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Home My WebLink AboutBailey Rd ~ .. COLONIAL SURETY COMPANY 50 Chestnut Ridge Road Montvale, NJ 07645 RECEIVED SEP 2 4 2002 DATED: September 19, 2002 Soulhold TOWD Cieri NOTICE OF CANCELLATION TO: OWNER/OBLIGEE Town of Southold Highway Dept. Peconic Lane Peconic, NY 11958 CERTIFIED MAIL RETURN RECEIPT RE: COLONIAL SURETY COMPANY PRINCIPAL: East Island Site Development ADDRESS: 54 Miller PlacelYappank Rd., Middle Island, NY 11953 BOND NO.: CSC-92884 TYPE OF BOND: License & Permit bond Tax Map Section 35, Block 1, Lot 25 EFFECTIVE DATE: 08/20/01 AMOUNT: $4,000.00 REASON FOR CANCELLATION: Non-payment of Premium Gentlemen: You are hereby notified that COLONIAL SURETY COMPANY elects to cancel the bond captioned above in its entirety, in accordance with the terms of said bond. This cancellation is to take effect: 30 days of receipt of this notice. Very truly yours, COLONIAL SURETY COMPANY Byk~AU.~~ Sherryann DePirro Attorney-in-Fact f:\wpdocs\data\underwrt\s1 00.11 0 TY UNDERWRITERS AGENC SURE 50 Chestnut Ridge Road Montvale, NJ 07645 (J tIf5(; J{ :1 '""""" ? 14rY '( '"rl ~,If')T;rC ~Ul'" \ 'Qllh'<__ \....~ 'i'l Ii , 0: 19~0 0002 ~927 1578 TOWN OF SOl'THOLD HIGHWAJ T"lT'('()NlC LA~JE ~n~ONIC, NY 11958 nl<T)rr,. t ,'.c '(P' """:)' '/ ,"J, 10 I "" ~:: \'''' """ ", N ,1 ,./ . it v~c y q\a~(oz dB . ~ f 1",II.ulll. "I,!,I"IIIII"I Date: 08/17/01 Transaction(s): Name: Town Of Southold P.OBoxl179 Southold, NY 11971 * * * RECEIPT * * * Receipt#: 1 Permits Check#: 3645 Total Paid: East, Island Site Development Co Inc 54 Miller Place Yaphank Rd Middle Island, NY 11953 Clerk 10: L1NDAC 3645 Subtotal $613.20 $613.20 Intemal ID: 38888 p" .. Permit No. / I f Mi- FileNo.)/ y . IUCEIVED TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Peconic Lane Peconlc, New York l111SB (516) 765- 3140 lUG 1 7 2001 ~u'ho.cS lown -.v.ICATION/PERMIT II~" HIOHWAV EXCAVATION AND REPAJ'R APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance of an Excavation Permit pursuant to Chapter 83 of the Code of the Town of Southold, Suffolk County, New York, and other applicable laws, ordinimces or regulations for the excavation herein described. The applicant agrees to comply with all applicable laws, ordinances, codes and regulations, and to permit authorized inspectors to make; necessary inspections of the job site. Print or Type 1) ~ l'>lJ>NO '5tfT:;: ~~"''''' Go" 11IlG,. 51- )<111.t..82. PlAq~ YRf,.u,.NI<.lW'j M'OOlB IWlN) Ny 11<1'33 Name of Applicant . Address 2) Name of Owner of Premises Address 3) 'WALL G.e.Wt'I"l( MAJ~ U~ BllIlEtf lUAV 10 t<M1'1fIkr Mt.N~ M~t~, G~ Work Description and Location (Street Number, Hamlet, Cross Street) (a) Is construction located within 75 feet of tidal wetlands? *Yes No J *If yes, other Town permits may be required. - 4) Builder's License No. Plumber's License No. Electrician's .License No. Other Trade's License No. 5) a) Attach plot plan showing location of pro~osed excavation and relationship to adjoining premises or public streets or areas, and giving a detailed descrip- tion of layout of excavation. b) Attach all other necessary permits and licenses for this project. c) Work covered by this application may not commence before issuance of a Highway Excavation Permit by the Town Clerk. 6) 7) Tax Map: Section '35 Starting Date: Q....S o? 0 f7 Block ,Lot Z5 Completion Date #- 020 J a 00 ( 8) Work Schedule: Phase Excavation....... .................................. Facility Installation................................. Backfill & Compaction.............................. P~vement Replacement.............................. Completion Date 9) Under which authority is the application made: 10) 11) Estimated Cost of Proposed Work: $ ,I" ''':>0 ...,,/ Remarks: D-39 Page 1 of 3 12) Insurance Coverage: (Attach copy) a) Insurance Company: b) Policy # c) State whether policy of certification on file with the Highway Depart- ment: ~? d) Coverage required extended to the Town: Bodily injury and property damage: $300,000/$500,000 Bodily Injury, and $50,000 property damage. 13) Security: I) ~ 00 Surety Bond lOt:> --Or Certified , total amount of $ ,Check I)rovldlld In the b) Maintenance Bond provided: ifOO 92 2 years or ~ Basic Application Fee...... ~ excavations @ $20.00 = $ 14) Fees for applications and permits: AI. /Service Connections ~ A2. /Additional Excavations same service @ $10.00 = $ ~ B. Excavations 18" in depth or less: 0-100 I.f. = $10.00 I. f. @ $0.10 - $ Additional C. Excavations 18" in depth to 5' in depth: 0-100 I.f. = $30.00 ~/ "~ -354- r. f. @ $0.30 $ 166. 2..9/' Additional - D. Excavations 5' in depth and over: ~ I.f. =,:~~.:0$0.50 = ~~.'~:~, Additional ----- . E. Utility Repair Excavations @$10.00 = $ No. Additional Repairs same service @ $5.00 = $ F. Notice to public utilities proof must be provided and attached to this application prior to issuance of permit. * * * fo/3 # Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to: rt::U7J-, ~ ~d x:-L7,_'0e_o~Jrrry ,,,,'" (b. in accordance with this application. SUPERINTENDENT OF HIGHWAYS TOWN OUTHOLD, NEW YORK ~ p- cfl- oj Date Permit Issued ~11or Date' sf(7/0( Dale Permit No. / / Y Received by the Town Clerk Note: Permit expires one (1) year from Date of ,Issuance. No work to start without 48 hour notice to the 'Superintendent of Highways. Permit must be available for inspection. 0-39 Page 2 of 3 ACORD. CERTIFICATE OF LIABILITY INSURANCIiAsi~~2NC I DATE (MM/DDIYY) 08/02/01 I PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Profile Coverage Corp. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 100 Comac Street, Suite 2 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Ronkonkoma NY 11779-6930 Phone: 631-981-7600 Fax:631-981-7681 INSURERS AFFORDING COVERAGE INSURED INSURER A: Admiral Insurance CO INSURER B: American International Group East Island Site Development INSURER c: Utica Mutual Insurance Co C~anr Ine 54 i1 er P1aee-Yarhank Rd. INSURER 0: Middle Island NY 1 953 I INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~~ TYPE OF INSURANCE POLICY NUMBER ~~t~iM~b5mYE PD.k+'E~~~J~rg'i'N LIMITS ~NERAL LIABILITY EACH OCCURRENCE , 1000000 A X COMMERCIAL GENERAL LIABILITY AOOAG09024 08/03/01 08/03/02 FIRE DAMAGE (Anyone fire) $ 50000 I CLAIMS MADE [!J OCCUR MED EXP (Anyone person) , 0 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE , 3000000 GEN'L AGG~EnE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1000000 n PRO- n POLICY JECT lOC ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT , 1000000 C X ANY AUTO BAC3213845 08/03/01 08/03/02 (Eaaccident) --=- - ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS - - HIRED AUTOS BODILY INJURY $ NON-QWNED AUTOS (Per accident) - - PROPERTY DAMAGE $ (Per accident) ~~GE LIABILITY AUTO