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Standley, BaileyFOR INTERNAL USE ONLY Received by: Joseph P. Paolom F� Grace Robinson Lori McConologue Z- - 2021-05-13 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 application, does state the following: Applicant NAME. Bailey Standley AGE: CURRENT ADDRESS: 7 W Cross St. Ste 7E Hawthorne NY 10532 (St #) (Street) (City) (State) (ZIP) PHONE# 2083205595 PERMANENT ADDRESS (if different): 3481 E 4058 N Kimberly ID 83341 (St 9) (Street) (city) (State) 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. #) (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 1 r Motor Vehicle (circle one): car truck van 0 On Foot &/or with vehicle drawn by hand or animal Vehicle Info: Vehicle Make 'T(_)LAo L;&, Vehicle Model rvo e- t— LicensePlateg B&-,LU0Cr State of Registration T Operator's License Number HC218321A I Weights & Measures Certificate Certificate # 1-1 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 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: 6Z9 0 f ? 4 , 20 Wappingers Falls, N.Y. Sworn to before nye this da of Notary ubli Francis I QiustO Notary Public, State of Now YOLK Reg, No. 01616387461 Qualified in Dutch@60 COPOW Commission Expires Feb arY 0. M7 Application inust 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. q� �� a; CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 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(fes) 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 215-587-6300 qrc No):215-569-3025 E-MAIL ADDRESS: holden Unit rshamco.com Philadelphia PA 19102 INSURERS AFFORDING COVERAQE NAI0 # INSURER A: Safety National Casuoy Corporation 15105 MKLM6MMP1000778 INSURED APTIENV-01 Aive Environmental, LLC 251 W River Park Drive, Floors 1-3 iNSURERB: Markel American Insurance Company 28932 INSURER 0: Navigators Insurance Comj?anV 42307 INSURER D: Evanston Insurance Company 35378 Provo, UT 84604 INSURER E- Lexington Insurance Compapy 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. €ETR TYPE OF INSURANCE IVSD WVQ SUER POLICY NUMBER MMI D1YEFF MM[DEYf YY' LIMITS R X COMMERCIAL GENERAL LIABILITY MKLM6MMP1000778 11/112023 11J1/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE i X f OCCUR DAMAGETED PREM SES E o€c wr nce $1,000,000 MED EXP (Any one person) $10,000 PERSONAL&ADViNJURY $1,000,000 GFN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY L] PRO - /ECT IX LDC PRODUCTS-COMPIOPAGG $2,000,000 $ OT ER' A AUTOMOBILE LIABILITY CA 6676643 11/112023 11/1/2024CDMBINED SJNGLE LMIT Ea accident $ 3,000,000 __ BODILY INJURY (Par person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NDN -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per accident $ C UMBRELLA LIAB X OCCUR GA23EXCZOFD491C 1111!2023 11/1/2024 EACHOCCURRENCE $2,000,000 X EKCESS LIAR CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ A A WORKERS COMPENSATION AND£MPLOYERS'LIABILITY YIN LDS 4068513 PS 400 11/1/2023 111112023 1111/2024 11/1/2024 X PR.EDTH- STAUTE ER EL. EACH ACCIDENT $1,000,000 ANYPRQ.PFgIET©RIPARTNERIExEGUT}vE OFFICERIMEMBER EXCLUDED? ❑ NIA E.L. DISEASE EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1,000,000 D E Contractor's Pollution Excess L€ability MKLV7ENV105074 52114892 11/1/2023 11/1/2023 1 1111/2024 11!112024 Each Pollution ConditionLimittAgg: Limit $5,000,000 $3,000,000 DESCRIPTION OFOPERATIONSlLOCATIONS IVEHICLES(ACORD101,Additional Remarks Schedule, maybe attached if more space Is required) The Excess Liability policy referenced alcove with !Navigators Speclaity 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. SHOULD ANY OF THE ABOVE DESCRIBED POUcIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Wappinger, ICY 20 Middlebush Road A T OR]ZEO PRESENTATIVE Wappingers Falls NY 12590' � (D1988-2015 AGORD CORPORATION. All rights reserved.