHEDULED AUTOS (pe rson HIRED AUTOS BODILY IN,)URY NON•OWNEDAUTOS '~~~ R, CL~~~> (Perac~ident) ~ S ~+ PROPERTY DAMAGE S (Psr acddonl) GARAGELWBILITY AUTO ONLY-EA ACCIDENT S _ ANY AUTO EA ACC OTHERTHAN _ S --_.. _---•.... AUTO ONLY: qGG S EXCE95AIMBRELLA LIABILITY ~ EACH DCCURRENCE _ S OCCUR ~ CLAIMS MADE AGGREGATE S -- S DEDUCTIBLE S RETEN710N $ _.._ g WORKERS COMPENSATION ANO ' _ rr QfiYLiM~S,1_ ~EH- -'~ EMPLOYERS LIABILITY ANY PROPRIETORlPARTNERIEXECUTIVE E.L. EACH ACCIDENT S OFFICERIMEMBER E%CLUDED7 E L DISEASE - EA EMPLOYE S II yes, describe undor SPECIAL PROVISIONS below E. L DISEASE -POLICY LIM17 S OTHER NAL4908002 05!2512009 05/25/2010 Aggregate 1.000.000 Professional Each Claim 1.000.000 DESCRIPTION OF DPERATIDNS 1 LOCATIONS 1 VEHICLES 7 E%CLUSIONS ADDED BY ENDORSEMENT! 3PECUIL PRDVi810NS 10 day cenceilation notice for non payment Df premium, 30 days for all other days. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUGE6 BE CANCELLED BEFORE THE EXPIRATION Town of Wappingers DATE THEREOF, THE ISSUING INSURER VYtLL ENDEAVOR TO MAIL 3f) DAYS WRITTEN 20 Middlebush Rd NOTICE TO THE CERTFICATE HOLDER NAMED TO LEFT, BUT FAILURE TO DO SO SHALL Wappingers Falls NY 12590 IMP08E NO OBUOATON OR LIABILITY OF ANY KIN O E , ITS A TS OR REPRESENTATNE$. AUTHORIZED REPRESENTATnIE AGaKD ZS (ZU0910t3) 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 aster the coverage afforded by the policies listed thereon ACORD 25 (2001!08) ~AC ~~ PATIENC-09 BUKR ~.~- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) PRODUCER (216) 622-7400 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION the James B. Oswald Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1360 East 9th Street, #600 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Cleveland, OH 44114-1730 ALTER THE COVERAGE AFFORDED BY THE POLICIES BE~ow_ INSURERS AFFORDING COVERAGE NAIC # INSURED Patio Enclosures, Inc. ALL LOCATIONS INSURER A: Nat'l Union Fire Ins Co of Pittsburgh PA 19445 700 East Highland Road INSURER e: Charter Oak Fire Ins Co 5615 Macedonia, OH 44056 INSURER c: Commerce & Industry Insurance Compan~19410 INSURER D: 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 unt/G nGrni orni,rrr. o.. ~.~., ......... POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GE NERAL LIABILITY A X EACH OCCURRENCE $ 1,000,00 COMMERCIAL GENERAL LIABILITY 4573017 7/5/2009 7/5/2010 AMA R N EL PREMISES Ea occurence $ 500,00 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10,00 1 00 PERSONAL 8 ADV INJURY , 0,00 $ 2 000 00 ' GENERAL AGGREGATE , , $ GEN L AGGREGATE LIMIT APPLIES PER: PRO X PRODUCTS -COMP/OP AGG $ 2,0~~,0~ POLICY LOC AU TOMOBILE LIABILITY B X ANY AUTO GOCAP291 D0359COF09 7/5/2009 7/5/2010 (Ea acciueDtj INGLE LIMIT $ 1,0~~,00 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GAR AGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION ' WC STATU- OTH- X $ C AND EMPLOYERS LIABILITY ~,. / N TORY LIMITS _ ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 67712436 7/5/2009 7/5/2010 E.L. EACH ACCIDENT $ 1,000,00 (Mandatory In NH) If yes, describe under E.L. DISEASE - EA EMPLOYEE $ 1,0~0,~0 SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 OTHER • -• -• -•.........~ . ~wn..v.w , rcrn~.~w i cn~~ua,vns wYUtU esr ENWfit3EMENT /SPECIAL PROVISIONS - '~ (~ * ~ ~~ `~ JUG ~ 5 20Q~ ~~~ ~~ ~~ CERTIFICATE HOLDER CANCELLATION SHOU LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN Town of Wappinger NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 20 Middlebush Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Wappingers Falls, NY 12590- ACORD 25 (2009/01) AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) lb. Business Telephone Number of Insured 330-468-0700 Patio Enclosures, Inc. 700 East Highland Road lc. NYS Unemployment Insurance Employer Macedonia, OH 44056 Registration Number of Insured 70-91405 1 Work Location of Insured (Only required if coverage is specifically ld. Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a Wrap-Up or Social Security Number Policy) 341007831 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) Commerce & Industry Insurance Company Town of Wappinger 3b. Policy Number of entity listed in box "la" 20 Middlebrush Road Wa m er Falls NY 12590 67712436 Pp~ g 3c. Policy effective period 7/5/09 to 7/5/10 3d. The Proprietor, Partners or Executive Officers are included. (Only check box if all partners/officers included) ^ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box " 3" insures the business referenced above in box "1 a" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also 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 ofpremiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c ", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Krist A. chs P t name of autho ' epr tative or licensed agent of insurance carrier) Approved by: ~~_ ~// 3 (Signature) Title: Client Service Administrator Telephone Number of authorized representative or licensed agent of insurance carrier: _(216) 367-4950 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 STATE OF NEW YORK 'S~'OR,IC>sRS' CO~!'ENSA'I`It~N B4)ARD C"ERTTE'TC'ATE t.3F INSURANCE C+(~'tdEItAGE ~EK THE NYS 17ISABILITY FIENEFITS LAW la. Legal Nantie and Address of Ibstnced (Lise sttret address only} ' lb. Btuiness Telephone Ntttuber+~fLtsture*~l PATIO ENCLOSURES INC (330) 467-4267 700 HIGHLAND EAST lc NYS LTueutploym~ettt Ittsua~at~e Eutplayer Registratiau MACEDONIA, OH 44056-2112 Nwnlteroflnsut~ed 7091405 ld. Federal F~xnployer deutificataa~ 1•rxtrtber of Instured or Social Security Nun~er 341-00-7831 2. Name and Address of the Entity Regt~sting prowl' of 3a. Name of Insruastc~e Carrier Coverage (Eattity Being, Lis#ed as the ~'~ti~cate bolder) NE1N YORI( STATE INSURANCE FUND Town of Wappinger 20 Middlebrush Road 3b. P"oliey Number of entity listed in box "la"': Wappinger Falls, NY 12590 DBL 2779 76 - 8 3c. Palit:y efl`e~ctiv~e period;. 07/01/2009 to 07/01/2010 4. tcy ca~~ers: a, ~ All of the en~ployex's eutployees eligible ~uxl+er the New'Yc~rk Disability Befits Law b. ~ t~ly die following class or classes of tAe etnployet's employees: Under penalty o~perjttry, I certify that I am an authorized representative or licensed agent of the utsttrance carrier referenced abo~~~e and that the na€ued insured has NYS Disability Beue~its insurance coverage as described abmNe. Irate Signed 07/13/2009 By /~~ (~igpa of irstteaatce carrier's surharixed reWatiee or NYS trieersed Iusurarrce Agent of char insurance carrier> Tclepl-oneNuu;ber (866) 697-4332 Title DIRECTOR IMF UNDERRITIfVG Yv'-tP4RTAATt`: ttbmc "4~" is cher~mt, and this tam is signed by tlrc carrier's aurtruizrct ~na1i+~+r a :3YS L.t~rscd ta~rroca Atoe~rt of that carrier, this eettitiicate is Ct]htFI.E1'E. ~?iait it diraecHy ro dre cexti frcate trulder- If t-mc '4b' is ehetl€ed, this certificate is Alt)r COMPLETE far purtwses of ~eetior 230, Subd. $ of the Di~ritty ]3ersetEts Lavt•. h roust be trailed: for cotnp~tetian to the ~4"orYerx' C $oard, I3H Plems A~reptanr.~e 11>sit. 2l1 t"adc Stre+ei, Altra~r, Neca 3Ce~ic 1'~~67- DART ~. Ta a comp y NYS ot° '+era' Carnpr3nsst on {t)ri, x'"4 " Part 1 as en c e State ©f New York Workers' Compensation hoard Ancardiug to ittEbrttttttiou nzttitttais~ed by the NYS Workers' Cau~eusaticm 13wtrd, the abarre-named +ettypleyer h°as cotrtplied +wath the ~'S d3isability Hepefits C,aw wylh respect to all. of hstlle~e emptayees. Dale Si,Eated $y ($ittttattlrle Of NYS DI°ptttt[S' COtup~saltior Hoard employee} Telephone Ntuuber Titre Please Note: Only ittsttratx~ carriegs licend to write NYS disability benefits iwsu~rance policies and NYS licensed insurance agents of those insuuance carriers am authorized to issue Fotiu DB-12Q. 1. Insurance bfokers are IrTC!'T ttthoriztd to issue this fottn. DB't~tl.! (S-06) Certificate Number 57788 ACORiD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) PRODUCER 610.868.8507 FAX 610.868.7604 THIS CERTIFICATE IS ISSUED AS A MATTER OF IN ORMATION9 Hampson Mowrer Krei tz Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 54 5. Commerce Way, Suite 150 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Bethlehem, PA 18017 INSURED ECS CONSTRUCTION MANAGEMENT INC 1176 N TRVING STREET ALLENTOWN, PA 18109 COVERAGES T41P Pni irticc nc u~ei ~o w.~r.r ~ ~~T.-.. .,.-.......... ._ ___...__ ___ INSURERS AFFORDING COVERAGE NAIC # INSURER A: SeleCtlVe Way Insurance Co 26301 INSURERB Selective Insurance Co of SE 39926 INSURER C: INSURER D: INSURER E: ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESP qR DING ~ EC TO WH CH THIS CERTIF CATS MAY BE SSUED MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iN R DD LTR NSR TYPE OF INSURANCE POLICY NUMBER P L C EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS GENERAL LIABILITY X 51857663 06/10/2009 06/10/2010 EACH OCCURRENCE $ 1, OOp ~ p0 COMMERCIAL GENERAL LIABILITY _ PREMISES Ea occurre~ $ 100 , 000 A CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5 000 PERSONAL 8 ADV INJ RY -~ U $ ], ~ QQQ ~ 000 GENERAL AGGREGATE 2 ' $ , QQQ ~ 000 GEN L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS -COMP/OP AGG $ 2 , QQQ , Q00 POLICY JECT LOC AU TOMOBILE LIABILITY S1857663 06/10/2009 U6/lU/201U X ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1 r OQ0 , 000 ALL OWNED AUTOS A SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY 51857663 06/10/2009 U6/lU/201U EACH OCCURRENCE $ 5 , QOQ, QQQ X OCCUR ~ CLAIMS MADE AGGREGATE $ 5 , QQQ ~ QQQ A $ DEDUCTIBLE $ X RETENTION $ $ ~ WORKERS COMPENSATION WC7950861 06/10/2009 06/10/2010 X AND EMPLOYERS' LIABILITY Y TORY LIMITS _ ER B / N ANY PROPRIETOR/PARTNER/EXECUTIVE^ OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT __ $ 1 , OQQ , QQQ (Mandatory in NH) If yes describe under E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000 , SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1 , Q00 , OQO OTHER ENTED/LEASED 51857663 06/10/2009 06/10/2010 20,000 LIMIT A E QUIPMENT ' ONS RE: SONIC 6127, WAPPTNGERS FALLS, NY `~ JUL , O 009 ~~ TOW~1 CLERi~ CERTIFICATE HOLDER CANCELLATION TOWN OF WAPPINGER ATTN: BUILDING DEPARTMENT 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 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 AUTHORIZED ?Yl.,moo R Hwltz~D C!'"C1 i Thomas Hartzell, CPCU/AA ~' 25 {2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD~, CERTIFICATE OF LIABILITY INSURANCE ioii5i2 0' PRODUCER (g'73) 890-0900 FAX: (973) 612-9860 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION C&H AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 783 North Riverview Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 324 Totowa NJ 07511 INSURERS AFFORDING COVERAGE NAIC #~ INSURED INSURERA:AmerlCan Int. Specialty Conklin Services & Construction, Inc. INSURER B: Commerce and Industry Co. 94 Stewart Avenue INSURERC:NY State Insurance Fund Newburgh, NY 12550 INSURER D: INSURER E: - --~-~-- -• ~wvv ni+v~ occrv iaautu I v Iris IIVSUHtU NAMtD ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T HIS 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. INS R ADD' L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIV DATE MM/DD/YY E POLICY EXPIRATIO DATE MM/DD/YY N LIMITS GENERAL LIABILITY EA H OCC RRENCE $ 1 , 000 , 000 X COMMERCIAL GENERAL LIABILITY PROP2719B1B ~ DAMAGE TO RENTED 300 0 A PREMISE Ea occurrence , 00 $ CLAIMS MADE OCCU R 10/17/2009 10/17/2010 MEDEXP An one erson $ 25,000 X XCU Included INCLUDES POLLUTION & 1 000 000 PERSONAL&ADVINJURY , , $ X Contractual PROFESSIONAL LIABILITY 2 000 000 GENERAL AGGREGATE , , $ GEN'L AGGREGATE LIMIT APPLIES PER : PRODUCTS -COMP/OP AGG $ 2 r 000 , 000 POLICY X jE ~ LOC AU TOMOBILE LIABILITY X COMBINED SINGLE LIMIT 000 000 $ 1 ANY AUTO (Ea accident) , , B ALL OWNED AUTOS CA 9343685 10/17/2009 10/17/2010 SCHEDULED AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS X BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA A C $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY $ 25, 000, 000 X OCCUR ~ CLAIMS MADE AGGREGATE $ 25, 000 , 000 A DEDUCTIBLE PROU271929? 10/17/2009 10/17/2010 $ X RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY G1465857-9 4/1/2009 4/1/2010. }{ WCSTATU- OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE **FOR REFERENCE ONLY** E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? If yes describe under SEPARATE CERTIFICATE TO E.L. DISEASE - EA EMPLOYEE $ 1 , 0 00 , 000 , SPECIAL PROVISIONS below FOLLOW E.L. DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADD~p F~ Ejj~~IENT/SPECIAL PROVISIONS Town of Wappingers is included as Addiy ~~ii~~~-i°th respect to all operations performed b or on behalf of th ~ y e Named Insured, but only if required by en and signed cont t. 4 s ~~~ ~ ` ~ f ~~~ s9 iL CERTIFICATE HOLDER - ' "~`~~~~'~ ~~- F ` CANCELLATION Town of Wappingers 20 Middlebush Road Wappingers Falls, NY 12590 ACORD 25 (2001/08) INS025 (oioa).Daa SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 ~ 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 REPRI AUTHORIZED REPRESENTATIVE Michael Culnen/JENN ©ACORD CORPORATION 1988 Page 1 of 2 Erie ~, CERTIFICATE OF INSURANCE ~\ Insurance ~ ~ ~ -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY - t00Erie Ins. PI. Erie, PA 16530 CERTIFICATE HOLDER COPY NAME AND NUMBER OF AGENCY DATE ISSUED 09/ 19/2009 GRAPEVILLE AGENCY, INC. NN 1 1 17 NAME AND ADDRESS OF CERTIFICATE HOLDER OR OTHER NAME AND ADDRESS OF NAMED INSURED ~ ~~~0~~~ JBR CONSTRUCTION CORP ~t ~ 2000 M DDLE BUSH I RDERS 1061 ROUTE 376 5EP WAPPINGER FALLS NY 12590-6346 WAPPINGERS FALLS NY 12590- ~-n~~lN CLER' This is to certify that policies, as indicated by Policy Number below, are in force for the Named Insured at the time that the certificate is being issued. ,' ";,::a'iYP~"i~FINSIHiANC~; ;, ~DIJCYNI,tMtttoH F04f E3bt.lo?t s'oF iN&fl tEFEC7tYE pi0.7E,. , LXP1pA71DN Dq7~ ;: UMiT RANRE :..: GENERAL LIABILITY Q467350040 10/23/2009 10/23/2010 EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY 1000000 OCCURRENCE FORM FIRE DAMAGE GEN'LAGGREGATELIMITAPPLIES (Any one premises) $ 1000000 PER: POLICY MEDEXP(Anyoneperson) $ 5000 PERSONAL & ADV INJURY $ 1 OOOOOO GENERAL AGGREGATE $ 2000000 PRODUCTS-COMP~OP AGG $ 2000000 BODILY INJURY $ (EACH PERSON) BODILY INJURY $ (EACH ACCIDEN PROPERTY DAMAGE $ BODILY INJURY AND $ PROPERTY DAMAGE COMBINED EXCESS LIABILITY Q34737001 1 10/23/2008 10/23/2009 EACH OCCURRENCE 2000000 ...,. OCCURRENCE FORM ,.> RETENTION $10000 AGGREGATE 2000000 STATUTORY " ,;: BODILY ACCIDENT $ EACH ACCIDENT INJURY DISEASE $ POLICY LIMIT BY DISEASE $ EACH EMPLOYEE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTJSPECIAL PROVISIONS CANCELLATION FOR NON-PAYMENT, CAUSE OR NAMED INSURED'S REQUEST: When an automobile policy is cancelled, wririen notice will be mailed to the Certificate Holder. When any of the above described policies (other than automobile) are cancelled before the expiration date thereof, The ERIE will endeavor to mail written notice to the Certificate Holder after the decision to cancel. Failure to mail such notice shall impose no obligation or liability of any kind upon The ERIE, its Agents or representatives. ® CANCELLATION FOR SPECIAL CONTRACTS: (If the box is checked, this certificate involves a special contract and the following cancellation provisions apply.) When an automobile policy is cancelled, written notice w~lbbe mailed to the Certificate holder. When any of the above described policies (other than automobile) are cancelled before the expiration thereof, The ERIE will endeavor to mail days written notice to the Certificate Holder after the decision to cancel. Failure to mail such notice shall impose no obligation or liability of any kind upon The ERIE, its Agents or representatives. FRIF INSI IR~N(`F (:R~ll IP This certificate is issued for information purposes only. It does not list, amend, extend, or otherwise alter the terms and conditions of insurance coverage contained in the Policy(ies) indicated above issued by The ERIE. The terms and conditions of the Policy(ies) govern the insurance coverage as applied to any given situation. Any party can request a policy and/or Declaration by asking the insured or the Agent. Limits shown may have been reduced by claims paid. UF-1568 2102 (E) (_IF SEE REVERSE SIDE AUTHORIZED ~~~ REPRESENTATIVE _~® ~~K~ CERTIFICATE OF LIABILITY INSURANCE OP ID RM DATE (MM/DD/YYYY) WHITM-1 PRODUCER 09/25/09 Frank H . Reis Inc THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 79 North Front Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Box 3967 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Ki t ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ngs on NY 12402 Phone: 845-338-4656 Fax: 845-338-4113 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Selective way Insurance co. 26301 INSURER B: Rochdale Insurance Company Whitman Electric Inc 39 INSURER C: Kieffer Lane Kingston NY 12401 INSURER D: nwe-e~.....-.. INSURER E: ~rvwcu 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/YYYY DATE MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY S1850803 10/01/09 10/O1/10 PREMISES (Eaoccurence) $ 100000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10000 X AGG PER LOC&PROJE PERSONAL&ADVINJURY $ lOOOOOO X AUTOM COMPL OPS ELITEPAC GL GENERAL AGGREGATE $ 3000000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OP AGG $ 3000000 POLICY X JE ~ LOC EBL 1000000 AU TOMOBILE LIABILITY A COMBINED SINGLE LIMIT (Ea accident) $ 1000000 X ANY AUTO 51850803 10/01/09 10/O1/10 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X DRIVE OTHER CAR PROPERTY DAMAGE $ X ELITE PAC AUTO (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: qGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $ 10000000 A X OCCUR ~ CLAIMSMADE 51850803 10/01/09 10/01/10 AGGREGATE $ 10000000 DEDUCTIBLE $ X RETENTION $ 10000 $ WORKERS COMPENSATION X AND EMPL OYERS' LIABILITY TORY LIMITS ER $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER RWC3159664 11/01/08 11/01/09 E.L. EACH ACCIDENT $500000 /MEMBER EXCLUDED? I-1 (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ 500000 If es, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 500000 OTHER A Inland Marine S1850803 10/01/09 10/O1/10 Sched/Rented&Lease DESCRIPTION OF OPERATIONS (LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ~E~EIVE~ . ~' - - ~~~ ~ CERTIFICATE HOLDER CANCELLATION T~~~ CLE ~~ 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 Wa in ers REPRESENTATIVES. pp g 20 Middlebush Road A~RESENTATIVE Wa in ers Falls NY 12590 --- AGVt<u Z5 (ZUU9/01~ ©1988-2009 ACORD CORPORATION. Ali rights reserved. The ACORD name and logo are registered marks of ACORD 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 STE 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 Folicy: PACKAGE INCLUDING AUTO You recently received a notice advising this policy was being cancelled effective 10/05/2009 . This notice is to advise that the policy is being reinstated without lapse in coverage. 0~ i ~ 1 2009 ~n~~N CIEF~~~ Other Party of Interest TOWN OF WAPPINGERS FALLS 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 Date Mailed: 25th ,day of September, 2009 v ~ / ~ j I ;i V FRAN DEEMING NYCT36 FORM# CT969897NY51995 09252009SNNY ODEN 3.0.09.08a Copy for Other Interests Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MM,°D/YYYY) 09/28 2 / 009 PRODUCER (201)944-6600 FAX (201)944-8660 THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION JM ASSOCIATES a Divi Sion of ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUB International Northeast HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES eFl ~w 1 Bridge Plaza North,5uite 360 Fort Lee, NJ 07024 INSURED Liberty Elevator Corp. 63-69 East 24th Street Paterson, NJ 07514 INSURERS AFFORDING COVERAGE NAIC # INSURERA: StarNet Insurance Company 40045 INSURER e: Employers Fire Insurance Co 20648 INSURER C: National Union Fire Insurance 19445 INSURER D: StarNet Insurance Company 40045 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHST . ANDINi 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 SUC , H POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY XPIRATION LIMITS GENERAL LIABILITY JM5000038000 09/25/2009 09/25/2010 EACH OCCURRENCE $ 1 OOO,OOO ' COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ ZOO , OOO CLAIMS MADE ^ OCCUR MED EXP (Any one person) $ lO , OOO A PERSONAL 8 ADV INJURY $ 1 OOO OOO , , GENERAL AGGREGATE $ 3 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRO PRODUCTS -COMP/OP AGG , , $ 3 , OOO , OOO - POLICY X JECT LOC AU TOMOBILE LIABILITY 7530214030000 10/09/2008 10/09/2009 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) 1 OOO OOO ALL OWNED AUTOS BODILY INJURY , , B 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: qGG $ EXCESSIUMBRELLA LIABILITY BE026045428 09/2S/2009 09/25/2010 EACH OCCURRENCE $ S , OOO, OOO X OCCUR ~ CLAIMS MADE AGGREGATE $ 5 , OOO , OOO C $ DEDUCTIBLE $ RETENTION $ g WORKERS COMPENSATION AND BNUWC0107583 10/26/2008 10/26/2009 we sTATU- oTH- EMPLOYERS' LIABILITY D Y ! N OFFICER/MEM ER EXCLUDED XECUTIVE E.L. EACH ACCIDENT $ 1 ~ 000 ~ QOO (Mandatory in NH) ~ E.L. DISEASE - EA EMPLOYEE $ 1 , 000 ~ OOO If yyes describe under SPEC(AL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1 , OOO , 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS E: Contract # 1873 Elevator service @ 169 Myers Corners Road - Wappinger Falls, ~,,~~ ~ .,, ~ aC ~ ~ 2 2009 ~ ~ s~ F , _ w ~v 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, Town of Wappi nger BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY 20 Mi ddl ebush Road OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Wappinger Falls, NY 12590 AUTHORIZED REPRESENTATIVE /~~ /t /~ Jackie Mortman/MARIA (o'ff` .~wC,~,v G~ ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID JFIS V^ 09/30/ F LIABI~I~ INSURANCE AS A MATTER OF INFORMATION AND CONFERS NO RIGHTS UPON THE CERTIFICA w!"~7K/J® CERTIFICATE C THIS CERTIFICATE IS S gELOW• DOES NOT AMEND, EXTEND OR /PRODUCER Marshall & Sterling, Inc. Suite 300 103 Executive D12553 New Windsor NY Fax:845-567-1030 Phone :845-567-1000 -_-__.__- ------ INSURED Office of Risk Managen-ent 22 Market StrNyt12601 ONLY HOLDER. THIS CERTIFICATE ALTER THE COVERAGE AFFORDED BY THE POLIO NAIC # INSURERS AFFORDING COVERAGE Ar onaut Insurance Co. INSURER A: INSURER B: _ INSURER C_~-----~- INSURER D. INSURER E: Poughkeepsie OD INDICATED. NOTWITHSTANDIN Y PER U W HAVE BEEN ISSUED TO THE INSUREDN AMED ABOVE FOR THE POLIC COVERAGES T WITH RESPECT TO WHICH THIS CE SIONS AND CONDITIONS OFOSUCH ISTED BELO ER DOCU TERMS THE POLICIES OF INSURANCE L ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTH ED B BPAID CLA MS. SUBJ RAN I , i ECT TO ALL TH LIMITS EDUC MAY PERTAIN, THE INSU S S OWN MAY HAVE BEEN R AGGREGATE LIMIT _- R D P L YEFF Y,n,E DATE MMIDDIYYYY $ lOOOOOO DATE MMID CH OCCURRENCE _ POLICIES. POLICY NUMBE EA $ lOOOOO INSR TYPE OF INSURANCE LTR NSR 10 / 01 / 0 9 ]. 0 / 0 ]. / 1 O PREMISES (Ea occurence) on) $ -------- GENERAL LIABILITY ILITY 4611579 - MED EXP (Any one pers $ lOOOOOO A }( $ COMMERCIAL GENERAL LIAB CLAIMS MADE CX1 OCCUR pERSONALB,ADVINJURY $ 2000000 AGGREGATE GENERAL 000000 $ 2 . PRODUCTS-COMPIOPAGG GEN'LAGGREGATELIMITAPPLIESPER: PRO- LOC $ lOOOOOO COMBINED SINGLE LIMIT POLICY JECT AUTOMOBILE LIABILITY (Ea accident) 10 / 01 / 10 --.----- 10 / 01 / 0 9 4 61157 9 A $ ANY AUTO BODILY INJURY $ (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accdent) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY EA ACC $ OTHER THAN ANY AUTO AUTO ONLY: AGG $ $ lOOOOOOO EACH OCCURRENCE EXCESSIUMBRELLALIABILITY $ lOOOOOOO _ ____ 10/01/09 10/0],/],0 AGGREGATE p, ]( OCCUR ~ CLAIMSMADE 4611579 $ $ DEDUCTIBLE $ ]( RETENTION $ O TORY LIMITS ER - WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y 1 N E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIV~ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) E.L. DISEASE -POLICY LIMIT $ If yes, describe under SPECIAL PROVISIONS below vl'~ ~ ,ate ~~ C' ~~ y ~ C OTHER e. + ~ ~ DESCRIPTION OF OPERATIONS 1 LOCATIONS ! VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PFivvisivna - Town of Wappinger is provided Additional Insured status, when required by ~~FD^ written contract or agreement, with respect to Insured's contract agreement ''`rirl~~4 with the Town of Wappinger for repair and maintenance of the Dutchess Rail Trail. CERTIFICATE HOLDER Town of Wappinger CANCELLATION .. SHOULD ANY OF THE ABOVE DESCRIBED P TOWAPPl DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEI NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHAT IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 20 Middlebush Road AUTHORIZED REPRESENTATIVE Wappingers Falls NY 12590 ~~y,p~ ©1988-2009 ACOI ACORD 25 (2009101) The ACORD name and logo are registered marks of ACORD .All rights reserved. ~~ 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. ~~~~ ®G~ R ~~onsh~ ~~ ~~. r~~,vnv ca ~cuumvi/ INSURANCE ~=°ATE'MM'°°'"'"Y' ~ ACORD® CERTIFLCATE OF LIABILITY _ L/ 09/25/2009 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1166 Avenue of the Americas HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR New York, NY 10036 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ~ Attn: marineandenergy.certrequest@marsh.com INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: COmmerCe And IndUStry InS CO 19410 PETRO INC , 47 PATRICK LANE POUGHKEEP E INSURER B: N/A __ N/A SI , NY 12603 INSURER C:N//.>, N/A INSURER D: N/A N/A ~ INSURER E: N/A N/A C: V V tKACit.`S i 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. INSWADD'LI TYPE OF INSURANCE I POLICY NUMBER POLICY EFFECTIVE POLICYE7fPIRATION I LIMITS TRINSR L ; DATE IMMIDD/YYYY) DATE IMM/DDNWY) I A GENERAL LIABILITY 360-25-05 10/01/2009 10/01/2010 EACH OCCURRENCE 1.000 000 - X ~ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTE~ $ 100 000 ~ PREMISES Ea occurrence , X CLAIMS MADE ^ OCCUR i MED EXP (Any one person) _ $ 5,000 PERSONAL & ADV INJURY $ 1 000 000 , , GENERAL AGGREGATE $ 5 000 000 , , XENERAL AGGREGAT IT APPLIE LP EC PRODUCTS -COMP/OP AG ~ $ 2,000,000 O POLICY 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 OTHER THAN EA ACC AUTO ONLY: AGG ~ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE ~ $ OCCUR ~ CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N .L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? L. DISEASE - EA EMPLOYE (Mandatory in NH) ff yes, describe under SPECIAL PROVISIONS below L. DISEASE -POLICY LIMIT OTHER ~~~ ~ V ~ ~, 11° DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ~ ryo~~ ~ ~t~/ E' ~ ~~~ ~A ,~1... ' j~ L' CERTIFICATE HOLDER NYC-003285703-09 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF WAPPINGER EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 MIDDLEBUSH ROAD SO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT WAPPINGER FALLS, NY 12590 , BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND U PO N THE INSURER, ITS AGENTS OR REPRESENTATNES. pp gB iI~~ I1Z~ 1 Aof MarshEUSA IRE3ENTATIVE __ T_ w ~ ~~ W~'~~ Paul Martelloni A[:UKD 25 {2009/01) ©1998-2009 ACORD 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. ~'LCEi 1/ ~L.~ ~~ ~ 0 5 2008 ~~~~~~~ ~LFRa ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER 09-09-2009 ~ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LAWLEY RICHWOOD LLC/PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 214 612 P : (8 6 6) 4 6 7 - 8 7 3 0 F : (8 0 0) 3 0 8 - 54 5 9 A~TER THE COVERAGE AFFORDED B~ THE POLDICEES BE OW 301 WOODS PARK DRIVE . CLINTON NY 13323 INSURERS AFFORDING COVERAGE INSURED INSURERA:Hartford Fire Ins Co THE GREAT AMERICAN SIGN COMPANY INC INSURER B:TW1n Cit Fire Ins Co j DBA GREAT AMERICAN SIGNS INSURER C: 13 COMMERCE CT . STE 1 INSURER D: ~ WAPPINGERS FALLS NY 125 9 0 INSURER E~ V V V GIlMl7CJ 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. INSfl LTR TYPE OF INSURANCE POLICY NUMBEfl POLICY EFFECTIVE DATE (MM/DD/YY POLICY EXPIRATION DATE IMM/DD/YY LIMITS i GENERAL LIABILITY l EACH OCCURRENCE ~ S2 r 0 0 0, 0 0 0 A COMMERCIAL GENERAL LIABILITY O 1 SBA RDS 313 10 / 0 6/ 0 9 10 / 0 6/ 10 ~ FIRE DAMAGE IAny one fuel S 1 r 0 0 0, 0 0 0 ~ CLAIMS MADE ! ~~ I OCCUR ~ MED EXP IAny one person) S1 0 r 0 0 0 X General Liab PERSONAL & ADV INJURY S2 , 0 0 0 0 0 0 , GENERAL AGGREGATE 54 , 0 0 0, 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG S4 , 0 0 0 , 0 0 0 POLICY PRO X LOC JECT AUT OMOBILE LIABILITY 7 COMBINED SINGLE LIMIT ANY AUTO ~~ ~ E` ~ IEa accident) S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS IPer person) S HIRED AUTOS ~ ~~~~ /~ V BODILY INJURY S NON-OWNED AUTOS IPer accident) g PROPERTY DAMAGE S P 1 1 Zpp id IP t) S er acc en GARAGE LIABILITY ~ oA/p0 ~ AUTO ONLY - EA ACCIDENT 5 ANY AUTO T~ p~I~ CLEi~ ~ EA ACC OTHER THAN S i AUTO ONLY: AGG S EXCESS LIABILITY _ I EACH OCCURRENCE S OCCUR u CLAIMS MADE AGGREGATE S S DEDUCTIBLE g RETENTION S g WORRERS COMPENSATION AND ' X WC STATU- ~OTH- TORY LIMITS ER B EMPLOYERS LIABILITY O 1 WEC TY5 9 3 8 10 / 0 6/ 0 9 10 / 0 6/ 10 E.L. EACH ACCIDENT S1 , 0 0 0, 0 0 0 E.L. DISEASE - EA EMPLOYEE S 1, 0 0 0, 0 0 0 E.L. DISEASE -POLICY LIMIT S1 , 0 0 0, 0 0 0 OTHER DESCRIPTION OF OPERATIONSlLOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDOflSEMENTISPECIAL PROVISIONS Those usual to the Insured's Operations. I.CK 1 Irl l..N 1 C ['1ULUtK I I ADDITIONAL INSURED: INSURER LETTER L'L1NCF•I 1 Ll 11[1N 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 (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE I Town Of Wappinger HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO 20 Middlebush R d OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR oa REPRESENTATIVES. Wappinger Falls NY 12590 i , AUTHORI D RE S~TIVE ~`7 /~~ WL;u-sv zy-s ~i/yi1 ©ACORD CORPORATION 1988 ACORD„ CERTIFICATE OF LIABILITY INSURANCE OP ID DY DATE (MMIDD/YYYy) PRODUCER DUTCH-3 09/01/09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT Donald B . Dedrick A enc Inc g y ION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Mill Street PO Box 319 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR , Dover Plains NY 12522 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone:845-877-9901 Fax:845-877-6771 INSURERS AFFORDING COVERAGE INSURED NAIC # INSURER A: steadfast Insurance Company Dutchess Environmental INSURER e: General Casualty 24414 Construction Inc 936 Route 6 wsuRERC Peerless Insurance Company 24198 Mahopac NY 10541 INSURER D: INSURER E: COVERAGES THE P(11 I(:IPA nr inic~ ion~iro ~ ~crr_., .,~, .,,., ~ ~...~ ..~-...__..- - -- -._ _. - - nvo~ncu rvHmtu r+dVVt hUK I HE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED DR 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 NSRd TYPE OF INSURANCE POLICY NUMBER DATE (MM DD~)E PDATE jMM%DD/YY)N LIMITS A GE X X NERAL LIABILITY COM EACH OCCURRENCE SlOOOOOO MERCIAL GENERAL LIABILITY TBA 09/02/09 09/02/10 PREMISES (Eaoccurence) $ 100000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ SOOO PERSONAL& D A VINJURY $ 1000000 X Professional GENERAL AGGREGATE ' $ 2000000 GEN L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS -COMP/OP AGG $ 2 0 0 0 O O O POLICY n JECT n LOC B AUT X OMOBILE LIABILITY ANY AUTO CBA0583370 10/10/08 10/10/09 COMBINED SINGLE LIMIT (Ea accident) g lOOOOOO ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ -GARAGE LIABILITY ~~~~fff ~ ~ AUTO ONLY - EA ACCIDENT $ ANY AUTO ~~ ~+ ~ EA ACC OTHER THAN $ EXCESS/UMBRELLA LIABILITY SE~ ~~ AUTO ONLY: AGG ~ EACH OCCURRENCE $ $ OCCUR ~ CLAIMS MADE G~~~ ~ AGGREGATE $ ~ $ DEDUCTIBLE n $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY C ~ - X TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? WC8445359 05/20/09 O5/2O/lO E. L. EACH ACCIDENT ~ - $ 100000 ' If yes, describe under E.L.DISEASE-EAEMPLOYEE! ~- 5100000 SPECIAL PROVISIONS below OTHER E. L. DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS /LOCATIONS! VEHICLES / EXCWSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS Certificate holder is listed as additional insured with regard to general liability coverage with written contract subject to the. language of the policy. CERTIFICATE HOLDER CANCELLATION TOWNWAP 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 Town of Wappinger 2 0 Middlebush Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Wappinger Falls NY 12590 REPRESENTATIVES. ACORD 25 (2001/08) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies mus on this certificate does not confer rights to the certificate holder in lieu of suc t be endorsed. A statement If SUBROGATION IS WAIVED, subject to the terms snd conditions h endorsement{s). require an endorsement. A statement on this certificate does not confer ri hts holder in lieu of such endorsement(s), of the policy, certain policies may g to the certificate DISCLAIMER The Certificate of Insurance on the reverse side of this form do the issuing insurer(s), authorized representative or producer, and the certificat es not constitute a contract between affirmatively or negatively amend, extend or alter the coverage afforded b the e holder, nor does it . Y policies listed thereon. ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID J1 DATE (MM/DD/YYYy) PRODUCER DWILS -1 08/21 / 09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Vanner Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 11 Pinchot Court, Suite 100 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Amherst NY 14228 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone:716-688-8888 Fax:716-688-9001 INSURED INSURERS AFFORDING COVERAGE NAIC # D W11sOn 26'I.eCtr ~ INSURER A: Cincinnati Ineuranoe Company J & D Wilson Realt2nc INSURER B: Jose h & Diane Wilson2nc. 188 ~ottage Street .INSURER c: Poughkeepsie NY 12601 INSURER D: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 70 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 CONDITION$ OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .TR NSR TYPE OF INSURANCE POLICY NUMBER Y EF E TIV P ICY E PIRA 1 GENERAL LIABILITY ~~~^ A X COMMERCIAL GENERAL LIABILITY CAP5887757 CLAIMS MADE ~ OCCUR GEN'L AGGREGATE LIMIT APPLIES PER POLICY I$ I JE ~ n LOC AUTOMOBILE LIABILITY A X ANY AUTO ~ ALL OWNED AUTOS SCHEDULED AUTOS ~ j H HIRED AUTOS j NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO CAA5887722 EXCESS/UMBRELLA LIABILITY OCCUR ~ CLAIMS MADE CAP5887757 DEDUCTIBLE X RETENTION $ 10 ~ 000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBC-R EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 08/24/09 08/24/09 08/24/09 i~ ~ --~ ;,~," ~~~ ~,~~ L ~~ '100 ~';'''1,111A11~ ~~~,~'~'~ 08/24/10 LIMITS EACH OCCURRENCE $ 1, OOO , O00 PREMISES (Eaoccurence) $100,000. MED EXP (Any one person) $ 5 r 000 PERSONAL & ADV INJURY $ 1 , 00 r 0 GENERAL AGGREGATE $ 2 r 000 , 000 PRODUCTS-COMP/OPAGG $.2 ~ 000 ~ 000 COMBINED SINGLE LIMIT 0$/24/10 (Ea accident) $1,000,000 PerDl erslon URY I $ P ) BODILY INJURY ~ (Per accident) ~ $ PROPERTY DAMAGE (Per accidenq $ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: qGG $ EACH OCCURRENCE $ 4 r QQQ ~ QQQ 08/24/10 AGGREGATE $ 4 ~ QQQ ~ QQQ _ $ $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ -~~~•~~ . ~..~. yr vrCrW nuns r WGATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Cown of Wappinger as Additional Insured under the General Liability .policy. with regard to work performed by the insured for the certificate. holder when °equired by written contract ~~ i ~n~.n ~ G nVLUtK TOWOF-1 Town Of Wappinger 20 Middlebush Road Wappingers Falls NY 12590 ;ORD 25 (2001/08) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD CORPORATION 1988 AC Rp~"' y .. '~---~' CERTIFICATE t Praoolrr~ (845)!331-49D0 FAX; (845) 831-5637 Antal~k ~ Mooza Inauranoe 3110 Maia $ttx~at F-9enaYi LLC. ~ Box 31 Beacon )F LIABILITY INSURANCE - ---, -W17E(tiNUDDJYYY,•) THIS GERTIFIGATf= IS ISSUED AS A MATTER QF NFb NFA7' ON ONLY AND GONFER5 NO RIGHTS UPON THE CER7iFICgTE HpLDER. THIS CERTIFICATE DOE8 NpT AMEND, EXTEND OR ALTER THE COVERAGE gpFpRpEp gy THE POLIGIE8 >~, INSU~D ~ 12548 INSURERS AFFORDING COVERAGE Chelsea ~aod>~orking INSUR~RaNational Gran a NAIC# ~: David S g Mutual twee Craxfard INsuRER a: f' • O. Bar 189 INSUReR c: ~9~~ssxille NY 12597 IN3UiRER D: M1Ar w. THE POLICIES OF INSURANCE LISTED gELpW ANY REQUIREMENT, TERM OR CONDITION OF AIVY CONTRACT OR OTHER DOCUMENT VV17'H RESPECT T HAVE BEEN ISSUED TD THE INSURED NAMED ABOVE FOR THE PpLICY PERIOD INDICATED: NOT~THSTANDIriG MAY PERTAIN, 7HE INSURANCEq~ORDEO BY THE POLICIES DESCRIBED HERt:IN IS SUBJECT TO AI.L THE TERMS, EXCLUSIONS POLICIES. AGGREGATE LIMITS SHQViIN MAY HAVE BEEN REDUCED gY pA10 CLAIMS O wl'i1CH THIS CERnF1CATE MAY BE ISSUED pE~ R AND CONOITIOyS QF SUCH GENERAL LIAIlLrr~r ~~ NUY9E(j p TuE IMIEW~nnN~w.E POU~ EXPIRATION • .I A I ~ ~ 1 cLwlu~ ra,~ uulr AP?uES aEU: AM1'AUTp ALLOy1~~AUf08 m AIJrOS HIRED Ai1Tgg NON.OW~AUT'OS GARAGE rJABILlTY ANYAUTO +sccess r ulreaELLA LIA9LITY OCCUR ~ CLAIMS LN16E DEbUCfI@l.E ~~~ S COMPENSAflON ANO EMPLOYMi'6' u~u,,. ANY /'RQPRIErORIPARTNERIEXECUTIVE Q OFFI~ C~~ ~ ~ EXCLUDED r-aAl- PA~nS~inNS>~ OTHER Reu>} (EaM~ NGLE uMrT S tBOOILN,' JRy $ ~B~OD! ~~URV S PF(CPERTY pgM„gCE (I'er ecatleny S AUiO QNLY _ ER ACCIp~ : DTHERTHMI EAAGC 3 AUTO ONLY' _-- _ I~'~p~OFrJt'rRATI0N8/LOCMIONS/VEHICLESIE%C1.1~101i&ADABpeYENDQRBE~AENT/SPECIAI.PRQVISIQNS 1te: Chen rmit, ifaw,i l ton Rd. D ,~Q~ Ta.m a>g ~appiager 20 Micldleb'as~ Road T+~aypin ~-~ FaZZsr IVY 52590 A~QRD ~5 ~~ auG 2 0 200` -rnn~~q ~~-~~~ $NQULO ANY OFTNE ABOyE DESCR18Eb PCLIC~S BE CANCELLED BEFORE 7HE EXPIRATION a-TE THEa7EOF, TWE 165UING IN&URER W~L ENDEAyOR TO MAIL 1 p PAYS VAirTrEN NQTICE TO 7HE CERTIFICATE HOLDER NAMED 70 THE LEFT, BAIT' FAILURE TO DO SO SHALL IMPOSE NO OT3LIGATION QR LIABILITY OF ANY KIND UPON THE IN3UREFy ITS AGENTS QR AUTHORQFn REPRE9EN7A71VE ~..-~_ Patrick Moore/SS 1 ~,. R ~(r ~ ~,~~_ [>~ 1988-2049 ACQRD CORPt5RA7tfOA1_ All rCnk4a rees...a,~ 7/9/2049 I7J19/2010 0 """""'`""~"'~ ThB AGQRd name and logo arr~ registered marks of ACORD ACORD CERT PRODUCER FICATE OF LIABILITY INSURANCE OP ID MO DATE (MM/DD/YYYY) Brinekerhoff & THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION2 O9 1134 Main St , Neuville, Inc , ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Fishkill Ny ~ PO Box 424 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12524 - 0424 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone:845-896-4700 INSURED Fax : 8 4 5- 8 9 7_ 5110 INSURERS AFFORDING COV ERAGE Clove Excavators I INSURER A Mountain Val le -----~--- NAIC # INSURER H: Y Indemnity 10205 Majesti nc, 9 Barnes Drive Poughkeepsie N c Insurance --- INSURER C: Company 42269 Y 12603 INSURER D: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE ANY REQUIREMENT TERM OR INSURER E: , INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFIC MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS POLICIES. AGGREGATE LIMITS SHOWN M WITHSTANDING SU I AY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYP ATE MAY BE 1 SSUED OR BJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITI ONS OF E OF INSURANCE POLICY NUMBER GENERAL LIABILITY SUCH P L FE V DATE MM/OD/YY N E M A X COMMERCIAL GENERAL LIABILITY 331-002452 DAT M /DDm LIMITS EACH 0 CLAIMS MADE ~ occuR OCCURRENCE $ 1, 000, 0 08/11/09 08/11/10 ( PREMISES Ea occurence) $ 5 O, 0 0 0 MED EXP (qny one person) $ 5 , O O O GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL & ADV INJURY $ 1, O O O , O O O PRO- POLICY JECT LOC GENERAL AGGREGATE $ 2, 0 0 0, O O O AUTOMOBILE LIABILITY _ PRODUCTS -COMP/OP AGG $ 2, 0 0 0, O O O '~ X ANY AUTO 331- 0 024 520 ALL OWNED AUTOS COMBINED SINGLE LIMIT 08/11/09 08/11/10 (Ea accident) $ 1, 000, 000 SCHEDULED AUTOS X HIRED AUTOS (BODI eYs N~JURY $ P ) X NON-OWNED AUTOS ___ ---~_ _____ BODILY INJURY (Per accident) $ GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY OCCUR ^ CLAIMSMADE X31-0024521 DEDUCTIBLE X RETENTION $ Z O, 0 0 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTMER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 0200804990-01 PROPERTY DAMAGE (Per accident) $ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ 5, OOO, OOO 08/11/09 O8/11/lO AGGREGATE x5,000,000 x $ 04/01/09 O4/O1/lO E.L. EACH ACCIDENT ER x100,000 E.L. DISEASE - EA EMPLOYEE $ l O 0, 0 0 0 E.L. DISEASE -POLICY LIMIT $ 5 O O, 0 0 0 :RIPTION OF OPERATIONS (LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 Aerations in the State of New Yorkll "~~ ..~~ ~anl~, ~! rr^' ~. ~, II ~ ~~~~ ~`~~~~ C'~ r~ ~g R I Ir I6rM 1 G nNLUCR WAPPING Town of Wappinger 20 Middlebush Road Wappingers Falls NY 12590 RD 25 /2DD91D8) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO 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 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. © ACORD CORPORATION 1988 PROA-~° CERTIFICATE OF LIABILITY INS URANCE OP ID MO DATE (MM/DD/YYYy) Brinckerhoff & THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION2 09 1134 Main St, ~ Neuville, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Fishkill PO Box 424 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR NY 12524 - 0424 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone:845-896-4700 Fax;845-897-5110 INSURED INSURERS AFFORDING C , OVERAGE INSURER A: General Casualty NAIC # Ronald H. Price and 8 Cochran Hill Rd, Sons, Inc. Poughkeepsie INSURERe Majestic Insurance Company 42269 INSURERC Ny 12603 ------- INSURER D: COVERAGES ----- THE POLICIES OF INSURANCE LISTED BELOW ANY INSURER E: HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 70 W MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DES POLICIES. AGGREGATE LI NOTWITHSTA CRIBED HEREIN IS S MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAI LTR NDING HICH THIS CERTIFI CATE MqY BE ISSUED OR UBJECT TO ALL THE TERMS EXCLUS MS. NSR TYPE OF INSURANCE , IONS AND CO NDITIONS OF SUCH GENERAL LIABILITY POLICYNUMBER FF DATE MM/DDS E LI Y E PIRA ON A X X COMMERCIAL GENERAL LIABILITY CCXO 3 714 68 DATE MM/DD/YY ---- -___ LIMITS EAC CLAIMS MADE ~ OCCUR H OCCURRENCE $ 1, 000, 000 08/14/09 08/14/10 ( ) PREMISES Ea occurence $ l O O, 0 0 0 MED EXP (Any one person) $ Jc , OOO GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL 8 ADV INJURY $ 1, O O O , O O O PRO- POLICY JECT LOC GENERAL AGGREGATE $ 2 , O O O . OOO AUTOMOBILE LIABILITY ___ __ PRODUCTS-COMP/OPAGG $ 2, OOO, OOO ~ X ANY AUTO CBAO 3 714 6 $ ALL OWNED AUTOS COMBINED SINGLE LIMIT 08/14/09 08/14/10 (Ea accident) $ 1, 000, OOO SCHEDULED AUTOS X HIRED AUTOS (Pe~l erstonJURY $ P ) X NON-OWNED AUTOS -~- BODILY INJURY (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE (Per accident) $ ANY AUTO AUTO ONLY - EA ACCIDENT $ EXCESS/UMBRELLA LIABILITY OTHER THAN EA ACC $ AUTO ONLY: X OCCUR ~ CLAIMS MADE CCUO 3 714 68 AGG $ EACH OCCURRENCE $ 3 , O O O , O O O 08/14/09 O8/14/10 AGGREGATE $3,000,000 DEDUCTIBLE $ X RETENTION $1 Q, 0 0 0 $ WORKERS COMPENSATION AND g EMPLOYERS' LlA81LITY ANY PROPRIETOR/PARTNER/EXECUTIVE 0200805000-O1 OFFICER/MEM X TORY LIMITS ER 04/01/09 O4/O1/lO E BER EXCLUDED? . L. EACH ACCIDENT $ 1, O O O O O O If yes, describe under SPECIAL PROVISIONS below , E.L. DISEASE - EA F.MPLOVEE. $ 1,. 0 0 0 , 0 0 0 OTHER _ E,L. DISEASE -POLICY LIMIT $ 1, O O O , O O O RIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Town of Wappinger is included as an additional insured. AUG ~ 4 2008 ~~~a ,. ~' ~'t~r= 'IFICATE HOLDER WAPPING Town of Wappinger 20 Middlebush Road Wappingers Falls NY 12590 7D 2512001/08) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO 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 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. aUT~IZED REPRESENTA E L~~`-~ ACORD CORPORATION 1988 ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE ~ PRODUCER 0 8- 0 3- 2 0 0 9 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I LAWLEY RICHWOOD LLC/PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1214 612 P : (8 6 6) 4 6 7 - 8 73 0 F : (8 0 0) 3 0 8 - 54 5 9 ~ A~TER THEHCOVERAGE AFFORDED B~ THE POLDICIES BE OW 1301 WOODS PARK DRIVE CLINTON NY 13323 INSURERS AFFORDING COVERAGE INSURED INSURERA:HartfOrd Fire Ins Co I THE GREAT AMERICAN SIGN COMPANY INC INSURER B: DBA GREAT AMERICAN SIGNS INSURER C: 3 COMMERCE CT . STE 1 INSURER D: I WAPPINGERS FALLS NY 12 5 9 0 I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING I ANY RF(11 IIRF~A FAIT TFRt`A n^ ~nni nrTinni n 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 I ~ POLICV EFFECTIVE POLICY EXPIRATION i LTR , TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YVI I DATE (MMIDDNY) LIMITS ~ A GENERAL LIABILITY ,COMMERCIAL GENERAL LIABILITY CLAIMS MADE ~ X I OCCUR X General Liab O 1 SBA RD8 313 1 O/ 0 6/ O 9 EACH OCCURRENCE S 2, O O O, O O O 1 O/ O 6/ 10 ~ FIRE DAMAGE IAny one fioel S 1, 0 0 0, 0 0 0 ~ MED EXP IAny one person) i s1 0, 0 0 0 PERSONAL & ADV INJURY 52 , 0 0 0 , 0 0 0 GENERAL AGGREGATE S4 , 0 0 0, O O O GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ' JECT X LOC I PRODUCTS -COMP/OP AGG S4 , O O 0 , 0 0 0 I AU TOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT S (Ea accdent) -` ALL OWNED AUTOS SCHEDULED AUTOS _, BODILY INJURY S .IPer person) I HIRED AUTOS I NON-OWNED AUTOS (~1~~ ('~ ~~+V BODILY INJURY S (Per accidenH C PROPERTY DAMAGE S IPer accident) GARAGE LIABILITY All 4^1~J ~j ry00 AUTO ONLY - EA ACCIDENT S ANY AUTO 9 ! ( OTHER THAN EA ACC I S AUTO ONLY: AGG S EXCESS LIABILITY _ OCCUR u CLAIMS MADE ~' '~ - ... .°~/' EACH OCCURRENCE S AGGREGATE I S S DEDUCTIBLE RETENTION S ~ ~._y '~.~ , S S WORKERS COMPENSATION AND EMPLOYERS' iIABILITV WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT S _ _. ~ . ~" E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE -POLICY LIMIT $ OTHER - DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/fXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Those usual to the Insured's Operations. CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL TOWn Of Wappinger 30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE I HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO 2 0 Middl ebush Road Wappinger Falls, NY 12590 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ` AUTHORI D RE SENTATIVE ~~~ - ~yvnv ~~-J I ~/mil ~' ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE OP DATE (MM/DD/YYYy) PRODUCER ID RMIN ~~~, -7 O8 14 O9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO Marshall & Sterling Inc RMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE . 66 Middlebush Rd Suite 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR , Wappingers Falls NY 12590 , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone:845-297-1700 Fax:845-297-2879 INSURERS AFFORDING COVERAGE INSURED NAIC # INSURER A: Oh1.0 Casualt Ins. Com an Kenneth J Donaldson INSURER B: NGM Insurance Com an 14788 Ca entry LLC 12 ~tor D INSURER C: m r Poughquag NY 12570-5704 INSURER D: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOT ANY RE QUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER IN IS S . WITHSTANDING WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR U E POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. BJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH LTR NSR TYPE OF INSURANCE .POLICY NUMBER DATE MM%Dpm E PDATE MM/DDS N LIMI TS GE NERAL LIABILITY A X X COMMERCIAL GENERAL LIABILITY B EACH OCCURRENCE $ IOOOOOO LA53472362 04/30/09 04/30/10 CLAIMS MADE ~ PREMISES (Eaoccu $ 100000 OCCUR MED EXP (Any one person) $ ], O O O O PERSONAL&ADVINJURY $ lOOOOOO GEN'L AGGREGATE GENERAL AGGREGATE $ 2000000 LIMIT APPLIES PEP.• POLICY PRO- PRODUCTS -COMP/OP AGG $ 2 O O O O O O JECT LOC AUT OMOBILE LIABILITY B }~ ANY AUTO B1V58998 02/01/09 02/01 COMBINED SINGLE LIMIT (Ea accident) $ l O O O O O O ALL OWNED /10 AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ NIRED AUTO S NON-OWNED AUTOS BODILY INJURY (Per accident) $ GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY OCCUR ~ CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER PROPERTY DAMAGE (Per accident) $ AUTO ONLY - EA ACCIDENT $ OTHER THAN ~ ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ AGGREGATE $ E.L. EACH ACCIDENT $ E. L. DISEASE-EA EMPLOYEE $ E.L. DISEASE-POLICY LIMIT $ )ESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Certificate Holder is provided Additional Insured status when required b --~~~~ ,/ written contract or agreement with respects to Residence of Vincent Scia~n"d~~~~ Y 107 Cooper Rd, Fishkill, NY ~~ .~~ AUG ~ ? 2008 y , :ERTIFICATE HOLDER TOWN024 Town Of Wappingers Building Department 20 Middlebush Rd Wappingers Falls NY 12590 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR .CORD 25 (2001/08) ©ACORD CORPORATION 1988 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name and address of Insured (Use street address only) Kenneth J Donaldson Carpentry LLC 12 Storm Dr Poughquag, NY 12570-5704 lb. Business Telephone Number of Insured 914-204-2364 1 c. 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) WAPPINGERS FALLS, NY 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) TOWN OF WAPPINGERS BUILDING DEPT 20 MIDDLEBUSH RD WAPPINGERS FALLS, NY 12590 1 d. Federal Employer Identification Number of Insured or Social Security Number 651226038 3a. Name of Insurance Carrier OHIO CASUALTY INS COMPANY 3b. Policy Number of entity listed in box "la": XWO(09)53472362 3d. The Proprietor, Partners or Executive Officers are: ^ included. (Only check box if all partners/officers included) ^all excluded or certain partners/officers excluded. 3c. Folicy effective period: 04/30/09 " to 04/30/10 This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers'I 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 wile send this Certificate of Insurance to the entity listed above as the certificate holder in box " 2". The Insurance Carrier will also note the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment ofpremiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c'; whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: John P. O'Shea (Print name of authorized representative or licensed agent of insurance carrier) Approved by: ~ ~ ~~, , , 8/14/09 Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 845-297-1700 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 foam. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) ~~~~~~EL.~ wv~,W.wcb.state.ny.us Al1G 1 7 700 -~A41A o, ~,~ ~~.r ACORD CERTIFICATE DATE (MMIDD/YYYY) OF LIABILITY INSURANCE OP ID DGRA PRODUCER KIRCH-5 08/05/09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INF rshall & Sterling Inc ORMATION D I , . .i10 Main Street HOLDER. TH 5 CERTIFICAT E DOES NOT AMEND EXTEND OR Poughkeepsie NY 12601 , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone:845-454-0800 Fax:845-485-7804 INSURED INSURERS AFFORDING COVERAGE NAIC # INSURER A: American Alternative Ins Corp Kirchhoff-Cansi li INSURER B g COn5trUCtlOn Management LLC INSURER C Ple sant V S , a a11ey NY 12569 INSURER U COVERAGES INSURER E THE POLICIES OF INSURANCE LISTEU BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI ANY RE OD INDICATED. NOTWITHSTANDING QUIREMENT, 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/DDM') DATE (MM/DD/Y1') GENERAL LIABILITY LIMITS A X COMMERCIAL GENERAL LIABILITY 88A2QL0000842 EACH OCCURRENCE $ 1 0 0 0 O O O 07/01/09 07/01/10 CLAIMS MADE ~ OCCUR PREMISES (Eaoccurence) $ 100000 MED EXP (Any one person) $ 5O O 0 X Blanket Ai PERSONALBADVIIJJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2000000 POLICY PRO JECT LOC PRGDUCTS-COMP/OPAGG $ 2000000 AUTOMOBILE LIABILITY ,q/yy q~0 COMBINED SINGLE LIMIT $ (Ee accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accldenq $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY qGG $ EXCESS/UMBRELLA LWBILITY OCCUR ^ CLAIMS MADE EACH OCCURRENCE $ . $ AGGREGATE DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND ~ EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED E.L. EACH ACCIDENT $ If yes, describe under E.L DISEASE - EA EMPLOYEE $ SPECIAL PROVISIONS below OTHER E.L. DISEASE -POLICY LIMIT $ ~EC~I~~~ DESCRIPTION OF OPERATIONS I LOCATIONS !VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS AUG 0 7 2Q09 ~~ ~~ ~ ~~WR! CLEF" CERTIFICATE HOLDER CANCELLATION TOWN036 SHOULD AIJY OF THE ABOVE DESCRIBED POLICIES BE CAIJCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL EIJDEAVOR TO MAIL 1 O DAYS WRITTEN TOWn o£ Wappingers 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. A OR D REPR ENT ACORD 25 (201/08) © 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. Aug ~ ~ zoos ~I.aWN CLEF' ACORD 25 {2001/08) ' DATE (MM/DD/YYYY) AC(~!?~M CERTIFICATE OF LIABILITY INSURANCE 10/23/2009 PRODUCER 616-447-2293 FAX 616-447-2544 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MS&G, Inc. dba Fortress Partners ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5 500 Northland Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite K NAIC # Grand Rapids., MI 49525 INSURERS AFFORDING COVERAGE INSURED Thomas F. Egan dbaCraftsmen; dba Access INSURER A: Praetorian InsuranceCo..~~.-- " Unlimteil;~ dba~'Craftsmen Mobility Systems INSURER B: 570 Hance Road INSURER C: '" _ _ __ Binghamton, NY 13903 INSURER D: INSURER E: r.n~iconr_cc THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLI(:Y rtrtlc~u Irvui~r~ ~ ~v. ~.~ ~ .~~ ~ ~ ~~ ~~~•~~~•~- 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' POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YYYY DATE MM/DD/YYYY GENERAL LIABILITY H220101062-00 10/03/2009 ZO/O3/2OlO EACH OCCURRENCE $ 1 , OOO , OO A R $ 100,00 X COMMERCIAL GENERAL LIABILITY PREMISES Ee occurrence CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5 , OO PERSONAL & ADV INJURY $ 1 , OOO , OO A GENERAL AGGREGATE $ 2 , OOO , OO PRODUCTS-COMP/OPAGG $ 1,000,Od GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO ~ ~j X~; ALL OWNED AUTOS A ~ SCHEDULED AUTO5 X HIRED AUTOS X NON-OWNED AUTOS X Registration plate endorse - 2 plates GARAGE LIABILITY ANY AUTO EXCESS /UMBRELLA LIABILITY OCCUR ~ CLAIMS MADE DEDUCTIBLE RETENTION $ AND EMPLOYERS' LIABILITI' ./ / ~~ ANY PROPRIEI ORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below OTHER aragekeepers: A eaters Phys. Dmg: H220201062-00 LO/03/2009 10/03/2010 COMBINED SINGLE LIMIT $ (Ea accident) 1, OOO BODILY INJURY $ (Per person) - BODILY INJURY $ (Per accident) t-~ ~~ V ~~ oct 2 6 Zap I~t'~""'~ Y~' ~t PROPERTY DAMAGE -(Per accident) $ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: qGG $ EACH OCCURRENCE $ AGGREGATE $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ '010 Garagekeepers: $75,000 Dealers Phys. Dmg: $35,000 H220301062-00~ 10/03/2 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ;eneral liability exclusions for the following: All Easy Base, Mini-Touch, EZ Transfer, EZ Reach, ;tide-N-Go, and/or Multi-lift Products -but exclusions apply to manufacturing exposure only, installation of these products by the named insured is included under the general liability policy CERTIFICATE HOLDER Town of Wappinger 20 Middlebush Road Wappinger Falls, NY 1259 RD 25 (2009/01) CANCELLATION 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 IMPOSE NO OBLIGATION OR LIABILITY OF At1Y KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE 0 David Young ~~~ ©1988-2009 ACORD CORPORATION. The ACORD name and logo are registered mal•ks of ACORD hts ~..~- - ~` 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. OCT 2 ~ 2009 °6'OV~N CLERK. 25 (2009101) ,r ~% ~..-~ 7 ~ DATE (MMIDDIYYYY) ~-~ ~ CERTIFICATE OF LIABILITY INSURANCE 10,20,2009 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION (645)469-4344 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR VERO AGENCY INC ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 145 MAIN ST. P O BOX 520 CHESTER, NEW YORK 10918 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: TRAVELERS INDEMNITY COMPANY MIKE ROMANO ELECTRIC INC INSURER B: 58 MAPLE AVENUE INSURER C: OTISVILLE, NEW YORK 10963 INSURER D: INSURER E: G~VtltAlata N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING THE POLICIES OF INSURANCE LISTED BELOW HAVE BEE ONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, TERM OR CONDITION OF ANY C POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN, THE INSURANCE AFFORDED BY THE AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICIES . INSRADD'L POLICY NUMBER DATECMM DDC/Y1'YY DATE MMxD nYW TYPE OF INSURANCE LIMITS LTR INSR GENERAL LIABILITY 10/24/2009 10/24/2010 I-680-4984W249-IND-09 EACH OCCURRENCE c ~~O - M $ 1 .000,000. 000 300 A X COMMERCIAL GENERAL LIABILITY urre nce) ISES Eaoc PRE . , $ CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5,000. PERSONAL tL ADV INJURY $ 1 ,000,000. GENERAL AGGREGATE $ 2,000,000, PRODUCTS -COMP/OP AGG $ 2,000,000. GEN'L AGGREGATE LIMIT APPLIES PER: PRO- LOC POLICY JECT $ AUT OMOBILE LIABILITY I-680-4984W249-IND-09 10/24/2009 10/24/2010 COMBINED SINGLE LIMIT (Ea accident) g 1,000,000. A ANY AUTO ALL OWNED AUTOS BODILY INJURY erson) (Per $ p SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ X NON-OWNED AUTOS PROPERTY DAMAGE t $ ) (Per acciden AUTO ONLY - EA ACCIDENT $ GA RAGE LIABILITY THER THAN EA ACC $ ANY AUTO O AUTO ONLY: AGG $ RELLA LIABILITY EACH OCCURRENCE $ EXCESS 1 UMB DE ~ AGGREGATE $ CLAIMS MA OCCUR DEDUCTIBLE RETENTION $ ATU- OTH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY STATE INSURANCE FUND YiN RIETOR/PARTNER/EXECUTIVE P E.L. EACH ACCIDENT $ ^ ANY ROP CERTIFICATE ATTACHED OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under _ r ~ ~ E.L. DISEASE -POLICY LIMIT $ OTHER ~ 2 6 20 OCT 9 _ AL PROVISIONS ~~ S P E G DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI ~. e ~ , ~ p ~®VVIV CLERK ~`~-- ~' ELECTRICAL CONTRACTOR l~A W!`CI 1 ATIAW CERTIFICATE HvLUtK _^"-°-" "--- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN DATE THEREOF TOWN OF WAPPINGERS , NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 20 MIDDLE BUSH ROAD IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P.O. BOX 324 REPRESENTATIVES. WAPPINGERS FALLS, N.Y. 12590 AUTHORIZED REPRESENTATIVE ' ~e~ nriooi~o nT1AW All r nHt'•c recurvarl ACORD 25 (2009101) '-' '""" """" "--"- --"-~ --- The ACORD name and logo are registered marks of ACORD New York State Insurance Fund Workers' Compensation & Disability Beneftts Specialists Since 1914 105 CORPORATE PARK DRIVE SUITE 200, WHITE PLAINS, NEW YORK 10604-3814 Phone: (914) 253-4874 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~r~~~~ MIKE ROMANO ELECTRIC INC 58 MAPLE LANE OTISVILLE NY 10963 POLICYHOLDER CERTIFICATE HOLDER MIKE ROMANO ELECTRIC INC TOWN OF WAPPINGERS 58 MAPLE LANE 20 MIDDLE BUSH ROAD OTISVILLE NY 10963 P O BOX 324 WAPPINGERS FALLS NY 12590 POLICY NUMBER W 1370 207-1 CERTIFICATE NUMBER 835355 PERIOD COVERED BY THIS CERTIFICATE 10/24/2009 TO 10/24/2010 DATE 10/20/2009 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1370 207-1 UNTIL 10/24/2010, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 10/24/2010 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. ~E~~~E ~ ~ -~ = OCT 2 6 2009 °~®UVN CLERIC NEW YORK STATE INSURANCE FUND 6~~ ~~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 1 0641 8461 0 U-26.3 ACORD~, CERTIFICATE OF LIABILITY INSURANCE 1oi21i2 9) PRODUCER FAx (410)465-0759 Atlantic Risk Management Corp. Suite 240 R d l t 8 0 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. oo oa , er Wa 5 5 Columbia MD 21045 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Natl Fire InS CO Of Hart A, XV its subsidiaries LLC Global Tower INSURER B:Transcontinental Ins Co A, XV , , and/or assigns INSURERC:Valle For a Ins. Co. A, XV 750 Park of Commerce Blvd. #300 INSURERD:Hanover Ins. Grou A,XIV Boca Raton FL 33487 INSURERE:Ironshore thru Socius A-, XI ES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INUIGA I tu. rvv I vvl I rla IHrvulrv~ HrvT 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 EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MMlDD/YY A GENERAL LIABILITY TCP2087Z82219 10/.31/2009 10/31/2010 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED 3 0 0, 0 0 0 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S MS MADE a OCCUR MED EXP (An one person) S 5 , 0 0 0 X CLAI ee Benefits lo Em PERSONAL&ADVINJURY S 1, 000, 000 p y Liabilit GENERAL AGGREGATE S 2, 000, 000 y EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG S 2 , 0 0 0 , 0 0 0 G POLICY JECOT X LOC $1, 000, 000 $ AUT OMOBILE LIABILITY BUA2087782169 10/31/2009 10/31/2010 COMBINED SINGLE LIMIT d s 1,000,000 ent) (Ea acci ANY AUTO ALL OWNED AUTOS BODILY INJURY P S _ e ~ ~ °" er person) ( SCHEDULED AUTOS `~1~ V ~ URY X HIRED AUTOS ~ 1/- ~; ~ D S X 9 y ~ H (p acciden NON-OWNED AUTOS T 2 6 240 OC 1 PROPERTY DAMAGE S (Per accident) ARAGE LIABILITY ~~ AUTO ONLY - EA ACCIDENT S G 4 OTHER THAN EA ACC S ANY AUTO AUTO ONLY: AGG S $ MBRELLA LIABILITY / L2099604006 10/31/2009 10/31/2010 EACH OCCURRENCE S 25,000,000 EXCESS U MADE X ~ AGGREGATE S 25, 000, 000 CLAIMS OCCUR S TIBLE S DEDUC C X RETENTION $ 10, 000 WORKERS COMPENSATION AND WC294362518 10/31/2009 10/31/2010 WC STATU- OTH- Y TORY LIMITS ~' ER S EMPLOYERS' LIABILITY E.L. EACH ACCIDENT 1, 0 0 0, 0 0 0 S ANY PROPRIETOR/PARTNER/EXECUTIVE 000 1 000 OFFICER/MEMBER EXCLUDED? E. L. DISEASE-EA EMPLOYEE , , S If yes, describe under DISEASE -POLICY LIMIT L E 1 0 0 0 0 0 0 S ~ ~ SPECIAL PROVISIONS below . . 10/31/2009 10/31/2010 Limit $325,000 per location D DTHER Builders Risk =x4003601001 Professional Liab MPL100o382009 10/31/2009 10/31/2010 $2,000,000 limit $5,000 deduct E DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONSADDED BY ENDORSEMENTISPECIAL PROVISIONS Insurance Verification Re. GTP Site Name & ID No.: NY-5185 / Wappinger Falls. Town of Wappinger is Additional insured on all policies except workers Compensation, subject to policy provisions. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town Clerk EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL TOW21 Of Wappinger 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 20 Middlebush Rd. FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Wappinger Falls, NY 12590 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /~ l/MMS ~~ id S - au Dav Y/ ~ nn ~I'f I'YC ATIA\I A~4Q ACORD 25 (2001108) INS025 m~nef ~ AMS VMP Mortpape Solutions, Inc. (800)327-0545 IJ NI,V R/ VVr~r Vr~,-~~,v~~ ,:,vu Pape 1 of 2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER 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. °6'~W~ CLERK ~ ~~ ACORD 25 (2001108) ~,,; INS025 l0108).0~ Page z of 2 ACORN CERTIFICATE OF LIABILITY INSURANCE OP ID LS ~ ~ DATE(MMIDD/YYYY) ^''' BHPNE -1 10 21 0 9 PRODUCER Spiegler Insurance Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CA License #OB71012 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 7777 Fay Avenue, Suite 203 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. La Jolla CA 92037 Phone:858-459-8834 Fax:858-459-9019 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Insurance Company Bl INSURER B: ue Haven POO18 Northeast Inc INSURER C: 2273 N Penn Rd Hatfield PA 19440 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 W ITH 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 P I YEFFECTIV DATE MMIDDIYYYY LI EXPIRATI N DATE MMlDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ X 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 COMBINED SINGLE LIMIT A X ANY AUTO 72 UEN QY2650 09/23/09 09/23/10 (Ea accident) $ 1~ 0 O O~ O O O ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE 8 2 5 0 0 DED PD ,a ~" ~ (Per accident) GARAGE LIABILITY ' '' AUTO ONLY - EA ACCIDENT $ ANY AUTO ~.~~ OTHER THAN ~ ACC $ Z 9 AUTO ONLY: qGG $ EXCESS i UMBRELLA LIABILITY O EACH OCCURRENCE $ __ OCCUR ~ CLAIMS MADE ~ ~ ~~ AGGREGATE $ { ®~•" $ DEDUCTIBLE $ RETENTION $ $ WOR AND KERS EMPL COMPENSATION OYERS' LIABILITY - - TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIV~ '°` ~ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ tf yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *10 Days for Non-Payment CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION WAPPWAl DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 O * DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 8UT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR T f W i REPRESENTATIVES. own O app nger A THO ZED REPRESENTATIVE 20 Middlebush Rd. U Wa in er Falls NY 12590 ACORD 25 (2009/01) ©1988-2009 ACORD 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. ~~~~~~~~ ~-C ®~-~ 2 6 2049 ~®VU[V CLER6~ '!~:-_ . ACORD 25 (2009/01) Erie Insurance 100 Erie Ins. PI. Erie, PA 16530 CERTIFICATE OF INSURANCE - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY - CERTIFICATE HOLDER COPY NAME AND NUMBER OF AGENCY DATE ISSUED 10/ 10/2009 A. C. PEPE INSURANCE AGENCY NN 1387 NAME AND ADDRESS OF CERTIFICATE HOLDER OR OTHER NAME AND ADDRESS OF NAMED INSURED TOWN OF WAPPINGERS MR ROOTER OF DUTCHESS 20 MIDDLEBUSH ROAD COUNTY INC WAPPINGERS FALLS NY 12590- 75 WEST RD PLEASANT VALLEY NY 12569-7914 This is to certify that policies, as indicated by Policy Number below, are in force for the Named Insured at the time that the certificate is being issued. TYPE OFlNSURANCE<:: PDLICY NUMBER POLICY - EFFECTIVE DA7~,. ~ . PpLlCY - ' EXPIRATION DATE LtMIT5 OF IN&URANCE GENERAL LIABILITY 0476350048 1 1 / 13/2009 1 1 / 13/20 1 O EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY 1000000 '{ OCCURRENCE FORM FIRE DAMAGE GEN'LAGGREGATE LIMIT APPLIES PER POLICY (Any one premises) $ 1000000 : ADDITIONAL INSURED MED EXP (Any one person) $ 10000 '! PERSONAL&ADVINJURY $ IODOOOO GENERAL AGGREGATE $ 3000000 PRODUCTS-COMPfOP AGG $ 3000000 BODILY INJURY $ (EACH PERSON) ' Q~ BODILY INJURY $ ( ~ (,U L `° (EACH ACCIDEN ~~ 1 PROPERTY DAMAGE $ -"'r5AIC1.~ , ,I F~ BODILY INJURY AND PROPERTY DAMAGE $ COMBINED p,°. EACH OCCURRENCE ,S`~ AGGREGATE STATUTORY BODILY ACCIDENT $ EACH ACCIDENT INJURY DISEASE $ POLICY LIMIT BV DISEASE $ EACH EMPLOYEE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTJSPECIAL PROVISIONS CANCELLATION FOR NON-PAYMENT, CAUSE OR NAMED INSURED'S REQUEST: When an automobile policy is cancelled, written notice will be mailed to the Certificate Holder. When any of the above described policies (other than automobile) are cancelled before the expiration date thereof, The ERIE will endeavor to mail written notice to the Certificate Holder after the decision to cancel. Failure to mail such notice shall impose no obligation or liability of any kind upon The ERIE, its Agents or representatives. ® CANCELLATION FOR SPECIAL CONTRACTS: (If the box is checked, this certificate involves a special contract and the following cancellation provisions apply.) When an automobile policy is cancelled, written notice w~lbbe mailed to the Certificate holder. When any of the above described policies (other than automobile) are cancelled before the expiration thereof, The ERIE will endeavor to mail days written notice to the Certificate Holder after the decision to cancel. Failure to mail such notice shall impose no obligation or liability of any kind upon The ERIE, its Agents or representatives. ERIE INSURANCE GROUP This certificate is issued for information purposes only. It does not list, amend, extend, or otherwise alter the terms and conditions of insurance coverage contained in the Policy(ies) indicated above issued by The ERIE. The terms and conditions of the Policy(ies) govern the insurance coverage as applied to any given situation. Any party can request a policy and/or Declaration by asking the insured or the Agent. Limits shown may have been reduced by claims paid. OF-t566 2102 (E) CIF SEE REVERSE SIDE AUTHDRIZED ~r_ REPRESENTATIVE Clipn4~!• 37F,1Q - - - - - - ncvnc ~1CORD,~ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1o/os/2oos PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ulster Insurance Services, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 180 Schwenk Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 3995 Kingston, NY 12402 INSURERS AFFORDING COVERAGE NAIL # INSURED H k h P INSURER A: M@rChantS MUtUai Ins CO ec erot lumbing & Heating of W d INSURER B: Rochdale Insurance Company oo stock Inc PO B INSURER C: OX 374 INSURER D: Clintondale, NY 12515 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 POLICY EXPIRATION LIMITS A GENERAL LIABILITY CPPW215310 06/15/09 06/15/10 EACH OCCURRENCE S1 OOO OOO X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1 OO OOO CLAIMS MADE ~ OCCUR MED EXP (Any one person) $5 OOO PERSONAL 8 ADV INJURY $1 OOO OOO GENERAL AGGREGATE $2 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2 OOO OOO POLICY PRO- LOC JECT AU TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ~~~' ~ y ., Y (Ea accident) ALL OWNED AUTOS L•/ BODILY INJURY $ SCHEDULED AUTOS ry C T (Per person) HIRED AUTOS ~ ~ O0 i L BODILY INJURY $ NON-OWNED AUTOS (Pereccident) PROPERTY DAMAGE (Per accidenQ $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO {~ OTHER THAN ~ ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND RWC316444d 01/22/09 01/22110 X WC STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1 OO,000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? YES E.L. DISEASE - EA EMPLOYEE $1 OO OOO If yas, dascdbevndar SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $SOO,000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Town of Wappinger 20 Middlebush Rd Wappingers Fails, NY 12590 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25 (2001/08) 1 of 2 #S45371/M44561 MMP 0 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•S (2001108) 2 of 2 #S45371/M44561 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10-6-09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Coverage Concepts, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4953 Nesconset Highway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Port Jefferson Station, NY 11776 INSURERS AFFORDING COVERAGE NAIC # INSURED Ibrahim VBZgUeZ EnterprlseS InC. INSURER A: Endurance DIBIA V8Z-Co Reclaiming Service INSURER e: Stemet Insurance Co. P.O. Box 1518 INSURER C: National Union Fire Ins.Co. of Pittsbu PA.. Highland, NY 12528 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' POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION LIMITS GENERAL LU181LrrY EACH OCCURRENCE $ 1 OOO OOO A X COMMERCIAL GENERAL LIABILITY Binder6599 10/05!2009 1O/OSIZOIO DAMAGE TO RENTED $ 5O OOO CLAIMS MADE X~ OCCUR MED EXP An one arson $ 5 OOO x Pollution Liability PERSONAL & ADV INJURY $ 1 OOO OOO GENERAL AGGREGATE $ 2 OOO,OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 OOO,OOO POLICY PRO LOC AUT OMOBILE LUIBILITY COMBINED SINGLE LIMIT $ 1'000,000' B ANY AUTO GSA0000025;.01 - .2712009 0712712010 (Ea accident) ALL OWNED AUTOS , ~ . BODILY INJURY + ~ ~ $ X SCHEDULED AUTOS -:z--~ (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS r ~ Y 1i (Per accident) X MCS90 ~~~ ~ C 4~ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ®C AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ °"~'4hrf,~~ (~~_ ~~ ~ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILrfY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND x WC STATU- OTH- C EMPLOYERS' LIABILITY W0005-45-5095 1010512009 10105/2010 E.L. EACH ACCIDENT $ SOO,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 5OO OOO If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT ,$ 500 OOO OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS 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 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 REPRESENTATNES. AUTHORIZED REPRESENTATIVE <SLW> ACORD 25 (2001/08) `" ~~4CORD 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. OCT Q 9 20D9 ACORD 25 (2001/08) ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID MF DATE (MM/DD/YYYY) ,~ PENZE-1 10 23 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Powers and Haar, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 159 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P . 0 . Box 217 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cold Spring NY 10516 Phone:845-265-3652 Fax:845-265-3750 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: NGM Insurance .Company 226 INSURER B: Penzetta Plumbing & Heatingg Inc. INSURER C: 49 N Elm Street . Beacon NY 12508 wsuRERD: 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLfCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER P I DATE MM/DD/YY P I Y EXPIRATI N DATE MMIDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 0 0 0, 0 0 0 A X COMMERCIAL GENERAL LIABILITY MPV44329 11~01~09 11~D1~10 PREMISES (Eaoccurence) $ 500, 000 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 1 ~ , D 0 ~ PERSONAL & ADV INJURY $ 1, 0 0 0, 0 0 0 GENERAL AGGREGATE $ 2, O D 0, 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 , ~ 0 ~ , 0 ~ 0 X POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1, 0 0 0, 0 0 0 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ A X SCHEDULED AUTOS B1V44329 11~01~09 11~01~10 (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: qGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1, 000, 000 A X OCCUR ~ CLAIMSMADE CW44329 11~01~09 11~01~10 AGGREGATE $ 1, 000, 000 $ DEDUCTIBLE $ }( RETENTION $ 10 , 0 0 0 $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EA9PLOYEE $ If yes, describe under DISEASE - P LICY L-IM11 E L $ SPECIAL PROVISIONS below . . OTHER °-~ (e' ! ~ DESCRIPTION OF OPERATIONS (LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS PLUMBING AND HEATING OPERATIONS IN THE STATE OF NEW YORK. RESTRICTION~I.~Pi`~~~ v PER THE TERMS AND AGREEMENTS OF THE POLICIES. ~i iI6... OCT 2 7 2009 ('"FRTIFIC:ATF HC11 IIFR CANCELLATION "' TOWN OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1D 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 ers Falls NY 12590 in Wa REPRESENTATIVES. g pp AUTHORRED REPRESENTATIVE Mar Lee C. Ferranti ACORD 25 (2001108) V AC:UKU (:UKI'UKA I IUN 7 ytltl 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. R~~~I'~ OCt 2 ? ZOQ9 TOw~ ~~~~~ ACORD 25 (2001/08) R~~ CERTIFICATE OF LIABILITY INSURANCE OPID xM DATE (MM/DD/YYYY) ~ LUZON-1 09/04 09 PRODUCER AEI UE A AMA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Mang Ins Agy LLC Fleischmanns HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 63 Old Rt. 28 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Fleischmanns NY 12430 Phone: 845-254-4802 Fax:845-254-4807 INSURERS AFFORDING COVERAGE ~ NAIC # INSURED INSURER A: Evanston Insurance CO L il INSURER B: AZ'Ch Insurance Compan uzon O Company Inc dbaLuzon EnvironmentalServices INSURER C: 1246 Glen Wlld Rd Woodridge NY 12789 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 DR 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 POLC FFECTIVE DATE MMIDDIYYYY P I Y'E PIRA 1 N DATE MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2, 0 0 0, O O O A X COMMERCIAL GENERAL LIABILITY 0 9 PKG019 81 0 9/ 0 3/ 0 9 0 9/ 0 3/ 10. PREMISES (Ea occurence) $ 5 0/ O O O X CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5 , O O O A X Pollution 09PKG01981 09/03/09 09/03/10 PERSONAL&ADWINJURY $ 2, OOO~ OOO A X Professional, EIL 09PKG01981 09/03/09 09/03/10 GENERAL AGGREGATE $ 2, 000., 000 GEN'L AGGREGATE LIMrr APPLIES PER: ' PRODUCTS - COMPIOP AGG $ 2 , O O O , O O O POLICY PRO- JECT LOC Ded 10000/15000 AUT OMOBILE LIABILITY COMBINED SIN LE I ANY AUTO G L M(f (Ea accident) $ 1, O O O, O O O ALL OW NED AUTOS BODILY INJURY B X scHEOULEDAUros FBCAT0078803 09/03/09 09/03/10 (Per person) $ X HIRED AUTOS BODILY INJ Y X NON-OWNED AUTOS UR (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 EMPLOYERS' LIABILITY Y / N TORY LIMBS _ ER ANY PROPRIETOR/PARTNER/EXECUTIVE~ OFFICER/MEMBER EXCLUDED? REFER TO NYS WC E.L. EACH ACCIDENT $ (Mandatory in NH) H es describe under BOARD FORM GSI 1 O 5 . 2 E.L. DISEASE - EA EMPLOYE $ y , SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMfT $ OTHER ~~E~ ~/E~ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS- S [-p:; ~ ~ ~~~~ _~ ~~ ~ ~~~ cLER~- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION WA 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 SO SHALL TOWn of Wappinger Code Enforcement Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 20 Middlebush Road REPRESENTATIVES. Wappingers Falls NY 12590-0324 w i+~r~~ n AUTHORI~DREP NT TIVE h~~R~ ~~ ~cvv~iv,l v 79SS-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACOR®~ CERTIFICATE OF LIABILITY INS~JRANCE DATE (MM/DD/YYYY) 9/11/2009 PRODUCER (260) 467-5690 FAX: (260) 467-5651 STAR Insurance - Fort Wayne Office 2130 East DuPont Road 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. Fort Wayne IN 46825 INSURERS AFFORDING COVERAGE NAIC # -_ __ _ _ __ -__-- INSURED ---- --._ - - - - - _.- - ---- INSURER ANATIONAL CASUALTY COMPANY 11991 ROAD RUNNERS CLUB OF AMERICA/2009 wsuRERB NATIONWIDE LIFE 66e69 AND ITS MEMBER CLUBS _ .- --- ---__.._ ___.---_- _-----__-. INSURER C: - - -- -_ -- 6434 POUND APPLE COURT ~_-- ___-- - -- _ ----- - _. __ INSURER D: COLUMBIA MD 21045 _ _-.___ _. 'INSURER E C 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 OUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ---r ~SRIADD'L ~ POLICYEFFECTIVI .TR INSRD TYPE OF INSURANCE POLICY NUMBER I DATE (MMIDDIYYY' GENERAL LIABILITY X ~ COMMERCIAL GENERAL LIABILITY i, I A I~! ~ ~ I CLAIMS MADE ' X ~ OCCUR ~KR00000000172601 ! 12/31/2008 I - j ~. X _~ LEGAL_LIAB. TO PART. i 12 : O1 A.M. I ~ -- I__ $1,000,000 ~ i I - I LIMITS EACH OCCURRENCE ,', $ 1,000, 000 _ _ _ ._. ;DAMAGE TO RENTED PREMISES jEa occurrence) $ I _ _ _ _ _3.00 , 000 12/31/2009 MED EXP (Any one person) ' $ i-- ----- 5, 000 I -- - 12:01 A.M. PERSONAL&ADVINJURY _ $ _ _._ __1,,000,-000 GENERAL AGGREGATE ' $ NONE - __ uca rcr~. I NKUUUG IS - CUMP/UP AGG ~ '_$ l ~UUU UUU I ~ POLICY ~ ~ PRO- ~' LOC ~ I ~ ~ AUTOMOBILE LIABILITY j ~ ~ COMBINED SINGLE LIMIT I I I ~ ANY AUTO I I ~ (Ea accident) ~ $ 1 , 000 , 000 ' A ~ ~ , ALL OWNED AUTOS $SR00000000172601 12/31/2008 ~ 12/31/2009 gODILYINJURY '_ SCHEDULED AUTOS . 12:01 A.M. 12:01 A.M. i (Per person) i $ X 'HIRED AUTOS I I ~ I I r-i ~ X ~ NON-OWNED AUTOS I ~ I BODILY INJURY ' (Per accident) $ I ~ !PROPERTY DAMAGE $ (Per accident) I i I GARAGE LIABILITY I i ;AUTO ONLY - EA ACCIDENT . $ ~i ANY AUTO ~/ fir` ~ ~ EA ACC N O~ H ~ $ I ~ ~ V E~ Y ` Y N AGG $ ~ ~ EXCESS I UMBRELLA LIABILITY ~I OCCUR ~ CLAIMS MADE I EP 14 2009 !EACH OCCURRENCE $ I !AGGREGATE ~ $ i -- DEDUCTIBLE ~ 1A, Vy~ CLE~ $ $ I I RETENTION $ ~ ~ ~ $ ' WORKERS COMPENSATION 'AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ^ OFFICER/MEMBER E C r - ~„~~"' ~ - ~ WCSTATU- iOTli-~ ~~~~`~'y`~.1MLT_S I ER I EI L, EgCH ACCIDENT $ X LUDED? (Mandatory in NH) I If yes, describe under ~ i I E.L. DISEASE - EA EMPLOYEE $ SPECIAL PROVISIONS below i I I E.L. DISEASE - POLfCY LIMIT $ B OTHEREXCESS ACCIDENT 6 ISPX0000003566300 ' 12/31/2008 12/31/2009 i ~ EXCESS MEDICAL $10, 000 MEDICAL i i i 12:01 A.M. i 12:01 A.M. _-.. i $250 DEDUCTIBLE nn c corrrvrr .nee PER CLAIM 52.500 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN THE OPERATIONS OF THE NAMED 'INSURED. 'DATE 6 EVENT: 09/20/09 Dutchess County Classic 5K, 1/2 Marathon, Kids Mile INSURED CLUB: Mid-Hudson Road Runners Attn: Vince Veltre c/o 7 Merrick Rd Poughkeepsie, NY 12603 _CERTIFICATE HOLDER CANCELLATION 09/20/09 Town of Wappingers Attn: Chris Masteson 20 Middlebush Rd Wappingers Falls, NY 12590 SHOULD ANY OFTHE 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 AUTHORIZED REPRESENTATIVE John Lefever/JJR ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (zoosot) The ACORD name and loge are registered marks of AGOP.D DATE (MMIDD/YYYY) 9/28/2009 !"'~ ® OF LIABILITY INSURANCE MATTER OF INFERRMACATE 7R~ CERTIFICATE THIS CERTIFICATE IS ISSU ONLY AND CONFERS NO RIGHTS UPON THE CEXTEND OR 471-6200 FAX: (845)471-9174 ;ER (845) HO ERTHE OVERAGE AFFORDED BYO THE POLICIES BELOW. ey-Finn & Company AL I NAIC # _ _ __ _ - - lavis Ave I URERS AFFORDING COVER- A-_G ____ Co -- ; 2ai71 _ __ --_- -- . NY 12603 ____ fhkeepsie _ _ - --- ---- :D Inc . Llo Brothers Contractors, E'ulton Street 12590 (INSURER I,Ty 12601 I ghke~psie ICH THIS CERTIFICATE MAY BE ISSUED OR TO THE INSURED NAMED ABORESPECT TO WHCY PERIO SIONS AND CONDITIONS OF SUCH IERp,GES - - E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED --- LIMITS E AFFORDED BY THE POLICIEES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EX IY REQUIREMENT, TERM OR CONDITION OF ANY CONT DUC D BOY PAED C-AIMS ENT ~ POLICY EXPIRA IT o 0 000 ~Y PERTAIN, THE INSURANC -___ ~pOLICY EFFECTIVE DA MMIDD YY $ -- 111 1-- )LICIES. AGGREGATE LIMITS SHOWN MAY HAVE 6EEN R __- D T M I EACH OCCURRENCE 100000 __------ _ -T POLICY NUMBER F naMAGE TO RENTED ^^o\~ $ _ _ _ I -_ - I M D EXP (Any one person) I $ --- GENERAL LIABILITY ~~ E-- I ENERAL LIABILITY 7 / 4 / Q D 1D 7/4/2DD9 PERSONAL&ADVINJURY ~_$__--- , ~X (COMMERCIAL G X III ~ CLAIMS MADE r X J OCCUR BP8457577 $ GENERAL AGGREGATE _ AGG $ ~ ----- PRODUCTS- COMPIOP i 1--1 ----_ ~ _~~ i _ I I GEN'L AGGREGATE LIMIT APPLIES PER: I I COMBINED SINGLE LIMIT g ~ PRO- LOC I P I ~~ }{ POLICY I ___ (Eaaccitlent) _--_--_ - '~pUTOMOBILE LIABILITY 7 / 4 / 200 9 7 / 4 / 2 010 BODILY INJURY $ (per person) I~ ANY AUTO 88455377 1 I ~'i X I '~ ALL OWNED AUTOS I SCHEDULED AUTOS D AUTOS I I I BODILY INJURY 'I $ (per accdent) ~ PROPERTY DAMAGE $ I HIRE 11 I NON-OWNED AUTOS I (Per accident) EA ACCIDENT $ ~ j ~ i i AUTO ONLY - ~ I _~ EA ACC $ ~ OTHER THAN AGG $ AUTO ONLY: li '~ GARAGE LIABILITY i ~ ~ ANY AUTO ~ I I $ EACH OCCUR_REN~E $ ;I ~ i $ AGGREGATE Ii EXCESS I UMBRELLA LIABILITY OCCUR ~ CLAIMS MADE /2009 7/4/2010 $ $ 7/4 U8458877 DEDUCTIBLE WC STATU- OTR T RY L MIT C I X~ 10 , 0001 X RETENTION $ ! - $ E.L. EACH ACCIDENT YE $ i WORKERS COMPENSATION PLOYERS' LIABILITY YIN E.L. DISEASE - EA EMPLO T I $ LI AND EM ANY PROPRIETORIPARTNERIEXECUTIVE ^ XCLUDED? E.L. DIS AS - E l O ry in NH) Manda o ( If yes, describe under SPECIAL PROVISIONS below OTHER I VI II I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PR ` --. 'a ( ~ CRIPTION OF OPERATIONS I LOCATIONS I VEaHICLES I s additional insured DES listed is ~ ~ ~+e/ ,' (~ '~wa~ ^ Certificate holder project Martz Field Tennis Court Reconstruction RE: Tovm of Wappinger 2p Middlebush Road Wappingers Falls, NY ACOR~009101) wS025 czoosoi> INS Insurance ~--- - __ Netherlands -__- --- _- lloa5 INSURER A__ --- Insurance Co _ .----- 2g198 Excelsior ___-- INSURER B_- -- -- Ins Co_ _ __ ---- -- Peerless --- INSURERC: _------' --- _ _-- --~----__. INSURER D___~--- -_- E J00,000 0001000 000,000 1,000,000 D0.000 00,000 :ANC'- E q ION 3O DAYS WRITTEN SHOULD ANY OF THE ABOVE DES gUIRER WILL ENDEAVOR TO MA)LBEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING IN BUT FAILURE TO DO SO SHALL ITS AGENTS OR NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEF , IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, REPRESEN~H~~~~~• ~ /~~~ AUTHORIZED REPRESENTATIVE ~ cif Robert Finn/AS TION. All rights reserved. © 1988-2009 ACORD CORPORA The ACORD name and logo are registered marks of ACORD