The URL can be used to link to this page

Home My WebLink About2010Receipt to the North Fork Animal Welfare League, Inc. for Current Contract Documents Per request of Town Clerk Elizabeth Neville on .July 7th, 2010 In response to the request of Town Clerk Elizabeth Neville on July Th, 2010 the following documents were received on July 8*~, 2010 from Gabby Gtantzman, North Fork Animal Welfare League Kennel Print name Manager, _ Signature 1. New York State Insurance Fund Certificate of Workers' Compensation Insurance dated 7.8.2010 for coverage 8.23.2006 through 6.1.2012. (one page) 2. Acord Prince Associates, Ine Certificate of Liability Insurance dated 7.8-2010 issued bY Hartford Insurance Co. for coverage 7.1.2010 through 7.l.2011. (one page) Received by Town Clerk's Office on NYSIF Fax Servsr 7/8/2010 8:56:06 AM PAGE 1/001 Fax Server New York State Insurance Fund Workers' Compensation & Disability Benefit~ Specializts $iIwe 1914 199 CHURCH SSEET, NEW YORK, N.Y. 10007-1100 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 1180245g0 NORTH FORK ANIMAL WELFN~E LEAGUE lNG PO BOX 297 SOUTHOLD NY 11971 POLICYHOLDER NORTH FORK ANIMAL WELFARE LEAGUE INC PO BOX 297 SOUTHOI-D NY 11971 CERTIFICATE HOLDER TOWN OF SOUTHOU3 TOWN CLERK PO BOX 1179 SOUTHOLD NY 11971 pOLICYNUMBER CERTIFtCATENUMBER I PERIODCOVEREDBYTHIS CERTIFICATE DATE Z 873415-6 628784 08/'23/2006 TO 06/01/2012 7/8/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 673415-6 UNTIL 06/01/2(312, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THESTATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WiTH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 06101/2012 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITI~N NOTICE OF SUCH CANCELLATION WiLL BE GivEN TO THE CERTIFICATE HOLDER ABOVE. NOTICEBY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE iS ISSUED AS A MAUl'ER OF INFORMATION ONLYANDCONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THECOVERASE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This cer~ficate cen be validat~l on our wsb sits at https://v~w.nysi f. com/cert/cerWal, asp or by ceiling (888) 875-5790 VALIDATION NUMBER: 291985507 07/0.?/~010 'ACORD,,, ~]~uc~ (516)822-6550 FA): ($15)822-6564 Prince Associates, Inc, Broadway Htcksvi]le, NY 11801 23:16 5168226564 P~INCE ~SSOC PAGE 01/01 CERI'IF CATE OF LIABILITY INSURANCE 07/o8/20i0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 13ELOW. ~Nsu.t: Northfork Animal Welfar~ League ~nc PO Box 297 Southhold, NY 11971 COVERAGES INSURERS AFFORDING COVERAGE NAIC # 1 HE POLICIES OF INSURANCE LISTEO BEL~ )VI HAVE BEEN I$~U ED TO THE INSURED NAMED ABOVE FOR THE POLrCY PERIOD iNDICATED NOTVVITNSTANDING ANY REQUIREMENT, TERi~ OR CONDITION OF ANy CONTRACT OR OTHER 0OCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAy BE $SUED OR 'AY PERTA N, THE INSURANC~ AFFORDE[ EY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALk THE TERMS EXCLUSIONS AN~ CONDIT~ON,~ OF SUCH POL~CIE~ AGGREGATE LIMITS SHO~N MA ~ I-AV~ BEEN RE~LJCED BY PAID C~JMS CLAMSMADE X OCCUR ' X ~ETENTION ~ 10 , 000 125BARK$422' 07/01/2010 07/01/2011 MEB gXP ,:^ny on~ p~onl j ~ PERSONAL A ADVtNJURy S GENERAL AGGREGATE ! ~ ~ ~ 000 ~ 000 PRODUCTS- COMP/O~ AGG ~ $ ~ ~ 000,000 1,000,000 1,000,000 ertiFicate Holder as Landlord of premises (269 Pecon~c Land, Pecomtc, NY) is Additional Insured. ;ERTIFICATE HOLDER Town of Southhold Att: Town Clerk P.O, Box 1179 Southold, NY 11971 CORD 2E (2009101) CAI~CELLATION Lt nda 6odn~ ck/LTNO~ I he A(~ORD ~a~e and logo are registered mark~ of ACORD