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HomeMy WebLinkAboutModa Studio ELIZABETH A. NEVILLE MMC FF c® Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 0 Fax(631)765-6145 MARRIAGE OFFICER ,f, ®�. 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 # 64 Issued to: MODA STUDIO Date(s): JULY 19,2019 Time: 8:00 AM—8:00 PM Locations: Kenney's Beach, Southold Permit No. 64 Issue Date: 7/16/19 This permit is for permission to use Town Maintained Roads and Properties ONLY Elizabeth A.Neville Southold Town Clerk ,%V Town ELIZABETH A.NEVILLE,MMC y� �/y Town Hall,53095 Main Road TOWN CLERK ® P.O.Box 1179 y = Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p • .F Fax(631)765-6145 MARRIAGE OFFICER y� o� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER a www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT MODA STUDIO DATE: JULY 19, 2019 TIME: 8:00 AM - 8:00 I'M LOCATION: KENNY'S BEACH KENNY'S ROAD, SOUTHOLD Filming/Still Photography Permit # 064 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: July 17, 2019 Doroski, Bonnie From: Doroski, Bonnie Sent: Tuesday,July 16, 2019 3:04 PM To: Blasko, Regina; Burke,John; Duffy, Bill; Flatley, Martin; Hagan, Damon; Kruszeski, Frank; Norklun, Stacey; Silleck, Mary Subject: Filming request 7/19/19 Attachments: filming permit_20190716150401.pdf Please review the attached filming application received today in the TC office. If there are any comments/concerns, please contact this office. Thank you. Your message is ready to be sent with the following file or link attachments: filming permit_20190716150401 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 1 f RECEIVED J L 1 6 2019 Southold Town Clerk APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT NO: Please Print ®r Type APPLICATION DATE: 16/7/2019 NAME OF APPLICANT: Jun Li u MAILING ADDRESS: 1635 Lexington Ave 2A New York, NY 10029 PHONE: BUSINESS: 347.399.8384 HOME: NAME OF ORGANIZATION/COMPANY: Moda Studio MAILING ADDRESS: liujunstudio( gmail com liuiunfotn a yahoo com PHONE: same as above FAX: DESCRIBE TYPE OF ACTIVITY(e.g.Motion Picture,Commercial,Television. Catalog,Magazine,etc.): Fashion Photoshoot DATE(S) AND TIMES) OF PROPOSED FILMING/PHOTOGRAPHY: July 19th 2019 8:00 to 6= 49 ,00 PROPOSED LOCATION(S) OF FILMIN /PHOTO`GR Y: (-atta4 additional sheet,if necessary) Tip ovvFMBiDSoutlhold g NAME OF PERSON IN CHARGE AT SITE: I Jun Liu NUMBER OF PERSONS AT LOCATION (cast&crew included): 15+a driver NUMBER AND TYPE OF VEHICLES AT LOCATION: 3 van+ 1 motohome(a makeup van) TYPE OF SPECIAL EQUIPMENT: ANY SPECIAL REQUIREMENTS: 1 motorhome parking near the beach Signature Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P.O.Box 1179 Southold,NY 11971 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. Signature Date 16/7/2019 Jun Liu ._ - Printed name Producer, Creative Director Title r ' / ® DATE(MM/DD/YYYY) .4� CERTIFICATE OF LIABILITY INSURANCE 7/16/2019 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). CONTACT PRODUCER Tom C. Pickard &Co., Inc. NAME: Certs Dept. 820 Pacific Coast Hwy PHONE FAX Hermosa Beach, CA 90254 (A/C,AIL° Ext 800 726 3701 AIC No): 310-318-9840 ADDRESS* Certs(@TCPinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# www.TCPinsurance.com License it 0555411 INSURER A Great American Insurance Company 16691 INSURED INSURER B. Jun Liu 1635 Lexington Ave. 2A INSURER C: New York NY 10029 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 50008009 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 ADDTYPE OF INSURANCE lNSD WVD POLICY NUMBER POLICY EFF MM/D LTR D//YYKYI' LIMITS A �/ COMMERCIAL GENERAL LIABILITY ✓ SPP4105985 8/5/2018 8/5/2019 EACH OCCURRENCE $$2000000 DAMAGE TO CLAIMS-MADE �OCCUR PREMISES(Ea occurrence) $$300,000 MED EXP(Any one person) $$10,000 PERSONAL&ADV INJURY $$2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $$4,000,000 ✓ POLICY F—] PRO F7 LOC PRODUCTS-COMP/OP AGG $$4,000,000 JECT OTHER $ A AUTOMOBILE LIABILITY ✓ SPP4105985 1/16/2019 8/5/2019 Eeaocd.ntINEDSINGLELIMIT $1000000 ANY AUTO Physical Damage BODILY INJURY(Per person) $ OWNEDSCHEDULED Limit is$125,000/Auto BODILY INJURY(Per accident) $ AUTOS ONLYL AUTOS $260N-OWNED ,000 Aggregate PROPERTY DAMAGE ✓ AUTOS ONLYHIRED A�OS ONLY Ded=10%Loss Subject to Per acidt $ Ph sical Dam1 1$1,000 Min $7,500 Max. $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED T RETENTION$ $ A WORKERS COMPENSATION WC2987253 1/18/2019 8/5/2019 ,/ STERATUTE EERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YNIA EL EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E L.DISEASE-EA EMPLOYEE S1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $1,000,000 A MISCELLANEOUS RENTED EQUIPM VT SPP4105985 8/5/2018 8/5/2019 $5,000 LIMIT/$500 DEDUCTIBLE A PROPS/SETS/WARDROBE SPP4105985 1/16/2019 8/5/2019 $25,000 LIMIT/$500 DEDUCTIBLE A THIRD PARTY PROPERTY DAMAGE SPP4105985 1/16/2019 8/5/2019 $1,000,000/$1,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED AND LOSS PAYEE BUT ONLY AS RESPECTS TO CLAIMS ARISING OUT OF THE NEGLIGENCE OF THE NAMED INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southold Town Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Road P.O. Box 1179 Southold, NY 11971 AUTHORIZED REPRESENTATIVE / TCP&Co -Tom Pickard ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 50008009 1 LIUJUNI I Master Certificate I TCP&Co. - Kellie Saxton 1 7/16/2019 10 21:08 AM (PDT) I Page 1 of 1 RECEIVE® JU L 1 6 2019 APPLICANT'S CHECKLIST FOR FILMING PERMIT Southold Town Clerk NOTE: All payments must be cash or certified check. Completed application $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. Permit Fees (Prior to issuance of permit): VFilm Fee-$100 per day of each day covered by the permit VCleanup deposit: Separate 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. VBeach Parking fee-$10 per vehicle,per day between May 1 and September 30. ALL CHECKS MUST BE CERTIFIED NOTE: Additional fees for'Cleanup and Traffic Control may be required at the direction of the Chief of Police and Superintendent of Highways Jun Liu -'_7 y TOWN CLERK'S CHECKLIST FOR FILMING PERMIT NOTE: All payment`s must be cash or certified check Applicant: L 080, S- Ua-ln Date Received: 111 (, 119 ✓ Completed application $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$1,000,000 (one million dollars)per occurrence for the duration of the filming or still photography. Indemnification agreement stating the applicant agrees to assume all liability for and will indemnify and hold the town harmless of and free from any and all damages that occur to persons or property by reason of said filming or still photography. Forward completed application to Chief of Police for approval or disapproval and determination if Traffic Control Fee is required Approved Disapproved No Fee Required Fee in the amount of$ 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. OVER Beach Parking fee - $10 per vehicle, per etween May 1 and September 30. ISSUED PERMIT 4• Countersign application Issue permit with name of applicant, locations(s), date(s), and time(s) 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. Doroski, Bonnie From: Flatley, Martin Sent: Wednesday,July 17, 2019 7:44 AM To: Doroski, Bonnie; Blasko, Regina; Burke,John; Duffy, Bill; Hagan, Damon; Kruszeski, Frank; Norklun, Stacey; Silleck, Mary Subject: RE: Filming request 7/19/19 I have no objections to this permit being approved. Please issue parking placards for vehicles involved in the shoot. Martin Flatley, Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Doroski, Bonnie Sent: Tuesday,July 16, 2019 3:04 PM To: Blasko, Regina <rblasko@town.southold.ny.us>; Burke,John<iohnbu@southoldtownny.gov>; Duffy, Bill <billd@southoldtownny.gov>; Flatley, Martin <mflatley@town.southold.ny.us>; Hagan, Damon - <damonh@southoldtownny.gov>; Kruszeski, Frank<fkruszeski@town.southold.ny.us>; Norklun, Stacey <Stacey.Norklun @town.southold.nv.us>;Silleck, Mary<marvs@town.southold.nv.us> Subject: Filming request 7/19/19 Please review the attached filming application received today in the TC office. If there are any comments/concerns, please contact this office. Thank you. Your message is ready to be sent with the following file or link attachments: filming permit_20190716150401 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 1 1 ® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 7/17/2019 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). CONTACT PRODUCER Tom C. Pickard & Co., Inc. NAME: Certs Dept 820 Pacific Coast Hwy RECEIVED PHONE 800 726 3701 FAX AIL No: 310-318-9840 Hermosa Beach, CA 90254 E-MAIL ADDRESS Certs TCPinsurance.com INSURERS AFFORDING COVERAGE NAIC# www TCPinsurance com Li Itq�#25E@412019 INSURERA. Great American Insurance Company 16691 INSURED INSURER B. Jun Liu 1635 Lexington Ave. 2A INSURERC New York NY 10029 Southold Town Clerk INSURER INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 50030323 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 /NSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDIYYYY A ✓ COMMERCIAL GENERAL LIABILITY ✓ SPP4105985 8/5/2018 8/5/2019 EACH OCCURRENCE $$2000000 DAMAGE TO RENTED CLAIMS-MADE F✓ OCCUR PREMISES Ea occurrence $$300,000 MED EXP(Any one person) $$10,000 ,PERSONAL&ADV INJURY $$2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $$4,000,000 ✓ POLICY❑JECT � LOC` PRODUCTS-COMP/OP AGG s$4,000,000 OTHER COMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY ✓ SPP4105985 1/16/2019 8/5/2019 Ea accident $1000,000 ANY AUTO Physical Damage - BODILY INJURY(Per person) $ OWNEDSCHEDULED Limit is$125,000/Auto BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS $250,000 Aggregate PROPERTY DAMAGE HIRED NON-OWNED o $ ✓ AUTOS ONLY ✓ AUTOS ONLY Ded=10/o Loss Subject to Per accident ✓ Ph sical Dam a1 1$1,000 Min $7,500 Max $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WC2987253, 1/18/2019 8/5/2019 ,/ STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E L DISEASE-EA EMPLOYEE $1,060,000 If yes,describe under E L DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below A MISCELLANEOUS RENTED EQUIPM CYT SPP4105985 8/5/2018 8/5/2019 $5,000 LIMIT/$500 DEDUCTIBLE A PROPS/SETS/WARDROBE SPP4105985 1/16/2019 8/5/2019 $25,000 LIMIT/$500 DEDUCTIBLE A THIRD PARTY PROPERTY DAMAGE SPP4105985 1/16/2019 8/5/2019 $1,000,000/$1,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED AND LOSS PAYEE BUT ONLY AS RESPECTS TO CLAIMS ARISING OUT OF THE NEGLIGENCE OF THE NAMED,INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southold Town THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main.Road P.O. Box 1179 AUTHORIZED REPRESENTATIVE Southold, NY 11,971 / y TCP&Co -Tom Pickard /irow 4 / ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD' 50030323 1 LIUJUN1 I Master Certificate I TCP&CO. - Kellie Saxton 1 7/17/2019 9.21 07 AM (PDT) I Page 1 of 1 , , Rudder, Lynda From: Silleck, Mary Sent: Wednesday,July 17, 2019 10:56 AM To: Rudder, Lynda Subject: FW: Filming request 7/19/19 -----Original Message----- From: Hagan, Damon Sent:Wednesday,July 17, 2019 10:32 AM To: Flatley, Martin; Doroski, Bonnie; Blasko, Regina; Burke,John; Duffy, Bill; Kruszeski, Frank; Norklun,Stacey; Silleck, Mary Subject: RE: Filming request 7/19/19 The town attorney's office has not objections to this permit being issued, provided the additional insured on the insurance binder is changed to the 'Town of Southold'from the 'Southold Town Clerk' as listed. Yours Truly etc., Damon A. Hagan Assistant Town Attorney Town of Southold Town Hall Annex 54375 Route 25 PO Box 1179 Southold, NY 11971-0959 Phone (631) 765-1939 Fax(631) 765-6639 ************************************************************************************************** *************** This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. ************************************************************************************************** -----Original Message----- , From: Flatley, Martin Sent:Wednesday,July 17, 2019 7:44 AM To: Doroski, Bonnie; Blasko, Regina; Burke,John; Duffy, Bill; Hagan, Damon; Kruszeski, Frank; Norklun, Stacey;Silleck, Mary Subject: RE: Filming request 7/19/19 I have no objections to this permit being approved. Please issue parking placards for vehicles involved in the shoot. Martin Flatley, Chief of Police 1 Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Doroski, Bonnie Sent: Tuesday,July 16, 2019 3:04 PM To: Blasko, Regina <rblasko@town.southold.ny.us>; Burke,John<johnbu@southoldtownny.gov>; Duffy, Bill <billd@southoldtownny.gov>; Flatley, Martin <mflatley@town.southold.ny.us>; Hagan, Damon <damonh@southoldtownny.gov>; Kruszeski, Frank<fkruszeski@town.southold.ny.us>; Norklun, Stacey <Stacey.Norklun@town.southoId.ny.us>; Silleck, Mary<marys@town.southold.ny.us> Subject: Filming request 7/19/19 Please review the attached filming application received today in the TC office. If there are any comments/concerns, please contact this office. Thank you. Your message is ready to be sent with the following file or link attachments: filming permit_20190716150401 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 2 Rudder, Lynda From: Yuko Nagasue <liujunstudio@gmail.com> Sent: Wednesday,July 17, 2019 11:13 AM To: Rudder, Lynda Cc: jun liu Subject: Re: Cert No. 50008009 - Certificate of Liability:Jun Liu - Southold Town Clerk Lynda, Just to make sure...so the new COI should be issued to info below? Please let us know. Southold Town Southold Towri Hall 53095 Main Road P.O. Box., 1179 Southold,NY 11971 Many Thanks! Yuko 2019:�-:7A 1719(7X) 11:08 Yuko Nagasue <liujunstudio@gmail.com>: Lynda, Okay. Let me ask for a new COI and will send it to you as soon as I receive it from our insurance company. Yuko 2019:�-r7A 17 Q(7)c) 11:04 Rudder, Lynda<Lynda.rudder@town.southold.ny.us>: You can send it to me. The address was correct just need to remove the word "clerk" From:Yuko Nagasue<liuiunstudio@gmail.com> I Sent:Wednesday,July 17, 2019 10:59 AM To: Rudder, Lynda <lynda.rudder@town.southold.ny.us> Cc:jun liu <liuiunfoto@vahoo.com> Subject: Re: Cert No. 50008009-Certificate of Liability:Jun Liu -Southold Town Clerk i i Hi Lynda, i Thanks for your help. 1 Can you give me the specific address to issue a new COI? Yuko { i ! 120194-:7A 17 Q(7k) 10:43 Rudder, Lynda<Lynda.ruddergtown.southold.ny.us>: Before I can release the permit. I need the insurance changed from Southold Town Clerk to Southold Town From: jomaceb@aol.com <jomaceb@aol.com> Sent:Tuesday,July 16, 2019 1:54 PM To: Rudder, Lynda <lynda.rudder town.southold.ny.us> Subject: Fwd: Cert No. 50008009 -Certificate of Liability:Jun Liu -Southold Town Clerk [i i From: Yuko Nagasue<liujunstudio(u��mail.com> Date: Tuesday, July 16, 2019 € Subject: Fwd: Cert No. 50008009 - Certificate of Liability: Jun Liu- Southold Town Clerk To:jomaceb <jomaceb@aol.com> Cc:jun liu<liuiunfotg&ahoo.com> Here is the COI. , I Thanks! i Yuko I ---------- � "i --------- From: notification(u ecertsonlinexom <notificationgecertsonline.com> I ; F]ft: 2019P-:7A 16 El(") 13:21 1 it-:& Cert No. 50008009 - Certificate of Liability: Jun Liu - Southold Town Clerk To: Southold Town Clerk<liuLunstudio(a,gmail.com> 2 This ACORD 25 (03/16) Certificate of Liability has been sent to you by TCP&Co. - Kellie Saxton of Tom C. Pickard & Co., Inc.. This is an automated email do not reply. Send reply to: KelliegTCPinsurance.com. i HAPPY TUESDAY! -KELLIE This document was created by eCertsONLINE. The attached or linked document(s) contain certification of insurance coverage for the insured named in the subject above. Your company is listed as the organization requesting receipt of these documents. If this document is sent via e-mail, you must click on the link below. The linked document is in a pdf format, and you must have Adobe Acrobat Reader installed on your system. To download the Adobe Reader for free, visit www.Adobe.com. i i If you have any questions regarding the content of this message, you should contact the Producer/Agency listed on the attached/linked documents. To find out more about how you can create, send and receive all of your Certificates of Insurance or Evidences of Property documents via email, fax, US mail or next day mail, call Insurance Visions at (800) j 497-9996, or visit our web site at www.eCertsONLINE.com. Click on the following link to retrieve and print the documents. I Yuko Nagasue I yj studio I moda studio www.iunliustudio.com 81.80.3943.6463 ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. Yuko Nagasue yj studio I moda studio www.junliustudio.com 81.80.3943.6463 Yuko Nagasue 3 yj studio I moda studio www.junliustudio.com 81.80.3943.6463 Yuko Nagasue yj studio I moda studio www.junliustudio.com 81.80.3943.6463 4 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/26/19 Receipt#: 256483 Quantity Transactions Reference Subtotal 1 Application Fee- Non-Refund 63a $100.00 2 Beach Permits 63b $20.00 1 Clean-Up Deposit 63c $25000 1 Daily Filming Permit 63d $10000 Total Paid: $470.00 Notes: Payment Type Amount Paid By Credit Card-Ref# $470.00 Essence, Communications Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Essence, Communications 241 37th Street, 4th Floor Brooklyn, NY 11232 Clerk ID: LYNDAR Internal ID 63d Vendor No. Check No. Town of Southold, New York - Payment Voucher Vendor Name Vendor Address En.ezed by MoAo— S�Ua-% 0 l D �Un L Audit Date Vendor Telephone umber. qqgI L� 82) �q l Ve noe Town Clerk. ; Vendor Contact '� Mew 'i(A M 100aq Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services 'G&�reFal Led erj�und and i�ccQpnt hIutitber'' Special Event Clean-up 1 - ` 250.00 250.00 Deposit Refund 'lC x:034'.'. .7. VI` YY► Total 250.00 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 from which the Town is exempt are excluded or discrepancies noted,and payment is approved. Signa ure alx Title Signat re Company Name Date _ Title Date Southold Town Board -Letter Board Meeting of July 30, 2019 RESOLUTION 2019-671 Item# 5.10 ADOPTED DOC ID: 15442 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2019-671 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JULY 30, 2019: WHEREAS Moda Studio supplied the Town of Southold with a refundable Clean-up Deposit fee in the amount of$250.00 and no Traffic Control fee was necessary 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, 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 Moda Studio, c/o Jun Lui, 1635 Lexington Avenue, 2A,New York,NY 10029. 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 July 30, 2019 Page 18 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 07/16/19 Receipt#: 257999 Quantity Transactions Reference Subtotal 1 Application Fee- Non-Refund 64a $100.00 4 Beach Permits 64parking $40.00 1 Clean-Up Deposit 64c $250.00 1 Daily Filming Permit 64dff $100.00 Total Paid: $490.00 Notes: Payment Type Amount Paid By Credit Card-Ref# $490.00 Moda, Studio Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Moda, Studio 1635 Lexington Ave 2 A New York, NY 10029 Clerk ID: BONNIED Internal ID*64dff