Moe, Brinton2021-05-1.3 JPP
Town of Wappinger
Application for Hawkers
&PSddler's License
License for Hawking and Peddling pursuant to Town of Wappinger Loci
regulating Hawkers and Peddlers in the Town of Wappinger, and in conr
application, does state the following:
1) Applicant:
NAME: Brinton Moe AGE:
CURRENT ADDRESS:
7 W Cross St. Ste 7E Hawthorne NY 10532
(St #) (Street) (City) (State) (ZIP)
PHONE#
9184046219
PERMANENT ADDRESS (if different):
192 N 725 E Vineyard UT 84059
(St #) (Street) (City) (State) (ZIP)
If Applicant is an Agent or Employer:
Applicant's Employer APTIVE ENVIRONMENTAL LLC
Address of Employer 5112 N 100 W Ste 150 Pmvo I IT 84604
(St. #) (Street) (City) (State) (ZIF
Proof of Employment (attach to application)
2) Nature of Business:
L Motor Vehicle (circle one): car truck van
i On Foot &/or with vehicle drawn by hand or animal
Vehicle Info: Vehicle Make —Dc)dqe Dart Vehicle Model
License Plate #.F551CK State of Registration UT
Operator's License Number 245498092
L Weights & Measures Certificate Certificate # N/A
Dutchess County Health Dept Permit Permit 4 NIA
2021-05-13JPP
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 Pleasan( 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: J i , 2� J � � .. �-ti, — --,I..,.
Wappingers Falls, N.Y. Signature of Applicant
Sworn to before ine this
� da Y'4
�} 20Z LeeA.Freno
Notary Public, State of New YO*
No. 01 PR6327313
Public Qualified in Outchess County
Nota
ry Commission Expires 7161=0
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 $200.00 fee, provided that a copy of said license is attached to the application.
.. CERTIFICATE OF LIABILITY INSURANCE
DATE (MMf0DfYYYY)
6/4/2025
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREII AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PROAUCER
Graham Company,
a Marsh & McLennan Agency, LLC company
30 S 15th Street, 20th Floor
Philadelphia PA 19102
CONTACT
NAME:
PHONE FAX
Arc No 9x0. 215-567-6300 Arc Nn :215-569-3025
E-MAILSS: MMAEastGrahemHoldenUnit@marshmma.com
D
INSURERS AFFORDING COVERAGE
NAIL#
INSURER A: Safety National Casualty Corporation
15105
27734516
INSURED APTIENV-01
APTIVE ENVIRONMENTAL, LLG
5132 N 300 W. Ste 150
INSURER B: Evanston IrsUrance Company
35378
INSURER C: Lexington Insurance Company
19437
INSURER D: Steadfast Insurance Company
26387
Provo, UT 84604
INSURER E
INSURER F
MED EXP An one person)$
COVERAGES CERTIFICATE NLIlI102741AnOR RFVI-glnM NIIMlI
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.
INSR
LTR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MM100lYYYY
LIMITS
C
X
COMMERCIAL GENERAL LIABILITY
Y
27734516
11/1/2024
111112025
EACH OCCURRENCE $1,000,000
CLAIMS -MADE T OCCUR
DAMAGE TO RENTED 3
PREMISES Eacccurranca $ 00,000
MED EXP An one person)$
PERSONAL & ADV INJURY $ 1,000,000
GEN'LAGGREGATE LIM17APPLIES PER:
GENERAL AGGREGATE $2,000,000
POLICY ❑PRO ❑X LOC
JEGT
PROOLJCTS - COMPIOP AGO $ 2,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
CA 6676643
11/112024
11/112025
COMBINER SINGLE LIMIT $ 3,000,000
Ea accidant
BODILY INJURY (Per person) $
X
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accldent) $
HIRED NPN -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accidoni
D
UMBRELLA LIAB
X
OCCUR
SXS 6439974-00
1 t1112024
11/1/2025
EACH OCCURRENCE $ 2,000,000
X
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $
DED T RETENTION $
$
A
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETDNPARTNEH/EXRCUTIVE I I
OFFICERIMEMBEREXCLUDED?
N1A
LDS 4068513
PS 4068512
11/112024
11/112024
11/1/2025
11/1/2025
X STATUTE ERH
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLGYEE $1,000,000
(Mandatary In NH)
Ites, describe under
DESCRIPTION OF OPERATIONS 1I
E.L. DISEASE - POLICY LIMIT $ 1,000,000
B
Contractor's Pollution
MKLVlENV104535
11/112024
11/1/2025
Each Pollulicn
0
Excess Liability
52114692
11/112024
11/1/2025
Condition Limil7Agg: $5,000,000
Limit: $3,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is requlrad)
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 12590
GANGCLLAII
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE; THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTtIORIZED PRESENTATIVE
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD