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4.04 4.4 SERVICES\Request For Proposals-Accept—ClearVU—Inspect for Asbestos—27 Indiana Ave Allen—6-19-2023 RESOLUTION AUTHORIZING ENGAGEMENT OF CLEARVU INSPECTIONS TO PERFORM PRE-DEMOLITION ASBESTOS SURVEY OF DWELLING LOCATED AT 27 INDIANA AVENUE RESOLUTION NO.: 12023 INTRODUCED BY: WHO MOVED ITS ADOPTION SECONDED BY: WHEREAS, by Resolution No.: 194,2023, the Queensbury Town Board authorized the preparation and distribution of a Request for Proposals (RFP)to qualified businesses for the inspection of a single family dwelling located at 27 Indiana Avenue in the Town of Queensbury bearing Tax Map No.: 309.13-1-7 and owned by Wayne Allen to determine if asbestos is on-site, and WHEREAS, the Town's Director of Building and Codes Enforcement received and evaluated the two (2) received proposals and has recommended that the Town Board accept the lowest submitted proposal of ClearVu Inspections, NOW, THEREFORE, BE IT RESOLVED, that the Queensbury Town Board hereby authorizes engagement of ClearVu Inspections to perform a pre-demolition, asbestos survey of the single family dwelling located at 27 Indiana Avenue for the amount of$400.00 for all lab fees billed per analyzed sample, and lab fees billed per analyzed sample for the amounts of$25 or $75 per sample as set forth in ClearVu's letter proposal dated 6/9/23 and follow-up proposal dated 06.13.2023 and presented at this meeting for a total amount not to exceed $1,500 contingent upon the Town's receipt of a proper certificate of insurance from ClearVu Inspections in form acceptable to the Town, and BE IT FURTHER, RESOLVED, that the Town Board further authorizes and directs that payments for such services shall be paid from Demolition — Misc. Contractual Account No.: 001-3650-4400 and assessed by the Town Board against the real property in accordance with an Order of the Warren County Supreme Court Judgment dated March 17, 2023, and BE IT FURTHER, RESOLVED, that the Town Board further authorizes and directs the Town Budget Officer to take all actions necessary to amend the budget and transfer $1,500 from Misc. Contractual Account No.: 001-1990-4400 to Demolition—Misc. Contractual Account No.: 001- 3650-4400, and BE IT FURTHER, RESOLVED, that the Town Board further authorizes and directs the Town Supervisor to sign any needed documentation and the Town Supervisor, Town Budget Officer, Director of Building and Codes Enforcement, Town Counsel and/or Town Purchasing Agent to take any and all action necessary to effectuate the terms of this Resolution. Duly adopted this 19t'day of June, 2023,by the following vote: AYES NOES ABSENT: • li11^11 CLEAR V %Iiik INSPECTIONS 518.832.9213 I ryan@clearvuinsrections.com I 18 Blackberry Lane,Queensbury,NY 12804 • Town Of Queensbury _ John O'Brien Bay Road Queensbury, NY 12804 RE: 27 Indiana Avenue,Queensbury NY 12803 We propose to perform a pre-demolition,asbestos survey of the municipality owned single family dwelling located in 27 Indiana Avenue,Queensbury,NY.These surveys will conform with the standards set forth in NYS Code Rule 56. Material sampling will involve the bulk sampling suspect of suspect asbestos containing building materials for laboratory analysis.As such,voids in building finishes will occur; we make every attempt to take samples in inconspicuous areas but it is ultimately the responsibility of others to fill voids in sampled materials. Surveying,sampling, handling,overnight shipping, PLM &TEM laboratory analysis and reporting for the Limited Renovation Asbestos Survey: $ 400.00-all lab fees billed per analyzed sample. Surveying,sampling, handling,overnight shipping, PLM &TEM laboratory analysis and reporting for the Limited Pre-Demolition Asbestos Survey. * $400.00 survey,sampling,&reporting. * Lab fees billed per analyzed sample: PLM 198.1 Analysis-$25/sample TEM 198.4 Analysis-$75/sample Report delivery is to be expected within 6 business days of sampling, barring extenuating circumstances. • $0.00 due at time of survey. • Remainder due at delivery of survey report. 48 hour lab analysis results available for 30%premium. Additional visits billed separately if/and required. In the event of a regulated asbestos building material is identified additional project monitoring,air sampling and clearance inspections maybe required by NYS Code Rule 56. Attach d to this proposal is a list of terms,conditions&limitations. \7 cr Date: 0Ryan Wil Asbestos Sampling & Handling License-879660/282890 Date: Representative-Town of Queensbury - INSPECTIONSLEARVU 518.832.9213 l ryan@clearvuinsnections.com I 18 Blackberry Lane,Queensbury,NY 12804 Town Of Queensbury John O'Brien Bay Road Queensbury, NY 12804 RE: Followup to asbestos survey proposal for 27 Indiana Avenue,Queensbury NY 12803 Per the walkthrough of the subject property,it is expected to have lab analysis fees in the area of $1,000.00-$1,500.00.This estimate is based upon the list of suspect asbestos containing building materials which are required to be sampled per NYS IICR 56-5.1(f)(1)(i) The lab fees are additional to the$400.00 fee for the site survey. ( Date: 06.13.2023 Ryan Wild Asbestos Sampling &Handling License-879660/282890 Lc- ir JUG , ?®? To�iv 3 BUI�p�GU& SBURY DEg PROGRESSIVE PROOREEWEp P.O.BOX 31260 DIRECT Auto TAMPA,FL 33631 NAIC Company Code: 11851 Policy Number: 940482980 Underwritten by: Progressive Advanced Insurance Co Policyholder: Ryan P Wild Page 1 of 1 June 14,2023 Customer Service 1-800-776-4737 24 hours a day,7 days a week Verification of Insurance for Ryan P Wild • This verification of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement,term or condition of any contract or other document with respect to which this verification of insurance may be issued or may pertain,the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of the policies. Please accept this letter as verification of insurance for this policy. Policy and driver information Policy number: 940482980 Policy state: New York ICC Code: 678 Policy period: Jan 22,2023-Jul 22,2023 There was no lapse in coverage during this policy period. Effective date: Jan 22,2023 Drivers: Ryan P Wild • Elizabeth M Wild Address: 18 Blackberry Ln Queensbury, NY 12804 Vehicle information Vehicle: 2022 GMC SIERRA C1500/K1500 • Vehicle identification number: 1 GTUUCED7NZ628224 Coverage information Liability To Others Bodily Injury Liability $100,000 each person/$300,000 each accident Property Damage Liability $100,000 each accident Mandatory Personal Injury Protection $50,000 each person Deductible: $0 Additional Personal Injury Protection-Full $50,000 each person Comprehensive Actual Cash Value Deductible: $500 Comprehensive Window Glass Deductible:$50 glass Collision Actual Cash Value Deductible: $500 Form VOI(07/13) • Request for Taxpayer Give Form to the Form (Rev.October2018) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service ►Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. ClearVU Inspections LLC 2 Business name/disregarded entity name,if different from above ai 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to m following seven boxes. ' certain entities,not individuals;see a instructions on page 3): g ❑✓ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation Partnership ❑Trust/estate p ❑ ai single-member LLC Exempt payee code(if any) ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)► `o 2 Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting w LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is y) a n ( code(if an another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of Its owner. ❑ Other(see instructions)► (Applies to accounts maintained outside the U.S.) d fn 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional) 18 Blackberry Lane co 6 City,state,and ZIP code Queensbury, NY, 12804 7 List account number(s)here(optional) Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid I Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other — — entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN,later. or Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. 8 7 — 2 5 7 2 4 7 6 Part II Certification • Under penalties of perjury,I certify that: 1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2.I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3.I am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid, acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part II,later. Sign Signature of 7(2 )--(?6 Here U.S.person► �� l Date► 4.26.2022 General Instructions •Form 1099-DIV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise •Form 1099-MISC(various types of income,prizes,awards,or gross noted. proceeds) Future developments.For the latest information about developments •Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and its instructions,such as legislation enacted transactions by brokers) after they were published,go to www.irs.gov/FormW9. •Form 1099-S(proceeds from real estate transactions) • Purpose of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption •Form 1099-A(acquisition or abandonment of secured property) taxpayer identification number(ATIN),or employer identification number (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an information return.Examples of information alien),to provide your correct TIN. returns include,but are not limited.to,the following. If you do not return Form W-9 to the requester with a TIN,you might •Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding, later. Cat.No.10231X Form W-9(Rev.10-2018) y A ® DATE(MMIDDM/YY) /1 CERTIFICATE OF LIABILITY INSURANCE 06/13/2023 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(les)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 Tiffany Sheffer NAME: Upstate Agency,LLC (aHCNN Eet): (518)932-0778 FAX(A/C No): (518)793-3627 103 Main Street E-MAIL Tiffany.Sheffer@upstateagency.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC q South Glens Falls NY 12803 INSURERA: Dryden Mutual Insurance Company 13919 INSURED INSURER B: Creative Spaces II LLC and Clearvu Inspections LLC • INSURER C: 18 Blackberry Ln INSURER D: INSURER E: • Queensbury NY 12804-1413 INSURERF: COVERAGES CERTIFICATE NUMBER: 2022-2023 Master 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 "ADDCSUBR POLICY EFF POLICY EXP LW TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERALUABILITY EA OCCURRENCE S 1,000,000 CLAIMS-MADE ' I OCCUR PREMISES(EaEoccu occurrence) S 50,000 LU _ MED EXP(Any one person) S 5,000 A Y CFT00030558 06/15/2022 06/15/2023 PERSONAL&ADV INJURY S Included GGE� PRCT ll EN'LAGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE S ^ 2,000,000 I POLICY n O- I I LOC PRODUCTS-COMP/OPAGG S 2.000,000 S JE OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) • ANY AUTO - • BODILY INJURY-(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY _ AUTOS ONLY (Per accident) S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATIONOTH- AND EMPLOYERS'LIABILITY Y/N I I E.L. STATUTE ER. ANY PROPRIETOR/PARTNER/EXECUTIVE N/A EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Location:27 Indiana Ave.,Queensbury,NY 12804 The Town of Queensbury is an additional insured with respect to general liability. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Queensbury ACCORDANCE WITH THE POLICY PROVISIONS. 742 Bay Rd AUTHORIZED REPRESENTATIVE Queensbury NY 12804 r I X.©198888-220015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD ,acoRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/13/2023 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 • NAME CT Tiffany Sheffer Upstate Agency,LLC PHONE (518)932-0778 (518)793-3627 (A/C,No,Ext): (A/C,No): 103 Main Street a-MAIL Tiffany.Sheffer@upstateagency.com INSURER(S)AFFORDING COVERAGE NAIC S South Glens Falls NY 12803 INSURERA: Dryden Mutual Insurance Company 13919 INSURED INSURER B: Creative Spaces II LLC and Clearvu Inspections LLC INSURER C: 18 Blackberry Ln INSURER D: INSURER E: Queensbury NY 12804-1413 INSURER F: COVERAGES CERTIFICATE NUMBER: 2023-2024 Master 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 AUUL-bUBH POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE S 1,000,000 • CLAIMS-MADE n OCCUR DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) 5 MED EXP(Any one person) $ 5.000 A Y CFT00030558 06/15/2023 06/15/2024 PERSONAL&ADV INJURY $ Included GEN'LAGGREGATE LIMIT APPLIES PER: • GENERALAGGREGATE S 2,000,000 X POLICY n jECOT- n LOC 2,000,000 PRODUCTS-COMP/OPAGG S OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person)• S OWNED SCHEDULED BODILYINJURY(Peraccident S _ AUTOS ONLY AUTOS ) HIRED NON-OWNED PROPERTY DAMAGE 5 _ AUTOS ONLY _ AUTOS ONLY .(Per accident) S UMBRELLALIAB _ OCCUR EACH OCCURRENCE _S EXCESS UAB CLAIMS-MADE AGGREGATE S DED RETENTION S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE n N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Location:27 Indiana Ave.,Queensbury,NY 12804 The Town of Queensbury is an additional insured with respect to general liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Queensbury ACCORDANCE WITH THE POLICY PROVISIONS. 742 Bay Rd AUTHORIZED REPRESENTATIVEE/ Queensbury NY 12804 67(. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD