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Kolb, AndrewFOR INTERNAL USE ONLY Received by: Joseph P. Paoloni Grace Robinson Lori McConologue I 2021-015-13 JPP Town of Wappinger Application for Hawkers & Peddler's License License for Hawking and Peddling pursuant to Town of Wappinger Local Law No. 10 of 1992, regulating Hawkers and Peddlers in the Town of Wappinger, and in c...... application, does state the following: 1) Applicant: NAME, Andrew Kolb AGE: CURRENT ADDRESS: 7 W Cross St. Ste 7E Hawthorne NY 10532 (St #) (Street) (City) (State) (ZIP) PHONE4 9188943835 PERMANENT ADDRESS (if different): 8527 E 56th St Tulsa OK 74145 (St 9) (Street) (City) (State) (ZIP) If Applicant is an Agent or Employer: Applicant's Employer APTIVE ENVIRONMENTAL LLC Address of Employer 5132 N 300 W Ste 150 Provo UT 84604 (St. 9) (Street) (city) (State) (ZIP) Proof of Employment (attach to al2plication) 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 El Motor Vehicle (circle one): car truck van 0 On Foot &/Or with vehicle drawn by hand or animal Vehicle Info: Vehicle Make '-i RVehicle Model License Plate g BAState of Regi strati on Operator's License Number 6083403770 L] Weights & Measures Certificate Certificate # [] Dutchess County Health Dept Permit Permit # 2021-0513 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: 2b Wap fingers Falls, N.Y. Signatur o Ap icant Francis J. Giusto Notary Public, State of Now York Reg. No. OIG 16387461 Qualified in Dutchess County CiO9T MissiOn 1=xpires 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. I@ A"R" CERTIFICATE OF LIABILITYINSURANCE DATE(MMIDDIYYYY) 611412024 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. 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 policy(ies) 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 West CONTACT NAME: PHONE FAX EdI215-567-6300 Arc No): 215 E-MAIL ADDRESS: holden Unit rahamco-Com INSURERS AFFORDING COVERAGE NA€C# Philadelphia PA 19102 INSURERA: Safety,National Casualty_Corporation 15305 MKLM6MMP1000778 INSURED APTJENV-01 Aptive Environmental, LLC 251 W River Park Drive, Floors 1-3 Provo, UT 84604 INSURER B: Markel American Insurance Company 28932 INSURERC: Navigators Insurance Company 42307 INSURERD: Evanston Insurance Company 35378 INSURER E. Lexln Eon 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 PAIDCLAIMS. ]NSR LTR TYPEOFINSURANCE ADDLS BR PaL1CYNUMBER POLICYEFF POLICY EXP LIMITS 0 X COMMERCIAL GENERAL LIABILITY MKLM6MMP1000778 111112023 111112024 EAC14OCCURRENCE $1,000,000 CLAMS -MADE FX OCCUR DAMAETORENTED PREM SES fEa occurrence $ 1,000,000 MED EXP (Any oneperson) $ 10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIM7 APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY [71 PRJECTO- LOC PRODUCTS - COMPIOP AGO $ 2,000,000 $ TH A AUTOMOBILELIA9ILITY CA 6676643 11/912023 11/1/2024 coMsiN DSINGtI L€MIT $3p00,Ofl0 Ea accident _ X BODILY 4NJURY (Per Person) S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPER7YLIAMAGi= $ Per a.'dent HIRED NODI -GINNED AUTOS ONLY AUTOS ONLY G UMBRELLA LIA8 X OCCUR GA23FXCZOFD491C 1.11112023 111112024 EACH OCCURRENCE $ 2,000,000 X AGGRFGATF $ EXCESS LIAB CLAIMS -MADE DED RFTENT[ON S $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRiETORIPARTNER)EXECUTIVE LDS 4068513 PS 4068512 11/112023 1111/2023 11/142024 1111/2024 X PE UTE 0RH- EL. EACI-1 ACCIDENT $ 1,000,000 AI OFFICEREMBER EXCLUDED? N 1 A {Mandatory in NH) E.L. tDISEASE- EA EMPLOYEE $1,000,000 EL. DISEASE- POLICY LIMIT $1.000,000 If yes, desctlbe wider DESCRIPTION OF OPERATIONS below D Contractor's Pollution MKLV7ENV105074 111112023 1111/2024 Each Pollution E Excess Liability 52114692 111112023 111112024 Condition L€mitlAgg: $5,000,000 Limit $3,000,000 DESCRIPTION OF OPERAT€ONS I LOCAT4ONS I VEHICLES (ACORD 101, Addiftonal 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. The Excess Liability coverage referenced above With Lexington Insurance Company provides limits in excess of the primary General Liability and Excess Auto Liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of tiWappinger, NY 20 Middleblash Road A' ORMED PRESENTATIVE Wappingers Falls ICY 12590 01988-2015 ACORD CORPORATION. All rights reserved.