HomeMy WebLinkAboutLong Pond Pictures ELIZABETH A.NEVILLE,MMC ® ®� Town Hall,53095 Main Road
TOWN CLERK �� P.O.Box 1179
CA Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER ® ®�. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER ,( www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
FILMING/STILL- PHOTOGRAPHY
PERMIT
Issued to: LONG POND PICTURES
' Quincy Morris
Date(s), Time(s) and Location:
MAY 23, 2019 5:30 AM-11:30 AM Route 25, East Marion
Permit No. 61
Issue Date: 5/21/19
This permit is for permission to use Town Maintained
Roads and Properties ONLY
Elizabeth A.Neville
Southold Town Clerk
r
. T
Form W-9 Request for Taxpayer Give Form to the
(Rev.December 2014) requester. Do not
Department of the Treasury Identification Number and Certification send to the IRS.
Internal Revenue Service
1 Name(as shown on your income tax return).Name is required on this line,do not leave this line blank.
TOWN OF SOUTHOLD
N 2 Business name/disregarded entity name,if different from above
N
t)
CZ
°- 3 Check appropriate box for federal tax classification,check only one of the following seven boxes. 4 Exemptions(codes apply only to
c certain entities,not individuals;see
❑Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership El Trust/estate instructions on page 3)
d c single-member LLC Exempt payee code(f any)A 1 6 355 4
Limited liability company Enter the tax classification(C=C corporation,S=S corporation,P=partnership)0,❑ Exemption from FATCA reporting
o Note.For a single-member LLC that is disregarded,do not check LLC,check the appropriate box in the line above for
+• y the tax classification of the single-member owner. code(if any)
ac MUNICIPALITY rp
[ Other(see instructions)► IY UNICIPALITY (Applies to accounts mamfamed oufsde the US)
va- 5 Address(number,street,and apt or suite no Requester's name and address(optional)
U
Q 53095 MAIN ROAD, PO BOX 1179
6 City,state,and ZIP code
U) SOUTHOLD, NY 11971
7 List account numbers)here(optional)
Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding.For individuals,this is generally your social security number( However,for
page _m —
resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other
entities,it Is your employer identification number(EIN).If you do not have a number,see Now to get a
TIN on page 3. or
Note.If the account Is In more than one name,see the Instructions for line 1 and the chart on page 4 for Employer identification number
guidelines on whose number to enter.
T11 6 0 0 1 1 1 9 3 1 9
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. 1 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. 1 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 inter t and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the
Instructions on page 3.
Sign Signature of
Here U.S.person► Date►
Supe V11 or, cott A. Russell.Form 1098(home mortgage interest),1098-E(student loan interest),1098-T
General Instructions (tuition)
Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt)
Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property)
as legislation enacted after we release it)is at www irs gov/fw9.
Use Form W-9 only if you are a U.S.person(including a resident alien),to
Purpose of Form provide your correct TIN
An individual or entity Form W-9 requester)who is required to file an information ff you do not return Form W-9 to the requester with a TIN,you might be subject
return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding See What is backup withholdmg2 on page 2
which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you:
number([TIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are wading for a number
identification number(EIN),to report on an information return the amount paid to to be issued),
you,or other amount reportable on an information return Examples of information
returns include,but are not limited to,the following 2.Certify that you are not subject to backup withholding,or
•Form 1099-INT Interest earned or paid) 3 Claim exemption from backup withholding if you are a U.S exempt payee.If
•Form 1099-DIV dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a r business
person,your allocable share of
( 9 any partnership income from a U.S.trade or business is not subject to the
•Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and
•Form 1099-B(stock or mutual fund sales and certain other transactions by 4 Certify that FATCA code(s)entered on this form(f any)indicating that you are
brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on
•Form 1099-S(proceeds from real estate transactions) page 2 for further information
•Form 1099-K(merchant card and third party network transactions)
Cat No.10231X Form W-9(Rev.12-2014)
Yom\
TOWN CLERK'S CHECKLIST FOR FILMING PERMIT'
NOTE: All payments must be cash or certified check
Applicant: a U%Y1C-Q Mon-I-s
Date Received: S - � --
1 - ' ,
Completed application
V $100 nonrefundable application fee
Certificate of insurance that evidences a public liability insurance policy
covering the town as an additional insured in the amount of$1,000,000
(one million dollars)per occurrence for the duration of the filming or still
photography.
Indemnification agreement stating the applicant agrees to assume all
liability for and will indemnify and hold the town harmless of and free
from any and all damages that occur to persons or property by reason of
said filming or still photography.
Forward completed application to Chief of Police for approval or
disapproval and determination if Traffic Control Fee is required
a/ Approved
Disapproved
No Fee Required
—� Fee in the amount of$ d S-00 required
Forward certificate of insurance and indemnification agreement to Town
Attorney for approval
Approved
Disapproved
COLLECT FEES AS FOLLOWS:
Permit Fees (Prior to issuance of permit):
Film Fee - $100 per day of each day covered by the permit
Cleanup deposit: Separate certified check for$250 for each day covered
/ by the permit.
✓ Traffic control fee - $1000 for each day covered by the permit if required
by the Chief of Police. NOTE: Additional funds may be required by
Police if it is determined that$1000 per day fee will be expended prior to
the termination of the permit period.
o\1�R 7
Beach Parking fee - $10 per vehicle, per day between May I and
September 30.
ISSUED PERMIT
Countersign application
Issue permit with name of applicant, locations(s), date(s), and time(s)
v
NOTIFICATION of ISSUED PERMIT
Chief of Police
Chief Building Inspector
Fire Marshal
Code Enforcement Officer
Superintendent of Highways
Superintendent of Parks and Recreation
REQUEST FOR EXTENSION OF PERMIT
Forward extension permit request to Chief of Police
If granted, collect additional $100 per day filming fee
Amend permit to indicate granted extension period
COMPLETION OF PERMIT PERIOD-
Chief of Police to provide applicant with statement of cost for providing
Traffic Control and police coverage. (Refund overpayment or collect for
additional costs within 30 days of termination of permit)
Superintendent of Highways inspections locations listed on permit and
determine if cleanup efforts by town personnel is required.
*If cleanup is required, Superintendent will provide Town Clerk
with a statement of actual costs. (Refund overpayment or collect
for additional costs within 30 days of termination of permit)
*If not cleanup is required, Superintendent of Highways will notify
Town Clerk and Town Clerk will remit the $250 certified check to
applicant.
RECEIVED
14
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ELIZABETH A.N VILLE,MMC ." _ M T w 111511,;9b`91Qq
5 Main Road
TOWN CLEF ,_ .. ,; g. ' P.O.Box 1179
t , .w,..yR „„a, w,•.,
•; .r:' mm-~ , 4 t-. S0Uth8fdt A 11971
° �
REGISTRAR OF VITAL STATISTICS s.�° ! °•�.�y,•f• �.;° : Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER � � =r� r www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER `
a
OFFICE OF THE TOWN CLERKi
TOWN OF SOUTHOLD
APPLICATION FOR FILMING/STILL PHOTOGRAPH
PERMIT NO:
Please Print or Type
APPLICATION DATE: J JS
NAME OF APPLICANT: G _ ._ _ (^ x
MAILING ADDRESS: �U
PHONE: BUSINESS:. �S' l'I HOME:
NAME OF ORGANIZATION/COMPANY.:, . __1 GAU C
MAILING ADDRESS: wpf 0 ire.- eS+
PHONE: FAX:
DESCRIBE TYPE OF ACTIVITY(e.g. Motion Picture, Commercial, T lievision. Catalog,Magazine, etc.):
_c
DATES)AND TIME(S) OF PROPOSED FILMING/PHOTOGRAPHY:
PROPOSED LOCATION(S)OF FILMING/PHOTOGRAPHY: (attach additional sheet, if necessa )
S Q-e ems.. ._
NAME OF PERSON IN CHARGE AT SITE:
NUMBER OF PERSONS AT LOCATION (cast& crew included):
NUMBER AND TYPE OF VEHICLES AT LOCATION:
TYPE OF SPECIAL EQUIPMENT:
ANY SPECIAL R UIREMENTS: _ - -- d
Signature Return to: Southold Town Clerk
Southold Town Hall
53095 Main Road a
P.O. Box 1179
Southold,NY 11971 Y
TO: OFFICE OF THE TOWN CLERK
