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Hemby, CadeFOR INTERNAL USE ONLY Received by: Joseph P. Paoloni L1 Grace Robinson J Lori McConologue lyo� Date Received: Serial #- 2021-05-1 _3 JPP Town of Wappinger Application for Hawkers ,,i\\je(& Peddler's License c c` -, The undersigned does hereby apply to the Town of Wappinger Town Clerk for a NEW%'r RENEWAL TEMPORARY A (I weekend only) License for Hawking and Peddling pursuant to Town of Wappinger Local Law No regulating Hawkers and Peddlers in the Town of Wappinger, and in application, does state the following: 1) Applicant; ITL.IvLrte ��r CURRENT ADDRESS: 7 W Cross St. Ste 7E (St 9) (Street) RUCWIE 4� Hawthorne (City) 11 4068600085 PERMNNENT ADDRESS (if different): 3,380 AGE-, NY 10532 (State) (ZIP) MT 59102 (St #) (Street) (City) (State) If Applicant is an Agent or Employer-, Applicant's Employer APTIVE ENVIRONMENTAL LLC Address of Employer 5132 N 300W Ste 150 Provo UT 84604 (St. 9) (Street) (City) (State) (ZIP) Proof of Employment (attach to application) (ZIP) 10 of 1992, 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 [J Motor Vehicle (circle one): car truck van 11 On Foot &/or with vehicle drawn by hand or animal Vehicle Info: "Vehicle Make Vehicle Model _49urkne-r-, License Plate # j3h:j Dj,� State of Registration Operator's License Number AAA0000503387 17 Weights & Measures Certificate Certificate 4 E Dutchess County Health Dept Permit Permit # 2021-05-13 JPP 3) Veteran Status ❑ 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 G 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: _ 6 % ® , 20�L Wappingers Falls, N.Y. Sworn to before me this ZOd of 'U 2 Z Notary Public Signature of Appl ant Francis J, Glusto Notary Public, Mate of New York Reg, No. 01 6 16387461 Qualified in Dutchess County Commission Expires 'February 11, 202-1 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 $200.00 fee, provided that a copy of said license is attached to the application. - 40OR" CERTIFICATE OF LIABILITY( INSURANCE FDATE(MMIDDNY'YY) 8/14/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. T141S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If S.UBROGAT[ON IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Graham Company, a Marsh & McLennan Agency, LLC company One Penn Square West CONTACT HONE . 295-567-6300 arc No): 215-569-3025 No Pti-MAIL E(AIC, ADDRESS: holden unit@grahamco.com INSURER($) AFFORDING COVERAGE NAIL# Philadelphia PA 19102 INSURER A: Safety National Casualty Corporation 15145 MKLM6MMP1000778 INSURED APTIENV-01 INSURERS: Markel American insurance Company 28932 Aptive Environmental, LLC 251 W River Park Drive, Floors 1-3 INSURERc- Navigators Insurance Company 42307 INSURER D: Evanston Insurance Company 35378 Provo, UT 84604 INSURER£: 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 I TYPE OF INSURANCE ADSL SUBR POLICYNUMBER POLICY EFF MMIDDNYYY POLICY EXP MMIODNYYY LIMSTS B X COMMERCIAL GENERAL LIABILITY MKLM6MMP1000778 11/112023 11/1/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE D RENTED PREMISES Eaaccurrencel $1,040,004 MED EXP Any oneperson) $10,000 PERSONAL e. ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGOREGATE $ 2,000,000 HPOLICY ❑ PRO SECT LOC PRODUCTS-COMPIOPAGG $2,000,000 $ OTHER; A AUTOMOBILE _ LIABILITY CA 6676643 11/112023 11/112024 COMBINED ,SINGLE LIM#T 83,000,000 Ea accident BODILY TNJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ _ PROPERTY DAMAGE $ Per accident HIRED NON -GINNED AUTOS ONLY AUTOS ONLY $ CUMBRELLA LIAB K OCCUR GA23EXCZOFD491C 111112023 1111/2024 EACH OCGURRENCE $ 2,000,000 AGGREGATE $ X EXCESS L€AB CLAIMS -MADE DED RETENTION $_ 5 A A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN LDS 4068513 PS 40$$$12 11/112023 11/1/2023 1111/2024 11/1/2024 PER DTH - STATUTE ER .ANYJ1WP IETOR/PARTNER1EXFCUTIVE E.L EACH.AGCIDENT $ 1,900;000 OFFICERlMEMBER EXCLUDED? NIA E.L. DISEASE- EA EMPLOYEE $1,000,000 (Mandatory in NH) )f yes, descdbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY UMl1 $ 1,000,000 D Contractor's Pollution MKLV7ENV1O5074 11/1/2023 1111/2924 Each Pollution E Excess Liability 52114892 1111/2023 111112024 Canditian Limit/Agg' $5,000,000 limit: $3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES {ACORD 101, Additional Remarks Schedule, may he 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. f• The Excess Liability coverage referenced above with Lexington Insurance Company provides limits in excess of the primary General Liability and Excess Auto Liability policies. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCOitDANCE WITH THE POLICY PROVISIONS. Town of Wap.pinger, NY 20 M'Iddlebush Road A T ORIZED RESE Wappingers Falls NY 12590 0 1988-2015 ACORD CORPORATION. All rights reserved.