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HomeMy WebLinkAboutPellegrini Vineyards 2019-21 (7MS PERMIT MUST BE KEPT ON THE PREMISES) Name of Event : Private Wedding Permit No. : PEL 3a Tvpe('s)_of Even Wedding Location_ofEvent : Pellegrini Vineyards Date(s) of Event : August 3,, 2019 Time-of Event : 5:30 p.m. to 11:00 p.m. 70MR9 QXF 20UUHOLID 12YIEHY (THIS PERMff MUST BE KEPT ON THE PREWSES) Name of Event : Private Wedding Permit No. : PEL 3b Type(s) of-Event : Wedding Location of Event : Pellegrini Vineyards Date(s) of Event : September 28,, 2019 Time of Event : 5:30 p.m. to 11:00 p.m. VTD mAtl��, mll ,i'lll-1 Q) F C101-: ��FEC'HAL IFERIguy I . (THIS PERMIT MUST BE KEPT ON ThE PREMISES) Name of Event : Private Wedding Permit,No. PEL 3c Tvpe(s) of Event : Wedding Location of Event : Pellegrini Vineyards Date(s) of Event : October 4., 2019 Time of Event : 5:36 p.m. to 11:00 p.m. (MS PERMIT MUST BE KEPT ON THE PREMISES) Name of Event : Private Wedding Permit No. : PEL 3d, TyMsl,of Event, : Wedding Location of-Event : Pellegrin! Vineyards Dates) of Event : October 5, 2019 TimeofEvent : 5:30 p.m. to 11:00 p.m. f"u+itar ` RESOLUTION 2019-438 14 -w ADOPTED DOC ID: 15213 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2019-438 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MAY 7, 2019: RESOLVED that the Town Board of the Town of Southold hereby granted permission to Pellegrini Vineyards,tolhold Special Event 2019-21 at.Pcllegrini.Vineyards, 23005,}Main Road, Cuteliogue,New York as applied for in Application.P-el3a-f for-S ( wedding events on August 3, Sept. 28, October 4, and'Oct 5,2019,from 530 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. e Elizabeth A.Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: William P. Ruland, Councilman SECONDER:Louisa P. Evans, Justice AYES: Dinizio Jr, Ruland, Doherty, Evans, Russell ABSENT: Robert Ghosio -0 . RECEIVED `y APR 2 2 2019 -?e.� 3p„�el Southold Town Clerk 90 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 refected or subject to a late processing fee of$250.00 by the Office of the Town Clerk, unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health,safety, and welfare of the community. When is a Permit Required? All Special Events,per Southold Town Code Article I,Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. AU use of residential property for profit such as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk: Please indicate submission of the following by checking off the boxes and signing below. ❑ A completed application form signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. �/❑� FEE: Is the application being submitted at least 60 days before the event[ ] Yes [ J No Ll If Yes,Fee of$_ S (� (J 0 has been submitted ❑ If 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 Parking(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 event. (See application form for details) ❑ Signature of Property Owner on the application authorizing Code Enforcement Personnel of the Town 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 Sign Activities associated with outdoor public events are strictly prohibited front 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 served, 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: RECEIVED APPLICATION FOR A PERMIT TO HOLD A APA 2 2 2019 SPECIAL EVENT �e( .306` Please provide ALL of the information requested below.Incomplete applications MULSl'QK+P� d Town Clerk reviewed. Special Event Permit# A0 ® Applicant(s)name:p����y Date of Submission f Name of Event d �i" Y� `� SCTM#'s 1000-Section 0 1' Block- t Lot(s) 7 Dates of Each Event: 7A 8- f /a e S If Multiple Dates are requested,applicant must give all information for all dates. Nature of Event: (Please attach a detailed description of EACH event to this application) Time Period(Hours)of Event: From 5 ` ® to Town Services requested: ( )Yes X No If yes,Describe Police Dept. Highway Dept. Describe Services A111f Maximum Number of Persons Attending At One Time: t Number of cars expected (5 Is a Tent or other temporary structure being used?[� Yes [ ]No If yes provide size(s) .5C7 �S Will food be sere d?[ Yes [ ]No .If yes provide number and name(s)of food vendor(s) tfer 2✓`e0 F—�iiJe•�7'S Suffolk County permit#(s) Will other vendors be on the premises during the event?[>4 Yes [ ]No If yes how many? z Describe Type ofvendor(s) / �t'� (fee ���'� �d�r rS f Property Owner(name/address): �`fet ��!! i���` °4 5�5 e7l"/ VI-c " AV- i�'VAC t0V Ar �� Gontact.Person and ContactTcl.# .`t csGc� 6 7 3`f e-mail address 4d' 4 e-!1 Event Location: Street-Hamlet Address: ) ©�Sr 6 [ ���t n C. le '�` f'`� /'" y SCTM# Will any services be requested [ ]Yes A-No. If Yes describe Police Highway Other: Mailing Address to Send Event Permit to: eol-e 1 d'`e Have any of the development rights been sold to the Town of Southold [ ]Yes [KNo and/or Suffolk County Agricultural Program? [ ]Yes [,'C 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 PARIING/EVENT PLAN TO THIS APPLICATION IF THE EXPECTED ATTENDANCE IS 300 OR MORE PEOPLE YOU MUST ALSO ATTACH A TRAFFIC CONTROL PLAN(see next Daae) .. A Parkinz/Event Plan may be a survey, site plan and/or aerial view(for example Goozle Earth) of the subiect property. INDICATE ON THE PLAN ALL of the followinn information: A parkinglevent 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 SIGNA T URE. I am the Owner of the Property where this event is to be held and I agree to comply with the 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 tare and correct to the best of my knowledge, and agree to provide notice to the Town in mediately 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 perrnitted special event to make any and all inspections necessary in connection with this Special Event: a mo , Print name of Owner Signature of Wer Jc4�R_ L--. Lq/`rtef��._� Print name of Authorized Person/Representative Signature of Aut zed 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, CounN 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 narking, ingress/egress/access, tent(s)or temporary structures) 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, tent(s) or temporary structures) 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 EnforcementPersonnel 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: Date Issued: 11-26-97 SEE SEC NO 102 yy 04.2699 k, MATCH- LIN _______.�—_._____ 0420-00 MATCH -- ------ FOR PCL No- SEE ae2w / 05.17-00 ---�---- — �i SEE SEC.NO- os-26430 '+ 102-04-0061 060500 W 24.3 140300 ey 24.4 39A �L 12-27.00 342AiP 0314-01d 04-12411 i 2y (76WN OF5DUTHOLD ,�0 ,p d pEVELOPMENfRIGMS) � 00.08-01 1x25-01 I 242 A 11-08-01 r 01.14-02 o31z-03 a, � 25 NP D4-30-03 I'U 28 !� 10-09-03 I r 12A(c) 12- W I 3 m $ ry1 N D4-2605 •� ^y D4-63-08 I � a � ty OB-10-05 I � p �, �+ •� 12-15-00 132 .11 ,tp 12-27-00 I 42.1A @ 01.22-07 I PECONIC LAND TRUST,INC 4 1' 0605-07 & b 91 -0 01-21.09 I 90-oFSOVpfOLO 0322-10 oE�DPMFMp1GtR5) ' r ,�, 05-7413 O5-22-13 I �`Kfv�11` 4 23 S.BA(c) Z 'I IIf" to U, W T).3A(c) ry •rz, ,�� r jD + w 13 1 r p 62A NS 241 Iw O $ 1.3A(c) t 1A 1 w w 21 28 �sA 1 L 295- ';U _ 10.1 ° °01gm 53.OA(c) 210 p 229 2.11 w •;) �: 1.4A so 6 230 q (- - 212 MA 1.OA a 213 G� 7 4A &7 38 4 d 1.OA y ,e 38AA(c) 1.8A OCG �-,�- '). PECOMO 214 . --- -- - 1ANOTRUST wNOFsounro ..�-Ae;', - vri' 2.3[I \y ry 215 DEVELpFMExfwbxrs) -T 67A(c) P4 z o .,r s m, 218 8.8 9s' 1.1A 2 f� 24.7A(c) 7oM� 6 7.1 13A 9 sp 25A• d Y ,1$ PNI3tFA 1 4y� nn 40 I 5 ` 20A 6 0 J, 39 3.3. •a a tm 89 'P 38A g •�O�5 ar � 1.7A(c) PECOMCIANOTRUST w m 2FOR PCL NO.10A - FOR PCL NO. SEE SEC.NO. )) FOR PCL NO. 1 I SEE SEC.NO. , 11601.003 3 BEE SEC.NO. 37 ° 1.1A 1 111E SEC.N 11601-007__ 11A(c)r ? _ ---- N30B 682; TCH —_--__Z_____ —� eu =Z-2e ,0,t cr. acm+omm u+. — aopoL.�-+� m o�uath. Lwwdn>Rxu+ —_�_� umnt.memsw-ra (21) ena�e O ,w..cnau. --a+ Nadoweu+—star Uff.---AL— E a„ecw.Uo u. — E �.�.•. a`aoe.�su. anc'antn. .._—� wr.�wanuu.--wn-- N y�mla�va 23 WA(a).12tA — D se.wwmaw —y-- D� '°""�'"""' RECEIVED b APR 16,2.018 — ti ZONING BOARD OFAPPEALS Z4,X jw ryia� f u, • v[n,yudglelds w " • Patty .;, ' •'gip , ' ,moi• -. �•ViaeStorW t� b2thsooais •. office • :, ``� ' .. • - Pcllcgrini;Rtin�`Y ,ineyards' - ' . v0mtaad - ' ' Cutchogoo,, 1935 r 631-7A- main Road RECEIVED _..... ...._ ... ... . .. .. �... _ .._. . _. . APR 7 2 .17 • . _..... _ ZONING BOARD OF APPEALS PROPERTY OWM( RS, •futSrl oH..,. „•a•rHi4'/w•a •�• _ f t}�" �^f• f-....t-���� � • `• L� p add f i—f ��='--''��:ri..�j�/:.:�.i: �.':•v./;i. a cc • i •u a�..v.a w.m.n. •m.H.>, .. i Y���i'.i...•��•�: � f/•5.: ,''`••:•`:���%�%`: � r '•r ••:•��;'.f.;:,.�j��� ' f(•!''/'%{r'l •�j�/ ; ' i of trfa twaua.w a wsr ,facet{,Ys tarty ,\ i •1-::•!y-i'f/.••- •:;\ ♦ ••• ,{/% '•• W LU � Y a.1/ 7 7;• % W�� rte` 0 �U r •✓+!�wawws t•a.fsa ''••� W. ' 0'•A„-M•ra:rtra aj'•W»•{•0-L•�s•<a1a •,.<. •a.f"«qa 4•+w t•+..r st• KEY •PLANi ��1�"�� 1t� 7^a 1N• " •ff•a•w \MSN•lu"MM btay^••,ow.Oi�1.y Hea .. 1 7 �Iwlao 8&4M . «•f--•"'f "7•:j j w)�f�o-:E:n•.F fn`T• rid 1 •a s j fir. S f r' ,• PARKING CALULATIONS SITE DATA •1 ' -. -S• a ,f is . ..w. 11�- _ V �•'• [.S-•It_e � .ti t.t a i•«,a•a.a1 M•-V. Ao• •�j�aw^�-..,SS�MI •�'.L:%•,y�l,�I ••I , • —C-43 ori • ~— t.W tw...a! «•S a..,'•Lo�* ..««w• i•HlI«I�t lH]• ),o-,.•t ��s..�. j:.'ai .`.:�t«� ::'.:••rte... �a'•r '.�:.a�:.t... :,,..: � � • V �G ': �V�F�Lr fJ"i' DCTHI,I. Wf.f •fur u� taf" t.M J•.•; t:u:' n•.1•c nc�taatNG DETAIL•- • 1-1I[•f aVF 1 MLY.Mtl•f.f.«LbwW1a �a ' aim R&W RECENED ! ""of •�y�y���� f•trt tbly :A • ���"f- !t":"''R aLQCiAill4i��i�ra.�r �••�•••••, .lrtf � %,..u•a rw w tf APR T 200 _' �•1 � � — � i :.tis u.na K p.ta rTa r a I 11955 - - �a• __ '-L�� L'.?' � - SITEZONING BOARD OFA TIO M , �_� w,...:t..:• ate:.,. -• i v "ll...��m..+n'c7aa .bca-.aE I � .52 r... Z �M GOiJGR ETF fA�/T Sco2E ! //l �j /J 'I x„•-."):rA•-f•o ?OI.�.��D:i�. O / ��^V �`C • i• ay I? SP-2:: i - O N m ZONING BOARD OF FiP{xfALS co —'6 Date:4/19/19 To:Town of Southold—Special Event Committee Re:Special Event Permit Applications 2019 From: Pellegrini Vineyards Mary, Last year,the Southold Town Zoning Board of Appeals requested a bit more detail regarding the wedding/private events we hold here at Pellegrini. In an effort to help expedite this process, here is some additional details of each event. - 6/14/19—North Fork Theater—Private Event—6-10pm—125 people o East End Events—Permit ID#- PT0002999 - 6/22/19—Vaccaro/Fonseca wedding—6-11pm—120 people o Christopher Michael Catering - Permit ID#-PT0006206 - 7/13/19—Pugliese/Deathwick wedding—6-11pm—180 people o East End Events—Permit ID#- PT0002999 - 7/27/19—Klatsky—Private Event —6-11pm—85 people o East End Events—Permit ID#-PT0002999 - 8/24/19—Hegemiller wedding—6-11pm—150 people o East End Events —Permit ID#- PT0002999 - 8/31/19—Levine/Menszak wedding—5-10pm—120 people o East End Events—Permit ID#- PT0002999 - 9/1/19—Lazar/Inoa wedding—6-11pm—100 people o East End Events—Permit ID#- PT0002999 - 9/6/19—Matthews/Khanin wedding—6-11pm—80 people o East End Events - Permit ID#- PT0002999 - 9/7/19—Siskind/Perruzza wedding—6-11pm-150 people o East End Events- Permit ID#- PT0002999 - 9/14/19—Gilman/Morici wedding—6-11pm - 150 people o East End Events- Permit ID#- PT0002999 - 9/21/19—Connolley/Dow wedding—6-11pm -125 people o East End Events- Permit ID#- PT0002999 - 9/27/19—Armstron/Graff wedding—6-11pm- 120 people o East End Events -Permit ID#- PT0002999 - 9/28/19—Blagar/Coates wedding—6-11pm—170 people o East End Events - Permit ID#- PT0002999 - 10/4/19—Anderson/Sperin wedding—160 people o East End Events - Permit ID#- PT0002999 10/5/19—Reindl/Abt wedding—110People o East End Events - Permit ID#- PT0002999 1 .5 67 e T COO 2, 9 Sincerely, John W. Larsen General Manager Pellegrini Vineyards 631-734-4111 x 207 JohnL@PellegriniVineyards.com ,a`coorzo CERTIFICATE OF LIABILITY INSURANCE 04/22/201.9 9 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 NAME: Farm Family Casualty Insurance Company MCO.N Ex 631-727-7767 AIC No,631-727-7941 18 First Street E-MAIL SS: eric.kirk@farm-family.com Riverhead, NY 11901 INSURERS AFFORDING COVERAGE NAIC# INSURERA Farm Family Casualty Insurance 13803 INSURED INSURER B; Pellegrini Vineyards LLC INSURERC: 23005 Main Road INSURER D: INSURER E: Cutchogue NY 11395 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 SUBR POLICY EFF POLICY EXP LIMITS LTR INSD YYY POLICY NUMBER MM/DDIY /Y MM/DDYYY A X COMMERCIAL GENERAL LIABILITY 3152G3148 05/03/201805/03/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 1X OCCUR 31521_6607 05/25/2018 05/25/2019 PAMAGE ToREM SES Ea occur RENTEante $ X Llgour Liability 31521_6608 05/25/2018 05/25/2019 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY 1 JERCOT F7 LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER $ B AUTOMOBILE LIABILITY 3152C4531 06/15/2017 06/15/2018 cOMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident C X UMBRELLA LIAB OCCUR 3152138064 05/03/2018 05/03/2019 EACH OCCURRENCE $ 3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PERTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEM BER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I I I E.L DISEASE-POLICY LIMIT $ D Liquor Liability3152F6081 08/22/20108/22/201 500,000/1,000,000 8 9 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) All upcoming events. CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 Route 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1 179 ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATIVE Kirk Associates LTD @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Untitled Map Legend 23005 Main ' • Write a description for your map. "o,I, ,- KAapinfo Saved Objpcts M E � �23005'Main Rd Google Earth 0 2018 Google �`a 4.. 1000 ft Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 04/24/19 Receipt#: 253343 Quantity Transactions Reference Subtotal 1 Event Fee Pella-f $150.00 1 Event Fee Pelta-f $150.00 1 Event Fee Pel3a-d $150.00 Total Paid: $450.00 Notes: Payment Type Amount Paid By CK#6388 $450.00 Pellegrini, Vineyards Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 f Name: Pellegrini, Vineyards 23005 Main Rd. Cutchogue, NY 11935 Clerk ID: LYNDAR Internal ID, Pel3a-d