HomeMy WebLinkAbout32500-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32625
Date: 09/24/07
THIS CERTIFIES that the building INGROUND SWIMMING POOL
Location of Property: 430 PECK PL
(HOUSE NO.)
County Tax Map No. 473889 Section 70
(STREET)
Block 3
SOUTHOLD
(HAMLET)
Lot 12
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
NOVEMBER 13. 2006 pursuant to which
Bui1ding Permit No. 32500-Z
dated
NOVEMBER 16, 2006
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
is ACCESSORY INGROUND SWIMMING POOL IN THE REQUIRED REAR YARD WITH
FENCE TO CODE AS APPLIED FOR.
The certificate is issued to JOHN & MAORA TOMICI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARnmIIIT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
7542
04/14/07
PLUMBERS CERTIFICATION DATED
N/A
Signature
Rev. 1/81
. {'!"vWJ
@ (2,tif 13 I)
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\~~t~>24 "16\
I L-;;LO., DEP7.
QF S""THO'') j
I TQWtL --'~--~LICATION FOR CERTIFICATE OF OCCUPANCY
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
This applIcation must be tilled in by typewriter or ink and submitted to the Building Department witb the following:
A. For new building or new IIse:
I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic features.
. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form).
~ Approval of electrical installation from Board of Fire Underwriters.
"-zf." Sworn statement from plumber certifying that the solder used in system contains less than 2/1 0 of I % lead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land nses:
I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. If a Certitlcate of Occupancy is
denied; the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00.
2. Cel1itlcate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certitlcate of Occupancy - $.25
4. Updated Certitlcate of Occupancy - $50.00
5. Temporary Cel1itlcatc of Occupancy - Residential $15.00, Commercial $15.00
Date.
New Construction:
Location of Property ~ 53 0
House No.
Old or Pre-existing Building:
(check one)
w~ \\s Av~VIII~ ,
Streel
5' n v+l1 0 I 0\
tJy
II q,l
Hamlet
Owner or Owners of Property: J 1:> ~ iI\
Suffolk County Tax Map No 1000, Section 7 ()
+- MOl v~ To W\ \ c.'\
Block _ ~
Filed Map.
I?...
Lot
Subdivision
Lot:
Pennit No.
I I
335tJO ~
Date of Permit. "I Ie. I Db
Applicant:
Health Dept. Approval:
Planning Board Approval:
_ Underwriters Approval:
Request for: Temporary Certitlcate
D.-2
Fee Submitted: $ ;.;>. <;"
Final Certificate:
__ (check one)
8-.Lc-.7'3 ) / c"
Co -t: 3J~;l.5
Applicant Signature
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO.
32500 Z
Date NOVEMBER 16, 2006
permission is hereby granted to:
JOHN TOMICI
PO BOX L.c. ~ I,
SOUTHOLD,NY 11971
for :
CONSTRUCTION OF AN INGROUND SWIMMING POOL IN THE REQUIRED REAR
YARD, FENCED TO CODE
at premises located at
430 PECK PL
SOUTHOLD
County Tax Map No. 473889 Section 070
Block 0003
Lot No. 012
pursuant to application dated NOVEMBER 13, 2006 and approved by the
Building Inspector to expire on MAY 16, 2008.
Fee $
150.00
kClL
/ Authorized Signature
ORIGINAL
Rev. 5/8/02
Nassau Suffolk Electrical Inspections, Inc.
sos-c Lincoln St . Riverhead, New York 11901 . Tel: 631-813-2890 . Fax: 631-813-2891
Application: 7384
Date: 12/4/06
Issued to: Tomico
Address: 1530 Wells Ave
Village: Southold
Introduced By;: Bethel Electric
License#:2880-ME
was examined and approved up to the above date and was in compliance with the NEe
Mic
Residential [8]
Ccmrercial
[let Gaage
I>ddition
Poo@
f-bt Tub
1st Roar
2rd floor
Baserrent
Switches Receptacles Fixtures G.F.1. Timeclock Heater
2 3 2
Fans Dishwasher Washer/Amps Dryer/Amps Oven Carbon
Range/Amps Monoxide
Furnace Oil Gas Heat Zones Whirlpool Sell
Transformers
Rough Insp: Meter Amps Phase Motors
12/1/06
Finallnsp: 12/4/06 2
Other Equipment: lnground pool
Out Res
JV=Af~ 61ectm:a/g~i=_ &>
7A{~,/- ~
This certificate must not be altered
In any manner
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/ i CA.TION LAW. '
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TOWN OF SOUTHOlD BUilDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONS1RUC11ON
REMARKS:
~r/J
[ ] ROUGH PLBG.
[ ] I~ATION
[ ~INAL
[ ] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT PENETRATION
&....
INSPECTOR
DATE ;y~# 1
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FIELD INSPECTION REPORT DATE I COMMENTS lj..i
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FOUNDATION (1ST) -.- ~
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PERMIT NO.
!:iUiLJJ1Nli t'.t\KMU At'J:'L!CAflUN CHECKLIS
Do you have or need the following, before applying
Board of Health
- -. 3 sets of Building Plans
Survey
5;2 6DV ~ Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
IV""I~ VI' ,:)VUlI1VLlJ
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N\:14971
TEL: 76S-18lJZ
Examined
J ~ If, , 20 Of;}
It/fV,20ok
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Approved
Disapproved alc
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Phone:
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I Building Inspector
'-,---::-'
APPLICATION FOR BUILDING PERMIT
\LJ~-' -'.-
- (',,\!' \ :'.....j
\'~':"_ ~ 'il _:1,.) ~__ ......
Date
II WOC:,
,20_
INSTRUCTIONS
a. This application MUST be completely filled in by iypewriter or in ink and submitted to the Building Inspector with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and ofbuilding$ on'premises, relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available for inspection througho\ltthe work.
e. No building shall be occupied or used in whole or in part for any purpose what-50-ever until a Certificate of Occupan
is issued by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of South old, Suffolk: County, New York, and other applicable Laws, Ordinances or
Regulations, for the c'onstruction of buildings, additions, or'alterations or for removal or demolition as herein described. The
applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit
authorized inspectors on premises and in building for nece~$8ry inspections.
"IMMEDIATE&. Y"
ENCLOSE POOL. TO CODE ~
UPON COMPLETION
BEFORE "WATER" AlL CONSTRUCTION SHALL .
State whether applicant is owner~ea:JJ1fm;~N. M~k~ ial,Egeneral contractor, electrician, plumber or builder
vOO~O~' EW YOR. S T~
. ... l)WJ~\\E p~ "~I.~8~'lb'.b
Name of owner of premises
~HI'-J IOMIG\
(as ?n the tax roll or latest A~OVED AS NOTED
If 1., .. f h .'. DATE.';'I'!/(X;BP # ;';,2~~b
app lcant IS a corporatIon, signature 0 duly aut onzed officer .~ .. r,
CJ-\f'FoRt> e:A~~ - .t>1t..,.c;.~q\r . FEE: 150 BY: ~IC, ~L
(Name and title of corporate officer) lINDERWRrTERSCERTlfICATE NOTIFY BUILDING DEPARTMENT AT
REQUIRED 765-1802 8 AM TO 4 PM FOR TH E!
Builders License No. H-r. ~ S FOLLOWING INSPECTIONS: I
.. (" 1. FOUNDATION - TWO REQUIRED
.~. _ I FOR POURED CONCRETE
ze. .. . 2. ROUGH - FRAMING & PLUMBING
- . 3. INSULATION .
.' CA TE 4. FINAL. CONSTRUCTION MUST
. . BE COMPLETE FOR C.O. \
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
T NOT RESPONSIBLE FOR
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be dope:
\530 "'" A~e- .' . .
House Number Street
County Tax Map No. 1000 Section
Subdivision
70
. Block -j:b-
Filed Map No.
..:.~ Lot ~
Lot
{0-.
(Name)
L State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~R ~I b ~L. "''<:fI ~
b. Intended use and occupancY_~125\ bE:1-JTIA-L.
.
.--
, Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition ~ Alteration ~
Other Work::I:7t \ht-:l'(L ~JltMt\..t\'"
I (Description)
k Estimated Cost
\O,~
Fee
If dwelling, number of dwelling units
If garage, number of cars
(to be paid on filing this application)
Number of dwelling units on each floor
>. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
Dimensions of existing structures, if any: Front
Height Number of Stories
Rear
Depth
Dimensions of same structure with alterations or additions: Front
Rear
Depth
Height
Number of Stories
Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
I
Depth~ 7~
, Size of lot: Front 13 ~
(
Rear_I ~S
O. Date of Purchase
Name of Former Owner
I. Zone or use district in which premises are situated
2. Does proposed construction violate any zoning law, ordinance or regulation: /'f'O
3. Will lot be re-graded ~ Will excess fill be removed from premises:@NO
4. NamesofOwnerofpremises'1;"~~iOM.~~i AddreSS~'530 ~ .~lbPhoneNo. 7~'1-97V
NameofArchitect~I')~1 Address ~PhoneNo 'Z-cJEl'71Ib
Name ofContractorj\IJU~t'W Pta...s Address~ Phone No. SAS'I/"Il.>'
5. Is this property within 100 feet ofa tidal wetland? *YES NO ~ "V J3TAlaJllMi
. IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAYBE REQUIRED :100001 JOOq :laOf
r1QIT,lJQMQO 11I0'<
6. Provide survey, to scale, with accurate foundation plan and distancesrtQ,N~PfJ~ lines. .R3"~""" :lFlO'!:!
7. If elevation at any point on property is at 10 feet Qr below, must ProVidb!~p~~Phi~al data on survey.
TATE OF NEW YORK)
SS:
:OUNTY OF~
t.L1 ~Fo ~ ~ 1'Ii\f\1\.) being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
i)He is the
(C ~~'t'r-~'
ontractor, gent, otpotate . fee. -- .,
,.
f said owner or owners, and is duly authorized to perform or hav'e' performed the saidwork and to make and file this application;
lat all statements contained in this application are true to the best of his knowlbllge-ian<MSelief; and that the work will be
erformed in the manner set forth in the application tiled therewith. .1: i 8', 32U
,-<_.,.i'tv.~ -'
worn to biIore me thiS
~ day of
20~
; 1"1+ \'.1'
1.,_ ';'11 'I>,
".
PETER 800TI-I
Notary Public, State of New York
No. 01806092004. Suffolk County
Term Expi'~s ! ..:::.1 2Q07
- 3-1'2-
.
TOWN OF SOUTHOLD PROPERTY RECORD CARD
.
.
1/;'7
OWNER
STREET
S
W
.5
~~~
TYPE OF BUILDING
'idJ 1<2
(~\ f\"
.\1-<, I' ~ \ :ACe..-
N
(J{S
"')
RES'i/ c>
LAND
FARM
COMM. CB.
MICS.
Mkt. Value
.~ic 1/ S "33
IMP.
TOTAL
DATE
REMARKS
",fp / 0 0
t;""S .., $ ::a.. c D 0
CD 6'5J
SOQ'
00 If
" 4
Q~l1c:..1 *"'......s. 150.060
( 17, / om/C(' IV Ie
,
AGE
NEW
FARM
BUILDING CONDITION
NORMAL
BELOW
ABOVE
Acre
Value Per
Acre
Value
House.2loL.
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
Tillable
Woodland
Meadowland
Total
DOCK
j
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- =,,- ,~.. .....-.
''';~'t-.t:> -
M. Bldg. J.(;xJ.7'=- ~j '3 ~-o J'-IS-7 ~ l.. 1/ ~ Ir_ I
Extension Isij oVf<R ~""fi: / I'"
JOX:l-6."- s-:ZO 37,j /9 S"6
Extension 105.,,/1' Fir'; BAS~';"" '75rO
Ii! X z.."::, ..1~ /&32'
Extension C.A~, E"lI/iR( ,.- t,S:--
.zX">"(, =- .s-~ /:2.::'
Foundation LA. Both z. Dinette
Porch Basement r:-,; I. /..- Floors ""'''' ".r lJ.8 K.
Porch Ext. Walls J4~.J?> Interior Finish IAlA I.. L- fl 1> lR.
Breezeway Fire Place 1/ ~l>. Heat -I€'5> DR.
Garage I Type Roof , Rooms 1 st Floor f BR.
Patio Recreation Room Rooms 2nd Floor FIN. B
O. B. Dormer Drivewoy
Total (,I/IJ /
COLOR G..... .c
TRIM <.<./ 1-1 I re
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STATEOFNEWYORK
WORKERB' COMPENSATION BOARD
CERTIFlCATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE
.
351 0 Veterans Memorial Highway
Bohemia, NY 11716
lb. Business Telephone Number of Insured
631-588-1300
Ie. NYS Unemployment Insurance Employer Registration
Number of Insured
I" Legal Name and address of Insured (Use street address only)
Dunrite Manufacturing Corp
0592920-5
Work Location of lnsured (Onl:y required if coverage is specifically
limited to certain locations in New YorkState, i.e. a Wrap-UP.Policy)
I d. Federal Employer Identification Number of Insured
11-2245133
2. Name and Address ofthe Entity Requesting Proof of
Coverage (Entity Being Listed as the Certificate Holder)
3a. Nam~ of Insurance Carrier
American International Co
3b. Policy Number of entity listed in box "Ia":
Town of Southold
Building Dept
Main Street
Southold NY 11971
WC1883215
30. Policy ~ffectiveperlod:
04/01/06 t~ 04/01/07
3d. The Proprietor, Parmers or Executive Officers are:
eg incl~di\'d. (Only ohock box n.n p",""",offioon includ,d)
o an excluded or certain partners/officers excluded.
3.. Demolition is:
o included.
IXl excluded.
(Definition ofDemol1tion on Reverse)
~
.
This certifies that the insurance can:i.er indicated above in box "3" insures the business referenced above in box <CIa" for "\i\IOIkers' compensation
uoderthe New Y 0Ik State Workers' Compensation Law. The lnsurance Carrier orits licensed agent will ,end this Certificate of Insurance to
lbe entity listed above as the certificate holder in box "2".
The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment a/premiums
PC.within 30 days IFthere are reasons other than nOnpayment cfpremiums that cancel the'policy or eliminate the inSuredfrdm the coverage
indicated on this Certificate. (These notices 11U!Y be sent by regular maiL) Otherwise, this Certificate is valid for a maximum of one year
after thisform is approved by. the. j~u~m:ce ca~rier or i!& licen:sed ag~nt. . .
Please Note: Upon the cancellation of the workers' cOlllpen.sation policyinc1icated on this Ionn, if the business cOntinues to be'name(l on a pennit,
license or contract issued by a certifi.cateholder, the business lnustpro1i.de that certificatehalder with a new Certificate of Workers' C.$pensation
Coverage or other authorized :proof that the business is complying with the mandatory coverage requirements of the New Yark State WorkeJ:s'
Compensation, Law.
Under penalty ofperjmy, I certify that I am an authorized representative or licensed agent ofllie insurance carrier referenced above
and that the named insured has the coverage as depicted on t.hi5 form.
Approved by:
Kevin McDonough
.A ~e of authorlzedrepreseritative or licensed agent of insurance cattier)
{J( (}/fCJJIf'!I-? 3/301200'>
. (Signature) (Date)
Approved by:
Title:
President of Walter Rose Agency, lnc
Telephone Number of authorized representative or licensed agent of insurance carrie,(845) 783 -25 5 5
Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-i05.2form, Insurance brokers are NOT
authorized to issue it.
C-I05.2
ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID S9 DATE (MMIDDNYYYI
DUNRI-1 03/30/06
;feER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
w- ter Rose Agency, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
stage Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Monroe NY 10950
Phone: 845-783-2555 Fax:845-783-2425 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Hartford
INSURER B: Twin Citv Fire Ins Co 347
Dunrite Manufacturing Co~ INSURER c: American International Co
3510 Veterans Memorial Highway INSURER D: Zurich Insurance Co. .
Bohemia NY 11716
INSURER E:
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.
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE rMMfDDfY DAT~Y,~J;D?f'::~~1 LIMITS
~NERAL LIABILITY EACH OCCURRENCE $ 1000000
A X COMMERCIAL GENERAL LIABILITY 01UENQS9371 04/01/06 '04/01/07 PREMISE~ Ce~t:o~~~~noe) $ 300000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10000
~ Pop Up PERSONAL & ADV INJURY $ 1000000
f-- GENERAL AGGREGATE $ 2000000
n'~ AGG~En ~L1MIT APPlSPER: PRODUCTS - COMPIOP AGG $ 2000000
POLICY ~~& LOC Emp Ben. abar
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
B ~ ANY AUTO 01UECGE8353 11/20/05 11/20/06 (Eaaooident)
- All OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS . (per person)
-
~ HIRED AUTOS BODilY INJURY
(Peraooident) $
~ NON-OWNED AUTOS
- PROPERTY DAMAGE $
(Peraooident)
GARAGE LIABILITY AUTO ONLY. EA ACklDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
[JESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X ITb",(v'LI~''f's I IU~~-
C EMPLOYERS' LIABILITY WC1511544 04/01/06 04/01/07 $ 100000
ANY PROPRIETORlPARTNER/EXECUTlVE EL EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYE $ 100000
If yes. desoribe under EL DISEASE. POLICY LIMIT $ 500000
SPECIAL PROVISIONS below
OTHER
D NYS Disability 1737292 01/01/06 01/01/07 statutory
DESCRIPTION OF OPERATIONS f LOCATIONS /VEHICLES / EXCLUSIONS ADDEO BY ENDORSEMENT / SPECIAL PROVISIONS
COVERAGES
CERTIFICATE HOLDER
CANCELLATION
Town of Southo1d
Building Dept
Main street
Southold NY 11971
SOUTH -7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAilURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001108)
@ACORD CORPORATION 1