HomeMy WebLinkAboutLaurel Lake Vineyard 2019-8 Southold Town Board- Letter Board Meeting of March 26,2019
RESOLUTION 2019-264 Item# 5.15
ADOPTED DOC ID: 15042
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2019-264 WAS
ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON
MARCH 26, 2019:
RESOLVED that the Town Board of the Town of Southold hereby grants permission to
Christopher Richards, East End Events Catering to hold Special Event 2019-8 at the Laurel Lake
Vineyard, 3165 Main Road, Laurel,New York as applied for in Application LLV 1 a-e for five (5)
wedding events: June 1, June 29, July 5,August 17, and August 24, 2019 from 6:00 PM to
11:00 PM provided they adhere to all conditions on the application and permit and to the Town
of Southold Policy for Special Events.
Elizabeth A.Neville
Southold Town Clerk
RESULT: ADOPTED [UNANIMOUS]
MOVER: William P. Ruland, Councilman
SECONDER:Louisa P. Evans, Justice
AYES: Dinizio Jr, Ruland,Doherty, Ghosio, Evans, Russell
Generated March 27, 2019 Page 31 ,
(THIS PERMIT MUST BE KEPT ON THE PREMISES)
Name of Event : Private Wedding
Permit No. : LLV #1a
Type(s) of Event : Wedding
Location of Event : Laurel Lake Vineyard
Date(s) of Event : June 1., 2019
Time of Event : 6:00 PM - 11:00 PM
TOWN OF SOUTHOLD
SPECIAL EVEM. T
PERMIT
(THIS PERMIT MUST BE DEPT ON THE PREMISES)
Name of Event : Private Wedding
Permit No. : LLV #1b
Types)`of Event : Wedding
Location of Event : Laurel Lake Vineyard
Date(s) of Event : June 29, 2019
Time of Event_: 6:00 PM - 11:00 PM
4
TOWN OF SOUTHOLD
SPECIAL EVENT
PERMN7
(THIS PERMIT MUST BE KEPT ON THE PREMISES)
Name of Event-: Private Wedding
Permit No. : LLV #1c
Type(s) of Event.: Wedding
Location of Event : laurel Lake Vineyard
Date(s) of Event : July 5, 2019
Time of Event : 6:00 PM - 11:00 PM
x
UOMM OF 80UUH (DLD
�31PIECUAL U
FIERN017
(THIS PERMIT MUST BE KEPT ON THE PREMISES)
Name of Event : Private Wedding
Permit No. : LLV #1d
Type(s) of Event : Wedding
Location of Event Laurel Lake Vineyard
Date(s) of Event : August 17,, 2019
Time of Event : 6:00 PM - 11:00 PM
TOWN OF SOUTHOLD
SPECRAL EVENT
PERMIT
(TMS PERMIT MUST BE KEPT ON THE PREMISES)
Name of Event : Private Wedding
Permit No. : LLV#1e
Types' of°Event: ' Wedding
Location of Event : Laurel Lake Vineyard
Date(s)-of Event : August 24, 2019
Time of Event : 6:00 PM - 11:00 PM
R
RECEIVE®
APPLICATION FOR A PERMIT TO HOLD A
Southold Town Clerk SPECIAL EVENT
Please provide ALL of the information requested below.Incomplete applications WILL NOT be
reviewed. , �-
Special Event Permit# 2019-8 Applicant(s)name:�,�(lp, '�?r
Date of Submission - f q—I q Name of Event li\1 I� Q15
SCTM#'s 1000-Section Iof -1-2-31 Block- Lot(s)
Dates of Each Event: 6111W(q - * ,5w
If Multiple Dates are requested,applicant must give all information for all dates.
Nature of Event: eidd 1�'l V' 7
(Please attacla detailed description f EACH event to this application)
Time Period(Hours)of Event: From 11
®U m to I I
<
Town Services requested: ( )Yes (�)No If yes,Describe Police Dept. Highway Dept.
Describe Services �p�)
Maximum Number of Persons Attending At One Time: Number of cars expected Y V
Is a Tent or other temporary structure being used? [ ]Yes [�]No If yes provide size(s)
W'11 food be served?[�1]Yes [ ]No If yes provide number and name(s)of food endor s) ��
, r���rk()I Suffolk County permit#(s) �(2S
Will other vendors be on the premises during the event?[ ]Yes [�No If yes how many? Describe
Type of vendor(s) ,, ^ ,�
Property Owner(name/address): �-�t�A�,l a W rp-
Contact Person and Contact Tel.# 0111'15 g 1'PjM 1' 5 ` )� + C✓
e-mail addressC C4 9 ® l
Event Location: Street-Hamlet Address: 31 b5 MW N _
SCTM# ®U Q - s ( I Z5- [-2--,?)" 1
Will any services be requested [ ]Yes [ No. If Yes describe Police Highway Other:
Mailing Address to Send Event Permit to: 3 16 5 l 4�
WJamls o:� lkvt� �Vxvds 2pig
�y I on I� � i � 2oiq fhrluCle + � LwV�aaQ IhDn� �4,
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Have any of the development rights been soldt the Town of Southold[ ]Yes [ ]�No and/or Suffolk
County Agricultural Program? [ ]Yes [ No If yes to either or both,also indicate on the
attached plan the boundaries of the reserved area upon which the event will take place.
YOU MUST ATTACH A PARKING/EVENT PLAN TO THIS APPLICATION IF THE
EXPECTED ATTENDANCE IS 300 OR MORE PEOPLE,YOU MUST ALSO ATTACH A
TRAFFIC CONTROL PLAN(see next page)
A Parking/Event Plan may be a survey, site plan and/or aerial view (for example Google Earth) of
the subiect property.INDICATE ON THE PLAN ALL of the following information:
A parking/event plan showing:
(1) The size of the property and its location in relation to abutting streets or highways.
(2) The size and location of any existing building(s)or structure(s)that will be in operation
during the course of the event and any proposed building,structure,or signs to be erected
temporarily for the event.
(3) The location of the stage or tents,if any.
(4) The designated areas of use for spectators,exhibitors,vendors,employees and
organizers.
(5) Location of all entries and exits.
(6) The location of all fire extinguishers and other fire safety equipment.
(7) The location of all temporary utilities to be installed for the event,if any.
(8) The layout of any parking area for automobiles and other vehicles and the means of
ingress and egress for such parking areas. The parking spaces must allow for 300 sq.ft.
per car.
(9) A traffic control plan for vehicles entering and leaving the site for the proposed event.
(10) Plan for the use of live outdoor music,loudspeakers and other sounds which will be used,
if any,and the type and location of speakers and other audio equipment.
(11) A description of emergency access and facilities related to the event.
(12) Provisions to dispose of any garbage,trash,rubbish or other refuse.
(13) Location and description of any additional lighting to be utilized in conjunction with the
event.
(14) Location of sanitary facilities on site.
Traffic Control Plan
Events for three hundred(300)or more people also require submission and approval of a traffic control
plan,acceptable to the Town of Southold,AND a qualified traffic controller must be provided.Please
attached a written description and/or notate on the parking event plan the following: 1)Who will be
conducting traffic,2)Where they will be stationed on site,3)How they will direct the entrance,
circulation,parking,and exiting of cars on site,and 4)Contact information for use by Southold Town
Police.
OWNER'S SIGNATURE:
I am the Owner of the Property where this event is to be held and I agree to comply with tl:e laws,
rules,regulations, conditions, and requirements of the Code of the Town of Southold,including but
not limited to the conditions listed below,as well as all other applicable agency rules and regulations
pertaining to the activities under this event. Furthermore,I hereby swear or affirm that the
information contained herein and attachments hereto are true and correct to the best of my knowledge,
and agree to provide notice to the Town immediately should there be any material changes regarding
to this application..
Furthermore,I hereby authorize Code Enforcement Personnel of the Town of Southold to enter the
property during the hours of the permitted special event to make any and all inspections necessary in
connection wit
h this Special Event.
N � n Sf A&wLPri ature of Owner
Pnnt name of Authorized Person/Representative Signature of Authorized Person/Representative
PERMISSION IS HEREBY GRANTED,SUBJECT TO THE FOLLOWING CONDITIONS:
1. By acceptance of this permit, applicant agrees to adequately supervise and direct all parking to be on
the premises or at another site, and to provide parking assistants and any additional traffic controls
necessary for this event. Parking is strictly prohibited on ANY Town, County or State Roads or Rights of
Way.
2. Traffic control at events for three hundred(300) or more people shall be provided by a qualified traffic
controller in accordance with the attached,approved traffic control plan.
3. One "on-premises" sign not larger than six (6) square feet in size may be displayed not longer than
thirty (30) days before this event, and removed immediately after the event. Directional parking signs
shall be adequately displayed.
4. Applicant indemnifies and holds harmless the Town of Southold from all claims, damages, expenses,
suits and losses including but not limited to attorney's fees arising from activities under this permit.
5. Tent proposals must receive permit approval from the Southold Town Building Inspector before
placement on the property and must meet all fire and safety codes.
6. This permit is valid only for the time, date, place and use specified above, and for the designated
event. Each additional day will require a separate permit application, fee, and related documents for
review,etc.at least 60 business days prior to the scheduled event.
7. Adequate temporary sanitary facilities must be provided by applicant for this event and applicant
agrees to remove the temporary facilities from the premises within 48 hours after the day of the event.
8. On-site food preparation is NOT permitted, although food may be catered subject to all Suffolk
County Department of Health regulations.
9. NO activities associated with this event, including but not limited to parking, ingress/egress/access,
tent(s)or temporary structure(s),or temporary sanitary facilities,shall be conducted on Town of Southold
Purchase of Development Rights land.
10. NO activities associated with this event, including but not limited to parking, ingress/egress/access,
tents or temporary structure(s), or temporary sanitary facilities, shall be conducted on Suffolk County
Purchase of Development Rights land without a permit issued by the Suffolk County Farmland
Committee.
11. Issuance of this permit does not authorize in any manner the occupancy of any building exceeding the
legal limitations under the fire code or other codes which would prohibit such increased occupancy.
12. Access shall be provided for emergency vehicles,to all public assembly areas,all buildings, all work
areas and any additional area where emergencies may occur. Two emergency-fire exits and exit paths
from the building(s) on the property, to a public way or remote safe area, shall remain open and
unobstructed at all times.
13. Owner assures full compliance with all fire,safety,building,and other Town laws.
14. Music,when outdoors,is required to stop at the time specified in the permit.Placement of the
speakers must be in a location that affords the greatest protection from noise intrusion upon adjacent
properties.
15. Owner will allow access to Code Enforcement Personnel of the Town of Southold during the
hours of the special event to make any and all inspections necessary in connection with this
Special Event.
16. ADDITIONAL CONDITIONS:
ANY VIOLATIONS IN CONNECTION WITH THE CONDITIONS LISTED HEREIN WILL
TERMINATE THIS PERMIT.
APPROVED Town of Southold
Resolution Number: 2019-264 Date Issued: 3/27/19
CERTIFICATE OF INSURANCE ISSUE DATE 3/12/2019
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).
PRODUCER INSURER(S)AFFORDING COVERAGE
Northeast Agencies, Inc
6467 Main Street-Suite 104 INSURER A: Colony Insurance
Buffalo, NY 14221
INSURER B: N/A
INSURED INSURER C:
East End Event Caterers Inc
c/o Christopher Richards INSURER D:
71 Washington Ave
Patchogue, NY 11772 INSURER E: N/A
COVERAGES
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.
INSF TYPE OF POLICY POLICY POLICY LIMITS
LTR INSURANCE NUMBER EFFECTIVE DATE EXPIRATION DATE
A GENERAL LIABILITY GL4233880 3/13/2019 3/13/2020 GENERAL AGGREGATE 2,000,000
PRODUCTS-COM/OP AGG. 1,000,000
PERSONAL i£ADV INJURY 1,000,000
EACH OCCURRENCE 1,000,000
DAMAGE PREM RENTED TO YOU 100,000
MED EXPENSE(Any one person) 5,000
B PERSONAL LIABILITY COMBINED SINGLE LIMIT
MEDICAL PAYMENTS TO OTHERS
C EXCESS LIABILITY EACH OCCURRENCE
AGGREGATE
D
E PROPERTY BUILDING
CONTENTS
BUSINESS INCOME
THE INSURER(S) NAMED HEREIN IS (ARE) NOT LICENSED BY THE STATE OF NEW YORK, NOT SUBJECT TO ITS
SUPERVISION,AND IN THE EVENT OF THE INSOLVENCY OF THE INSURER(S), NOT PROTECTED BY THE NEW YORK
STATE SECURITY FUNDS. THE POLICY MAY NOT BE SUBJECT TO ALL OF THE REGULATIONS OF THE
DEPARTMENT OF FINANCIAL SERVICES PERTAINING TO POLICY FORMS.
DESCRIPTION OF OPERATIONS/SPECIALTY ITEMS
Caterers-Laurel Lake Vineyards and the Town of Southold are named as additional insureds with respect to general liability. Event Dates: 05/01/19-11/01/19
CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
Laurel Lake Vineyards BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
3165 Main Rd ACCORDANCE WITH THE POLICY PROVISIONS.
Laurel,NY 11948 AUTHORIZED SIGNATURE
PERMITS TO OPERATE A FOOD ESTABLISHMENT AND
PERMIT FEE PAYMENTS ARE NOT TRANSFERABLE.
Notify the Bureau of Public Health Protection of any change of
ownership,type of business activity,business name,or billing
address by calling 631-852-5999 Permits become void upon
change of ownership.New,owners must apply and pay for a new
permit pnor to beginning operation Operating without a valid
permit may subject you to legal action,including a hearing,fines
and possible suspension of the operating permit
CSS AMERICAN GRILL
CSS AMERICAN GRILUEAST END E
71 WASHINGTON AVENUE
PATCHOGUE,NY 11772
_ DETACH PERMIT HERE AND DISPLAY PROMINENTLY TO THE PUBLIC
Suffolk County Department of Health Services
SVZN 9E-LLQ LaICS LTOMA.4IQ4,MD,A4i{,M3L MSVJ 360 Yaphank Avenue Suite 2A
suPFouccOWN EXEC— CCM% ONSR Yaphank,NY 11980
831-852-5999
sU2 . O rrY www.suffolkcountyny.gov/health
r n��rnr-1rT OFo��n:.r,l�sExacss
PERMIT Facility ID FA0003152
Account ID AR0007491
TO OPERATE A FOOD ESTABLISHMENT ' Issued: 2/15/2019
CXS AMERICAN GRILL/EAST END E
10095 MAIN RD UNIT 1 W
MATTITUCK, NY 11952
OWNER NAME: CSS AMERICAN GRILL. LLC
Restaurant Seats=0 Permit ID Number: PT0002999 Code Variance
Exterior Seats=0 Mechanical Dishwasher Required
Catering Seats=0 Valid From 2/15/2019 To 3/31/2020 Off-Premises Catering Approved
Bar Seats=0
Total Seats=80
This permit will expire upon the date speed or upon a change of ownership.
This permit is NOT transferrable and is granted subject to compliance with the provisions of Article 13 of the Suffolk County Sanitary Code and all applicable state,local,
and municipal laws,ordinances,codes,rules,and regulations.
THIS PERMIT MUST BE PROMINENTLY DISPLAYED TO THE PUBLIC
• Ao J,
pro
Door r" D
i`
Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 03/14/19 Receipt#: 252161
Quantity Transactions Reference Subtotal
1 Event Fee LLV1a-e $15000
Total Paid: $150.00
Notes: LLV1
a. 6/1/19
b. 6/29/19
c. 7/5/2019
d 8/17/19
e. 8/24/19
Payment Type Amount Paid By
CK#17564 $150.00 Laurel, Lake Vineyards
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Laurel, Lake Vineyards
3165 Main Rd.
Laurel, NY 11948
Clerk ID: LYNDAR internal ID LLV1a-e
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TOWN OF SOUTHOLD
Town Code Chapter 205 "Public Entertainment and Special Events"
SPECIAL EVENT PERMIT INSTRUCTIONS AND APPLICATION FORM
Applications for a Special Event Permit are subject to an inter-departmental coordinated review by the
Southold Town Board,Town Attorney,Town Assessors,Land Preservation,Building,Planning,Zoning
Board of Appeals and Police Departments,and the Suffolk County Planning Commission.
Application fee: $150.00 per application. Up to six (6)multiple events of the same type, occurring over
a period of three months,may be permitted on one(1)application for a fee of$150.00. However,specific
details of each event must be included with this application.
All applications must be submitted at least 60 business days before the event. Applicants
are encouraged to submit applications as early as possible.
Any completed application that is not submitted 60 or more business days prior to the scheduled
event may be rejected or subiect to a late processing fee of$250.00 by the Office of the Town Clerk,
unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town
Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing.
The Committee will obtain comments on all applications from relevant Town, County and/or State
agencies and will forward completed applications to the Town Board with a recommendation as to
whether to grant or deny the application.
The Town reserves the right to request additional information from an applicant to address issues related
to the health,safety,and welfare of the community.
When is a Permit Required?
All Special Events,per Southold Town Code Article I,Section 205-2(Definitions)must obtain a permit.
Occasional events on private residential properties hosted by the owner thereof that are by invitation such
as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits.
Any use of residential propgM for profit,such as a venue for weddings or other events is prohibited.
This application is deemed complete once all the following requirements are submitted to the Town
Clerk: Please indicate submission of the following by checking off the boxes and signing below.
[�A completed application form signed by the owner and the event manager. Applications without
property owner's signature/approval will be rejected.
EE: Is the application being submitted at least 60 days before the event M/Yes No
If Y
IfYes,Fee of$ 16000D has been submitted
ElIf No,Fee of$ has been submitted
The applicant/owner of the property where the special event is proposed to take place must provide a
certificate of insurance not less than 2 million dollars naming the Town of Southold as an additional
insured
A Parkin /Event Plan: consisting of a survey, site plan and/or aerial view of the subject property that
includes the locations of on-site parking, sanitary facilities, and tents or other temporary structure(s).
(See application form for details)
Events for three hundred (300) or more people require submission and approval of a traffic control
plan acceptable to the Town of Southold AND a qualified traffic controller must be provided at the
Vivent. (See application form for details)
signature of Property Owner on the application authorizing Code Enforcement Personnel of the Town
1� P Y pP g
of Southold to enter the subject premises during the hours of the event to ensure compliance with any
and all special event permit conditions.
My signature below affirms that I have submitted all the information required above in connection
with my application.
Dated Sitture
Activities associated with outdoor public events are strictly prohibited from taking place on land
preserved through the sale of development rights to the Town of Southold, and can only take place on
land preserved through the sale of development rights to the County of Suffolk with a permit issued by
the Suffolk County Farmland Committee.
If food is to be sewed, it must be catered and prepared off-site by food vendors who hold a permit to
operate issued by the Suffolk County Bureau of Public Health Food Protection Unit.
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V . I SOUTOLD,NY. !1971
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APPROVED BY
:� $ PLANNING BOARD TOTAL AREA =22938 aeras
n V TOWN OF SOUTHOLD CATAGORJESSITE A = 2.060 Acres
0c 1196
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04ZECESSED 75WT.INCANDESANT,EXT.196H HAT f kE V�� --� ^}_� `t s, Ow
[c 674 1161 4OWT.2M FLORESANr fSOFFIr MOUHTI ' rQ/PQ- • �' -
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RETAIL 1700 s*11• LOT COVERAGE i `•! Baas S(',(e •-"� & f(LC• ` o Z
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LL INDUSTRIAL 1600 s.lf. I
I E OFFICE 1100 sglL TOTAL AREA 23.00 Acres 1,00/,860$711. i '1', 23o cOUryL „-�-�..� SQZII, 3 FOLK CORD LTO z Q
STORAGE-WINERY BLDG 3500 aq.11. BULDlNG
8,000 sq./L I �' _} Nj�'
AGISCUL TURAL-STORAGE BLDG.2600 sq.11. I I
PALO S LOT COVERAGE 0.01 1%
SPACES
1700 aq.1L/200 rq.-q-11. B.5 `S
LANDSCAPING I X 1 _ •- ,
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LL#WSTRIAL /Boo sq.11./500 sgJ1. 36 SAIVTARY RL-0f.�VB j OwAK
OFp7CE 1100 sq IL/100 sq U. 11.0 GROUND WATER MANAGEMENT ZONE IV 20 Acres2ess WeNandsl•300gp,d=6000 gp.d. —_—CASE N0.96-/76
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" SPACES REOUgTEO 266 OFFICE 1100 aµ/1. = 0.06 al./s Jf. 66 d. I sw•saiLrrua �.
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SPACES SUPPLIED 44 STORAGE-AGRICER_TURAL BLDG. I „crrr m
2600 sq./f.= 004 gallsq/L f04 gpd. I __ �___ __ �� - waeovEo roxDoxslxuerrox ONLY
Zr=GE CALCULATED FLOW 667 gpd. I IAT LAUREL RL�.DAVG LOVE AC a- ---1 T =y�nrr. __ UD-94-o> 647 a.Z
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leooF AREA-Maw BUILDw6 8500 sq.R. I T(�V OF SOUTHOLD — T ` 11E W1^T� w
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esoo•0.4z 3570 ea./L 7ro Gays Flow 667=2= 1334 Gpd. S K FOUNT Y IVY a�TRAFFICIFLOW
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PROVIQE 4-10'/f,dlo pooh f 6/t.deep - 667 gpd,/1.5 gpd s41R 445 s7/f.o1 sJderall •u1Y 5,1996 I DRIVEWAY SECTION FRaAt E BFtGR a o 1
a+xau.amours acn ]� L
ROOF AREA-STORAGE BUILDING 3500 sq./f 445'sq./A/25H sq./b/vert,/l.1B'd/a.poo!' 16 V.F. I >E' +7tvasn' nE rarsrrls.c avua or�erAcc moDm ssr< f S�GruTaaEL�r.
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• 900 go! Spec Tank 8 S'Na Lea Mq Pool 12 It deep I 29 PERCHERON LANE T v y. a s"+ i;2 a
PROVIDE 4-'8 h.d'a.pools B f!.deep Estimated DmIr Warlaroler lrom Process SYsfem- 75 gpd. i I I ROSL YN HEIGHTS,N.Y 11577 ,• i I i 4X04
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TYPE A qor antJl-a ers�.sE P.O.BOX 909 .I
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CW aF MM 1AIE' SOUr1JOL0, ivy. 11971 '
85-292
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