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Home My WebLink AboutELIH 2019-29 Southold Town Board - Letter Board Meeting of June 18, 2019 A RESOLUTION 2019-537 Item # 5.5 yT ADOPTED DOC ID: 15311 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2019-537 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 18, 2019: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Eastern Long Island Hospital to hold Special Event 2019-29 at 13355 County Road 48, Cutchogue,New York as applied for in Application ELI1 a for an event on August 10, 2019 from 4:00pm to 10:00 pm provided they adhere to all conditions on the application, 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 l Generated June 19, 2019 Page 16 7(0WH OF SOUTHOLD (THIS PERMIT MUST BE KEPT ON THE PREMISES) Name of Event : 2019 Summer Gala Permit No. : ELI #1a Tvne(ilof"Event : Fundraiser Location of Event 13355 Middle Road, CR 48., Cutchogue Qat6(sj,,of'Event August 10, 2019 Time of Event : 4:00 PM to 10:00 PM RECEIVE® 1 5 2019 MAY Southold Towyn Clerk a0`o,-X� E LT ICL_ 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 subject to a late Processing fee of$250.00 by the Office of the Town Clerk unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk. The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health, safety, and welfare of the community. When is a Permit Required? All Special Events,per Southold Town Code Article I, Section 205-2(Definitions) must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residential property for profit, such as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk: Please indicate submission of the following by checking off the boxes and signing below. 1 A completed application form signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. El FEE: Is the application being submitted at least 60 days before the event/Yds [ ] No ❑ If Yes,Fee of$ has been submitted ❑ If No,Fee of$ has been submitted Updated 8/7/2018 /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 u 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) ElEvents for three hundred (300) or more people require submission and approval of a traffic control l— 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 a7T7 'obove in connection with my application. � ► 5 a Da ed lare atu Activities associated with outdoor public etly prohibited from taking place on land preserved through the sale of development rn 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. Updated 8/7/2018 RECEIVED M AY 1 5 2019 Southold Town Clerk APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVENT E Please provide ALL of the information requested below.Incomplete applications WILL NOT be reviewed. 1 Special Event Permit# Applicant(s)name: GuS�C�hL[�Y�CI�SIG�'IGy' Hs l Date of Submission Name of Event wcnfy' _K— SCTM#'s 1000-Section -S-1 Block- I Lot(s) 1—!T-- IO Dates of Each Event: -r If Multiple Dates are requested, applicant must give all information for all dates. Nature of Event: N,on` -Pc6 ,T Voy-)A(Dkksc (Please attach a detailed description of EACH event to this application) Time Period(Hours) of Event: From 5 0I-VN to 01 QfVN Town Services requested: ( )Yes (X)No If yes, Describe Police Dept._Highway Dept. Describe Services Maximum Number of Persons Attending At One Time: Number of cars expected J 50 Is a ent or other temporary structure bein used? [X] Yes [ ]No JLf yes provide size(s) WA5-x3D4�!1-9L Ox f 4W aux 3a Will food be served? [x]Yes [ ]No If yes provide number and name(s)of food vendor(s) y� h/ ,-rCd a S Updated 8/7/2018 L f�t✓� � 7U'd�D� Suffolk County permit#(s) !7n(0� Will other vendors be on the premises during the event? [)(] Yes [ ]No If yes how many? 19 Describe Type of 6id_<i�rYd ,�Qrw?es QuMA401.suul, Vur6l1? od, �� ®► ble5, p�ep�l V6,Iet5e viQS, (_vs°1-6 , ��h# o-F @>� o�c•a`7 �-�� j Property Owner(name/address): Contact Person and Contact Tel.# 4ildC 56.)eC v 5 tl� —73,a-Y300 e-mail address ho a.c5Ll)een&— a "o rZI Event Location: Street-Hamlet Address: 13355 ffl, Ade Ra , _, 1 ,_yp N55 SCTM# Mailing Address to Send Event Permit to: aU� d�� , (-��,�� /V �(� Have any of the development rights been sold to the Town of Southold [ ] Yes [X]No and/or Suffolk County Agricultural Program? [ ] Yes [X]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 subject 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. Updated 8/7/2018 (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 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 true and correct to the best of my knowle - and agree to provide notice to the Town immediately should there be any material changes re ding to this application. . Furthermore,I hereby authorize Code Enforcement Personnel of the own of S old to enter the property during the hours of the permitted special event to make a and all ' spections necessary in connection with this Special Event. 1)40 10 Print name of Owner S' ature of Owner Print naive 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. Updated 8/7/2018 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 narking, 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: Date Issued: Updated 8/7/2018 Y8 A EASTERN LONG ISLAND HOSPITAL 201 Manor Place, Greenport, NY 11944 . 631 -477-1000 • Fax 631-477-1746 April 4, 2019 Leslie Kanes Weisman, Chairperson Zoning Board of Appeals Town of Southold PO Box 1179 Southold,NY 11971 Dear Ms. Weisman: On behalf of Eastern Long Island Hospital and the patients we serve, I am respectfully requesting that the application fee be waived and only charged the processing fee for the attached event permit. This permit is for Eastern Long Island Hospital's largest fundraiser on Saturday, August 10, 2019 and is to be held at 13355 Middle Road, Cutchogue from 4 pm to 10 pm. Eastern Long Island Hospital is a 501 c3 not- for-profit organization with a mission to provide essential healthcare services to the residents of the North Fork and Shelter Island. The Summer Gala is a major benefactor for our Emergency Department. Thank you in advance for your consideration. Sincerely, Ice a S. Sweeney President Foundation/External Affairs Issue Date: 04/10/2019 CERTIFICATE OF INSURANCE RMLMIC a serkshIre Hathaway company INSURER: MLMIC Insurance Company SERVICING OFFICE: 8 British American Blvd.Latham, New York 12110.(518)786-2700.(800)635-0666 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 policies below. NAMED INSURED: Eastern Long Island Hospital Eastern Long Island Hospital Association 201 Manor Place Greenport, New York 11944 {_COVERAGES _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED ABOVE FOR THE POLICY PERIOD INDICATED. NOT WITH STANDING 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS POLICY POLICY TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS kk DATE DATE !'PROFESSIONACLIABILITY' EACH MEDICAL INCIDENT $ ❑CLAIMS MADE ❑OCCURRENCE AGGREGATE $ GENERALUABILITY AH 1002132 04/25/2019 04/25/2020 EACH OCCURRENCE $2,000,000 IFx� COMMERCIAL GENERAL LIABILITY PERSONAL&ADV INJURY $2,000,000 ❑X OCCURRENCE DAMAGE TO PREMISES $ 100,000 RENTED TO YOU (Any one premises) Owner's&Contractor's Prot MED ExP(Any one person) $ 10,000 ❑ GENERAL AGGREGATE $6,000,000 PRODUCTS-COMP/OP $6,000,000 AGGREGATE i,EXCESS LIABILITY EACH PERSON/EVENT $ ❑ UMBRELLA FORM TOTAL $ OTHER THAN UMBRELLA FORM $ I,DESCRIPTIONOF OPERA-IONS/LOCATIONS/VEHICLES/SPECIAL TEMP, Coverage is provided subject to the terms and conditions of the above referenced policy for the Certificate Holder as additional insured as per NYGO102 0313 RE: 2019 Summer Gala- "Summer Evening on the Farm" "CANCELLATION SHOULD ANY OF THE ABO11-1i 'VE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT THE MAILING OR THE FAILURE TO MAIL NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES AND IT IS UNDERSTOOD THAT THE NAMED CERTIFICATE HOLDER EXPRESSLY CONSENTS TO THE SAME. CERTIFICATE HOLDER Town of Southold 54375 Main Road PO Box 1179 Southold, NY 11971 AUTHORAD REPRESENTATIVE COI-HOP-04-07 Issue Date 02/12/2019 LMIC CERTIFICATE OF INSURANCE t?j tejMLMIC Insurance Company a Berkshire Hathaway company INSURER: MLMIC Insurance Company SERVICING OFFICE: 8 British American Blvd*Latham, New York 12110.(518)786-2700-(800)635-0666 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 policies below. NAMED INSURED: Eastern Long Island Hospital Eastern Long Island Hospital Association 201 Manor Place Greenport, New York 11944 _COVERAGES __ _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED ABOVE FOR THE POLICY PERIOD INDICATED NOT WITH STANDING 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY POLICY TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS DATE DATE PROFESSIONAL LIABILITY EACH MEDICAL INCIDENT $ ❑CLAIMS MADE ❑OCCURRENCE AGGREGATE $ d GENERAL LIABILITY`^ AH1002132 04/25/2019 04/25/2020 EACH OCCURRENCE $2,000,000 COMMERCIAL GENERAL LIABILITY PERSONAL&ADV INJURY $2,000,000 X❑ ❑X OCCURRENCE DAMAGE TO PREMISES $ 100,000 RENTED TO YOU (Any one premises) Owner's&Contractor's Prot MED Exp(Any one person) $ 10,000 ❑ GENERAL AGGREGATE $6,000,000 PRODUCTS-COMP/OP $6,000,000 AGGREGATE jEXCESS LIABILITY' 4a 'MP EACH PERSON/EVENT $ ❑ UMBRELLA FORM TOTAL $ OTHER THAN UMBRELLA FORM $ j p ESCRIPTION AF OPERATIONS&OCATIONSIVEHICLES/SPECIAL.rrEMS Coverage is provided subject to the terms and conditions of the above referenced policy for the Certificate Holder as additional Insured as per NYG0102 0313 RE: " Summer Evening on the Farm"to be held August 10, 2019. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT THE MAILING OR THE FAILURE TO MAIL NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES AND IT IS UNDERSTOOD THAT THE NAMED CERTIFICATE HOLDER EXPRESSLY CONSENTS TO THE SAME. CERTIFICATE HOLDER Mattituck Environmental Services 13355 Middle Road Cutchogue, NY 11935 AUTHORAD REPRESENTATIVE COI—HOP-04-07 y y,i- •r. j Jr Av'. t? a 0-1 a ,^s " s-- t - J �,1`X'+sr k•irlr°«''� ,r• �, 1-a4 •,