Taal, KarelFOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni E
Grace Robinson
Lori McConologue
Date Received:
7A—
Serial #:
2021-05-13 JPP
Town of Wappinger
ADDlication for Hawkers
0
cv—peddler's License
,c&je
0 q 5 2�Z4
ot \�app�ng
cAerk
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does hereby apply to the Town of Wappinger Town Clerk for a
NEW RENEWAL TEMPORARY
I (I weekend only) I
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 connection with such
application, does state the following:
1) Applicant:
NAME: -TAAL
AGE:
CURRENT ADDRESS:
(a "o.*Ez-
(St #) (Street) (city),
(State)
(ZIP)'
PHONE#
- G, 4 6
PERMANENT ADDRESS (if different):
S-4 �V0A\�Q AbJA/VA
(,0A
(St #) (Street) I (City)
(State)
(ZIP)
If Applicant is an Agent or Employer:
Applicant's Employer S()/ -e7- rQ 0
P K I OEC
Address of Employer
(St. #) (Street)
(City)
(State) (Zli
Proof of Employment (attach to application)
2) Nature of Business:
6?F-�
F-1 Motor Vehicle (circle one): car truck van
EIC6nFoo , /or with vehicle drawn by hand or animal
On
Info: Vehicle Make Vehicle Model
License Plate #
Operator's License Number
Tape a 2"X 2"
color photo (less
than 60 days Old)
State of Registration
Ll Weights & Measures Certificate Certificate #
1-1 Dutchess County Health Dept Permit Permit # _
2021-05-13 .IPP
3) Veteran Status
U 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: 0616S- —, 201A
Wappingers Falls, N.Y.
Signature of Applicant
Sworn to before me this lr�
Joseph P. Paolonj
NOTARY PUBLIC, STATE OF NEW YORK
0 Reg'strafion No. OIPA6295254
Quaflfied in Dutohess County
Cornmssion Expires December 30, 202
otary P is
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
C E8A763B'I 5
DATE(MM/ DD/YYYY}
OIa/05�2024
THI5 CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NOLDER. THIS CERTIFICATE DOES N07 AFFIRMATIVELY OR
NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NGT 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 be endorsed. If SUBROGATION WANED, 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
CONTACT NAME:
JOHN A PARKS CO.,INC,
49 WEST WILLIS
DETROIT, MI46201
PHONE(ac/no/ext);
FAX(ac/no):
® COMMERCIAL GENERAL LIABILITY B[LiTY
EMAILADDRESS:
INSURED
Karel Taal 67 Hosner Mountain Rd, Hopewell Junction, NY, 1.2533,
INSURER(6}AFFORDING COVERAGE
NATO#
INSURER A: ATAIN SPECIALTY INSURANCE COMPANY
OCCDRANCE
INSURER B:
INSURER C:
INSURER D:
DAMAGE TO
INSURER E:
❑ ri nrMc,manF ® nrriivaFnirc
COVERAGES CERTIFICATE NUMBER: CE8A763615 REVISION NUMBER:
ZANY RES IS TO NOT WITHSTAN QUIREMENT, TIERM OFY THATTHE
ON OF ANY CONTRACT ORO TH R OI:JMFNT WITH RELICIES OF INSURANCE LISTED BELOW KAVE BEEN ISSUESPECT TOTO THEINS WHICH Th SU REDNC CERTIFICATE MAY HT IED ABOVE FOR THEOSSUEP LICY OR MAY PPERIODCERTAIN THE INSURANCEDINC I
LTR TYPE OFRRSURANCE ADDL INSIRI SUER WVD NUM R (MMP/DD YYEYFY) (MME DDY EXP11 UMUS
CERTIFICATE HOLDER CANCELLATION
Wappinger NY 20 Middlebush Rd Wappingers Falls NY 12590
GENERAL LIABILITY
THE EXPIRATION ➢NTE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
EACH
STEPHEN R. PARKS JOHN A. PARKS CO., INC
® COMMERCIAL GENERAL LIABILITY B[LiTY
OCCDRANCE
$2,o-aa,o-0a
DAMAGE TO
❑ ri nrMc,manF ® nrriivaFnirc
RENTED
CERTIFICATE HOLDER CANCELLATION
Wappinger NY 20 Middlebush Rd Wappingers Falls NY 12590
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION ➢NTE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AU14ORIZED REPRESENTATIVE
STEPHEN R. PARKS JOHN A. PARKS CO., INC
CEIIA763EI15
POLICYNUMBSR: CIP16614 COMMERCIAL GENERAL. LIABILITY
CG 20 26 07 04
THIS ENDORSMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED- DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
3ON(S) OR ORGANIZATION(S) AS REQUIRED BY WRITTEN CONTRACT WITH THE "INSUWD", MEANING "INDEPENDENT SALES
NTATtVES" ACTIVELY ENGAGED IN "MEMBER COMPANY BUSINESS ACTIVITIES AND FUNCTIONS", PART OF INDEPENDENT DIRECT
INSURANCE PROGRAM.
IlInfonnation required to complete this Schedule, if not shown above, will be shown in the Declaratlons. 11
Section II -Who Is An Insured is amended to Include as an additional insured part, by your act or omisslons or the acts or omissions of those acting on
person(s) or organization(s) shown in schedule, but only with respect to your behalf:
liability for "bodily Injury", "property damage" or "personal and adwertising A In the performance of your ongoing operations: or
Injury" caused, in whole or in B. In connection with your premises owned by or rented by you.