Small Jr., FidelFOR INTERNAL USE ONLY
Tow
Received b�y: Joseph P. Paoloni LL Applic''
04
Grace Robinson L
& PC_
Lori McConologue
.&jed
,Re
Date Received:
Serial #:
vq app,
The undersigned does hereby apply to the TZqtl
NEWX RENEWAL
License for Hawking and Peddling pursuant to Town of Wappinger Lo
regulating Hawkers and Peddlers in the Town of Wappinger, and in co
application, does state the following:
1) Applicant:
NAME: Fidel Small Jr AGE:
CURRENT ADDRESS:
7 W Cross St. Ste 7E Hawthorne NY 10532
(St #) (Street) (City) (State) (ZIP)
PHONE#
7863489637
FhKMAINEIN I AL)L)KtSz5 (it oitterent):
5215 NW Torino Lakes C Port St Lucie FL 34986
(St #) (Street) (City) (State) (ZIP)
If Applicant is an Agent or Employer:
Applicant's Employer APTIVE ENVIRONMENTAL LLC
Address of Employer 5132 N 300 VV Ste 150 Proyn LIT 846n
(St. #) (Street) (City) (State) (ZIf
Proof of Employment (attach to ap]21ication)
2) Nature of Business:
Door to dQor solicutation of Apbye's pest control sery2ces thrQUgb resideotual
areas oL/annmngpr, on foot
L Motor Vehicle (circle one): car truck van
I.- 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 61961918
L Weights & Measures Certificate Certificate 4 N/A
Dutchess County Health Dept Permit Permit H NZA
2021-05-13 JPP
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 Pieasant, 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 governing ones activities in the Town of
Wappinger as a Peddler or Hawker.
Dated: i I� 20 Z4
Wappin ers Falls, N.Y.
Sworn to before me this
jj
i o ,20�i�
I
N tary Public
Lea A. Frenc
NoWry Public, State of New Yolk
No. 01 rR6327313
Clual'f'ied In Dutchess CoifW
i:omrrriaglori f;,xpires 710
gnature of Applicant
'k 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
F DAT (MMIDDi
61412025
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 pollcy(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,
p Y�
a Marsh & McLennan Agency, LLC company
30 S 15th Street, 20th Floor
CONTACT
NAME:
PHONE. PAX
Arc oE • 215.567-6300 Arc NDI: 215-569-3025
ADDREss; MMAEastGrahamHoldenUnit@marshmma.com
Philadelphia PA 19102
INSURERS AFFORDING COVERAGE
NAIC#
INSURERA: Safety National Casualty Corporation
15105
111112025
INSURED AP71ENV-01
APTIVE ENVIRONMENTAL, LLC
5132 N 300 W. Ste 150
INSURERS: Evanston Insurance Company
35376
INsuRERc; Lexington Insurance Company
19437
INSuRERD: Steadfast Insurance Company
26387
Provo, UT 84604
INSURERE:
INSURERF:
L:[7VFFr AL:Yti TTFRTIFIf`&TF NIINIRFR•1nA7AARMQ RR111CIrw NI IfiARCC.
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.
!LTR
TYPE OF INSURANCE
ADDDL
SNUB
POLICY NUMBER
fPM1D�IYYYY
MMIDO/YYYV
LIMITS
C
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
Y
27734516
11/1/2024
111112025
EACH OCCURRENCE $1,000,000
PREMISES Eaoccurrorcel $300,000
HIED EXP (Any one Person) $
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER;
POLICY ❑PECROT LOC
J
GFNHRALAGGREGATE $ 2,000,000
PRODUCTS - COMPIOPAGG $2,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
CA 8678843
11/1/2024
11/1/2025
COMBINED SINGLE LIMIT $ 3,000,000
Ea accident
BODILY INJURY (Per person) $
ANY AUTO
1X
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Poraccidenp
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE $
Per accident
D
UMBRELLA LIAB
X
OCCUR
SXS 6439974.00
11/1/2024
11/1/2025
EACH OCCURRENCE $ 2,000,000
X
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $
DED RETENTION
A
WORKERS COMPENSATION
EMPLOYERS' LIABILITY Y 1 N
ANYPROPRIErORIPARTNERIEXECUTIVE
OFFICEFUMEMBEREXCLUDED?
NIA
LDS 4088513
PS 4068512
11!112024
11/1/2024
11/1/2025
11/1/2025
X STATUTE 'H-
ERAND
E.L- EACH ACCIDENT $ 1,000,000
E.L. DISEASE -Z=A HMPLOYEE $ 1,000,000
(Mandatory In NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS below
B
C
Cortraclor's PDIlutfon
Excess Lieblity
MKLVl ENV104535
52114892
11/1/2024
11!112024
11!112025Each
11/1/2025
Pollution
ConditionLimitlAgg: $5,000,000
Limit $3,000,000
DESCRIMON OF OPERATIONS! LOCATIONS I VEHICLES (ACORD I01, Additional Remarks Schedule, may be altached'd more space is required)
The Excess Liability policy referenced above with Steadfast Insurance Company proVdes 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.
v- a I mr 11 n r� I lwi n 4,JAR4CLLA I IVIV
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,
-IDRI2ED ARESENTATIVE .
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