ONLY. EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC , AUTO ONLY' AGG $ EXCESS LIABILITY EACH OCCURRENCE $ 6000000 B ~ OCCUR D CLAIMS MADE BE007402583 08/03/01 08/03/02 AGGREGATE , 6000000 $ 8 OEOUCTIBLE , X RETENTION $ 10000 $ WORKERS COMPENSATION AND I ~bCR~'C;MITSI IU~~- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE. EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER I Y I ADDITIONAL INSURED; INSURER LETTER: A CANCELLATION SOUTHH3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ....3..L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL TOWN OF SOUTHOLD IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR MAIN RD. SOUTHOLD NY 11971 I~RESENTATIVES. AUTHO~ED.l..EPRESENTATIVE .-I v '~ / 7 ACORD 25-5 (7/97) '; @ACORDCORPORATION 1988 COLONIAL SURETY COMPANY - Inc. 1930- 50 Chestnut Ridge Road Montvale, NJ 07645 201-573-8788 BOND NUMBER: CSC-92884 LICENSE/PERMIT BOND KNOW ALL PERSONS BY THESE PRESENTS that we, East Island Site Development. Middle Island. NY (hereinafter called the Principal) as Principal, and COLONIAL SURETY COMPANY, a PA corporation with principal offices at Montvale, New Jersey (hereinafter called the Surety) as Surety, are held and firmly bound unto Town of Southold. Southold. NY 11971 (hereinafter called the Obligee), in the penal sum of Four Thousand Dollars And No Cents Dollars ($4,000.00), for the payment of which well and truly to be made we do hereby bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally. firmly by these presents. Signed and sealed this 20th dav of AU2ust. 2001. WHEREAS, the said Principal has made or is about to make application to said Obligee for [a license as] or [a permit toJ Permit for Highway Excavation and Repairs, Tax Map Section 35, Block I, Lot 25 for a term beginning on AU2ust 20th. 2001 and ending on AUl!ust 20th. 2002. NOW THEREFORE, if the Principal shall indemnify the Ohligee against any loss directly arising by reason of the failure of said Principal to comply with the laws or ordinances under which such license or permit is granted, or any lawful rules or regulations pertaining thereto, then this obligation shall be void; otherwise to be and remain in full force and effect. PROVIDED, HOWEVER, AND UPON THE FOLLOWING EXPRESS CONDITIONS: 1. This bond shall remain in full force during the term of said license or permit unless cancelled in accordance with paragraph 2 below; but if said license or permit was issued for a term of one year or any other specific term, and said license or permit is renewed for one or more specific terms, this bond shall be and is hereby extended to cover during such additional term or terms. In no event, however, shall the liability of the Surety be cumulative from year to year or from period to period, nor exceed the penal sum written in the first paragraph of this bond. 2. This bond may be terminated or cancelled by Surety by giving l.!l days prior notice in writing from Surety to Principal and said Obligee, such notice to be given by certified mail. Such termination or cancellation shall not affect liability incurred or accrued under this bond to the effective date of such termination or cancellation. East Island Site Development ~ .-#L- . princi~ (Seal) By UREl)'f~MP ANY /' - (Seal) Attorney-in-Fact Fonn M300-11O (Rev. 9/89) COLONIAL SURETY COMPANY Duncannon, Pennsylvania Administrative Office: 50 Chestnut Ridge Road, Montvale, New Jersey 07645 ~~~~=~=~~~gc-:::::;:: ::;r;::::: ,""0:::::::: ~-,: :>':~=~,,=====~~ ,;~'-"~.~~'~ COt! -B:::~~~ :~~~~-:;;;-~-- ;~/;~~~---s:-~~~?:'~:.:: :f~~:~~'~~~~1 :$~~.~~ ~,~~.. /.:2-- ~~~~ -;- '~:~:::: ~~ ~~~ ~~..:: __,~~~~~i -~~~~?2 k~~-:..~::: ~~~:~~'-: ~~'ffi~~ ~~~~- -~~~~ ~','::%:::~:~,~0;%::: ,;;;---,>-p~~;~- -~"';?~~~ . . = ~..'=:s:--~~ -:::;:: , ::--;- zSS::::::c~~-::' s,- .:?;;. ~ ~ ~e jlresents 10 be $ign.d by its .~l>t ~I EIy .. '<< -':.-;- .. :...;' _..;r j -~,~~ i:tm', ~- -.~~ ~ &_~ ?F~~~ Z~_ 05~ ~ ::;/- ;..::::: / ~,~ ~-< :.::; -' ~ ZO~h ~- ;:::::..~~~~::; ~~- /~""~~~ ~-~=~ ;%::: :-::;;:;<~~'::%:-~'~ -:""c:>::;,,~~~_ ;;'~~~- '_/::.::::3:::~~~ ::%'::::;;'-~~3~ -~:~ ~~~ B~_: :<.:.,,~:~ = /",,~~.:~:' :.s:::~=~~~~~~"""~~~ ~ Original printed with Blue and Black ink @ Forverilication of Iheauthenticityol this Power of Attorney you may call201-573-8788and ask @ for the Power of Attorney clerk. Please refer lathe above named ,nd.v'dl,al(S) and deta,lsof the ~ bond to which the power IS attached ~r.::--:::~.=-~~'-':zB~~?'~~:;- <_.:--<--- FOnTl 8-100-101 (Rev 10/00) State of New Jersey County of Bergen On this 20th day of August , in the year 2001, before me, Theresa Simmons, a Notary Public, personally came Sherryanne DePirro, to me known and known to me to be an Attorney-in-Fact of Colonial Surety Company, the corporation described in the within instrument, and she acknowledged that she executed the within instrument as the act of said Colonial Surety Company in accordance with authority duly conferred upon her by said Company. Theresa Simmons A Notary Public of New Jersey My Commission Expires August 16,2005 <::::" M )JNI../M~'UJ Theres; Simmons Notary Public COLONIAL SURETY COMPANY Duncannon, Pennsylvania - Inc 1930- FINANCIAL STATEMENT-DECEMBER 31, 2000 ASSETS LIABILITIES & SURPLUS .Stocks and Bonds. . . . ... .. $ 4,449,943 707,618 63,188 539,114 974,530 Total Admitted Assets 6,734,393 Reserve for Unearned Premiums. . . . . . . . . . . . .. $973,175 Claim Reserves . . . . . . . . . . . . 1,263,000 Other Reserves . . . . . . . . . . . . . . . . . . . . .. 259,813 Collateral Held. . . . . . . . . . . . . . . . . . . . . 778,507 Capital Stock. . . . . . . . . . . . . . . . . . . . . . 1,000,000 Surplus . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,459,898 Total Liabilities & Surplus. . . . . . . . . . 6,734,393 Cash in Office & Banks. . . . . . . . . . . . . . . . . . Accrued Interest & Dividends. . Premiums & Agents Balances Receivable . . . . OtherAssets....... ........... .Bonds and stocks are valued on basis approved by National Association of Insurance Commissioners. STATE OF NEW JERSEY COUNTY OF BERGEN 55.: I, Wayne Nunziata, President of COLONIAL SURETY COMPANY, do hereby certify that the foregoing is a full, true and correct copy of the Financial Statement of said Company, as of December 31, 2000. IN WITNESS WHEREOF, I have signed this statement at Montvale, New Jersey, this 6th day of February, 2001. ~ President Wayne Nunziata LI U--<>-Lo Antoinette Vuolo Notary Public Antoinette Vuolo A Notary Public of New Jersey My Commission Expires August 16, 2005 COLONIAl ~IIRFTV ~nI\JlP4NV MAINTENANCE BOND Bond # CSC-50353 KNOW ALL MEN BY THESE PRESENTS: That East Island site Development as Principal, and COLONIAL SURETY COMPANY, a Pennsylvania Corporation duly qualified to transact business in the State of New Jersey, as Surety, are held and firmly bound unto Town of Southo1d in the full and just sum of One Thousand and 00/100------------------ DOLLARS ($ 1,000.00-------- ), LAWFUL MONEY OF THE United States, to the payment of which sum well and truly to be made, the Principal and Surety bind themselves, and each of their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these president. WHEREAS, the Principal has entered into an agreement with the Obligee for Site Improvements as per APplication to the Town of Southold Hiqhwav Deoartment dated 8/2/01 at certain land known as Section 35, Block 1, Lot 25 WHEREAS, by said agreement, the Principal will furnish a bond conditioned to guarantee for a period of Two Years ending August 20, 2003 against all defects in workmanship and materials which may become apparent during said period. NOW, THEREFORE, THE CONDITION OF THE OBLIGATION IS SUCH that, if the Principal shall indemnify the Obligee for all loss that the Obligee may sustain by reason of any defective materials or workmanship which become apparent during the aforesaid period, then this obligation shall be void, otherwise to remain in full force and effect. Signed, sealed and dated ~ -\> Witne August 20, 2001 East Island Site Development (Seal) B COLONIAL TY OMP ANY tJ~. State of New Jersey County of Bergen On this 20th day of AUgUst, in the year 2001, before me, Theresa Simmons, a Notary Public, personally came Sherryanne DePirro, to me known and known to me to be an Attorney-in-Fact of Colonial Surety Company, the corporation described in the within instrument, and she acknowledged that she executed the within instrument as the act of said Colonial Surety Company in accordance with authority duly conferred upon her by said Company. Theresa Simmons A Notary Public of New Jersey My Commission Expires August 16,2005 ~~ Theresa Simmons Notary Public . . COLONIAL SURETY COMPANY Duncannon, Pennsylvania - Inc 1930- FINANCIAL STATEMENT-DECEMBER 31, 2000 ASSETS LIABILITIES & SURPLUS *Stocks and Bonds. . . . . . . . . . . . . . . . . . . . $ Cash in Office & Banks. . . . . . . . . . . . . . . . . . Accrued Interest & Dividends. . . . . . . . . . . . . Premiums & Agents Balances Receivable. . . . Other Assets ......................... 4,449,943 707,618 63,188 539,114 974,530 Reserve for Unearned Premiums. . . . . . . . . .. $973,175 Claim Reserves . . . . . . . . . . . . . . . . . . . . . 1,263,000 Other Reserves ....................... 259,813 Collateral Held. . . . . . . . . . . . . . . . . . . . . .. 778,507 Capital Stock. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,000,000 Surplus. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,459,898 Total Liabilities & Surplus. . . . . . . . . . 6,734,393 .>................................ Total Admitted Assets . . . . . . . . . . . . . . 6,734,393 'Bonds and stocks are valued on basis approved by National Association of Insurance Commissioners. STATE OF NEW JERSEY COUNTY OF BERGEN 55.: I, Wayne Nunziata, President of COLONIAL SURETY COMPANY, do hereby certify that the foregoing is a full, true and correct copy of the Financial Statement of said Company, as of December 31, 2000. IN WITNESS WHEREOF, I have signed this statement at Montvale, New Jersey, this 6th day of February, 2001. U? Wayne Nunziata President l/~ Antoinette Vuolo Notary Public Antoinette Vuolo A Notary Public of New Jersey My Commission Expires August 16, 2005