Canales, AlejandroCMtye
)h P. Paoloni
e Robinson
McConologue
The undersigned does hereby apply to the T
2021-05-13 JPP
Town of Wappinger
Application for Hawkers
& Peddler's License
dP
NZ
)F)iawr n Clerk for a
License for Hawking and Peddling pursuant to Town of Wappinger Loc
regulating Hawkers and Peddlers in the Town of Wappinger, and in con
application, does state the following:
NAME: Alejandro Canales AGE:
CURRENT ADDRESS:
7 W Cross St., Ste 7E Hawthorne NY 10532
(St #) (Street) (City) (State) (ZIP)
PHONE # ---
PhRMANENTADDRESS (it different):
8690 N Columbia Blvd Portland OR 97203
(St #) (Street) (city) (State) (ZIP)
If Applicant is an Agent or Employer:
Applicant's Employer APTIVE ENVIRONMENTAL LLC
Address of Employer 5139 N 300 \A/,I;tp 150 Provo I IT 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 0193049
L Weights & Measures Certificate Certificate 4 N/A
1- Dutchess County health Dept Permit Permit # _ N/A
PRNIR11813191»
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 int' !-�
Wappingers Falls, N.Y.
Sworn to before me this
y of J J 0 Q, 20
9—(/
aAmp-
Notary Public
20�
Signature of Applicant
Lee A. t;reno
Notary Public, State of Now Yolk
No. 01 FR632i7313
Qualified in Dutchess County
Commission Expires 7161-1-0-0
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.
Ae-�� 7 C
C<> CERTIFICATE OF LIABILITY INSURANCE
DATE (MWDDNYYY)
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 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,
a Marsh & McLennan Agency, LLC company
30 S 15th Street, 20th Floor
CONTACT
NAME:
PHONEFAX
C 2t5-567-6300(AIG.No): 215-569-3025
ADDRESS: MMAEastGrahamHold enUnit marshmma.com
INSURERS AFFORDING COVERAGE NAIC#
Philadelphla PA 19102
INSURERA: SafetyNational CasualtyCor oration- 15105
INSURED APTIENV-01
APTIVE ENVIRONMENTAL, LLC
5132 N 300 W. Ste 150
INSURER B : Evanston Insurance Company 35376
INSURERC : Lexington Insurance company 19437
INSURER o: Steadfast Insurance Company 26387
Provo, UT 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. NOTWITHSTANDINCa 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 ]S SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILNS
TYPE OF INSURANCE
ADDL
INSO
SUBR
wVD
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MMIDDIYYYY
LIMITS
C
X
COMMERCIALGENERALLIABILITY
Y
27734516
11/1/2024
11/1/2025
EACH OCCURRENCE $1,000,000
CLAIMS -MADE FX] OCCUR
DAMAGE70TED 300,I)D0
PREMISESSEa occurrence) $
MED EXP Any oneperson) $
PERSONAL & ADV INJURY $1,000,000
AGGREGATE LIMITAPPLIES PER:
GENERALAGGREGATE $2,000,000
GEN'L
POLICY jECT- [X] LOC
PRODUCTS - COMP/OP AGG $ 2,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
CA 6676643
1111/2024
1111/2025
Ea as deDnISINGLE LIMIT $ 3,000,000
BODILY INJURY (Per person) $
X
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILYINJUHY (Per accident) $
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE $
Par accidBlt
$
D
UMBRELLA LIABX
OCCUR
SXS 0439974.00
1111/2024
1111/2025
EACH OCCURRENCE $ 2,000,000
AGGREGATE 8
X
EXCESS LIAR
CLAIMS -MADE
DED RETENTION$
$
A
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
OFFCERIMEMB REXCLNUdGE?ECUTIVE ❑
NIA
LDS 4068513
PS 4068512
11/112024
11/1/2024
1111/2025
11!1!2025
X SEEAR'UTH QRH
E.L. EACH ACCIDENT $1,000,400
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
(Mandatary In NH)
If yos, doscriba under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 1,000,000
B
contractor's Pollution
MKLVl ENV104535
1111/2024
1111/2025
Each Pollution
C
Excess Liability
52114692
11/1/2024
1111!2025
Condition Umit/Agg: $5,000,000
Limit: $3,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be aaachad if more 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
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
O 1988-2015 ACORD CORPORATION. All rights reserved
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD