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HomeMy WebLinkAbout20250064 125 Church Street Roof Replacement Application **HANDWRITTEN APPLICATIONS WILL NOT BE ACCEPTED** rFOR OFFICE USE] �roc:l CITY OF SARATOGA SPRINGS (Application#) DESIGN REVIEW COMMISSION CITY HALL-474 BROADWAY (Date received) SARATOGA SPRINGS, NEW YORK 12866-2296 RPaRATED TEL: 518-587-3550 X2533 www.saratoga-springs.org (Project Title) APPLICATION FOR: ARCHITECTURAL/HISTORIC REVIEW Staff Review APPLICANT(S)* OWNER(S) (Ynotggp/ican ATTORNEY/AGENT Name Star Roofing Saratoga Excelsior Group Star Roofing Address 16 Van Rensselaer Road P.O. Box 1296 16 Van Rensselaer Road Albany, NY 12205 Saratoga Springs, NY 12866 Albany, NY 12205 Phone 518-449-3422 / 518-583-9115 / 518-449-3422/ Email danielle@starroofing.net danielle@starroofing.net Identify primary contact person: 8 Applicant ❑ Owner ❑Attorney/Agent *An applicant must be the property owner, lessee, or one with an option to lease or purchase the property in question. Applicant's interest in premises: ❑ Owner ❑ Lessee ❑ Under option to lease or purchase PROPERTY INFORMATION Property Address/Location: 125 Church Street Tax Parcel #: 165 50 _ 2 _ 17 (tor example:/65.52-4-37) Date Acquired by Owner: Current Zoning District: Property use: ❑ Residential G Non-residential/mixed-use Type of Review: ❑Architectural a Historic ❑ Extension/modification (of current approval) Summary description of proposed action: Shingle roof replacement Has a previous application been filed with the DRC for this property? IM No ❑Yes—date(s)? -App.No.(s)? Revised 01/2021 **A "complete" application consists of 1 hard copy(original) ,and I electronic copy of application &ALL other materials as required below: New Construction/Additions ❑ Color photographs showing site/exterior details of existing structures and adjacent properties ❑ Site plan,drawn to scale,showing existing&proposed construction, property lines&dimensions, required&proposed setbacks&lot coverage,site features(fences,walks,trees,etc.);on no larger than 2'x3'sheet—smaller preferred if legible ❑ Elevation drawings showing design of all sides of existing&proposed construction—label dimensions, colors, materials, lighting(fixture &lamp type,wattage),etc.-include compass bearing&scale; no larger than 2'x3'sheet—smaller permitted if legible ❑ Floor plans for proposed structure;on sheet no larger than 2'x3'—smaller permitted if legible ❑ Product literature,specifications and samples of proposed materials and colors Change in exterior building materials (windows,doors, roof, siding, etc.),or color(in non-residential districts only) ❑ Color photographs showing site/exterior details of existing structures and that illustrate affected features ❑ Elevation drawings showing all sides of existing&proposed construction—label dimensions,colors, materials, lighting(fixture&lamp type,wattage),etc. -include compass bearing&scale; no larger than 2'x3'sheet—smaller permitted if legible ❑ Product literature,specifications and samples of proposed materials and colors Within front Yard setbacks in Historic Districts on (Front setbacks:UR-I &INST-HTR=30';UR-4=25';UR-2,UR-3&NCUD-1=10') - Installation, removal or change in material of drive-and walkways - Installation or removal of architectural,sculptural or vegetative screening over 3' in height - Installation of accessory utility structures or radio/satellite transmission/reception devices (more than 2' diameter) For any of above: ❑ Color photographs showing site/exterior details of existing structures,and of adjacent properties ❑ Site plan showing existing&proposed construction: include property lines&dimensions, required&proposed setbacks&lot coverage,site features(fences,walks,trees,etc.) street names,compass bearing&scale; no larger than 2'x3'sheet—smaller preferred if legible ❑ Product literature,specifications and samples of proposed materials and colors Sigrine/Awnings ❑ Color photographs showing site/exterior details of existing structures, and adjacent properties ❑ Plan showing location of proposed sign/awning structure on building/premises: no larger than I I"x 17" ❑ Scaled illustration of proposed sign/awning structure and lettering(front view&profile): include all dimensions of structure;type, dimensions and style of lettering or logo; description of colors, materials, mounting method and hardware ❑ Descriptions,specifications of proposed lighting including fixture&lamp type,wattage,mounting method,and location ❑ Product literature,specifications and samples of proposed materials and colors Demolition ❑ Color photographs showing site/exterior details of existing structures,and of adjacent properties ❑ Site plan showing existing and any proposed structures-include dimensions,setbacks,street names,compass bearing,and scale ❑Written description of reasons for demolition and, in addition: ❑ For structures of"architectural/historical significance",demonstrate"good cause"why structure cannot be preserved ❑ For structures in an architectural district that might be eligible for listing on National Register of Historic Places,or for a "contributing"structure in a National Register district(contact City staff), provide plans for site development following demolition- include a timetable and letter of credit for project completion Telecommunication facilities ❑ Color photographs showing site/existing structures,and of adjacent properties ❑ Site plan showing existing and proposed structures:include dimensions,setbacks,street names,compass bearing,and scale ❑ Scaled illustration of proposed structures: include all dimensions;colors, materials, lighting, mounting details ❑ Consult Article 240-12.22 of the City's Zoning Ordinance and City staff to ensure compliance with requirements for visual impact assessment and existing and proposed vegetative screening Revised 01/2021 Request for extension of current approval ❑ Identify date of original DRC approval: Current expiration date: Org.App. No. ❑ Describe why this extension is necessary and whether any significant changes have occurred either on the site or in the neighborhood. SEQR Environmental Assessment Form ❑Applicants proposing the following must complete"Part I"of the SEQR Short Environmental Assessment Form(available here: http://www.dec.ny.gov/docs/permits ei operations pdf/seafpartone.pdfl: -Construction or expansion of a multi-family residential structure(4 units +) -Construction or expansion(exceeding 4,000 sq.ft.gross floor area)of a principal or accessory non-residential structure -Telecommunications facility, radio antennae,satellite dishes -Demolition Disclosure Does any City officer, employee or family member thereof have a financial interest (as defined by General Municipal Law Section 809) in this application? ❑ No ❑Yes - If yes, a statement disclosing the name, residence, nature, and extent of this interest must be filed with this application. Certification I/we,the property owner(s), or purchaser(s)/lessee(s) under contract, of the land in question, hereby request an appearance before the Design Review Commission. By the signature(s) attached hereto, I/we certify that the information provided within this application and accompanying documentation is,to the best of my/our knowledge,true and accurate. I/we further understand that intentionally providing false or misleading information is grounds for immediate denial of this application. I/we hereby authorize the members of the Design Review Commission and designated City staff to enter the property associated with this application for purposes of conducting any necessary site inspections relating to this application. Furthermore, I/we agree to meet all requirements under Article VII for Historic Review or Article Vlll for Architectural Review of the Zoning Code of the City of Saratoga Springs. Pa4,��& Z�)&&44, Date: 1/23/25 (applicant signature) Date: (applicant signature) If applicant is not the currently the owner of the property,the current owner must also sign. TI-Ma-ick schel& 25/01/2025 Owner Signature: Frederick Scheidt(Jan 25,202512:47 EST) Date: Owner Signature: Date: Revised 01/2021 CITY OF SARATOGA SPRINGS ;J DESIGN REVIEW COMMISSION F City Hall-474 Broadway Saratoga Springs, New York 12866 Opp{ED `C� Tel:518-587-3550 x2533 www.saratoga-springs.org INSTRUCTIONS ARCHITECTURAL/HISTORIC REVIEWAPPLICATION I. ELIGIBILITY:An applicant to the Design Review Commission for Architectural Review or Historic Review must be the property owner(s) or lessee, or have an option to lease or purchase the property in question. 2. COMPLETE SUBMISSIONS:Applicants are encouraged to work with City staff to ensure that an application is complete. The DRC will only consider properly completed applications that contain 1 original and 1 diaital version of the application and ALL other required materials as indicated on the application. HANDWRITTEN APPLICATIONS WILL NOT BE ACCEPTED!! 3. ACTIONS REQUIRING REVIEW: Architectural Review District Historic Review District • any exterior changes that require a building permit • Installation or exterior change to a structure requiring a • any change in exterior building materials building or demolition permit • a new, or change to an existing,sign or sign structure • any material change to exterior of a structure including: • demolition of a structure -addition or removal of exterior architectural features - installation, removal or material changes to exterior Within a non-residential zoning district: building elements such as roof, siding,windows, doors, • a change in exterior building color porches, etc. • installation of an awning -enclosure or screening or buildings openings such as windows,doors, porches, etc. - installation of utility, mechanical or misc. accessory structures to the exterior of a building such as HVAC equipment, solar panels,wind turbines, radio/satellite transmission/reception devices, etc. ■ Within a front yard setback: -installation, removal or material changes to drive-or walkways -installation or removal of architectural,sculptural or vegetative screening that exceeds 3' in height -installation of accessory utility structures or radio/satellite transmission/reception devices over 2' in diameter • a change in exterior building color within a non- residential zoning district • a new, or change to an existing, sign or awning • installation of telecommunications facilities Note—Ordinary maintenance or repair that does not involve a change in material, design or outer appearance is exempt from Historic or Architectural Review. Revised 01/2021 4. DESIGN GUIDELINES: The Design Review Commission will evaluate whether the proposed action (construction, alteration or demolition) is compatible with existing structures and surrounding properties using the following criteria: • Height—consistent with historic form and context of site and surrounding properties • Scale—relationship of structure and its architectural elements to human size, form, perception • Proportion—relationship among building elements including front facade, windows, and doors • Rhythm—pattern resulting from repeating building elements such as door/window openings, columns, arches, and other facade elements • Directional Expression—compatibility with horizontal &vertical expression of surrounding structures • Massing&Open Space—relationship of structure to open space between it and adjoining buildings • Setback—compatibility with surrounding structures • Compatibility of the following with surrounding structures/properties: - Major building elements (storefronts, doors, windows, roof) - Building materials - Color—(in non-residential zoning districts only) 5. DECISIONS:The Design Review Commission may approve, approve with conditions, or disapprove an application. The DRC may impose appropriate conditions and safeguards in connection with its approval including nature/quality of materials, manner of construction, and design. An applicant may appeal a denied DRC application on the grounds of hardship. Application approvals shall expire within 18 months of the filing date unless the project has sufficiently commenced (i.e. building/demolition permits obtained and construction/alteration begun). Applicants may request up to 2 extensions if requested before expiration date of prior approval. 6. AGENDA DATE: Check City's website (www.saratoga-springs.org) for meeting dates. Applications are placed on an agenda on first-come,first-served basis as determined by the completeness of the application. 7. APPLICATION FEE(NON-REFUNDABLE): Make checks payable to the"Commissioner of Finance". REFER TO THE CURRENT FEE WORKSHEET INCLUDED IN THIS DOCUMENT. ADDITIONAL INFORMATION: More detailed information on Architectural Review, Historic Review and the Design Review Commission responsibilities may be found in the City's Zoning Ordinance available in City Hall and on the City's web site at http://vvww.saratoga-springs.org/544/Zoning-Ordinance. Revised 01/2021 City of Saratoga Springs OFFICE OF PLANNING AND ECONOMIC DEVELOPMENT FEES-2023 Application to City Council FEE Comprehensive Plan amendment $1,800+$300/acre Zoning Ordinance amendment $800+$300/acre Planned Unit Development PUD amendment $800+$300/acre Application to Zoning Board of Appeals Use Variance $1,400+$50/app Area Variance-Residential $350/1 st var+$50/app+$150/ea add variance Area Variance-Non-residential $1000/1 st var+$50/app+$2001 ea add variance Interpretations $650+$50/app Post Work Application Fee Application Fee x 2+$50/app Variance extensions 50%of Application fee+$50/app Application to Design Review Commission Demolition $500 Residential Structures Principal $70 Accessory $70 Extension $35 Modification $55 Multi-Family,Comm,Mixed-Use Structures Sketch $200 Principal $650 Extension $250 Modification $400 Multi-Family,Comm,Mixed-Use Accessory,Signs,Awnings Principal $150 Extension $100 Modification $150 Post Work Application Fee Application Fee x 2 Application to P anning Board Special Use Permit $1200+$50/app Temporary Use Permit $500 Special Use Permit-extension $400 Special Use Permit-modification $550+$50/app Site Plan Review-incl.PUD: Sketch Plan $400 per sketch Site Plan Full Residential $400+$250/unit Non-residential $800+$150/1000 sf Administrative SPR Residential $400 Non-residential $800 Extension Residential $250 Non-residential $350 Subdivision-incl.PUD: Sketch Plan $400 per sketch Preliminary Approval Residential:1-5 lots $700+$50/app Residential:6-10 lots $1100+$50/app Residential:11-20 lots $1450+$50/app Residential:21+lots $1800+$50/app Residential-extension $350 Final Approval Residential $1,550+$200/lot+$50/app Non-Residential $2,400/lot+$50/app Final Approval Modification Residential $400+$50/app Non-Residential $800+$50/app Final Approval Extension Residential $250 Non-Residential $350 Other: Lot Line Adjustment/Subdivision Administrative Actioi$400 Letter of Credit-modification or extension $400 Letter of Credit-collection up to 1%of LoC Recreation Fee $2000/lot or unit Land Disturbance $750+$35/acre Watercourse/Wetland Permit $750 SEQRA EIS Review Draft&Final TBD OPED Fees 5 Page 1 of 1 saratogaDRC Application with instructions and fee worksheet125 church- Star Roofing Final Audit Report 2025-01-25 Created: 2025-01-23 By: Danielle Dollar(danielle@starroofing.net) Status: Signed Transaction ID: CBJCHBCAABAAF3gn9HpDBCdh2AYloo1BCCaE03CiBaxl "saratogaDRC Application with instructions and fee worksheet12 5 church- Star Roofing" History Document created by Danielle Dollar(danielle@starroofing.net) 2025-01-23-2:35:59 PM GMT-IP address:208.125.59.122 Document emailed to fred@saratogaexcelsiorgroup.com for signature 2025-01-23-2:36:03 PM GMT Lfl Email viewed by fred@saratogaexcelsiorgroup.com 2025-01-23-3:09:31 PM GMT-IP address:45.47.133.64 b© Signer fred@saratogaexcelsiorgroup.com entered name at signing as Frederick Scheidt 2025-01-25-5:47:30 PM GMT-IP address:45.47.133.64 do Document e-signed by Frederick Scheidt(fred@saratogaexcelsiorgroup.com) Signature Date:2025-01-25-5:47:32 PM GMT-Time Source:server-IP address:45.47.133.64 Q Agreement completed. 2025-01-25-5:47:32 PM GMT Adobe Acrobat Sign r QWENS CORNING F { r fi Grayt TruDefinitionT" DURATION* SHINGLES with SureNail A,Technology Bold contrast. 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Summer Harvestt i I Want to know more about Owens Corning" products or find an Owens Corning"' Preferred Contractor in your area? It's easy to reach us: 1-800-GET-PINK I www.roofing.owenscorning.com OWENS CORNING ROOFING AND ASPHALT, LLC ONE OWENS CORNING PARKWAY • TOLEDO,OHIO,USA 43659 7-800-GET-PINK" INNOVATIONS FOR LIVING' www.roofing.owenscorning.com Pub.No.10014054.Printed inU.S.A.October 2011.THE PINK PANTHER & "1964-2011 Metro-Goldwyn-Mayer Studios Inc.All Rights Reserved.The color PINK is a registered trademark of Owens Corning.02011 Owens Corning. - lH�nstbn,!r.�n<i.Mempnis) , 7 r �� •'' Al ': Syr +�' :.�� j4�•-��,;•,�,? P''�:y�`�+ � r� ,�'"�,v@;.�'�+;a s���''�'�••: ,� �•'• _ '' r1�is'r'`, �it r:;d�: � � ' *FM p J pia' •�.1 � ;��g• u>. ���!��"_, 71,j - � ��.��..gip•; - •r A; rW •: ��- ,li s P .:. f � 1 kill pp pq kk W' ." - rs=r,•• f - "� ." 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Vve_r. ...i•�., _ - � T•'l� �#fir n 1'�' .. _ �T _ � X•�'��j}},'F •� .}�'�r F• ,:• ;•i� '�-.'fir`' ".�• ! ¢:-1;, ,5i i 4f •fir'.(` }',�' ,..-ry.v p�� ''� _ h��� - .�.. jl p it C MA 34, k f: •1�"j l� til 5���.• .rI, ,-r :r cr r: ` tm .a+ 1 • �•�y 't`Y. �':..J�iF,'�•".. }� 1F;•riR riY fI.�I��-.. f.,�„ �I^(�:. j/r �ri rr4- L . 4 N r •1 :► r r '•C'�' „tri'�• a:.s:Zt k � S-.Y ,_fir. [�7•�r3 r'..S ;H�y 1�,y. y I�� r ,.. `�1 rs 1, �■' [ Proposal STAR ROOFING and 16 Van Rensselaer Road RESTORATION A!FT Albany,NY 12205 www.starroofinlg.net (518)449 3422 �Q Fax: (5118)449-3426 To: Saratoga Excelsior Group Phone: (518)378-6226 :Date: 1111124 P.O.Box 1296 Project Location: 125 Church St Saratoga Springs,NY 12866 Saratoga Springs,NY 12866 Attn: Fred Scheidt Project Number-27964 We hereby submit specifications and estimated for: l. Remove existing one layer of shingleslroofing and drip edge from roof surface_ Should additional layer(s)of shingles exist,there will be an additional cost of$3,700.00 for each layer removed and disposed of. 2. Install ice and water leak barrier on fast Six(6)feet of roof,in valley areas and around penetrations and chimneys. 3. Install synthetic underlayinent or equal felt paper oil remainder of roof surface. 4, .Install new drip edge on all edges. S. Repair existing flashing as needed and install new pipe boots(flanges). 6. Install new shingles. Owners to select color. Manufacturer.GAF or Certaiiffeed or Owens Corning Style:Architectural Color: 7. Remove all debris from job site. Clean up on a daily basis. 8.Includes installation of 112"CDX plywood over the existing planks on the entire roof. Other, *Price is for the entire roof.Does not include any detached buildings or additional work of any kind. *Does not include any of the small eyebrow or small return roof areas. *Remove and dispose of snow slides. Shingle installation includes a limited"Lifetime"manufacturer's warranty. " Install shingled over ridge vent(s)on the ridges of the roof. *Reflassh chimney(s)with new metal flashing,as needed. *Valleys will have a double coverage ofunderlayinent on the entire length,both.025 metal and ice and water leak barrier, * Star to obtain any necessary permits,owner responsible for cost. FIVE YEAR WORKMANSHIP GUARANTY-MANUFACTURERS GUARANTY ON MATERIALS Credit Card$ $43,930.00 Cash 1 Check$ $42,65.0.00 Payment to be made as follows: $20,000.00 upon delivery of materials,balance in fun upon completion. All material is gaamteexl to be as specified.All work to be completed in a luakssional tnanner according to standard praellees.Any alteratino or detviation from the abrne spmifications involving extra Authorized eons will lne c.%muted only upon written onics,and well become an Signature; extra charge over and above the estimate.All agreements contingent Authorized by: Erie Prace r upon strikes,awklertts or delays beyond our control.ownors to carry Note:Teri s proposal may be fire and other necesmry insurance.Our workers are fully covettd by withdrawn by us if not accepted within 21 days. Was kers Compensation insurance- ACC E PTANCE OF PROPOSAI.--The above process, speeifitilions and conditions are satisfactory and hereby acceptml. You arc nuthorired to do the work as specified-Payment will bo mant- as out Itatel above.In,the event of default(nnn-puymcnt)I agree that I will be ttsponsible for all reasonable collection.coon and oI[utrmy Signature: cast-incuered in collecting this dot,t also agree a liinince owrge ur I S%will be assessed an all delinquent balances. Signature: Date of Acceptance: -T- STARROO-03 TINAKEENAN ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/28/2024 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(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 CONTACT NAME: NFP Property&Casualty Services, Inc. PHONE FAX 159 Wolf Road (A/C,No,EXt): (518)244-4245 (A/C,No):(518)244-4262 Suite 200 ADDRESS: Albany,NY 12205 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Admiral Insurance Company 24856 INSURED INSURER B:Selective Insurance Company of South Carolina 19259 Star Roofing and Restoration Star Improvements Inc DBA INSURER C:Pennsylvania Manufacturers Indemnity Company 41424 Star Improvements Inc DBA 16 Van Rensselaer Road INSURER D: Albany, NY 12205 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. INSR TYPE OF INSURANCE ADDL SUB' POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM DD MM DD W A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CA000003881-21 4/1/2024 4/1/2025 DAMAGE TO RENTED 300,000 X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY�X JECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO S2637577-00 4/1/2024 4/1/2025 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY per., dent) ent $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 6024019207564 4/1/2024 4/1/2025 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Equipment Floater/Co S 2637577-00 4/1/2024 4/1/2025 Leased/Rented 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is listed as Additional Insured with respects to General Liability for permit purposes CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Saratoga Springs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9ACCORDANCE WITH THE POLICY PROVISIONS. 474 Broadway Saratoga Springs, NY 12866-2292 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:STARROO-03 TINAKEENAN LOC#: 1 , lk O ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED NFP Property&Casualty Services Inc. Star Roofing and Restoration Star Improvements Inc DBA p Y Y Star Improvements Inc DBA POLICY NUMBER 16 Van Rensselaer Road EE PAGE 1 Albany, NY 12205 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Forms: General Liability: CG2010 07/04 Additional Insured -Owners, Lessees or Contractors-Scheduled person or organization -Blanket when required by written contract. CG2037 07/04 Additional Insured -Owners, Lessees or Contractors-Completed Operations- Blanket when required by written contract. Contractors Enhanced Coverage-AD6893 01/17-Includeds Waiver of Transfer of Rights of Recovery Against Others To Us -Blanket where required by written contract prior to occurrence or loss, Primary/Noncontributing Insurance Endorsement- Blanket- persons or organizations qualifying as an insured under an additional insured --Owners, Lessees, or Contractors. Endorsement-where required by written contract prior to occurrence or loss. Auto Liability: CA7809NY 04/24-ElitePac Commercial Auto Extension NY includes Additional Insured on a primary and non-contributory basis and Waiver of subrogation Umbrella Liability: CX0001 4/13-includes Additional Insured and Waiver of Subrogation-PCX6357 05/23-Other Insurance-Primary and Non-Contributory includes Additinal Insured on a primary and non-contributory basis. ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD N Y S I F PO Box 66699,Albany,NY 12206 New York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AA A A A A 161519703 MR '1 LOVELL SAFETY MGMT CO.,LLC 22 CORTLANDT STREET 33RD FLR NEW YORK NY 10007 7 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER STAR IMPROVEMENTS INC T/A CITY OF SARATOGA SPRINGS STAR ROOFING&RESTORATION BUILDING DEPARTMENT 16 VAN RENSSELAER ROAD CITY HALL 474 BROADWAY ALBANY NY 12205 SARATOGA SPRINGS NY 12866 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z 2249 301-9 385880 01/01/2025 TO 01/01/2026 11/20/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2249 301-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/ CERTVAL.ASP. THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS' COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND /1""' 4 DIRECTOR,I SURANCE FUND UNDERWRITING VALIDATION NUMBER: 336516905 111111 III II II i niii nisi nisi nui nm nm nm nin um�����nm nin uui m I I I I I I II 00000000000134536666 Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC Policy-22493019] U-26.3 139 [00000000000134536666][0001-000022493019][##Z][16519-19][Cert_NoP-CERT_1][01-00001]