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Weir, GriffinFOR INTERNAL USE ONLY Received by: Joseph P. Paoloni 1. 1 Grace Robinson [I i - N --f If — 2010-01-15 JCM Town of Wappinger Application for Hawkers A, & P'eddler's Lisense license for Hawking and Peddling pursuant to Town of Wappinger Local Law No. 10 of 1992, regulating Hawkers and Peddlers in the Town of Wappinger, and in connection with such application, does state the following: 1) Applicant: NAMEj -k"I AGE: CURRENT ADDRESS:. (St #) (Street) (City) PHONE# PERMANENT ADDRESS (if different): (State) (ZIP) (St #) (Street) (City) (State) (ZIP) If Applicant is an Agent or Employer Applicant's Employer ower Home Remodeling Group-., Address of Employer 60 Commerce Dr Trumbull CT 06611 � � Commerce - - -7 ............ . .... ...... .. ... . .... . (St. #) (Street) (City) (State) Proof of Employment V(attach to a lication 2) Nature of Business: e Wrydjw& 5rd,221 00 1 W Tape a 2"X 2" color photo (less than 60 days Old) X Motor Vehicle (circle one)- Vicar , truck van L On Foot &/or with vehicle drawn by 4 an or animal Vehicle Info: Vehicle Make— f0WArD, Vehicle Model < License Plate State of Registration Operator's License Number Lj Weights & Measures Certificate Certificate 4 n rl Dutchess County Health Dept Permit Permit # Y1 I a A� H CERTIFICATE OF LIABILITY INSURANCE TE (MMfDDfYYY DA 3/21/2024 Y) 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(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 endorsentent(s). PRODUCER Lacher & Associates Insurance Agency Lacherinsurance Group 632 East Broad Street CONTACT PHONE FAX 1.215-723-4378 'j'.No): 215-723-6757 E-MAIL rss• cerlificato lachorinsurance,com Souderton PA 18964 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: Harleysville Insurance Co of New York 10574 1/1/2025 INSURED POWEROL-01 Power Home Remodeling Group, LLC 2501 Seaport Drive, 4th Floor INSURER B: Markel American Ins Co 28932 INSURER :Arch insurance Company 11150 INSURER D: Arch Indemnity Insurance Company 30830 Chester PA 19013 INSURER E: MED EXP (Any one person) $ 10,000 INSURER F : COVERAGES CERTIFICATE NUMBER: 1005957011 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. IL7R TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDrYYYY LIMITS C X COMMERCIAL GENERAL LIABILITY 11GPP1061300 1/112024 1/1/2025 EACH OCCURRENCE $2,000,000 CLAIMS -MADE FKOCCUR DAMAGETO S(RENTED PREMISES Eaaccurrence) $2,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $4,000,000 POLICY 1K JET 7 LOC PRODUCTS- COMPIOPAGO $4,000,000 Policy Gen Aggregate $10,000,000 OTHER: I C C AUTOMOBILE X LIABILITY ANY AUTO 11CA91081300 11 CAB1081400 MA ONLY 111/2024 1!112024 1/1/2425 1/1/2025 COMBINED SIN OLE LIMIT $2000,000 En accident BOUIL,Y INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accident A X UMBRELLALIA13X. OCCUR CRAD000027 1/1/2024 1/1/2025 EACH OCCURRENCE $3,000,000 AGGREGATE $9,000,000 EXCESS LIAR CLAIMS -MADE _ DED X RETENTION $ GL&Products Aggregate $ 3,000,000 C ❑ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN 11WC11081300 FLONLY 14WC1108140D 11112024 1/1/2024 1/1/2025 1/1/2025 X PER °R" E.L. EACH ACCIDE=NT $1,000,000 ANYPROPRIETORlPARTNERIEXECUTIVE OFFI CERIM EM BER EXCLUDED? NIA E.L. DISEASE; - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E,L. DISEASE - POLICY LIMIT $ 1,000,000 B EXCESS LIABILITY MKLM7EUE101220 4/1/2024 1/1/2025 EACH OCCURRENCE 5,000,000 AGGREGATE 5,000,000 Excess or 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if mora space is required) CERTIFICATE HOLDER CANCELLATION Town of Wappinger 20 Middlebush Road Wappingers Falls NY 12590 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 41f4lt�eo ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD