Cedeno, RichardFOR INTERNAL IJSE ONLY
Received by: Joseph P. Paoloni []
Grace Robinson C7
Lo V, 't meco rvc h)
Date Received: / A
Serial #: c (0
0
2010-01-15 JC
Town of Wappinger
Application for Hawkers
Peddler's Lisense
:t \ 6-
The undersigned does hereby apply to the Town 4 Wappinger Town Clerk for a
1" EW RENEWAS, TEMPORARY
(i weekend only)
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:
NAME:_....
,�.�, �`tA,ay...",M ("I C V") 0�...�...�. .. �... _... w.. AGE .w."...��:...
CURRENT ADDRESS:
('a _
_ .�,
(St ) . (Street) (L ty) (State) (ZIP)
PHONE #
PERMANENT ADDRESS (if different):
(St #) (Street) (City) (State) (ZIP)
If Applicant is an Agent or Employer:
Applicant's Employer , P�Sver Home Remodeling Group
Address of Employer 60 Commerce Qr Trumbull CT 06611
(St. #) (Street} (City) (State) (ZTI
Proof of Employment attach to armlication
Nature a us ness•
Tape a 21'X 2"
color photo (less
than 60 days Old:)
X Motor Vehicle (circle ane):ca truer van
Vehicle Info: Vehicle Make \ °r animal
c
0 On Foot &lar with vehicle drawn by hada Vehicle Model
License Plate # . a
_ _�f6r
Operator's LicenseNumbcr .
El Weights & Measures Certificate Certificate # nIq
F Dutchess County Health. Dept Permit Permit 4
AH
�....-�� CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDNYYY)
3121/2024
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 endorsod.
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 endorsoment(s).
PRODUCER
Lacher & Associates Insurance Agency
Lacher Insurance Group
632 Bast Broad Street
CONTACT
PHNAME:
ONE FAX
,Ext: 215-723-4378(XC.No): 215-723-5757
ADDRESS: certificate@lacherinsLirgnce.com
INSURERS AFFORDING COVERAGE NAIC#
Souderton PA 18964
INSURER A: Harleysville Insurance Co of New York 10674
11GPP1081300
INSURED POWERCL-01
Power Home Remodeling Group, LLC
2501 Seaport Drive, 4th Floor
INSURER 8: Markel American Ins Co 28932
INSURER C: Arch Insurance Company 11150
INSURER D: Arch Indemnity Insurance Company 30830
Chester PA 99013
INSURER E
INSURER F:
COVERAGES . CERTIFICATE NUMBER: 1005957011 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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
MMIDD/YYYY
POLICY EXP
MMIDDIYYYY
LIMITS
C
X COMMERCIAL GENERAL LIABILITY
11GPP1081300
1/1/2024
1/112025
EACH OCCURRENCE $2,000,000
CLAIMS -MADE �OCCUR
DAMAGE TO RENTED
PREMISES Eaeccurrence $2,000,000
MED EXP (Any one person) $10,000
PERSONAL &ADV INJURY $2,000,000
GEN'LAGGREGATE LIMITAPPLIES PER:
GENERALAGGREGATE $4,000,000
PCLICY � JPEC7 1:1 LOC
PRODUCTS - COMPIOP AGG $ 4,000,000
Policy Gen Aggregate $10,000,000
OTHER:
C
0
AUTOMOBILE
X
LIABILITY
ANY AUTO
11 CAB1 081300
11CAB1081400 MAONLY
1/1/2024
111!2024
1/1%2025
1/112025
COMeIN FDS INGLE LIMIT $ 2,000,000
Ea accident
BODILY INJURY (Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (per accident) $
PROPERTY DAMAGE $
Per accident
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
$
A
X
UMBRELLALIAB
X
OCCUR
CRA0000027
1/112024
1/1/2025
EACH OCCURRENCE $3,000,000
AGGREGATE $ 9,000,000
EXCESS LIAB
CLAIMS -MADE
DED I X RETENTION$
GL&ProdurlsAggregate $3,000,000
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
IIWCIIDS1300 FLONLY
14WCI1 081400
1/112024
1/1/2024
1!1!2025
111%2025
X PER CE
STATUTE ER
ANYPROPRIETORIPARTNERIEXECUTiVE
E.L. EACH ACCIDENT $1,000,000
OFFICERIMEMBER EXCLUDED?
N/A
E.L. DISEASE -EA EMPLOYEE $ 1,000,000
(Mandatory In NH)
If yes, descrlbe under
DESCRIPTION OF OPERATIONS below
I
I
E.L. DISEASE -POLICY LIMIT $1,000,000
B
FXCFSS LIABILITY
MKLM7EUE101220
4/1/2024
1/1/2025
EACH OCCURRENCE 5,000,000
AGGREGATE 5,000,000
Excess of 3,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORO 101, Additional Remarks Schedule, maybe attached if more space Is required)
I+tK I II-II:A I t HULUGK L:ANL;tLLAI IUN
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
4�z�ep
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