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Alvarez, Rene2021-05-13 .TPP Town of Wappinger Application for Hawkers �,ed& Peddler's License r tf, The undersigned does hereby apply to the Town of Mppinger Town Clerk for a NEWX RENEWAL TEMPORARY (Iweekend only) 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 conn--- .4 application, OeS Kate the following: 1) Applicant: NAME: Rene Alvarez CURRENT ADDRESS: AGE: 7 W Cross St. Ste 7E Hawthorne NY 10532 (St #) (Street) (City) (State) (ZIP) PHONE# 3602181303 PERMANENT ADDRESS (if different): 297 20TH AVE LONGVIEW WA 98632 (St #) (Street) (City) (State) If Applicant is an Agent or Employer: Applicant's Employer APTIVE ENVIRONMENTAL LLC Address of Employer 5132 N 300 WSte 150 Provo I IT R4604 (St. #) (Street) (City) (State) (ZIP Proof of Employment -----(attach to application) (ZIP) 2) �Nature of Business: 19MR11oro MR , MR, ir—,n, 110-0, MEMO 1111 im, L Motor Vehicle (circle one): car truck van L On Foot &/or with vehicle drawn by hand or animal Vehicle Info: Vehicle Make Vehicle Model License Plate # State of Registration Operator's License Number VVDLBZNH8C6FB L Weights & Measures Certificate Certificate 4 N/A L... Dutchess County Health Dept Permit Permit 4 N/A 2021-05-13 ,TPP 3) Veteran Status L 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: White Plains, Mount Pleasant, Clarkstown 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 govenling ones activities in the Town of Wappinger as a Peddler or Hawker. Dated. , 2 Wappingers Falls, N.Y. Sw to Not"ary Public me this Lee A.1~reno Notary Public, 8tatie of New York No. 01 i° 86327313 Qualified irl Dutchess County Commission Expires 7161:1 KV)AA Signature of Applicant 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. ACC>Ra CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 6/412025 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 polioy(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 30 S 15th Street, 20th Floor Philadelphia PA 19102 NOAMTACT PHONE FAX Arc Nc • 215-567-6300 to ; 215-569-3025 aDREs : MMAEastGrahamHoldenUnit marshmma.com INSURERS AFFORD] NG COVERAGE NAIC# INSURERA: Safety National Casualty Corporation 15105 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX1pCCUR INSURED APTIENV-01 APTIVE ENVIRONMENTAL, LLC 5132 N 300 W. Ste 150 INSURERB: Evanston Insurance Company 35378 INsuRERc: Lexington Insurance company 19437 INSURER D: Steadfast Insurance Company 26387 Provo, LIT 84604 INSURER E : DA 9XN97 —CRR"N PREMISE Ea ccur ence $ 300,000 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 REOUIRFMENT, 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. `LTR TYPE OF INSURANCE ADDL I D SUBR WVD POLICY NUMBER POLICY EFF MWDDIYYYY POLICY EXP MMIDDIYYYY LIMITS C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX1pCCUR Y 27734516 1111/2024 11/1/2025 EACHOCCUHRENCE $1,000,000 —TED DA 9XN97 —CRR"N PREMISE Ea ccur ence $ 300,000 MED EXP (Any oneperson) $ PERSONAL &ADV INJURY $1,000,000 GEN'LAGGREGATELIMITAPPLIES PER : POLICY ❑ jEO M LOC GE NERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOPAGG $2,000,000 $ OTHER; A AUTOMOBILE LIABILITY CA 6676643 11/1/2024 11/1/2025 E� aoCldeOn[SINGLE LIMIT $ 3,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNER SCHEDULED AUT050NLY AUTOS RODILY INJURY (Per $ } HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Por 2 dent $ D UMBRELLALIABX OCCUR SXS6439974.00 11r112C24 11/1/2025 EACH OCCURRENCE $2,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ A AND EMPLOYERS' LIABILITY ANYPROPRIETOFVPARTNEPJEXCCUTIVE YIN ar-r-icEwMEMSERExcLUDEo? N r A LDS 4068513 PS 4066512 11/1/2024 11/112024 1111/2025 11/1/2025 X STATUTE QTH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,040,000 (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below B C Contractor's Pollution Excess Liability MKLV1 ENV104535 52114892 11/1/2024 11/1/2024 11/112025 11/112425 Each Pollution Condition LlmitlAgg: $5,000,000 Limit: $3,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare space Is required) The Excess Liability policy referenced above with Steadfast 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, The Town of Wappinger, NY is an additional Insured on the above General Liability policy if required by written contract. Town of Wappinger, NY 20 Middlebush Road Wappingers Falls NY 92590 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. .PORIZED PRESENTATIVE . ©1988-2015 ACORN CORPORATION- All rinhts rasarvarl_ ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD