Rogers, AaronFOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni F]
Grace Robinson _Ij
Lori McConologue
Date Received:
2021-05-13 JPP
Town of Wappinger
Application for Hawkers
(N & Peddler's License
_101to
Serial
The undersigned does hereby apply to the Town of W pinger Town Clerk for a
NEWX RENEWAL TEMPORARY
(I weekend only)
License for Hawking and Peddling pursuant to Town of Wappinger Local Lave No. 10 of 1992,
regulating Hawkers and Peddlers in the Town of Wappinger, and in coil n�c,j !j
application, does state the following:
j
1) Applicant. -
NAME: Aaron Rogers
CURRENT ADDRESS:
7 W Cross St. Ste 7E
AGE:
Hawthorne NY 10532
(St 9) (Street) (City)
PHONE #.2089485331
PERMANENT ADDRESS (if different):
1133 S Railroad Ave Sugar City
(State) (ZIP)
(St #) (Street) (city) (State)
If Applicant is an Agent or Employer:
Applicant's Employer APTIVE ENVIRONMENTAL LLC
Address of Employer 5.1.32 N 300 W Ste 150 Provo UT 84604
(St, 4) (Street) (City) (State) (ZIP)
Proof of Employment (attach to application}
(zip)
Tape a 2"X 2"
color photo (less
than 60 days Old)
2) Nature of Business:
Door to door solicitation of Aptive's pest control services through residential
areas of Wappinger, on foot
—1110,
U Motor Vehicle (circle one): car truck van
El On Foot &/or with vehicle drawn y harid Vrflanimal
Vehicle Info: Vehicle Make Vehicle Model iA n er-
License Plate 9 KT Do State of Registration
Operator's License Number 8262028866356
E Weights& Measures Certificate Certificate #
E Dutchess County Health Dept Permit Permit #
2021-05-131PP
3) Veteran Status
LI Veteran Applicant - Exempt from license fee (attach certificate from Dutchess County)
Names of all other municipalities in which the applicant has been a vendor in the preceding 6
months:
4) Compliance
That the applicant, if the License requested hereby is granted, consents and agrees to conduct the
aforesaid business or activity pursuant to all of the terms and regulations of the Local Law above
specified, and all other rules, regulations and Laws governing ones activities in the Town of
Wappinger as a Peddler or Hawker.
Dated: �� Or , , 20_c
Wappingers Falls, N.Y.
Signature of Applic t
Sworn to before me this
ZP tdafZ, 20-4
Francis J. CCiusfa
Notary i'ubiic, Stato of New York
Reg. No, OIG1638746,
Notary ubli
Qua jf ed in Duchess County
Commission Expires February 11, 2027
Application must be accompanied by a fee of Two Hundred Dollars ($200.00) plus $50 for
each addition to the original license per year, payable to the Town of Wappinger. This is a
non-refundable fee.
Applicants possessing a valid Dutchess County Veterans Vendors License are exempt from
the $200.00 fee, provided that a copy of said license is attached to the application.
` CERTIFICATE OF LIABILITY INSURANCE
DATE {MM6!14!IDDNIDDIYYYY}
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policyties) must have ADDITIONAL INSURED provisions or be endorsed.
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),
PRODUCER
Graham Company,
a Marsh & McLennan Agency, LLC company
One Penn Square Vilest
CONTACT
NAME:
PHONE FAX
• 215-567-6309 41c No: 216-569-3025
aDOR�ESs: Holden unit rahamaa.com
Philadelphia PA 19102
INSURER(N AFFORDING COVERAGE NAICYI
INSURER A: Safety National Casua4 Corporation 15145
MKLM6MMP1000778
INSURED APTIENV-01
Ap1 W River Park Drive, Floors 1-3 tive Environmental, LLC
25
INSURER B. Markel American Insurance Company 28932
1NstiRERC: Navigators Insurance Company 42307
INsuRERD: Evanston Insurance Company 35378
Provo, LIT 84604
INSURER E: Lexington insurance Company 19437
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1821872424 REVISION NUMBER -
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN .MAY HAVE BEEN REDUCED BY.PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
POLICY EFF
fMMiOO1YYYYL
POLICY EXP
fMM1DDNYYyI_LIMITS
a
X COMMERCIAL GENERAL LIABILITY
MKLM6MMP1000778
111112023
1111/2624
EACH OCCURRENCE $1,000,000
CLAIMS -MADE OCCUR
DR= TORENT Q
EMISEs Ea occurrence) $1,000,000
MED EXP (Anyone person) $ 10,000
PERSONAL&ADVSNJURY $1,000,1100
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PRO SECT LOC
GENERAL AGGREGATE $ 2,009,000
PRODUCTS -COMPIOPAGG $2,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
CA $876643
117172023
1111/2024
COMBINED SHOLE LIMIT $ 3,000,000
Ea accide rt
80DILY dNJURY (Par person) $ —
X
ANY AUTO
OWNED SC DIJLED
AUTOSONLY AUTOS
130DILYINJURY (Peraccident) $
HIRED NON-OWNFD
AUTOS ONLY AUTOS ONLY
PROPERTYDAMAGE $
Per accident
C
UMBRELLALIAS
IX
I
OCCUR
GA23EXCZOFD491C
111112023
11/1/2024
EACH OCCURRENCE 52,000,000
X
AGGREGATE $
EXCESS LIAR
CLAIMS -MADE
DED RETENTION $
$
A
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
LDS 4068513
PS 4066512
111112023
11]112023
11/1/2024
111112024
X PER O7H-
SiA7UTE ER
E.L. EACRACCIDEVT $ 1,00{1,000
ANYPROPRIETOR,PA1RTNER/F_XECE1TIVE L
OFFICFRlMFMBFR EXCLUE)ED?
NIR
EL. !DISEASE- EA EMPLOYEE $ 1,000,000
(Mandatory in NH)
if yas doscri.bo under
DESCRIPTION OF OPERATIONS below
EL. DISEASE- POLICY LIMIT $ 1,000,000
D
E
Contractor's Pollution
Excess Liability
MKLV7ENV105074
52114892
111112023
111112023
1111/2024Each
1'11112424
Pollution
ConditionLimitlAN: $5,OOo,000
Limit $3,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 141, Additional Remarks Scliedule, may be attached if more space Is required)
The Excess Liability policy referenced above With Navigators Specialty Insurance Company provides limits in excess of the Auto Liability only.
The Excess Liability coverage referenced above with Lexington insurance Company provides limits in excess of the primary General Liability and Excess Auto
Uabftity policies.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION .DATE THEREOF, NOTICE WALL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Town of Wappinger, IVY
20 Middlebush Roast AUT ORIZED PRESENTATIVE
Wappingers Falls NY 12590
M 04,5d
0 1988-2015 ACORD CORPORATION. All rights reserved.