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HomeMy WebLinkAboutBreeze Hill Partners 2019-28 Southold Town Board - Letter Board Meeting of June 18, 2019 RESOLUTION 2019-536 Item# 5.4 yap`*Drax - ADOPTED DOC ID: 15310 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2019-536 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 Breeze Hill Partners to hold Special Event 2019-28 at Breeze Hill Farms, 31215 County Road 48, Peconic,New York as applied for in Application BHla-c for events on July 27, 28, and September 21, 2019 from 6:00pm to 11:00 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: Jill Doherty, Councilwoman SECONDER:William P. Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Evans, Russell Generated June 19, 2019 Page 15 r SOUTHOLD W.. 'TO SPECOAL EVENT, P E RM ROT (THIS IT MUST BE KEPT ON THE PREMISES) Name of Event : Private Wedding Permit o. : BH #1c Tvpe(s) of Event : W Wedding Location ofEvent : Breeze Hill Farms Date(s) of Event September 21, 2019 Time of Event : 6:00 PM - 11:00 PM C 'TOWUH (THIS PERMIT MUST BE KEPT ON THE PREMISES) Name of Event- : Private Wedding Permit No. : BH #1b Type(s) of Event Wedding Location of Event : Breeze Hill Farms Date(s) of Event July 28, 2019 Time of Event : 6:00 PM - 11:00 PM TOWN OF SOU74OLED ZFEECUAL (THIS PERMIT MUST BE KEPT ON THE PREMISES) Name of Event : Private Wedding Permit No. : BH #1a Type(s) of Event : Wedding Location of Event : Breeze Hill Farms -Date(s) of Event July 27, 2019 Time of Event : 6:00 PM - 11:00 PM go 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. X] 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 F4 Yes [ ]No If Yes,Fee of$150.00 has been submitted ElIf No,Fee of$ has been submitted Updated 8/7/2018 0 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) N/A ❑ Events for three hundred (300) or more people require submission and approval of a traffic control elan 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. May 22, 2019-- �� Dated Signature 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 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 Pin 1 0- - c APPLICATION FOR A PERMIT TO HOLD A RECEIVED SPECIAL EVENT MAY 2 4 2019 Please provide ALL of the information requested below.Incomplete applications WILL NOT be reviewed. ^^ { Southold Town Clerk Special Event Permit#O(Q �a� Applicant(s)name: Date of Submission 5/22/19 Name of Event grpp7_p Hill SCTM#'s 1000-Section-7 4 Block- 1 Lot(s) 36 Dates of Each Event: 7/27/2019 7/28/2019 9/x/2019 If Multiple Dates are requested,applicant must give all information for all dates. Nature of Event: See, attached (Please attach a detailed description of EACH event to this application) Time Period(Hours)of Event: From 6:00 p.m, to 11:00 p_m_ Town Services requested: ( )Yes (x)No If yes,Describe Police Dept. Highway Dept. Describe Services NIA Maximum Number of Persons Attending At One Time: 250 Number of cars expected 125 Is a Tent or other temporary structure being used? [ ]Yes [ ]No If yes provide size(s) 80 by 100; 60 by 80; 40 by 60 Will food be served?[ ]Yes [ ]No If yes provide number and name(s)of food vendor(s) See items 2,3,and 4 attached. Suffolk County permit#(s) Will other vendors be on the premises during the event?[X ]Yes [ ]No If yes how many? Describe Typeofvendor(s) SPP, items 2.1. and 4 attached Property Owner(name/address): Breeze Hill Partners, LLC Contact Person and Contact Tel.# Rosemary Buccheri (631) 876-5159 e-mailaddress breezehillfarmevents@gmail.com Event Location: Street-Hamlet Address: 31215 County Road 48, Peeonic, New York SCTM# 1000-74-1-36 Will any services be requested [ ]Yes [X] No. If Yes describe Police Highway Other: Mailing Address to Send Event Permit to: c/o William C. Goggins, Esq., P.O. Box 65, Mattituck, New York 11952 Have any of the development rights been sold to the Town of Southold [ ] Yes ]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 ParkinaTyent 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 structures)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 a►n 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 affir►n 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 with this Special Event. Christopher Pia, Member Print name of Owner Sigr}�tur of Owner William C. Goggins Print name of Authorized Person/Representative Signature of Authorized Pers presentative 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 pro%ride 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 ;`:OT permittod, althougli 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, tent(s) 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. JULY 279 2019 GARVIS EVENT 31215 County Road 48, Peconic, New York SCTM No. 1000-074.00-01.00-036.000 1. Event Date: July 27, 2019 2. Guests: 250 guests 3. Hours: 6:00pm-11:00pm 4. Cars expected 100-125 5. Caterer: East End Caterers: Chris Richards License No. PT0002999 6. Music Vendor: East End Entertainment (DJ): Michael Variale 631.833.4149 7. Music Duration: 6:00pm—11:00pm 8. Tent Vendor: McBurnie Tent Facilities to be used is set forth on the attached map. JULY 2812019 DANEK EVENT 31215 County Road 48, Peconic, New York SCTM No. 1000-074.00-01.00-036.000 1. Event Date: July 28, 2019 2. Guests: 50 guests 3. Hours: 6:00pm-11:00pm 4. Cars expected 25 5. Caterer: Self Catered 6. Music Vendor: 74 Events (DJ) Gary Hoffman 917.604.3970 7. Music Duration: 6:00pm—11:00pm 8. Tent Vendor: McBurnie Tents Facilities to be used is set forth on the attached map. SEPTEMBER 21, 2019 WATERS EVENT 31215 County Road 48, Peconic, New York SCTM No. 1000-074.00-01.00-036.000 1. Event Date: September 21, 2019 2. Guests: 250 guests 3. Hours: 6:00pm-11:00pm 4. Cars expected 100-125 5. Caterer: Fresh Flowers 6. Music Vendor: Code Bleu: Sean (631) 277-7777 7. Music Duration: 6:00pm—11:00pm 8. Tent Vendor: Elite Tent, 100 Carney St., St#1, Glen Cove, New York. 11542 Facilities to be used is set forth on the attached map. ' UNDERTAKING 31215 County Road 48, Peconic, New York SCTM No. 1000-074.00-01.00-036.000 The Applicant, Christopher L. Pia undertakes to present and post on site the NYS Liquor Authority Permit during times when alcohol is being served. atf'A' CHRISTOPHER L. PIA P�l .w.-L -t..o:j�::� Leie tle�aiAu9'It='� t •�,� :.,"•.�„"'' tr al600cn " � e•aa`+ o •::4t....-'"""�./ ,,,.,.>.r" gyp' r 4,: /^^ '''^ ' r,/'�-.a'� Jam. .J'r f M� ;.:s'I•"..� � ,.; �+ .4.v; � �`.',�*' ,}'f .,✓,,,+� i• .w"a>_. Wit_ t'..-. - _—..— � -- - ,�• K.. t t y .. � ! m: s�. �,.._ . ',v,tom• Its .;:,'l L.. • 106141 �o CERTIFICATE OF LIABILITY INSURANCE DATE(MMOO YM .,.� 05/22/2019 SIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES FLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. (PORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to e tars and condMons of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the Irdficate holder In lieu of such endorsement(s). )UCER fi EILEEN CUSHMAN RYAN KUHN PHONE •631-722-4100 FAI c Ne;631-722-4500 1116 MAIN ROAD SRI., PO BOX 2336 INSURERS AFFORDING COVERAGE I NAIc0 AQUEBOGUE,NY 11931 INSURER.A:FARM FAMILY CASUALTY INS.CO. 120 RED INSURER 6: BREEZE HILL FARM&PRESERVE INC INSURER C: PO BOX 246 INSURER D: PECONIC, NY 11958 INSURERS: INSURER F JERAGES CERTIFICATE NUMBER: REVISION NUMBER: IIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS :RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, (CLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUSR TYPE OF INSURANCE jam POLICY NUMBER MMMMAPOLICY fiFP nnnM SUM111111YYYpyl LIMITS COMMERCIAL GENERAL LIABILITY X 3152105107 05106/2019 05/08/2020 EACH OCCURRENCE S 1000.000 CLAIMS-MADE F1 OCCUR PREMISES lEa amE en� S 100,000 X SPECIAL FARM PACKAGE MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 POLICY❑JECTPRO. LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER S AUTOMOBILE LIABILITY COMBINED IN LE LIMITI S cadent ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per a=dent) S NON-OWNED PROPERTY DAMAGE S HIRED AUTOS-1 AUTOS accident) � $ uMSRELLAUAB 1XX1 OCCUR 3101B1336 06/11/2018 06/11/2019 EACHOCCURRENCE $ fiXCESSUAB CLAIMS-MADE 06/11/2019 06/11/2020 AGGREGATE s 1,000,000 DED RETENTIONS 5 WORNERSCOMPENSATION PER DTH• AND EMPLOYERS'I RABILITY YIN STATUTE ER ANY PROPRIETORMARTNER/EXECUT WE ❑ NIA E L EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? (Mandatory In NN) E.L DISEASE-EA EMPLOYEE S If yos,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S :RIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101.Additional Ramada Schedule,maybe attached If mon spaoo Is requlnd) RTIFICATE HOLDER AS ADDITIONAL INSURED DDING OF THE NICOLE/WATERS IS SEPT.21ST 2019 2TIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF SOUTHOLD ACCORDANCE WITH THE POLICY PROVISIONS. 53095 ROUTE 25 SOUTHOLD, NY 11,971 AUTHORIZED R SENTATIVE` I 1988-2014 ACORD CORPORATION. All rights reserved. )RD 2512014/011 The ACORD name and loco are realstered marks of ACORD co CERTIFICATE OF LIABILITY INSURANCE DATEJMWOONYYY) 05/22/2019 IIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to e terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the Irtificate holder In lieu of such endorsemen s). )UCER E EILEEN CUSHMAN RYAN KUHN PHONE .631-722-4100 �No:631-722-4500 1116 MAIN ROAD NO PO BOX 2336 INSURERS AFFORDING COVERAGE HAIC0 AQUEBOGUE.NY 11931 IIISURERA:FARM FAMILY CASUALTY INS.CO. 120 RED INSURER 6: BREEZE HILL FARM&PRESERVE INC INSURER C: PO BOX 246 INSURER o: PECONIC, NY 11958 INSURER E: INSURER F: /ERAGES CERTIFICATE NUMBER: REVISION NUMBER: IIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER'DOCUMENT WITH RESPECT TO WHICH THIS :RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, i (CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCfiADDL UR POLICY EFF POYCY E7IP POLICY NUMBER OMITS COMMERCIAL GENERAL LIABILITY X 3152G5107 05/06/2019 05/08/2020 EACH OCCURRENCE 5 1 000 000 CLAIMS-MADE FIOCCUR PREMISES occurrence) S 100.000 X SPECIAL FARM PACKAGE MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 POLICY❑JECT LOC PRODUCTS-COMP-OPAGG S 2,000,000 OTHER S AUTOMOBILELJABIUTY COMBINED SINGLE LIMITI S IEa accident ANY AUTO BODILY INJURY(Per penton) S ALL AUTOS AUTOS OWNED SCHEDULED BODILY INJURY(Per accident) S NON-OWNED PR00ERTY DAMAGE S HIRED AUTOS AUTOS $ UMBRELLA LIAR XX OCCUR 3101 B 1336 06/11/2018 06/11/2019 EACH OCCURRENCE $ EXCESSLUW I CLAIMS-MADE 0611/2019 06/11/2020 AGGREGATE $ 1,000,000 DED I I RETENTIONS S WIORKSRSCOMPENBATIONP R OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETORiPARTNER/EXECUTIVE E L EACH ACCIDENT S OFFICERIMEMBEREXCLUDED? 0 NIA (Mandatory In NH) E L DISEASE-EA EMPLOYEE 5 It yes.describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ :RIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schadula,may be Htached N more apace N mgulred) 1TIFICATE HOLDER AS ADDITIONAL INSURED' DDING OF THE NICOLE/WATERS IS SEPT.21ST 2019 tTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF SOUTHOLD ACCORDANCE WITH THE POLICY PROVISIONS. 53095 ROUTE 25 SOUTHOLD,NY 11971 AUTHORIZED 9EHTATIVIS i 1988.2014 ACORD CORPORATION. All rights reserved. _)RD 25(20141011 The ACORD name and loao are realstered marks of ACORD Client#:4264 FRESFLA ACf)RL?, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 5/23/2019 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Co NAME: ok Maran Cook Maran &Associates arc°No E13:631 324-1440 Fax A1C No 461 Pantigo Rd ADDRE selectcertificates@cookmaran.com East Hampton, NY 11937-2647 INSURER(S)AFFORDING COVERAGE NAIC# 631 324-1440 INSURER A:Sentinel Insurance Company,Ltd. 11000 INSURED INSURER B-Property&Casualty Ins Co of Hartford 34690 Fresh Flavors Inc INSURER C 29 Montauk Blvd. INSURER D East Hampton, NY 11937 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 CONTRACTOR 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 SUB POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDIYYYY MMfDDNYYY A X COMMERCIAL GENERAL LIABILITY X 12SBMBQ4045 5101/2019 0510112020 EACH OCCURRENCE $2,000000 CLAIMS-MADE XOCCUR PREMISESOEa oNTED nce $1,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,000 PRO- POLICY JECT X LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER $ A' AUTOMOBILE LIABILITY 12SBMBQ4045 5/01/2019 05/01/202 COEaMBINED SINGLE LIMITa ccidnt $2,000,000 e ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY Ix AUTOS ONLY Peracradent $ A X UMBRELLA LIAR X OCCUR 12SBMBQ4045 5/01/2019 05101/2020 EACH OCCURRENCE $1110001000 EXCESS LIAR, CLAIMS-MADE AGGREGATE $1,000,000 DED I X RETENTION$10,000 $ B WORKERS EMPLOY RS'LICOMPENSATION ILIT 12WECTR2489 5/01/2019 05/01/202 X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER EXECUTIVE YIN N E L EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? 7N N/A (Mandatory in NH) E L DISEASE-EA EMPLOYEE s.500,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E L DISEASE-POLICY LIMIT $500,000 A Liquor Liability 12SBMBQ4045 0510112019 05/01/202 1,000,000 each occ _ 2,000,000 agg DESCRIPTION OF OPERATIONS t LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Re:The Waters Wedding, Breeze Hill Farm on Saturday,September 21,2019 from 1 pm-12midnight. Breeze Hill Farm is an Additional Insured in regard to General Liability policy as required by written contract. CERTIFICATE HOLDER CANCELLATION Breeze Hill Farm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 31215 County Rd.(Rt.48) ACCORDANCE WITH THE POLICY PROVISIONS. ` Peconic,NY 11958 AUTHORIZED REPRESENTATIVE V � ' - ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S2011124/M1968355 PAT24 7 ® v r: DATE(MMIDDIYYYY) AC"RO CERTIFICATE OF LIABILITY INSURANCE ��•. 05/21/2019 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 Jackie Ortiz NAME: Brady Risk Management A/cN o Exc (631)549-8561 ac No): (631)549-8557 PO Box 2540 E-MAIL jortiz@bradyrisk.com risk.com ADDRESS, INSURER(S)AFFORDING COVERAGE NAI C# Halesite NY 11743 INSURERA Navigators Insurance Company 42307 INSURED INSURER B• StarStone National Insurance Company 25496 Bimbi Ltd.,Lupeth Ltd,DBA:Red Bar&Restaurant INSURER C c/o Brady Risk Restaurant Group INSURER D 417 New York Avenue INSURER E Huntington NY 11743 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 Off Site Catering REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSRR ADDLSUBR POLICY EFF POLICY EXP TYPE OF INSURANCE NSD WVD POLICY NUMBER MMIDDIYYYY MM DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE - $ 1,000,000 CLAIMS-MADE �OCCUR PRAEM SES Ea occur ence $ 100,000 Liquor Liability$1 MM/$2MM MED EXP(Any one person) $ EXCLUDED A CE18CGL1349281V 12/31/2018 12131/2019 PERSONAL&ADV INJURY $-1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER GENERALAGGREGATE $ 2,000,000 POLICY [:] JECT �LOC J PRODUCTS-COMP/OPAGG $ 2.000,000 OTHER Employee Benefits S 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) S A OWNED SCHEDULED CE18CGL1349281V 12/31/2018 12/31/2019 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLYAUTOS ONLY Per accident X $ UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 5,000,000 BNEXCESSIJAB CLAIMS-MADE 85547H185ALI 12/31/2018 12/31/2019 AGGREGATE $ 5,000,000 ED I I RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE ❑ NIA EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If ves,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ . .T DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Bimbi Ltd DBA Red Bar Restaurant,417 New York Avenue,Huntington,NY 11743 ***OFF SITE CATERING***July 28,2019 from 1 pm to 1Opm LOCATED AT.Breeze HIII farm,31215 County Road,Route 48,Peconlc,NY 11958 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Breeze Hill Farm ACCORDANCE WITH THE POLICY PROVISIONS. 31215 County Road AUTHORIZED REPRESENTATIVE Route 48 Peconic NY 11958 f - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD � Y AGENCY CUSTOMER ID: 00001097 LOC#: ACCOR" ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Brady Risk Management Bimbi Ltd.,Lupetti Ltd,DBA Red Bar&Restaurant POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE. ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance `**LIABILITY FOR ENTERTAINMENT IS EXCLUDED- -LIQUOR LIABILITY IS EXCLUDED`*' Breeze Hill Farm is Included as Additional Insured on the aforementioned off-site catering location,when required by written contract,as respects to General Liability for offsite catering operations and products completed exposure ONLY for the following event date(s)07128/2019,located at Breeze Hill Farm,31215 County Road,Route 48,Pecornc,NY 11958. G' ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF INSURANCE -ISSUE DATE 3/20/2019 ITHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS I 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 TI1E ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ISUBJECT 'IMPORTANT.IF THE CERTIFICATE HOLDER IS AN ADDITIONAL� INSURED,THE POLICY(IES)MUST BE ENDORSED.IF SUBROGATION IS WAIVED, TO THE TERMS AND CONDITIONS OF THE POLICY,CERTAIN POLICIES MAY REQUIRE AN ENDORSEMENT.A STATEMENT ON THIS ICERTIFICATE 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 104i I Buffalo NY 14221 � INSURER A Colony Insurance � INSURER B. NIA INSURED INSURER C East End Event Caterers Inc c/o Christopher Richards INSURER D 71 Washington Ave INSURER E- NIA I Patchogue. NY 11772 JCOVERAGES 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 j RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED I HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY I PAID CLAIMS. INS TYPE OF I POLICY POLICY POLICY LIMITS LTR, INSURANCE NUMBER EFFECTIVE DATE EXPIRATION DATE A i GENERAL LIAB'LIT`•' GL4233880 3/13/2019 3/1312020 GENERALAGGREGATE 2.000.000 PRODUCTT S-COWOP AGG 1,000.000 i 4 I PERSONAL&ADV INJURY 1,000,000 EACH OCCURRENCE 1,000.000 1 DAMAGE PREM RENTED TO YOU 1 100,000 MED EXPENSE(Any one person) 5,000 I B ( PERSONAL'_IA6;:.'TY COMBINED SINGLE LIMIT r MEDICAL PAYMENTS TO OTHERS C 1 EXCESS LIABILITY ( J EACH OCCURRENCE I i AGGREGATE ID i s I E ' ? BUILDING ROPERTY 1 CONTENTS ' BUSINESS INCOME ; I THE INSURER(S) NAMED HEREIN IS(ARE) NOT LICENSED BY THE STATE OF NEW YORK, NOT SUBJECT TO ITS ji 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 OPERA T IONS;SPECIALTY ITEMS I Caterers-Breeze Hill Farm&Preserve are named as adai6onal insureds wdn respect to general liaiTUty E CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Breeze Hill Farm&Preserve BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 31215 CdOnty Rd 48 ACCORDANCE WITH THE POLICY PROVISIONS. Peconlc,NY 11958 AUTHORIZED SIGNATURE «� Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/24/19 Receipt#: 254625 Quantity Transactions Reference Subtotal 1 Event Fee BH1a-c $150.00 Total Paid: $150.00 Notes: Payment Type Amount Paid By CK#3889 $15000 Breeze, Hill Farm Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Breeze, Hill Farm Po Box 246 Peconic, NY 11958 i Clerk ID: BONNIED Internal ID: 131-11a-c