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SIGN-661-2019 Walgreens TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development -Zoning Department (518) 761-8256 SIGN PERMIT Permit Number: SIGN-0661-2019 Tax Map No: 302.6-1-55.2 Permission is hereby granted to: Sign Studio,Inc. For property located at: 724 GLEN ST in the Town of Queensbury,to construct or place at the above locati n in accordance with application together with plot plans and other information hereto filed and approved and -n compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Type of onstruction Owner Name: Sign-Fre standing $0.00 Owner Address: Total Val e $0.00 Contractor or Builder's Name/ Address Elec cal Inspection Agency Plans&Specifications Freestanding(Monument)Sign Walgreens (replacing Rite Aid) 14.2 sq.ft. $ 42.60 PERMIT FEE PAID Dated at the Town of Queensbury; SIGNED BY: 0 y fo the Town of Queensbury. 0 Zoning Administrator Code Coin pflanrce and Worraea- zonal Sheet for Permit Use Queensbury Dept, of Community Devel pment Projectfor: �<<S ✓�� n M%n1.r,ti. _5,��� EnevGov He No. SI,KN 6&t-�ofq Applicant Name: �/�r�Cd�«n5 �i�©� Ll✓� �.� �w- ��y� Zoning Administrator Tax Map No. APPROVED Application Lot # House road,street 1 2019 Apartment Building No. Lot Size: - {` :. inq Administrator TOWN OF QUEENSBURY Mobile Home Park: Business Plaza: GUt rrcns Planned Unit Dev. Subdivision: Phase /Section Effective Year Zoning Designation Zoning Ordinance Prior to 1967, July 10 Subject to current setback requirements at time of development. Section 179-20-10,B Subsequent to Development of lots within subdivisions subsequent to July 10, 1967 shall use the Julv 10, 1967 setback requirements in place at the time of the approval of the subdivision. 1967 1982, June 11 1988,September 19 Corner lot rule Prior to Nov.23, 1992 approved subdivisions * (see note on back of form) 2002, April 9 2009, May 12 Town of Queensbury no longer regulates docks 8, boathouses on waters of Lake E_ff_ectiv_e Year 2013 George. A Building Permit is�till needed, but Planning and Zoning issues are not t applicable unless the project is on "our side" of the Mean-High-Water-Mark MHWM ). Applications for construction are regulated_ by the Lake George-Park Commission. �l�5ltroC, ��Yrvnu,+,,U�> Sin �r� o `✓� ►�1 ��` 4vM G ie t e^ Road Name Setbacks Exist!q Re wired Proposed Difference Front 1 Front 2 Side 1 " Side 2 Rear 1 _ Rear 2 Shoreline Travel Cooridor _ Overlay Zone _ Buffer Town of Queensbury Code Compliance and Informational Sheet for Permit Use _ Q;ueensbury Dept. of Community Development Yes No _ meets depth,width,&square footage requirements preexisting,nonconforming lot with proper setbacks required frontage on public road has required off-street parking permeable area is adequate (Requirement is %) building does not exceed maximum height (Max. ff.) _ Is lot in a Flood Zone? Floor Area Ratio worksheet required?Zone: WR-1 A * Corner Lot Information for Subdivisions Approved Prior to November 23, 1992 Section 179-30.1 which requires front yard setbacks on both roads for a comer lot was not enacted until November 23,1992. Therefore,prior to November 23, 1992 parcels within approved subdivisions have one (1) front yard,two (2) side yards,and one (1)rear yard setback. Review Type _ _ _ File No.. . .___.. ._... .._Aclion ._-.._ .. Resolution Date and Notes . - - _.. . ..... _._..—_...... Zoning Board of Appeals PlanningBoard--------- ------_.—_... ---._._—__ _.—.-- -----•__ ._..__..__. .._..._.._...--------. - TownBoard •-------------- ----- __._...__......._..---------•---....__._—... —.._-------•-•------_.....--------•---- Check List Pd Rec'd Notes - Local Law No.1,2013 effective Jan.28,2013 $850 new dwellings(per unit): SFD, Recreation Fee Paid duplexes and two-family,multi-family dwelling,apartments,condos,townhouses,or manufactured and modular homes. NOT included are,Mobile Homes,- _— Engineering Fee Paid Site Plan Maps on File - Subdivision Mylar Signed and Filed with Countv --- Application appears to conform to the requirements'of Section(s)of the local Town Code: Application requires additional review for the following: Zoning Board of Appeals Planning Board _ Town Board of Health _ Town Board for Mobile Home Outside of a Mobile Home Park Other _Reviewed by Staff Date —_ .Notes r t J Cross -may )� at�'l Town of Queensbury E C E i 1f E_1) Office Use Only Town of Queensbury Buildin & Codes , Received: SIGN PERMIT AP� VYlV"j�I.j,CCj�//�{�� p Tax Map ID: �VL.�iJvvi�� Permit No.: ZONING OFFICE �'��N Permit Fee: $ �2. Date September 1.7, 2019 Applicant Sign Studio, Inc.(Ron Levesque} Tax Map ID 302.6- 1 -55.2 Address 98 Niver Street, Suite #8 Zoning C T Cohoes, NY 12047 Property Owner Queensbury Fine,LLG Contractor/Agent:Sign Studio, inc. (Ron Levesque) Address 1529 Western Ave Ste 102 Address 98 Niver Street Suite #8 Albany, NY 12203 Cohoes NY 12047 Phone 518 862.0861 Phone 518.266 0877 Contact Person for Sign Code Compliance: Ronald Levesqu e Day Phone: 518.266.0877 Building Street Address: 724 Upper Glen Street Site Plan,Variance,or Subdivision Approvals SIGN F Location of proposed installation 724 Upper Glen Street, Town Of Queensbury Business Complex/Plaza/Mail name N/A Business name Wal reens Currents "Rite Aid" Type of Sign proposed Freestanding Sign - Existing - Reface If sign is to be Illuminated, indicate X intemal -_external _Incandescent neon ,X-other LED Modules Do signs currently exist on property? X Yes -_._No(if yes, list all existing signage) See Attached Brand Book Change ofword1copy From RITE AID PHARMACY to Wal reens Sign Wording/Copy Walgreens Sign Size Length 2' 0" x Widt1 7' 1 =Total sq.ft. 14.2 Sign Height(freestanding) 6' 0" OAH Color&Material to be used White/Red/BIDE!, 3/16" Polycarbonate/Acr lic This application creates a change in the New Face Panels Only following existing site conditions(fill in all Change in numter of signs from to applicable spaces) Change in setback for sign from to Change in size from to Change in height of sign from to Declaration: To the best of my knowledge, the statements contained in the application, together with the plans and specifications submitted,are a true and complete statement of all proposed work to ba done on the described premises and that all provisions of the Zoning Ordinance,and all other laws pertaining to the proposed work shall be complied with,whether specified or noted,and that such work is authorized by the owner. APPLICANT-PRINT NAME Ronald d. Levesque (Sign Studio Inc APPLICANT-SIGNATURE: Date: September 17, 2019 Declaration: I hereby authorize the appll t to place a sign my property or building: OWNER-PRINT NAME: OWNER-SIGNATURE: ``--�' Date: Town of Queensbury Building&Codes Sign Permit Application 518-761.8256 Site Identification MFOEVE) P�A 0("'T - I I-U,19 Q"--c- TOWN' O" N=-My I vLL ZONING OFFICE Vol 724 u p p 4A n u r l%",lVP , November Site Identification SITE PLAN SCOPE OF WORK NEW CHANNEL LETTERS PAINT EXISTING CANS CABINET SIGN +� S CABINET SIGN E� PYLON REFACE a REPLACEMENT FACE REMOVE 1 Daw.12-1&i6 'Pr J t N 'Store#19426 CUSTOMER APPROVALAn .. sealo: ea. NTS Addre ]24 Upper Glen St amp.,Spnw.e i1r '1 N C O R P O• A T E 0 �-- City I State' ZIP: �' RR Oueensbury,NY 12804 30 s 10whob b R-// A-*"-O\991CI RU6(1I15264 0a PM; Thefese H. CllentA �PProval: Date: — P1B SI0A194 Site Identification REPLACEMENT FACE EXISTING 85"O.D. 82"V.O. o O O > N N PROPOSED /�G1\REFACE SPECIFICATIONS: .177"WHITEACRYLIC FACE W/ RENT THIS SPA= 3M #3630-53 "CARDINAL RED" SCRIPT WALGREENS COPY. BACKGROUND TO REMAIN WHITE. PAINT CABINET DARK BRONZE 313 IMMIIIIIIIIIII 3M#3630.53 Cardinal RED D1:12-19-18 PrletN a:Store#19426 .-J�— .... OV C� SIGN CUSTOMER APPROVAL. 5 le: .Add a NTS 724 Upper Glen St I N C O ! I O R A T [ O ,Drawn: Clryl Statal Zlp: m RR l]ueensbury,NY 72804 1500 West F ba S1.Anahelm,CA 92902 (714)5".9144 FAX(714)S20-5-7 PM" Therese K COW Approval; Data: Site Identification REMOVE REMOVE Drive Thru Now - KIM, Law r I� Pharmacy AL r _ T Date. ProJeQ Name• _- �r�r /�w�s`/wO'�F� 11-'.9-1A •S10rBA 19426 CUSTOMER APPROVAL C� �YN Scale Atldress °^ _ NTS 724 Upper Glen St F M C O R P O R A T E O "—.RR C,tYjsW.jz(p:Qu—sbwy.NY 128M „ 1300 Weal E'l o 51.Anaheim,CA 94802 - --" )714)520-91"FAIL•(7141520-5947 PM: Theresa H. Clienl Approval: Dab: IdentificationSite p6 S.S.P.H.SCREWS PgUMU WAGNER JEWELRE TRIM CAP 5116'X 316'SLOTTED HOLE -SEE CHART FOR SIZE IN TOP OF ANGLE A4 ALUM.RETURNS ' STAPLED TO ACM BACK 1M-BRAKE FORMED ALUM.MOUNTING CUP .t]]02]93'REQACRYLIC FACE _____ SLOAN PRISM'RED'LEO ------ 3MM ACM BACKER _ 1 �--- SI16'0 THRU HOLE PRE-FINISHED MITE v Q MOUNTING CLIP DETAIL SH9"PAM ELECTRIC WALL BUSTER 2 W/10'OF WHP — .� ---------------- CARLING TYPE EXTERNAL 1 I I I DISCONNECT SWITCH I _--—��-% I I MOUNTING CHART- - - i 1 I 1M"aW PLATED STEEL .— SPACER 6 MOUNTING HARDWARE I _ THREADED ROD THRU WALL 1 I I I.-LAGS WITH SHIELDS (PROVIDED BY INSTALLE 1 1/6'LAG BOLTS I 1 �._____ : I 1 1M"TOGGLE BOLTS I I 1 I : I 1 NOTE: TRANSFORMERS X TO HOUSE I �IL n _______! 1)THREADED ROD WILL BE PROVIDED STANDARD POWER SUPPLIES-- --- ----.._ _..._.. -_.—..... __ 1 1 I I -ALLOTHERHARDWARE IS TO BE PROVIDED BY (PROVIDED BY INSTALLER) I I I II-_�JI�{gryyJ�-.�JI} THE INSTALLER AS RED. I I r I 21 DESIGN INTENDED FOR NOi GREATER THAN I I 3RD STORY MOUNTING-HIGHER ELEVATIONS 1 I 1 REQUIRE RENEW IW Xe'-D^LONG FLEXIBLE LIQUID TIGHT --------------- CONGUIT WHIP TO OWNER PROVIDED POWER TWO STEEL RIVET NUT N CNANN EL LETTER SECURED TO MOUNTING ANGLE-- --- W/14-.20 X i-LONG S.S.HEX HEAD BOLTS I _ _ �. --ACRYLIC FACES NB^BRAKE FORMED ALUM.MOUNTING CUP SECURED TO MOUNTING CUP .WALL WI IM"0%SIC LONG aNC-COATED STEEL XFX HEAD BOLTS ALL LETTER TO HAVE A MIR OF 13)WEEP HOLES --- TRIM SAP SEAM •ONE OF THREE TO SE AS CLOSE LOCATION TO BACK OF LETTER AS POSSIBLE WALL INSTALLATION HARDWARE TO BE PROVIDED BY INSTALLER -- 1 SECTION VIEW(TYR) n SEAM DETAIL 2 Walgreens Details Dak: Pro(ect N9m9• 12-19-18 51Gre#19628 USTO CMER APPROVAL COAST SIGN � Addr9w:- �- NTS 724 UPPerGbn St I N C O R P O R A T i 0 OnwRRR :CMIsm9lappueensbury,14Y 12804 1500 Wen Fm M St.A—I kI,CA 92882 M._._ CRMI ro9el: OM9: p14)320.9144 FAX:17141520.8947 I ThBro9A N APP IdentificationSite ••- Check InformationPermit requiredT Yes I INO I 10o awning signs count toward building sign square footage? Company Name: Coast Signs Purchase Oder l: Type of permit? yes No Project Manager. Theresa Heitkamp Due Dale: IlWmmauon Allowed? Yes No Maximum h'of sign akowed? 3100 W.Embasry St Zoning regulations forAwnings? Letterset allowed on top or on awning? ly. I No Anaheim,CA 921102 Permit required to re-skin?••IMPORTANT•• I Y. No Address PROJECT INFORMATION Address: 724 Upper Glen S[. ProjeR Name: Walgreens City,Rate,Zip: Queensbury NY,12804 Zoning Classification: Commercial intensive qty.allowed: Pylon(P) ,no Monument(M) Parcel Number: Code Attached? Iyes INo Max.ft': lurrsdiction: I If no,explain Overlay,Sign Plan,Spedal District. Hyperlink to modes if avaiWble: Permit to replace(aces? Can faces 6e replaced in nonwnforming sign? Yes No PROJECT NOTES Is a shared pylon sign required? Y I INO NOTES Ordinance Contact: POD Fax Number: Phone Number: Email add—, Physcal Address: DIRECTIMax.h'e Mu.OAH: Qty.allowed: Permitreq'dfarfasemplacemenls? Yes No Logos allowed? IN. I IPermit required? Yes No Internal Illumination Allowed? Y No Electoral Permit required? Yes No Required on plans? Ya NO Setback requirements? NOTES Permitting Contact: Phone Number. Email address: Physical Adress: Max.fts: Mac.GAH: Qty.allowed: Permit required? NOTES NOTES REQUIRED TO SECURE PERMITS& NS Haw square Tuotageallowance cakulated? Formula for Sign area Calculation: She plan to scale My- NO Wall sign englneeringreq'd Ya No a Multiple Shape? Elevaboni No rwt exceed 2D%pf[he".'re.of the wall or up[0 30 sq.fL, Prope ID number No ATM Drive-Thru sign engineering req'd Yes No whichever is less.Buildings lasted Aleast 100 linear ft Legal description No Drawings No irons the(con[properly are permitted to have a Pre-assigned UL numbers req'tl No Awnings engineering req'd Yes Nowall/roofsign at]00 sq.k.6alding with mare than 100Mac.W:Inclde Letter and linear h.from the front property are permitted to have ofauthorh numn No Landsnpe tan req'd Yes No Character Heights additional 10 sq.ftr of sign surface for each 10 h of Single Shape? letter by License,bontl req'd to permit Yet NO QN.allowed: Street Front Only? Yes No Type of License or Bond W Obtain Permit: LED allowed Jai—depth off mooch Multiples Per Elevation? Y No Building Dimensions raga on plans Yes No Gnfaces be replaced in ron-conforming sign without Roof Signs allowedY Yu IN. PamI required for face replacement? Yu No Back panels count towards square h7 lyes I Ift I ILogos on efts count towards wall sign? Yes No Perini[applications required bringing sign Into code Yes No Are Gbinet Signs allowed? Nontilluminated letters mount towards wall sign V. No SuMing ISipn Electrical I Does wdereq.ire a licensed el—lei..to NOTES Permit Jurisdiction perform the final wnnection Y No ary 1 1 Inspettions Required Y Ift SUBMITTAL METHODS:•PREFERRED Before installation type(;( Mail I JE—v In Person Onlim I After installation type(,) Time to secure permit Inspection C.M.ot permit Expiration I Phone Number 0 of sets rep d lDravAngs sneered Email or Unk Installer need to be onsite for inspectionsY No Installer need to provide any equipment Yes I IN. NOTE$ Data: P J•ct Nam•• 12-19-18 8lore p 19428 CUSTOMER APPROVAL Cjjjj S Scale'NTS Addraa. 724 Upper Glen St �_-- � 1 NI C O R Is O R A T IF R Drawn: CRyIstateIZip: —� RR QuaerMbury,NV 12806 ' 150(Weal 0-9144 St.Anaheim,-5•�FM. Client Approval: D.M. —J b ()19)520-9144 FAX-(714)52o.Sa67 Tflxesa H. COAST SIGN I N C O k P O R A T E D Landlord Authorization anti Consent Form Walgreens Store: 19426 Address: 724 Upper Glen St. Queensbury, NY owner'4114/ Laudlord Contact: Name; Cam.[l '���rJlt�-1-/i Jt- �y� Company: Vanguard Fine LLC. Address: 1529 Western Ave. Ste. 102 Albany,NY 12203 Phone: 519862-0861 Lmail: bfeinman(of vanguardfine.com I ain it drily atithorized representative for the.ohct a referenced address. In n1y capacity as Landlord/landlord's represent Live, I do hereby authorize Coast Sign, Inc. to perform all work associated with the above referenced location. I approve of the sign drawing submitted. I further authorize Coast Sign or its representative to obtain a permit in their name. All permits for the sign program hereby consented by Landlord. Costs associated with permit acquisition and signage installation will be at the expense of Walgreens. Authorized 13y (Name, Title) C,_-)4e, Authorization Signature bated Please e-mail this completed form to: Rachel Duran Project Manager f �ltitLtttr�n�lnos�atri©r1gum Coast Sign, Incdrpoialod 1500 VV l"Inbassy St. Alin in, ( A 92fi02 Phan€1 714 990 106b The sion indsialry's fodder ifl rarpora(+a brandinF1. West southwest ieuthear,t soutlraas! nR4fltitlarlerp Moll 0461"1inO Pn,iect Management Proiect 10011411e111ent Project Management Manufacturing 1hoo Wf:tz ilhaAay Hb 1909 L.Hay lid, No.9 12H 8331 1:.Wolkor Springs Ln,No.302 1698 I'etimeler Rd. Anailxjnl,CA 91d®k Chanulier,AZ 85225 Knoxville,TN 37923 Grur.nvillo,SC 29606-5244 i111n8N 114 W 0144 Idiom!480 926 5780 Wilnur 805 693 0101 10imie H84 277 8187 Ie11'iid ki11)Iid4Y fax 480 632 9/00 fax 866 693 0184 fax H04 217 8445 nationwide I roA0141011,C)om ORK Workers' CERTIFICATE OF sure Compensation Board NYS WORKERS'COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured SIGN STUDIO INC 98 NIVER ST STE 8 (518)266-0877 COHOES,NY 12047 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically 48816346 limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security Number 14-1793851 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Employers Preferred Insurance Co 3b.Policy Number of entity listed in box"la": EIG269041901 Town of Queensbury Attn:Building and Codes 3c.Policy effective period: 742 Bay Road Queensbury,NY 12804 08/18/19 to 08/18/20 3d.The Proprietor,Partners or Executive Officers are: ❑included.(Only check box if all partners/officers included) ®all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1a"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2'. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. 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 policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Mary P. Storti (Print name of authorized representative or licensed agent of insurance carrier) Approved by: C>SkZR&_� 09/25/19 (Signature) (Date) Title: Operations Manager Telephone Number of authorized representative or licensed agent of insurance carrier: 877-266-6850 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT autorized to issue it. C-105.2(9-17) www.wcb.ny.gov THESI-1 OP ID: CB CERTIFICATE OF LIABILITY INSURANCE -.Al.(M 09/1 /207/20 9 19 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 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). CONTAPRODUCER NAME: Sean Culnan Culnan Insurance Agency,LLC. PHONE - 16C N.Greenbush Rd (A/C.N0. o E1:518-326-1191 ac No Troy,NY 12180 E-MAIL Sean Culnan INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Erie Insurance Company 26263 INSURED The Sign Studio, Inc. INSURER B: 1 Ingalls Ave Troy,NY 12180 INSURER C INSURER D: 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 POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY Q375150416 01/0112019 01/01/2020 PREMISES Ea occurrence $ 1,000,000 CLAIMS-MADE x i OCCUR MED EXP(Any one person) $ 10,000 X ContractualLiab PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 17 POLICY X PROJEC LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident A X ANY AUTO Q125840017 12/08/2018 12/08/2019 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X PROPERTY DAMAGE $ HIRED AUTOS NON-OWNED AUTOS PER ACCIDENT X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE Q255170263 01/0112019 01/01/2020 AGGREGATE $ 1,000,000 DED I X RETENTION$ 10000 $ WORKERS COMPENSATION WC ST 'OER R AND EMPLOYERS'LIABILITY Y/N T RY LIMITMITS ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ A Lease/Rent Equipm. Q375150416 01101/2019 01/01/1020(Blanket 350,000 I I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION TOWNQUE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Queensbu THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN rY ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Building and Codes 742 Bay Road AUTHORIZED REPRESENTATIVE Queensbury, NY 12804 Sean Culnan ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD