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Steppe, JadenFOR INTERNAL USE ONLY Received by: Joseph P. Paoloni 1-1 Grace Robinson Lori McConologue Date Received: rN e-- ;- Serial #: d!:�� — —I The undersigned does hereby apply to the T 2021-05-13 JPP Town of Wappinger Application for Hawkers x .,,46N & Peddler's License Iel 'C'e" � 414-2—k�� jp- 1 ;44 Wapp ger Town. Clerk for a NEWX RENEWAL License for Hawking and Peddling pursuant to Town of Wappinger regulating Hawkers and Peddlers in the Town of Wappinger, and in application, does state the following: 1) Applicant: NAME: Jaden Steppe AGE: CURRENT ADDRESS: 7 W Cross St. Ste 7E Hawthorne NY 10532 (St #) (Street) (City) (State) (ZIP) R, PHONE# 4347606343 PERMANENT ADDRESS (if different): 58p Radford Lane unit 20 Charlottesville VA 22903 (St #) (Street) (City) (State) (ZIP) If Applicant is an Agent or Employer: Applicant's Employer APT'IVE ENVIRONMENTAL LLC Address of Employer 5112 N soo W sti, 1 -90, Pm\/o I JT 84 i,,/i,_ (St. #) (Street) (City) (State) Proof of Employment (attach to application 2) Nature of Business: I.- 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 861243251 Weights & Measures Certificate Certificate # N/A L Dutchess County Health Dept Permit Permit 9 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 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 governing ones activities in the Town of Wappinger as a Peddler or Hawker. Dated: j V Fi f 1- , 20 Z, Wappingers Falls, N.Y. Sworn to before me this e)d;�of r) e, 20 Iajatw- Notary Public Lea A. Freno Notary public, state of New YOM No. 01FR66327313 Qualified in Dutchess County Commission Expires 716! ,Z,2 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 exec- `nm the $200.00 fee, provided that a copy of said license is attached to the apple Iru w° vt'� Lij NCy6 !+ IqYS` trY+ b n'r S _ KR A [)R©� DATE (MWDD)YYYY} �.` CERTIFICATE OF LIABILITY INSURANCE 6lalzoz5 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 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 endorsemeni(s). PRODUCER Graham Company, a Marsh & McLennan Agency, LLC Company 30 S 15th Street, 20th Floor CONTACT NAME: PHONEFAX e 5x1), 215-567-6340 A1C No): 215-569-3025 AODRIES& MMAEastGrohamHoldenUnit marshmma.com INSURERS AFFOROINGCOVERAGE NAIL# Philadelphia PA 19102 INSURERA: Safety National Casualty Corporation 15105 Y INSURED APT1ENV-01 APTIVE ENVIRONMENTAL, LLC 5132 5132 N 300 W. Ste 150 INSURERS: Evanston Insurance Company 35378 IN Lexin ton Insurance Company 18437 wsuRERD: Steadfast Insurance Company 26387 Provo, UT 84604 INSURER E INSURER F COVERAGES CERTIFICATE NHMRFR:1DR74.,iRRn9 REVISION NLIMRFR! 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 IN D SUBR WVD POLICYNUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS C X COMMERCIAL GENERAL LIABILITY Y 27734516 11/1/2024 1111/2025 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR GE G R PREMISES Eaeccurrenc $ 300,000 MED EXP (Any ono person) $ PERSONAL & ADV INJURY .$ 11000,000 GEN'L AGGREGATE LW17 APPLIES PER: GENERALAGGREGATE $2,000,000 PPL)CYAEGTRO [X] LOC I PRODUCTS - COMPIOPAGO $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY CA 8678643 11/1/2024 11/1/2025 COMBINED SINGLE LIMIT Ea aecldent $ 3,000,000 BODII-Y INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY D UMBRELLA UAB X OCCUR SXS8439974-00 11/1/2024 11/112025 EACHOCCURRENCE - $2,000,000 _ AGGREGATE $ X EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ A A WORKERSCOMPENSATION AND EMPLOYERS` LIABILITY Y 1 N ANYPROPRIE CRIPARTNERIEXECUTIVR OFr-ICERIMEMBEREXGLUDCO? NIA LDS 4068513 PS 4068512 11/1/2024 11/1/2024 1/11/2025 11/112025 OT X STATUTE77 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) it yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B ContractDrsPollution MKLVIEiNV104535 11/1/2024 11/1/2025 Each Pollution 0 Excess Liability 52114892 11/1/2024 11/1/2025 Condition Limit/Agg: Limit: $5,000,000 $3,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if mure space Is required} The Excess Liability policy referenced above with Steadfast Insurance Company provides limits in excess ofthe 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 t;ANGII I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUT-IORIZE6�PRESENTA71VE . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD