Ross, SoibiFOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni Ll
Grace Robinson J
Lori McC,onologue
Date Received:
Serial
The undersigned does hereby apply to the Towdu
NEWX RENEWAL
License for Hawking and Peddling pursuant to Town of Wappinger LocE
regulating Hawkers and Peddlers in the Town of Wappinger, and in conn
application, does state the following:
1) Applicant:
(1
NAME: Soibi Ross
CURRENT ADDRESS -
7 W Cross St. Ste 7E Hawthorne
AGE:
NY 10532
(St #) (Street) (City)
(State) (ZIP)
PHONE#
9168723712
PERMANENT ADDRESS (if different):
7490 Bedford Park Way Sacramento
CA 95829
(St #) (Street) (City)
(State) (ZIP)
If Applicant is an Agent or Employer:
Applicant's Employer APTIVE ENVIRONMENTAL
LLMC
Address of Employer 51'12 N inn \A/ Stp 150
Provo LIT 84604
(St. #) (Street)
(City) (State)
(ZIP)
Proof of Employment (attach to application)
2) Nature of Business:
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 Y7100507
L Weights & Measures Certificate Certificate 4 N/A
L Dutchess County Health Dept Permit Permit # N/A
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 ti
months: White Piahs, Mount Pleasant, Cfarkstawn
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: _ t••` I" , 20
2-A
Wappingers palls, N.Y.
lSw.o�rn to before me this
I2'd of Jdr)-..20
pm
No a Public
Signature of Applicant
Lee A.'Freno
►Mary Public, State of New Yb;k
No. 01 FR6327313
Qualified its OutMess C0
Cornmisslon ExOroa 7/6=`%
* 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.
AC'ORC7�DATE
CERTIFICATE OF LIABILITY INSURANCE
(MMIDD1YYYY)
614!2025
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 INSUREII 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 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
CONTACT
NAME:
PHONE Fax
(AiC, No. Ext : 215-567-6360 Arc Na : 215 569-3025
ADDRIESS: MMAEastGrahamHoldenUnit marshmma.com
INSUI AFFORDING COVERAGE
NA 9
INSURERA : Safety National Casually Corporation
15105
1111/2024
INSURED APTIENV-01
APTIVE ENVIRONMENTAL, LLC
5132 N 300 W. Ste 150
INSURER : Evanston Insurance Company
35378
INSURER : Lexington Insurance Company
19437
INsuRERD: Steadfast Insurance Company
26387
Provo, UT 84604
INSURER E:
DAMAGE TO RENTED
PREMISES Eacccurronce
INSURER::
MED EXP (Any oneperson)
$
COVIF11 S rFRTIFIf'ATF NIIIMRFR•inR7AgAnna RC111CInA1 A11111ARPR•
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
j D
WVn
POLICY NUMBER
MMILDIDfYYYYY
POLICY EXP
LIMITS
C
X COMMERCIAL GENERAL LIABILITY
Y
27734516
1111/2024
11/1/2025
EACH OCCURRENCE
$1,444,000
CLAIMS -MADE X OCCUR
DAMAGE TO RENTED
PREMISES Eacccurronce
$ 300,000
MED EXP (Any oneperson)
$
-
PERSONAL& ADV INJURY
$1,000,000
GFN'LAGGREGATELIMIT APPLIES PER
GENERAL AGGREGATE
$2,000,000
POLICY E jE LOC
PRa4ucrs COMPIOP AGO
$ 2,444,000
$
OTHFH:
A
AUTOMOBILE
LIABILITY
CA 6676643
11/1/2024
1111/2025
ea BIN/ D SINGLE LIMIT
$ 3 400 000
BODILY INJURY (Per person)
$
ANY AUTO
1X
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accideri)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPER TY DAMAGE
Per accident
$
D
UMBRELLA LIAR
X
OCCUR
SXS 6439974-00
11/112024
11/1/2025
EACH OCCURRENCE
$ 2,440,000
X
EXCESS LAB
CLAIMS -MADE
AGGREGATE
$
DED, RETENTION $
$
A
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y 1 N
ANYPROPRiETCPIPARTNER!EXECUTIVE ❑
OFFIGER+MiEMBERCXCLUDED?
N!A
LDS 4068513
PS 4088512
11/112024
11/112024
11/1/2025X
11/1/2025
STATUTE OTRH
E.L. EACH ACCIDENT
$ 1,400,000
E. L. DISEASE - EA EMPLOYEE
$1,000,000
{Mandatory in NH)
If es, describe under
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DIYSORIPTION OF OPERATIONS below
e
0
Contractor's Pollution
Farness Liability
MKLVIENVIO4535
52114892
11/1/2024
11/1/2024
11/1/2025Each
1111!2025
Pollution
Gonditlan LimVAgg:
Limit:
$5,000,000
$3,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached N more space Is requlred)
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 bywritten contract.
Town of Wappinger, NY
20 Middlebush Road
Wappingers Falls NY 12590
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AITliORIZED PRESENTATIVE0.
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