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Ellis, StevenFOR INTERNAL USE ONLY Received by: Joseph R Paoloni F Grace Robinson Lori McConologue --I Date Received: Serial #: 2021-05-13 JPP Town of Wappinger Application for Hawkers & Peddler's License -nge j The undersigned does licreby apply to the Town bf-Akappinger Town Clerk for a RENEWAL TEMPORARY (I weekerld 0111y) License for Hawking Lind Peddling pLirsuant to Town of Wappinger Local L,,i w No, 10 of 1992, regulatingIlawke.rs and Peddlers in the Town of"7appi 1� nger, and in coruiectiott vvith Such application, does statc d'ie following: z:1 1) Applicant: NAME:AGE:Z�'s--- CURRENT ADDI RESS u .0 (St #) (Street) (City), (Stale) (ZIP) PHONE# PERMANENT ADDRESS (if different): (St #) (Street) (City) (State) (ZIP) If Applicant is an Agent, or Employer: Applicant's Eniployer R"nnter ee'110-(,�r,< Address of Employer > Q ox-, - -le-541 T 14Kh JV l' ),�-1520 (St. #) (Street) (city) (State) (ZIP) Proof of Employment _ (attach to application) 2) Nattire of Business: n^,O P s VW, 1 '11 "e.,.V 4 — 01 ren J, k— ij Trq)e 1 2' color photo (Jess dial 60 days Old) E Lj Motor Vehicle (circle one): car truck van �'`W Foot /or with vehicle drawn by hand or animal Vehicle Info: Vehicle Make Vehicle Model License Plate # State of Re-istration Operator's License Number 7— Weights & Measiires Certificate Certificate Duteliess Comity Health Dept Permit Permit 2021-05-13 JPP ')} Veteran Status Veteran Applicant - Exempt from license fee (attach certificate fr-om Dutelless County) hilies of all other municipalities in which the applicant has been a vendor in the preceding 6 mouths: 4) Compliance 'Rat the applicant, if the License reqLiestcd hereby is granted, consents and agrees to conduct the aforesaid bLISillOSS 01- activity pUrSLIant to all of the terms and regulations of the Local Law above sj)ccified, at'id rail other reales, regulations and Laws governir).�j ernes activities in the '"rown of Vappinger as a Peddler or Hawker. Rae(.i: 20,;cl %V.,urgers Falls, N.Y. Sworn to I)cforc me this zi 200 1-- —7 1 0 )ta ry PV F, taU IC Si,,rmWre of Applicant YISSETT SANDOVAL No OIS,A633�1064 Aalms rltan H, JaMed nWesi,11 Application intist be accompanied by a fie of Two Hundred Dollars ($200,00) PILIS $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 fromt7 the $200.00 fee, provided that a copy of said liconse is attached to the application., DATE (MMIDWYM) '� CERTIFICATE OF LIABILITY INSURANCE 08!3012024 THIS -CERTIFICATE IS ISSUED AS .A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CE=RTIFICATE 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. Ii 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 GEICO Commercial Lines Program PO Box 5316 Binghamton NY 13902 REND PAINTING, INC 34 Chelsea Ridge Drive F Wappingers Falls NY 12590 EMAIL rADDRESS: commerciaiseryice_@homesite.com INSURER{S}AFFORDING COVERAGE NAIC 14 URER C : URER D! URER E : URER F: Midvale I COVERAGES CERTIFICATE NUMBER: 00001186772721 REVISION NUMBER: 27138 HIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FUR I HE POLICY PEREOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE SSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF .RI inH Pnl InIF.9 I INAITR ..qHnWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A COMMERCIAL GENERAL LIABILITY P00082063 0a12812024 0812812025 EACH OCCURRENCE s1,000,000 DAMAGE TO RENTED CLAIMS -OCCUR MADE PREMISES (Ea occurrence) $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,aoo,000 GEN'LAGGREGATE LIMITAPPLIESS�PER: GENERAL AGGREGATE 2,000,000 PRODUCTS - COMPIOPAGG $2,000,000 �-'t(I X POLICY ❑PRO- I�J OC JECT OTHER: SINGLE LIMIT AUTOMOBILECOMBINED LIABILITY {Fa accident) ANY AUTO BODILY INJURY (Per person) OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY(Per accident) PROPERTY DAMAGE I-ILRED AUTOS NON -OWNED ONLY AUTOS ONLY Per accident) UMBRELLA LIABOCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE OED RETENTION $ ORKERS COMPENSATION PER I DTH - AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECU -TIVE CFFICER)MFMBER EXCLUDE07 ❑ NIA E.L. EACH ACCIDENT (Mandatary In NH) E.L. DISEASE - EA IF yes, describe under E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below PROFESSIONAL LIABILITYL I OCCURRENCE AGGREGATE DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE, MOLDER CANCELLATION TOWN OF WAPPINGER 20 MIDDLEBUSH RD WAPPINGERS FALLS NY 12590 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AUTHORIZED REPRESENTATIVE ©19882015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD .. .--^i1011111 A+ "I?if ADDITIONAL REMARKS SCHEDULE AGENCY: NAMED INSURED: GEICO Commercial Lines Program RENU PAINTING, INC POLICY NUMBER: CP00082063 CARRIER: NAIL CODE EFFECTIVE DATE: Midvale Indemnity Company 27138 08/2812024 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE.: CERTIFICATE OF LIABILITY INSURANCE Painting TOWN OF WAPPINGER IS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY POLICY. ACORD 101 (ZOOS/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .. .--^i1011111 A+ "I?if ADDITIONAL REMARKS SCHEDULE AGENCY: NAMED INSURED: GEICO Commercial Lines Program RENU PAINTING, INC POLICY NUMBER: CP00082063 CARRIER: NAIL CODE EFFECTIVE DATE: Midvale Indemnity Company 27138 08/2812024 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE.: CERTIFICATE OF LIABILITY INSURANCE Painting TOWN OF WAPPINGER IS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY POLICY. ACORD 101 (ZOOS/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD