McKenzie, RayFOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni E:
Grace Robinson 11
Lori McConologue
2021-05-13 JPP
.Tbiwn of Wappinger
Application for Hawkers
q,e0eWEA 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 connection with such
application, does state the following:
1) Applicant:
NAME: A"4 Y AGE: -? " Tape a 2"X 2"
CURRENT ADDRESS: color photo (less
than 60 days Old)
Z
Ay
(St) (Street) (City) (State) (ZIP)
PHONE#
PERMANENT ADDRESS (if different):
(St #) (Street) (City) (State) (ZIP)
If Applicant is an Agent or Employer:
Applicant's Employer :65
Address of -._49 AI*7'�F4/,�/ , z2 7y,
(St, #) (Street) (City) (State) (ZIP)
Proof of Employment (attach to gpplicationa__ ..
2) Nature of Business:
-
F Motor Vehicle (circle one): car truck van
U On Foot &/or with vehicle drawn by hand or animal
Vehicle Info: Vehicle Make IL:VAd Vehicle Model kEd
License Plate #6WState of Registration
Operator's License Number
Ll Weights & Measures Certificate Certificate #
El Dutchess County Health Dept Permit Permit #
2021-05-13 JPP
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: xtl w 0< �3c) 20.ES
Wappingers Falls, N.Y.
Sworn to before me this
3 4,G)
da fp
Notary Public
z.l
Siature of Applicg&
Lee A. Frena
Notary Public, State of New York
No. 01FR6327313
Qualified in Dutchess County
C.Drnm,ission Explres 7/6/ � r)z,)
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 $200.00 fee, provided that a copy of said license is attached to the application.
Ro► CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDIYYYY)
,'(C"
1212212022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on
this certlflcate does not confer rights to the certificate holder In lieu of such endorsements .
PRODUCERCONTACT
Edgewood Partners Insurance Center
One State Street Plaza, 9th Floor
New York NY 10004 -
CertfCale Unit
PHONE FAX
• 404.781-1700 AI
MAIL
AUD : c6dilicate a icbrokers.r:om
INSURER$ FORDING COVERAGE NAIC#
X COMMERCIAL GENERAL LABILITY
CLAIMS -MADE OCCUR
X SIR $1.000,000
INSURERA: XL Insurance America, Inc. 24554
INSURED ALTICE•Oi
Altice USA, Inc. & as par attached named lnsured sohedUle
One Court Square West
INSURERS! Greenwich Insurance Company 22322
INSURER C:
INSURERO:
Long Island City NY 11101
INSURER E •
INSURER F:
THIS IS TO CERTIFY THAT THE. POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY 13E ISSUEo OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUCJEOT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED. BY PAID CLAIMS.
INQm SR
TYPEOFINSURANCE
A
SUB
POLCYNUMaER
POLIOYEFF
APiIMLpYE1SP
LIMIT$
A
X COMMERCIAL GENERAL LABILITY
CLAIMS -MADE OCCUR
X SIR $1.000,000
USOOOSSML123A
11112023
1/1/2024
EACH OCCURRENCE $1,000,000
REMI E D n $ 500,000
MED EXP (Anyoneperson) $
PERSONAL & ADV INJURY $1,000,000
OF -NIL AGGREGATE LIMIT APPLIES PER
X POLICY ❑ j�T LOC
GENERAL AGGREGATE $2,000,000
PRODUCTS • COMPIOPApp $ 2,000,000
$
THFR:
B
AUTOMOBILE
)(
LIABILITY
ANYAUTO
RAD9437830.06
1/1/2023
1/1/2024
MB.IIIdantlSINGLELIMrr $3,000,000
BODILY INJURY (Per parson) $
OWNED SCHEDULED
AUTOS ONLYAUTOS
BODILYINJURY (Per accident) $
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERT DAMAGE
R $
$
"A
X
UMBRELLA LIABOCCUR
IN
USM08663OL123A
11112023
11112024
EACH OCCURRENCE $8,000000
EXCESS UAS
CLAIMS -MADE
AGGREGATE $ 5,000,000
DED X RETENTION
$
A
WORKERS COMPENSATION
AND FMPLOYEAV LABILITY YIN
ANYPRO P RIETORIPA RTNERIEXECUTNE'
OrrIOERIMEMBERCXCLUDEDI F-]N1A
(Mandatary In NH)
If yes, describe under
RWD3001837-06
1!112023
1/1/2024
X STET UTE SRH•
E.L. EACH ACCIDENT $1,000,000
H.L. DISEASE - EA EMPLOYEE $1,000,000
6L. DISEASE - POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS balow
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If moreapece Is roqulrad)
Evidence of Insurance
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL SE 11ELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATI VE
(019UB 2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
* * * RECEIPT * * *
Date: 11/30/23
Receipt#: 115224
Quantity Transactions Reference Subtotal
1 Peddlers Permit 23-21 $50.00
Total Paid
Notes
Payment Type Amount Paid By
Credit Card -Ref # $50.00 Mckenzie, Ray
Name: Mckenzie, Ray
6 Gerts Way
Hopewell Jct., NY 12533
$50.00
Clerk ID: LM Internal ID: 23-21