FROM: LONG POND PICTURES
RE: FILM APPLICATION for LONG POND PICTURES
5/15/19
TYPE OF ACTIVITY:
Motion Picture Filming
-Low Budget Independent Feature Film
LOCATIONS/DATES AND TIMES OF PROPOSED FILMING:
May 21"-Orient Point @ Orient Point County Park 6am-9am,Truman Beach 9a—1pm
May t"—Rt. 25 between Beach Cove Rd and Truman Beach (7am-1pm Driving Shots. Intermittent
Traffic Control)
NAME OF PERSON IN CHARGE AT SITE:
(39
UUt1 ��� �� � � a1L� G1��e��t3C�ans
NUMBER OF PERSONS AT LOCATION: �J
25
NUMBER&TYPE OF VEHICLES AT LOCATION
8-10 vehicles
2—16 ft cube trucks
INDEMNIFICATION AGREEMENT
TOWN OF SOUTHOLD
FILMING/STILL PHOTOGRAPHY PERMIT
The Applicant shall indemnify and hold harmless the Town from and against all
suits, claims,demands or actions for any damage and/or injury sustained or alleged
to be sustained by any party or parties in connection with the performance of
filming or still photography by the Applicant, his employees or agents or any
subcontractor and in case of any such action brought against the Town,the
applicant shall immediately take charge of and defend the same at his own cost and
expense. In addition, the Applicant will name the Town as an additional insured on
any applicable policies.
5-h
Si Ure Dat
kA1ftC'-V' Mn (-Q--�
Printed name r
LocA A- Mq-x--
Title
DATE(MWDD/YYYY)
Q �® CERTIFICATE OF LIABILITY INSURANCE
05/15/2019
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 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
ME: Amanda Mo r0
Film'Emporium, Inc. M914 833-2433 FAX No:
1890 Palmer Ave#403 E-MAIL Ex
Larchmont, NY 10538 ADDRESS: amanda@filmemporium.com
INSURERS AFFORDING COVERAGE NAIC#
Phone No 914 833-2433 Fax No INSURER A• EFM-Empire Fire and Marine Insurance Company 21326
INSURED INSURER B: NAS-North American Specialty Insurance Company 29874
Long Pond Pictures, Inc. INSURER C.ZII-Zurich American Insurance Company of Illinois 27855
32 Washington Square W#4E
New York, NY 10011 INSURER D:
INSURER E:
Phone No 8326054129 Fax NO. INSURER F
COVERAGES CERTIFICATE NUMBER:812912 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 POLICY NUMBER MWDD/YYY MM/DD/YYY
EFM X COMMERCIAL GENERAL LIABILITY EN0981419-00 04/30/2019 04/28/2020 EACH OCCURRENCE $ 1,000,000
DAMAGE T' RENTED
CLAIMS-MADE ERI OCCUR X PREMISES Ea occurrence) $ 100,000
MED EXP(Any one person) $ 5.00
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 1,000,000
X POLICY L-1JECT F� LOC PRODUCTS-COMP/OP AGG $ 1,000,000
OTHER $
ND
EFM AUTOMOBILE LIABILITY EN0981419-00 04/30/2019 04/28/2020 (CEO,acccidentSINGLE LIMIT $ 1,000,000 000000
ANY AUTO X BODILY INJURY(Per person) $ Included
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ Included
NAS X AHIRED NON-OWNED
UTOS ONLY X AUTOS ONLY EKN2001864-00 04/30/2019 04/28/2020 PeOPEcRdTe DAMAGE_P�'Max $ 125,000
X AUTO PHYSICAL (10$
nAMAQP
UMBRELLA LIAB HOCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
ZII WORKERS COMPENSATION WC1130792-00 04/30/2019 04/28/2020 X STATUTE. OTH-
ER
AND EMPLOYERS'LIABILITY
Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE N/A EL EACH ACCIDENT $ 1,000,00
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) Proof of Workers E L DISEASE-EA EMPLOYEE $ 1,000,00
Dyes, IPTIONescribe under --Compensation Insuranceonl EL DISEASE-POLICY LIMIT $ 1 OQODDD
DESCRIPTION OF OPERATIONS below
NAS Inland Marine EKN2001864-00 04/30/2019 04/28/2020 See Attached
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES
Certificate Holder Is named as an Additional Insured and Loss Payee as their Interests may appear Production Sometime Other Than Now
All coverages expire at 12 01 a m Standard Time.
CERTIFICATE HOLDER CANCELLATION
Town of Southold Southold Town Hall SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
53095 Main Rd PO Box 1179 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Southold, NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS.
United States Of America
AUTHORIZED REPRESENTATIVE /1
Phone No Fax No
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
This certificate of Insurance does not affirmatively or negatively amend,extend,or alter the coverage afforded by the Insurance policy
DATE(MMIDDIYY)*
ADDITIONAL COVERAGE DETAILS 05/15/2019
INSURED Long Pond Pictures, Inc
The following is attached to and made part of certificate number 812912
Policy Details Coverage Limit Deductible
Inland Marine
Company North American Specialty Insurance Company
Policy Number EKN2001864-00
*Period. 04/30/2019-04/28/2020.364 Day(s)
Rented Equipment 450,000 2,500
Owned Equipment Excluded
Rented Props,Sets,Wardrobe 100,000 2,000
Rented Furs,Jewelry,Art&Antiques Coverage Excluded
Negative Film,Videotape and Digitalized Image 100,000
Faulty Stock,Camera&Processing 100,000 5,000
Faulty Stock,Camera&Processing-Broad Form Excluded
Library Stock Coverage Excluded
Extra Expense 100,000 2,500
Third Party Property Damage 1,000,000 2,500
Office Contents 25,000 1,000
Cast Coverage
Cast Extra Expense Excluded
Cast Covered Person Extension(no sickness) Excluded
Cast Covered Person Extension Aggregate(sickness) Excluded
Cast Covered Person Extension Per Person(sickness) Excluded
Cast Family Bereavement Extension Excluded
Cast Essential Person Excluded
Animal Death,Illness,Injury Excluded
Animal Extra Expense Excluded
Hired/Non-Owned Physical Damage-Aggregate 500,000
Hired/Non-Owned Physical Damage-Per Vehicle 125,000 10%of loss,$1,500 minimum,
$7,500 maximum
Rental Cost Reimbursement Excluded
Accounts Receivable Excluded
Valuable Papers and Records Excluded
Money&Securities Excluded
Civil Authority Excluded
Agency And Talent Re-Shoot Costs Excluded
Strikes or Civil Protest Excluded
Waiver of Subrogation Excluded
Coverage Extension Endorsement
Coverage Extension Endorsement Included 500
Accounts Receivable 25,000
Valuable Papers and Records 25,000
Debris Removal 50,000
EDP(Electronic Data Processing Equipment) 5,000
Employee dishonesty 5,000
Fire Department Service Charges 25,000
Fire Equipment Recharge 10,000
Outdoor Property(total) 25,000
Outdoor Property(per Item) 5,000
APM-CERT-DETAILS 1205 Certificate Number 812912
Rudder, Lynda
From: Flatley, Martin
Sent: Friday, May 31, 2019 12:55 PM
To: Rudder, Lynda
Subject: Re: film
Yes
Sent from my Verizon, Samsung Galaxy smartphone
-------- Original message --------
From: "Rudder, Lynda" <lynda.rudder@town.southold.ny.us>
Date: 5/31/19 10:31 AM (GMT-05:00)
To: "Flatley, Martin" <mflatley@town.southold.ny.us>
Subject: film
-------- Original message --------
From: "Rudder, Lynda" <lynda.rudder@town.southold.ny.us>
Date: 5/31/19 10:31 AM (GMT-05:00)
To: "Flatley, Martin" <mflatley@town.southold.ny.us>
Subject: film
Can I return Quincy's money?
i
Doroski, Bonnie
From: Flatley, Martin
Sent: Monday, May 20, 2019 3:24 PM
To: Doroski, Bonnie
Subject: RE: Quincy filming
I have been in conversation with him since Friday and worked out our coverage of the filming. For his shoot tomorrow,
there would only be about one hour for us to assistNm as most of it takes place at Trumans Beach (he has permission
from them).Thursday we would be assigning two officers from 0530-1130 hrs to the shoot. I estimate that it will cost
our department$1,301.05 for our involvement. I believe he might be waiting for a Lyn to notify him of permit-don't
know about deposit.This is his emailguincylocations@gmail.com
Martin Flatley,Chief.of Police
Southold Town Police Department
41405 State Route 25,
Peconic, New York 11958
631-765-3115
From: Doroski, Bonnie
Sent: Monday, May 20, 2019 3:12 PM
To: Flatley, Martin <mflatlev@town.southold.nv.us>
Subject: Quincy filming
Importance: High
Chief,
Lynnie forwarded me your email about the filming that's supposed to take place tomorrow, I haven't heard anything
from him though, so no filming permit has been issued. And more importantly...no money has been received from him
with the exception of the application fee. Have you heard anything from him? ti
�'e�u2ie �. Donaal¢i ,
Deputy Town Clerk
Southold Town Clerk's Office
53095 Main Road
Southold, NY 11971
(631) 765-1800 office
(631)765-6145 fax
1
Doroski, Bonnie
From: Rudder, Lynda
Sent: Friday, May 17, 2019 12:03 PM
To: Doroski, Bonnie
Subject: FW: Movie Shoot
From: Flatley, Martin
Sent: Friday, May 17, 2019. 11:29 AM
To: Rudder, Lynda -
Cc: Neville, Elizabeth
Subject: Movie Shoot
Lyn,
I just met with Quincy from the upcoming movieshoot in East Marion and worked out the details of the shoot.
Apparently they will only need us for an hour,on May,21 and then from 0530-1130 hrs. on May 23. 1 believe we will
handle Tuesday with our cars on the�road since it is such a small window. On Thursday, we will be assigning two officers
to the shoot from 0530-1130. 1 estimate this will cost our department appx. $1,500 to cover. I would imagine Quincy will
be calling regarding the permit being approved as he was asking about it when I dropped him off.
Martin Flatley,Chief of Police
Southold Town Police Department
41405 State Route 25
Peconic, New York 11958
631-765-3115
1
Vendor No Check No.
'own of Southold, New York - Payment Voucher
VendorNameVendor Address Entered by
c�o � M+ es �, Y�� Audit Date
Vendor Telephone fiber ,y
1 Town Clerk
Vendor Contact
C, ��loYriS ` Z 0001
Invoice Invoict Invoice Net Purchase Order
Number Date- Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number
c
1 l 5
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14 A I rn
I I
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Payee Certification Department Certification
The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me
does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly
been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions
due and owing,and that taxes om which the Town is exempt are excluded. or discrepancies noted,a=entis
igna Trtle Stat e rn
Company Name Date 10- Titl Date (0:-t
Southold Town Board - Letter Board Meeting of June 4, 2019
RESOLUTION 2019-523 Item # 5.29
o
ADOPTED DOC ID: 15299
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2019-523' WAS
ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON
JUNE 492019:
WHEREAS Long Pond Pictures supplied the Town of Southold with a refundable Clean-up
Deposit fee in the amount of$250.00 and a Traffic Control fee estimate of$1,301.50 and
WHEREAS the Southold Town Police Chief, Martin Flatley, has informed the Town Clerk's
office that the Clean-up Deposit Fee may be refunded, and
WHEREAS the Southold Town Police Chief, Martin Flatley has provided the Town Clerk's
office with an actual Department expense for the film in the amount of$1,301.50, now therefore
be it
RESOLVED that Town Board of the Town of Southold hereby authorizes a refund be issued in
the total amount of $250.00 to Long Pond Productions, c/o Quincy Morris, 244 5th Avenue,
#F 12,New York,NY 10001.
Elizabeth A. Neville
Southold Town Clerk
RESULT: ADOPTED [UNANIMOUS]
MOVER: James Dinizio Jr, Councilman
SECONDER:Jill Doherty, Councilwoman
AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Evans, Russell
Generated June 5, 2019 Page 45
Town of Southold
P0Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 05/21/19 Receipt#: 254435
Quantity Transactions Reference Subtotal
1 Clean-Up Deposit 61-clean $25000
1 Daily Filming Permit 61-fee $10000
1 Traffic Control Fee 61-traffic control $1,301.50
Total Paid: $1,651.50
Notes:
Payment Type Amount Paid By
Credit Card-Ref# $1,651.50 Long, Pond Pictures
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Long, Pond Pictures
Quincy Morris
32 Washington Square W
New York, NY 10011
Clerk ID: BONNIED Internal ID 61-traffic control