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HomeMy WebLinkAbout125 Lands End Rd Town of Southold P.O Box1179 Southold, NY 11971 * * * RECEIPT * * * Date: 02/14/25 Receipt#: 337645 Quantity Transactions Reference Subtotal 1 Excavation Permits 1779 $0.00 Total Paid: $0.00 Notes: Payment Type Amount Paid By Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Harsham, Priscilla 56 Pine Street East Moriches, NY 11940 Clerk ID: MARIAD Internal ID: 1779 ' q Permit No. ` TOWN OF SOUTHOLD g : HIGHWAY DEPARTMENT Peconic Lane Peconic,New York 11958 (631)765-3140 APPLICATION/PERMIT FOR EETGH'VVAY E-XCAVATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance of an Excavation Permit pursuant to Chapter 237 of the Code of the Town of Southold,Suffolk County,New York,and other applicable laws,ordinances or regulations for each individual contiguous excavation project herein described. The applicant agrees to comply with all applicable Iaws, ordinances,codes and regulations,the attached"General Conditions of Permit"and"Special Conditions",if any and to permit authotized inspectors to make necessary inspections of the job site. +Print or Tne Name of Applicant Phone a JSs PP Number Address of Applicant Name of Contractor Phone Number Address of.Contractor 3. Name of Property Owner Requesting Service(if applicable) Address of Owner 4. 1 CGlY1C G �- � i it: 1GtA tof,,c51� s.� =fin �1"tt i�lr'a i`� t 2� worn Description and Location{Street Number,Hamlet,Cross Stree (a) Is construction located within 75 feet of tidal wetlands? *Yes No "If yes,other Town permits may be required. NOTE: All information requested by this Signature of Applicant Application/Permit Form is Required for a complete application! Date S. (a) Attached plot plan to reasonably and adequately describe the proposed work. Provide accurate schematic site plan showing the location of all proposed excavations and relationship to adjoining premises,public streets or areas,and give a detailed description of all site and pavement restoration work. (b) Attach all other necessary permits and licenses for this project. (c) Work covered by this application may not commence before issuance of Highway Excavation Permit by the Town Clerk. 6. Tax Map No.: District 1000 Section 15 Block " Q , Lot — t. l 4 7. Starting Date: _ I/aq/t3 . Completion Date: 2626, 8. Work Schedule: Phase Completion Saate Excavation __ Work Schedule Facility Installation Must be provided Backfill&Completion � for consideration as a Pavement Replacement `=}Li Complete Application, 9. Under which authority is application being made: \ � See Town Code Chapter 237(E)-Provide Resolution by,or authority from,the Utility being modified. 10. Estimated Cost of Proposed Work: S 11. Remarks: D-39 I of 3 12. Insurance Coverage:(Attach Copy) (a) Insurance Company, :E E 22t Gr=i -" (b) Policy#: �}j C3G�Cx�GOt -C�1 (c)State whether policy of certification on file with the Highway Department: y �� r 'c f "� (d)Coverage required extended to the Town: Any Loss including Bodily injury,property or commercial injury caused by or attributable to the work performed: $1,000,000 per Occurrence and$2,000,000 general aggregate. 13. Security: (a)Surety Bond 'f or Certified Check provided in the total Amount of$ (b)Maintenance Bond provided; 2 years or 3 years. 14, Fees for Road Opening Applications and permits: Basic Application Fee for Each Project Location - $500.00 J A Project Location would include each Bell Hole and/or every road opening or excavation within any 50'Radius whether or not they may be inter-connected by open trench or directional boring. The total number of Project Locations shall be subject to the approval of the Highway Superintendent. AL_ /Service Connections excavations @$50.00 $ No. A2, /Additional Excavations same service @$20.00 $ No. B. Trench Excavations 18"in depth or less Total Lineal Footage of Excavation; L.F.@$10.00 $ C. Trench Excavations 18"in depth to 5'in depth Total Lineal Footage of Excavation; L.F.@$30.00 $ D, Trench Excavations 5'in depth and over Total Lineal Footage of Excavation; L.F.@$50.00 $ E_ Utility Repair Excavations @$1,000.00/Each $ No. Additional Repairs of Same Service @$500.00/Each $ No. F. Official Notice to public utilities-proofrnust be provided and Shall be attached to this application prior to issuance of permit. 15. Fees for New or Alteration to Curb Cut: Basic Application Fee - $50.00 A Curb Cut would include any new or alteration of an existing driveway within the boundary of the right of way, The configuration of such is to the conditions set forth in Chapter 237 of town code. 1" TOTAL$ Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation permit to: `ems in accordance with this application and subject to the"General Conditions"and"Special Conditions"of permit(if any)attached hereto. SUPERINTENDENT OF HIGHWAYS TOWN OF OLDI NEW YORK Daniel Goodwin Goodwin Date Received by the Town Clerk Date 2 02S Date Permit Issued 2 14 .Z 0 Z 5 Permit No. NOTE: Permit expires one(1)year from date of issuance. No work to start without 24 hour notice to Superintendent of Highways. Permit must be available at all times for inspection,on site,during construction. D-39 2 of 3 Copy Distribution: '7 l 9 Permit# Highway Department Engineer(with page 3) Applicant Town Clerk(Original) Il'�dSPECT OR'S REC€.1RDS Inspection Date Findings(use code) Applicant Notified i st 2nd 3`d 4`h (To Permit Clerk) REMARKS CODE 1B Improper Barricades IL Improper Lights ST Sunken Trench or Excavation UTM Unable to Measure(due to backfiiling) BUC Building Under Construction W lP Work in Progress DB Improper Backfill(too high,not sufficient) HFS inspector Holding for Final Settlement of Excavation RFR Ready for Repair D-39 3 of 3 QL'-" RAL CONDITIONS OF PEIWT APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR I. Permittee's Contractors to Co"iy with Permit Retruirements. The Permittee is responsible for informing its independent contractors,employees,agents and assigns oftheir responsibility to comply v ith this permit,including all speeialfsite specific arcd general conditions imposed by the Highway Superintendent while acting as the perrnittee's agent with respect to the permitted activities,and such persons shall be required to comply with all permit requirements. 2. No Right to Trespass or Interfere with Private Pronerttr Ritrhts This permit does not convey to the permittee any right to trespass upon the lands of adjacent property owners in order to perform the permitted work nor does it authorize the impairment of any rights,title,or interest in real or personal property held or vested in a person not a party to the permit. 3. Protection of the I eltwar anti]Y utura kSis*llway Maintenance if future operations or highway maintenance projects by the Town of Southold require an alteration in the position of the utility,structure or work herein.authorized,or if,in the opinion ofthe Highway Superintendent the work perforated under this permit shall cause unreasonable obstruction to required highway maintenance or endanger the health, safety and/or welfare of vehicular or pedestrian traffic,this permit shall be revoked and the utility, structure,ill,excavation,or other modification of the highway hereby authorized shall not be completed. Additionally,the permit may be revoked if the Highway Superintendent finds that the issuance of the permit was illegal or unauthorized or that The applicant failed to comply with any of the terms and conditions of the permit or Chapter 237 ofthe Town Code. 4. Revocation.of the Permit l.v the)'i hwav Su»erintendent• If the Highway Superintendent deems it necessary to revoke this permit and the project hereby authorized has not been completed,the applicant shall,without expense to the Town and to such extent and in such time and manner as.the Superintendent may require,remove all or any portion of the uncompleted utility,structure or fill and restore the site to its former condition. 5. Notice Of Cotuntencement- At least 24 hours prior to commencement of the project,the permittee and/or contractor shall notify the Town Highway Department in writing that they are fully aware of and understand all terms and project conditions of this permit. Upon completion of the work,the contractor shall provide photographs of the completed work to the:Town Highway Department and request a Final inspection. 6. Storage Of aiprn' The storage of construction equipment and/or materials shall be confined within the project work area and/or adjacent areas where permission/Iegal access has been obtained in a mariner that does not interfere with normal highway traffic. 7• UtYlity Mark Ontsr The Applicant/Contractor shall be responsible for verification of all existing utility mark-outs and:shall take all precautions to protect same. Damage to existing utilities shall be the responsibility of the contractor and shall be repaired at the contractor's expense. 8. Road Closures: All scheduled road closures must first receive written permission from the Southold Town Board prior to closing a road. Temporary lane closures may be permitter)with the approval of the Highway Superintendent. This item will included but not be limited to the installation of appropriate signage and flag men to stop and start traffic to allow for single lane traffic. Road Closures due to unforeseen emergencies require immediate notification of the Highway Department and shall be limited to immediate and/or expedited restoration of the Work Zone. 9. No Construction Debris in Road Shoulder Area: All.Construction Debris shall be removed from the job site on a daily basis. All stockpiled soil as well as alLother project materials that will be staged within the Right-of Wily must be delineated with reflective signage or other means to meet the minimum requirements of the NYS DOT Construction Standards. GENERAL CONDITIONS OF PERMIT APPLICATION/PERNHT FOR HIGHWAY EXCAVATION AND REPAIR (Continued) 10. Install,Maintain Erositln Contt�c�ts• Required Erosion Control Measures(i.e.silt fencing)is to be placed on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good functional condition until thick vegetative cover is established. H. Clean Fill Only: All project back-fill shall consist of clean sand,gravel or soil(NOT asphalt,slag,flyash, broken concrete or demolition debris). All unsuitable soils excavated at the site(i.e.Clay,Bog,etc.)are to be removed from the site and not used to backfill any excavation within a Town Highway. 12. All Areas of Soil Disturbance: All areas of soil disturbance resulting from the approved project shall be stabilized to the satisfaction of the Highway Superintendent immediately following project completion. If the project site remains inactive for more than 48 hours or planting is impractical due to the season,then the area shall be stabilized with straw,hay mulch and/or jute matting until weather conditions favor germination. 13. Backfill&Compaction of all Excavations: Back Fill shall consist of clean fill or soils which exhibit a well-defined moisture density relationship as determined to be in accordance with ASTMD 698. Fill shall be placed in maximum lifts of twelve(12")inches thick and shall be mechanically compacted to a Ninety- five(95%)percent maximum dry density. Suitable hydraulic compaction by water jetting at three-foot intervals will also be permitted subject to a project specific approval by the Highway Superintendent. 14. Restoration of the Road Shoulder Area- All man-made improvements located within existing road shoulder areas must be protected to the greatest extent practical. Items would include but not be limited to driveway&private road aprons,mail boxes,sprinkler systems,trees and ornamental plantings. Excavations through driveways and private road pavements must be reconstructed to meet all requirements of Southold Town Highway Specifications. All pre-existing road shoulder improvements that have been disturbed during construction must be replaced or repaired by the contractor to the satisfaction of the Highway Superintendent. 15. Sebernatic Plans with all Technical information and Scone of Work: To reasonably and adequately describe the proposed work,accurate schematic site plans must be provided to show or indicate all proposed construction activity required under this permit. All Pavement surfaces scheduled for excavation must be saw cut to the full depth of asphalt and/or concrete pavements. Accurate size of bell holes or width of trenching must be indicated by dimension or labeling. This schematic site plan must provide details on all restoration required to meet the requirements of these General Conditions and requirements found in the Southold Town Highway Specifications. 16. Pavement.Reconstruction; All Pavement sections must be reconstructed in the following manner; (Note:When Concrete Pavements are Present,Please review Restoration requirements with the Highway Superintendent) a) Complete all rack-fill&soil compaction work as needed to provide a suitable sub-base; b) Over-cut existing asphalt bell hole or trench by twelve(12")inches on all sides; c) Install a compacted lift of 4"thick Stone Blend base(RCA Blend must meet NYS DOT Specification); d) Install a two and one half(2.5')inch compacted lift of Asphalt Base Course; e) Install a one and one half(1.5")inch of Asphalt(Type 6)Wearing Course. (Provide AC at all joints) All worklisted herein must meet the minimum requirements of the Southold Town Highway Specifications. k 17. TreucWng of Pavement Surfaces Exceeding One Hundred(1001)beet in Len 1h All trenching of pavement surfaces exceeding 100'in length must first be reconstructed to meet the requirements of Item # 16 as noted above. Once all pavement reconstruction is completed to the satisfaction of the Highway Superintendent,the entire road section and/or width of road over the entire length of trench shall be repaved with a two(2")inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). (&T, 1j22) a>t5 RIGHT OF WAY CLEARANCE CERTIFICATE To: R. Causin, Regional Director, Region 10 Date: January 17, 2023 From: M. Librizzi, Real Estate Officer P.I.N.: 0808.74 Project Highway Runoff Mitigation: NY 25 & NY 27 Suffolk County I certify that; the right-of-way has been or will be acquired in accordance with the Highway Law, the Eminent Domain Procedure Law, The Uniform Relocation Act, and Title 23 of the Code of Federal Regulations, Part 635, Section 309, Para. (c) (when applicable), and that the status of the right-of- way is as follows: Select a, b, c, or d ❑ (a) No right of way (including clearance of the existing right of way) is required for the project. ® (b)All the necessary rights of way, including control of access rights have been acquired including legal and physical possession. All payments/deposits are completed if applicable. There are no improvements existing that need to be removed or demolished and/or all occupants have vacated the land and/or improvements and the Department has the physical possession and the right to remove. ❑ (c) All the necessary rights of way, including control of access rights have not been completed, however, the acquisitions are being progressed and all legal and physical possession will be completed ten (10) days prior to advertising for bids (see attached ROW 9-15A "Acquisition and Clearance Status Report" for completion schedule). ❑ (d) Acquisition of a few remaining properties has not been completed and will not be completed prior to project advertisement for bids. All eligible occupants of the residences, if any, on such properties have had replacement housing made available to them in accordance with 49 CFR 24.204. (See attached ROW 9-15A "Acquisition and Clearance Status Report"for completion schedule as well as the ROW 9-16A"Special Note—Availability of ROW"). The completion schedule will be included in the contract plans, engineering substantiation and a report of the quantity and quality of relocation assistance. A note designating the lack of availability shall appear on the specific plan sheet of each indicated property. If the project has federal aid in any phase of the project, FHWA approval of this (these) projection(s) is required. Proiect description: No. of maps required for project: 8 No. of Claimants: 8 No. of maps not requiring payment: 0 No. of Relocations required: 0 No. of Relocatio completed* NA No. ofZtic o te: 0 No. p t t date: 8 Real Eer ROW 9-14A (10n018) v r ° � �. .P�� �„ .: - r m -•s•���'{may t Y � V .Nw t eb. H t L§hn. k o b° Orient Point Cou Monty Man)II Charters 'o MR2�3 1054 r l t l' F:TE -5 Tv 10 Ma Rd .pout Rnm e° on Tree Co x iRDuryea sQnent Po ini t 3 L~ I Y 7 f`xA'1« ! 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UNIT CURB-CHANGE momf T Erxl aay LuvERSE u vATSO f LS M, SiC4l,tW�IER TREgTNENT3Y9TE415WID-MAiOMLM RtEA'R✓;EMFLAY:RATE OVEFIOCFSWT02(I L'R EP 1 BOTH TO C-1 _043.6co2 Kz FwxEOCONCRETEPWITC ASS0,15NCNDIAMETER - -- APPROVED 1/27/25 63.60 REDfFOR(FOCONCRCTFPP_ClAtS310.4DX,TI LIOVAEIER -"' LF n 603.6ml NEWFORCEOCLWtC:;E.TF HCIiL+JAY!L EIAn7TI L PLC.CLA9311EIq 14•6N C.2 GP/�Y _ IF 603.6)112 PEPffOTw.EOCONLREIE H(FWLTN7AL ELL(FTICALPY[C1A$S 1{EIE 19'N9E'30'SDAN -- IF a TAf3b}00C 9PEQAi ORAATA6C STRI,V^iUpE.IYPE B93lFACiIMG BA9N LF 804.501011-SPEUALDRVNAGE S'RIA;711RF.ryPEOCATf318ASOV "`--- SDV.Y4IDI$ SPECw.E Lh2aNAGE b'T1U(:tUFE-T'PF 49 CATCH BASIN LF AFf I%SEALi11NiL'CSTY;N4NEVER,LLC AL 1f.RF.O OT: .--� .-.__._._.._.._ _........___...._._._................._...__.._.-_._...„.._..._._._.....__._._..._._._.._.._ LR: JNII!ARv 7i.1027 O14 6M.60/013 $PEL'•JJ.DRAINAGE 97Rt;�RL:P...ryPEWCfiTf?I BASTY Ur "'----'•'-^'-.-. co"WID73 $PEMtD1 FOVAGE 9'AU:II1f.E-TYPE 69 MAM10L[ -'-. .-. LF . 601:SOt01F S?EGaL CWA!Nn'GESIRUDTLY.6•lyjiF.8t M;1.1(OtE LF f ..1 " G55.OF93U;1C fA6T FRAME F].'Nm10UT ClJRB BOXANO tNIH NEII(:IAD:'c'GkAiF'.G3 -- .> " 656.OT06 CART FNAr _ CVJANO RET!4W'!tt'z`GRA'IE Li3. p'-'• aE+].N'lIM UNMOLW1AUlE f]7R11 U0X "E K�.12m RUIhNOLE FRAME 8(:OVER T /.. . $do a AS-BUILT REVISIONSALSTDP,H DRAINAGE DIP50V-EVENT Pln 0808.71 DESiRPNON OF ALTERATION;: BRIDGES CIkYJiiS 4L D!g4S104S IN it%ESS OTHERWISE"GtEO CGtTItACT kWIOLR `S�,R XiGNMAY m;� MNOFF YITIDATIOV -- e2eaea4 ' GRhtNACE TABLES-01 -_._..,._�_•._- lOWNS CT$Cumme,EAST iAVP-O8,RIVERHEAD,SOUTNAIFTOX LOCATIO%I•IARL7.Or DRAINA",E STRL'CTOIES DRAWING NO.DRT-01 YEttONx 1c COUNTY,SY}'FDLe SHEET NO.62Ai OF 210 w` 17 IS A IMATiCA OF LAW FOR ANT PERSON UNLESS IKY ARE ACTING UNDER THE DIRECTION OF A LICENSED PROFE$SRON, ENG!NELTL ARCF:'TEC1,lAN)SCAPE ARLNIRCT,Otl LLYD$URKYOk.TO ALIER AN ITEM IN 4NV OAT,Y-AN II0l REARGS TIIE STAMP fF A LTCENSEU PROFESSIONAL IS AETGiEO,IRE ALIEflln9 ENIMEER,AROf(TEC T,I,M E, A:TAITEC',CR LAND SG1 1, �Ltw YDRf[I BRirTIRCnt O( -� '''• SHALL STALT THE OCCLR/ERT AND ISLLIFIE THE NOTATION•RTERED BT•F0I1.01IE0 AY TEEIR SI(NATURE.Thf.OpTE DF S9O1 ALiFRAT1OC AND/SPECIFIC OEYCR(PTIOY�Df THE ALTEAATION, 15/20 rj- r: �' TransportitlDR ' . . ' st'.NN be 4590 & cl APPROVED 1/27/25 PLUM ISLAND ANIMAL DISEASE CENTER PLUM ISLAND FERRY PARKING LOT DRAINAGE PLA14S - Nfs ginType K with 'HIS SHEET SUPERSEUES sual 71 [SSI�IET AN _+ ~ SHALL SILUP DIE INCLUX THE NOTATION'ALTEKO Rr DLIOWEO By THEIR SIONATURE.THE DATE OF SUCH ALTERA710%AND A SPECIFIC DESCAPION&THE ll.-AERANIONT 17/201,E:�IT } D264984 Location 1 Drainage Marks Per Onsite Discussion 2-4-25 M91Cw15 251 \ . stop 40755 MAIN RD 125 LANDS END RD 1,10CPP z' 120 LANDS END RD �\ J {Existing Pool To 1 ' t lrrQ Tema _ js In of �p \ ti I �4'� �3 7 S q jj Existing ,... II '� Crossing To .,. �. be - Sl Remain .., . a r.: \ , t e\ S. NYS RTE 25 WAIN RD I '\ `T [_.:. . .. .. . L (,. •� ._2 .., i., .. ....... xAi -.lam 1, ".S� .... - ........ ......... .. .. ..... W ------------- •I '� 4, S i { PLUM ISLAND u ANIMAL DISEASE CENTERLCIn 4... 2+ RCP fAS1FUCIFD NY R fffi PLUM ISLAND PARKING.CRRY LOT i M ' .,4 V -- MM MINE-SEE OWC,NO.ORP!-02 A F'IY SE/d:NdF.DES?Y A HA!U'YEfl.:LG AI.TEREO Or. ON: DECMER.5.2022 ON: i $ I YO 0 23 40 60 Btr I 1 i i AS-FNR*REVISIONS 7 SFCFU ORAMC:VR � Pit' ROMA CI_ L MEh;IDNS R t UtE35 OlhEkklSl N01EU TRACT MCA OF A1F e H1 H6AY RWDff'MlI!WTIINt _ Ii2Gg 4Ba .T._�.......____.�,. DRAINAGE PLANS gJ•a „+ RYS RIE 2S,INS ATE 27 .,� liMs 0 SwlumN EFSI xrtu?IGtI,F:1 ttf�.A0..SCU7!(A&7GY LOCATION? DRAWING NO.'HP 1-01 CO:RAY:SIIFOLd RECIDN 0 SHEET NO. 9,OF 210 TI IS A YIP ATIDN 0=LAB FOR ANY FERSOIL UNLESS THEY ARE ACTING 9f✓OFR'NE OINECT[OY Oi A LiCCNSED PROFESSIONAL'NGINEER AR[IIITFCt.L/NUSCIYE NICHITEA'7,OR LAND SURYEfOR, n /-. '_i L; :"....' TU ICIER R(TEN IN ANT NAt',(F dN tTEN BEARING 111E 51AAIF 0i A LIlTN1ED PRCFESSIONAL 15 ALTERF.U,iNF.AL':EflIXC ENFIN.ER,ARCRITF.Ci,;ANDSLAPE AP"NiTECT,OR LAND SMTYCYDR f._,J N6W�'OAit(Department of :• ,+ �.+ SI±PLC STAMP TILE DCCMdFNI Ahli INCL6T1[iIIE NOTAi!p`1"ALTERED 9Y°FOLLOVED OT INEIH SIGNAIUE,711E GATE OF SUC!1 AL'IERATICN.ANU d'S CIPIC OESCND'I;U11 OF THE ALTERATION. ""-lam TransportO[IOn �1 ROSECON-02 TTREIMANIS .4�o CERTIFICATE OF LIABILITY INSURANCE DATE 20242024YY) 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 endorsement(s). PRODUCER License#BR-1584333 CONTACT Theresa Treimanis NAME: Barclay Insurance Brokers,LTD PHONE FAX 50 Glen Street A/C,No,Ext:(800)212-1892 111 (A/C,No Glen Cove,NY 11542 E-MAIL SS:ttreimanis@barclaybrokers.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Rlver ort Insurance Company 36684 INSURED L INSURER I3:Accident Fund Insurance Company Of America 10166 Rosemar Contracting Inc. INSURER C:United States Fire Insurance Co. 21113 P.O.Box 16 INSURER D:The Guardian Life Insurance Co.Of America 64246 East Patchogue,NY 11772 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. TYPE OF INSURANCE ADDL SUBR INSR SD POLICY NUMBER LTR POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE a OCCUR X X MK00000007-01 6112/2024 6/12/2025 OREMIsEs ERENTED occurrence) $ 100,000 X Contractual Liab A9ED EXP An one person) $ 5,000 X Included PERSONAL&ADV INJURY S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,000 POLICY JEC7 �LOC PRODUCTS-COMPIOPAGG $ 4,000,000 OTHER: S A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 2,000,000 Ea accide t S X ANY AUTO X MKG00000007-00 6/12/2024 6/1212025 BODILY INJURY Perperson) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident S X HIRED X NON-OWNED r PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident S S IS X UMBRELLA LIAR HOCCUR EACH OCCURRENCE g 4,000,000 EXCESS LIAB CLAIMS-MADE X X GXL0001485 03 6/12/2024 6/12/2025 AGGREGATE $ 4,000,000 DED I I RETENTIONS $ C WORKERS COMPENSATION X PER 71 OTH- AND EMPLOYERS'LIABILITY ATUT ER ANY PROPRIETORIPARTNERl 408-747066-3 7l12/2024 7112/2025 STEXECUTIVE YIN X E.L.EACH ACCIDENT 5 1,000,000 OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH It yes,desrbeunder E.LDISEASE-EAEMPLOYE S 1,000,000 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S 1,000,000 D Disability 00998894-0000 7/1/2024 7/1/2025 STATUTORY DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if morespace is re qwired) Contract Number:D264984 Storm Drainage Improvement,Highway Runoff Mitigation Project.New YOrK State Departement of Transportation is named as an additional insured on a primary non contributory basis.Waiver of Subrogation in favor of certificate holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE New York State Department of Transportation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Office of Contract Management ACCORDANCE WITH THE POLICY PROVISIONS. 50 Wolf Road.Suite 1CM Albany,NY 12232 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:ROSECON-02 TTREIMANIS NEW YORK CONSTRUCTION TE 144coRo MIDDIYY CERTIFICATE OF LIABILITY INSURANCE ADDENDUM FDATE (M/2024YY) THIS ADDENDUM SUMMARIZES SOME OF THE POLICY PROVISIONS IN THE REFERENCED INSURANCE POLICIES AND IS ISSUED AS A MATTER OF INFORMATION ONLY; IT CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. ALL TERMS,EXCLUSIONS AND CONDITIONS IN THE ACTUAL POLICY SHOULD BE CONSULTED FOR A MORE DETAILED ANALYSIS OF COVERAGE, AS THIS ADDENDUM DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES. AGENCY License#BR-1584333 NAMED INSURED(S) Barclay Insurance Brokers,LTD Rosemar Contracting Inc. POLICY NUMBER EFFECTIVE DATE CARRIER NAIC CODE MK00000007-01 6/12/2024 Riverport Insurance Company 36684 ADDENDUM INFORMATION CERTIFICATE NUMBER: REVISION NUMBER: A. Insurer X❑Admitted/authorized X1 Excess line or free trade zone B. General Liability(GL)policy form X❑ISO/ISO modified Other C. Specific operations excluded or restricted(GL policy) XI Location: Work within the five boroughs(Manhattan,Brooklyn,Bronx,Queens and Staten Island of New Type of construction: York,New York Building height: Classifications [see attached declarations/endorsement] Designated work [see attached endorsement] D. Additional insured endorsement(GL policy) ❑X CG 20 10 CG 20 26 ❑CG 20 32 ❑ CG 20 33 ❑X CG 20 37 CG 20 38 ❑Other: #: Title: E. According to the terms of this GL policy,the additional insured has primary and noncontributory coverage X❑Yes No and no other option is available with this insurer F. Additional insured will receive advance notice if insurer cancels(GL policy) Yes ❑X No and ❑no other option is available with this insurer G. Blanket contractual liability located in the"insured contract"definition(Section V,Number 9,Item f.in the ISO CGL policy)is removed or restricted Yes and Ono other option is available with this insurer ❑X No changes made H. "Insured contract"exception to the employers liability exclusion is removed or modified(GL policy) Yes and ❑no other option is available with this insurer ❑X No changes made I• GL policy(including endorsements)does not cover the additional insured for claims involving injury to employees of the named insured or subcontractors(not workers'compensation) Yes and Fno other option is available with this insurer �X No changes made ACORD 855 NY(2014106) Attach to ACORD 25 ©2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM INFORMATION continued AGENCY CUSTOMER ID:ROSECON-02 TTREIMANIS J. Earth movement,excavation or explosion/collapse/underground property damage is excluded or restricted(GL policy) Yes and M no other option is available with this insurer ❑X No changes made K. Insured vs.insured suits(cross liability in the ISO CGL policy)are excluded or restricted(other than named insured vs.named insured) ❑Yes and no other option is available with this insurer IX No changes made L- Property damage to work performed by subcontractors(exception to the"damage to your work"exclusion in the ISO CGL policy)is excluded or restricted Yes and ❑no other option is available with this insurer ❑X No changes made M. Excess/umbrella policy is primary and non-contributory for additional insureds Yes,by specific policy provision Yes,by endorsement No and no other option is available with this insurer 06/12/2024 AUTHORIZED REPRESENTATIVE SIGNATURE DATE(MM/DDNYYY) ACORD 855 NY(2014105) Page 2 of 2