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Murphy, AmmonFOR INTERNAL USE ONLY Received by: Joseph P. P,aoloni Ej Grace Robinson 1-1 Lori McConoloaue Town of Wappinger Application for Hawkers Peddler's License 0 License for Hawking and Peddling pursuant to Town of Wappinger L regulating Hawkers and Peddlers in the Town of Wappinger, and in cc application, does state the following: m 1) Applicant: NAME: Ammon Murphy AGE: CURRENT ADDRESS: 7 W Cross St. Ste 7E Hawthorne NY 10532 (St #) (Street) (City) (State) (ZIP) PHONE# 4236471511 PERMANENT ADDRESS (if different): 621 pike drive Trenton GA 30752 (St #) (Street) (City) (State) (ZIP) If Applicant is an Agent or Employer: Applicant's Employer APTIVE ENVIRONMENTAL LLC Address of Employer 5119 N '400 NN Stp 150 Provo IIT R4 (St. #) (Street) (City) (State) Proof of Employment Iattach to a2plication) 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 231916230 L Weights & Measures Certificate Certificate ## 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 6 months: White Plains, Mount Pleasant, Clarkstcwn 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: riot o ,20K Wappingers Palls, N.Y. Signature of Applicant Sworn to before me this yof,20j I a 9-tAW N tart' Public m Lee A, Freno t4otary Public, State of New Yolk No. OIFR6327393 Qujaiifed in putcheea County. COM mission Expires 7113 � Application must be accompanied by a fee of each addition to the original license per year, non-refundable fee. Applicants possessing a valid Dutchess Coun the $200.00 fee, provided that a copy of said ACCIM ►® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 6/4/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificale holder Is an ADDITIONAL INSURED, the policy(les) mus! have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to 1he terms and conditions of the policy, certain policies may require an endorsement. A statement on this cerlificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER Graham Company, a Marsh & McLennan Agency, LLC company 30 S 15th Street, 20th Ffoor CONTACT PHONE FAX No Ext : 215-567-6300 A Nn :215-569-3025 ADDRESS: MMAEastGrahaIold enUnit marshmma.com INSURERS AFFORDING COVERAGE NAIC9 Philadelphia PA 19102 INSURERA: Safety,National Casualty Corporation 15105 2773451$ INSURED APTIENV-01 INSURERB : Evanston Insurance Company 3537B APTIVE ENVIRONMENTAL, LLC 5132 N 300 W. Ste 150 INSURERC: Lexington Insurance Company 19437 INSURERB: Steadfast Insurance Company 26387 Provo, LIT 84604 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER.1087438009 REVISION NUMBER: 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. !NSR TYPE ADOLISi POLICY NUMBER POLICY MDfYMDYY M16JYY LIMITSLTR C X I COMMERCIAL GENERAL LIABILITY Y 2773451$ 11/1/2024 11/1/2025 EACH OCCURRENCE $1,000,000 CLAIMS -MADE y' OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person $ PERSONAL & AoV INJURY $ 1,000,000 G EN'L AGGREGATE LIM IT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY [7 PECTRO � LOC J PRODUCTS - COMPIOPAGG $2,000,000 $ CTH ER: A AUTOMOBILE LIABILITY CA 6676643 11/1/2024 11/1/2025 COMBINED SINGLE LIMIT $ 3,000,000 Ea accident BODILY INJURY (Par parson) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) PROPERTYDAMAGE Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY D UMBRELLA LIAR X OCCUR SXS 6439974-00 11/112024 11/112025 EACH OCCIIHHBNCE $ 2,000,000 AGGREGATE $ X EXCESS LIAB CLAIMS MADE DFD RETENTION $ $ A A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y I N ANYPROPR1C70Fi1PARTNEFVEXECUTIVE LDS 4068518 P5 4068512 11/1/2024 1111!2024 19/1/2025 11!1!2025 X 5EATUTE OR7H- E.L. EACH ACCIDENT $ 1,00D,000 OFFICERIMEMBEREXCLUDED? ❑ (Mandatory in NH) N 1 A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 if yes, describe under DESCRIPTION OF OPERATIONS below 3 C Contractor's Pollution Excess Liability MKLV1 ENV104535 52114892 1111/2024 11!112024 11!112025 11!112025 Each Pollution condition L1mitlAgg: $5,000,000 LlFnit: $3,000,600 DESCRIPTION OF OPERATIONS! LOCATIONS f VEHICLES (ACORD 161, Additional Remarks Schedule, may be attached if more 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 bywritten contract. Town of Wappinger, NY 20 Middlebush Road Wappingers Falls NY 12590 I IVIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TkiORIZED PRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD