HomeMy WebLinkAboutNorth Fork Chamber of Commerce - St. Patrick's Day Parade Vendor No. Check No.
Town of Southold, New York - Payment Voucher
Vendor Name Vendor Address Entered:by:
C"�00_1�r �01v%nMLYCb �e i Q .A>:�di�Doti
Vendor Tele1ph(on Number (� ('
1 lQ CJ�� —1 5 Town Clerk `
Vendor Contact I
�vs rsG C - .3s
Invoice InNoice' Invoice Net Purchaj Order
Number Date Total Discount Amount Claimed Numbei Description of Goods or Services General I-ed er Fund and Account Number
e�
Special Event Clean-up
0�00c)—xz 250.00 I 250.00 Deposit Refund 71.030
• I •
•
i
i
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 venfied with the exceptions
due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved.
Si natur Title Signatu
Company Name Date Titl Date ZG
I I P
Southold Town Board -Letter Board Meeting of April 7, 2020
yUFFOI,r RESOLUTION 2020-263 Item# 3.5
AQP �Gj
ADOPTED DOC ID: 16120
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2020-263 WAS
ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON
APRIL 7,2020:
WHEREAS the following groups have supplied the Town of Southold with a refundable Clean-
up Deposit fee, for their events and
WHEREAS the Southold Town Police Chief, Martin Flatley, has informed the Town Clerk's
office that this fee may be refunded, now therefor be it
RESOLVED that Town Board of the Town of Southold hereby authorizes a refund be issued in
the amount of the deposit made to the following
Name Date Received Amount of Deposit
North Fork Chamber of Commerce 1/17/20 $250.00
Joseph Corso
c/o Peconic Retreat
555 New Suffolk Avenue
Cutchogue,NY 11935
2 �L
Elizabeth A. Neville
Southold Town Clerk
RESULT: ADOPTED [UNANIMOUS]
MOVER: Jill Doherty, Councilwoman
SECONDER:Robert Ghosio, Councilman
AYES: Nappa, Dinizio Jr, Doherty, Ghosio, Evans, Russell
Generated July 7, 2020 Page 10
ELIZABETH A.NEVILLE,MMC �� COIj Town Hall,53095 Main Road
TOWN CLERK g y� P.O.sox 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER A Telephone(631)765-1800 "
RECORDS MANAGEMENT-OFFICER- www.southoldtownny.gov_- -
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK RECEIVED
TOWN OF SOUTHOLD
JAN 1 7 2020 .;
APPLICATION-FOR`A=PERMIT TO HOLD-A Southold °'�� terk
SPECIAL EVtNT
Please provide ALL of the information requested below.Incomplete applications WILL NOT be
reviewed. _
Date of Submission 0 l I I0 ()
Name of Event 'A-iu rjV W`- `�6 A.-�3 PAS
Name of Organization:
Is this a Not-For-Profit Event?Yes/No Y 25
Contact's Name:
r.
Mail ingAddress: ��j �-evJ lj��Fr1 (� (�pQ CyD�lyf CIO
Contact's Phone Number:
Contact's Email Address: S CW O I CR
Event Location and Site Dia am: p.ry'E G ti �'n v✓'` ��, C"«� r� Cu��S -
gr .� �
(Use additional paper if necessary)
Event Date(s): an F.D 0 rn 5 f
(Include set up and shutdown times anddates)
Nature of Event:
(Please attach a detailed des ription to thA application)
Time Period(Hours) of Event: From V,0090,2, to -3-,3 0 (1 dN,-
Maximum Number of Expected Attendees:
Specify any special requirements (i.e. road closure,police presence): 5 4,0 Q6 ?0
If a Tent'or other temporary structure will be used please contact the Southold Town Building Department
at 631-765-1802
Mailing Address to Send Event Permit to: 65(jC_ o_e- 5 u K—o��-
r 9
Event Fees: -_•
$250 for,events with less than 1000 expected attendees
$500-for'events with 1000 or more expected attendees
Clean-up Fees(Can NOT be waived):
$1,500.00 Clean-up for Bicycle and/or Running Special events(ONLY)
1$250 or more Clean-up deposit all other events
CERTIFICATE OF INSURANCE REQUIRED: Not less than$2,000,000 naming the Town of
Southold as an additional insured.
***NOTE: PLEASE SEE ATTACHED REVISED, ADOPTED TOWN
POLICY***
Additional information and requirements may be required as deemed necessary by the Town Board.
4,5
Print name of Authorized Person filling out Signale of Alithorized Person filling out application
application _
*Upon the request by applicant,the Town Board may waive in whole or in part any of the application
requirements.
2
ELIZABETH A.NEVILLE,MMC �® Town Hall,53095 Main Road
TOWN CLERK P.O.sox 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER �. ®�. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK RECEIVED
TOWN OF SOUTHOLD
JAN 1 7 2020
APPLICATION FOR A PERMIT TO HOLD A southold Town Clerk
SPECIAL EVENT
Please provide ALL of the information requested below:Incomplete applications WILL NOT be
reviewed.
Date of Submission III I I
Name of Event A-iu nry6f Pwi, r L 1 15
Name of Organization: aN` d�-Cc iwitf9-
Is this a Not-For-Profit Event?Yes/No 25
Contact's Name: -((9 So k C (0 0 I (
Mailing Address: ��<j �-LvJ �:���-r141c (� �����o��� CLO
o
Contact's Phone Number: 616 90" — q/3 y
Contact's Email Address: ti 00250 l e
_I �
Event Location and Site Diagram: �d %r► �,CL
1/+�9 Ct k b C !LU "` l=•ry-�,.t�5 RC f �t��e5 -
(Use additional paper if necessary)
Event Date(s): 1,00 0 r�5t1-jq-'0 3, 30 Qq,
(Include set up and shutdown times anddates)
Nature of Event: � a %a ate 61Ncid \1 LL
(Please attach a detailed des ription to tW application)
Time Period(Hours) of Event: From to
Maximum Number of Expected Attendees: j,"00 — w 2eilrt"� y� ,L r P
Specify any special requirements (i.e. road closure,police presence): :love CLS ?o — �,LQ�- y D
A CERTIFICATE OF LIABILITY INSURANCE
'OliTl:t�tirDDlj/h�i(Yj'
• _,• _ -
Wis-EUR-RiCkTE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEk;THIS
CV$IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,EXTEND OR ALTER THE COVERAGE AFFORDED 8'Y THE ObLICIES
13EL•OW."T�l$CERTIFICATE OK(NSURANCE DOES NOT CONSTITUTE A CONTRACT 13ETWEEN THE ISSUING.INSURER(S),AUTHDRIZED.,
ItEP12E8ENTAT1Vl=0(1 PRODUCER,AND THE CERTIFICATE HOLDER,
L IMFeRTANT: If the certificate holder is an ADDITIONAL INSURED,the poliey(ies)must have ADDITIONAL INSURED provisions or be_endorsed.
'11 SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require a�n'endorsement. A st'atement-on
thls e6itificate does not confer rights to the certificate holder in lieu of such endorsement(®).
PRObuceR CONTACT NAME; Alexandda Whitney
MCMsnrt PricetAg6ncy.Inc 01)477.8830'••
AIC No g
- AFC No
828:FRSnCStreet EMAIL alexandria@mcmannprice Com -
ADDRESS'
PO Bb1C2095 - INSURER(S)AFFORDING COVERAGE + - NA(C$
NY 11944-0876INsuRERA Hartford Fire Ins Ca: '" "`TI M827"
INSURED
INSURER e.
•The North Fork Chamber of Commerce
INSURER'c
' INSURER 0:
PO Bl)x 141$ INSURER E - -
�� '•
::7.Southold* NY 11971-1415 INSURER F
CovmACES•,,_• CERTIFICATE NUMBER: CL2011302710 AEVIS10NfNUM&EK-. -`•' -
THlS'IS'TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY.PFVOIJ'
--•INDICATE!). NOTWITHSTANOING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH Y+i1S ••• - -^•
CEf}°rIF°dkfE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT-TO ALL TH_ETER'_M&_,
ER�LY)S 8A*ND CONDITIONS OF,4UCH POLICIES.LIMITS SHOWN'MAY HAVE BEEN REDUCED BY PAID CLAIMS.1paim '
LTR ("'`"'-." `TYP80FIN8URANCE INBD WVD POLICY NUMBER (MMI0wwM IMwouny"I
COMMERCIAL GENERAL,LIA6nJTY EACHOCCURR{NCE g 2,000,00-""
CLAIMS-MADE! ®OCCUR P I Ea o surrence $ 300.1100
MED EXP(Any one Damm) S 7 0,000
A Y 128BABHO373 11/26/2018 1112512020 PERSONAL 4ADvINJUW S 2,000,000
«( GEMLAG�REQATELIMITAPPUESFERsGENERAL AGGREGATE g 4;000,000
PAUCY, JEOT LOG PRODUCTS-COMPIOR M S 4,000,000
01H ER- S
AUTOM081LE LIABILITY COMEHNED
Mod N MI 3
ANYAUTO BODILY INJURY(Per Deleon) S
OWNED $CHEOULED
AUTOS ONLY AUTOS BODILY INJURY(Perecclderdl $
HIRED NON-OWNED PROPERTY OAMA pE y
AUTOS ONLY AUTOS ONLY ta.4
flMetZEll/('j,1A9''' HCLAIMB-MADE
EACHOCCURRENCE S
1X(!%9$LIAR AGGREGATE - :•ir ':• . .9. ... ti:s-
�...
DED RETENTIONS
PAND
KERS COMPENSATION PE
EMPLOYERS{JABILITY YIN PFk0PRIETOHl?ARTNERIEXECUTIVE NIA EL.EACHACCIDENT S
OFNCERIMEMBER EXCLUDED?
(Mandoory In NH) F—L.bISEASE-EA EMPLOYEE• $
!(yes,deacrabe untler
DESCRIPTION OFOPPRAT10NS bolow E L.DISEASE•POLICY UMIT S
DESCRIPTION OF OPERATIONS J LOCATIONS!VEHICLES(ACORD 101,Additional Rem4dc3 Schedule,may he attached if more apece le required)
With respect to the St Patrick s Day Parade being hold on Saturday,March 14th,2020 in Cutchogue.Certificate holder Is listed as additional insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBEP POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 1179
AUTHORIZEDREPRES ATIVE
Southold NY 11971
• t]
1968- 016 ACORD CORPORATION, All rlghts reserved.
ACORD 25(Z01 6103) The ACdRD Paine and logo are registered marks of ACORD
Town of Southold Police Department
Special Event Cost Analysis
Event: St. Patricks Day Parade
Date(s): Warch 14, 2020
1 7- -
Location: Cutchogue Village
Patrol-MI 16—ci'Cio 6 for
Event',,'
Reg Hours IOTHrs j4i(� '
Wage I Total Comments'
Police Of'fic'ers
Lt Ginas 3 $275.31
Sgt Brewer 3 $247.65
PO McNamara 3 $207.69
PO Johnson 3 $122.16
PO Joseph Crosser - 3 $78.09
—7
Reg Hours OT Hrs Total Comments
-H—kghw7ijoqtr—or
PO Onufrak- 3 $207.27
PO Flatley 3 $209.19
Wi i Ri We7 Vnii 7it�s, �
Traffic Conte6 I
"
Reg Hours OTHrs Total Comments
TC Officer
TC Officer
TC Officer
TC Officer
TC Officer
Equipment.Costs. 7,
T. ;7
c
PID Vehicles 4 of vehicles r,,;
7 $10.00 $210.00
Command Van 0 $2500
Marine Patrol Boats 0 $2000
ITotal Department Cost for Event = 1 $1,557.36
Prepared by Chief M. Flatley 1/28/2020 Page 1
Doroski, Bonnie
From: Flatley, Martin
Sent: Monday,January 27, 2020 6:06 PM
To: Doroski, Bonnie
Cc: Blasko, Regina
Subject: RE: Emailing: of chamber-st pats parad_20200121153155
Attachments: CA St Pats Parade2020.xlsx
I have no objections to this parade taking place as in the past. My cost analysis is attached
Martin Flatley,Chief of Police
Town of Southold Police Department
41405 State Route 25
Peconic, N.Y. 11958
Tel: 631-765-3115 — l
-----Original Message-----
From: Doroski, Bonnie <Bonnie.Doroski@town.southold.nv.us>
Sent:Tuesday,January 21,2020 3:32 PM
To: Blasko, Regina <rblasko@town.southold.nv.us>; Burke,John<iohnbu@southoldtownny.gov>; Doroski, Melanie
<Melanie.Doroski@town.southold.nv.us>; Duffy, Bill<billd@southoldtownny.gov_>; Fisher, Robert
<Robert.Fisher town.southold.nv.us>; Flatley, Martin<mflatlev@town.southold.nv.us>; Hagan, Damon
<damonh@southoldtownnv.gov>; Kruszeski, Frank<fkruszeski@town.southold.nv.us>; Norklun, Stacey
<Stacey.Norklun@town.southold.nv.us>;Silleck, Mary<marvs@town.southold.ny.us>; Spiro, Melissa
<Melissa.Spiro@town.southold.nv.us>
Subject: Emailing: of chamber-st pats parad_20200121153155
Please review the attached application received from the North Fork Chamber of Commerce for their annual St.
Patrick's Day Parade. Send any comments/concerns to this office. Thank you.
Your message is ready to be sent with the following file or link attachments:
of chamber-st pats parad_20200121153155
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.
i
1
Doroski, Bonnie
From: Spiro, Melissa
Sent: Wednesday,January 22, 2020 12:32 PM
To: Qoroski, Bonnie
Subject: RE: Emailing: of chamber-st pats parad_20200121153155
This is not preserved lands.
Melissa
-----Original Message-----
From: Doroski, Bonnie
Sent:Tuesday,January 21, 2020 3:32 PM
To: Blasko, Regina <rblasko town.southold.nv.us>; Burke,John<iohnbu southoldtownny.gov>; Doroski, Melanie
<Melanie.Doroski@town.southold.ny.us>; Duffy, Bill<billd southoldtownny.gov>; Fisher, Robert
a
<Robert.Fisher town.southold.ny.us>; Flatley, Martin<mflatley a town.southold.nv.us>; Hagan, Damon
<damonh@southoldtownnv.gov>; Kruszeski, Fran k'<fkruszeski@town.southoId.ny.us>; Norklun,Stacey
<Stacey.Norklun@town.southold,nv.us>;Silleck, Mary<marvs town.southold.nv.us>; Spiro, Melissa
<Melissa.Spiro@town.southold.nv.us>
Subject: Emailing; of chamber-st pats parad_20200121153155
Please review the attached application received from the North Fork Chamber of Commerce for their annual St.
Patrick's Day-Parade. Send any comments/concerns to this office. Thank you.
Your message is ready to be sent with the'following file or,link attachments:
of chamber-st pats parad_20200121153155
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
IM�Tl H F U I K
ap CHAMBER OF COMMERCE
i
RECEIVED
JAN 1 7 2020
1/20/20
Southold Town Clerk
To Whom It May Concern:
Please be advised that the North Fork Chamber of Commerce and the Cutchogue Fire
Department are in the process of planning the 16th Annual St.Patrick's Day parade. The
proposed date of the parade is March 14,2020 with a start time of 2:00 pm. The route
will begin at Eugene's Road and head west to Cases Lane, ending at the village green.
The estimated time of the parade is 1 hour. At Chief Flatley's suggestion,we staged the
participants on Eugene's Road prior to the step-off,and will do the same this year.
During the parade we would need to have the Main Road shut down to traffic from Cox's
to Alvah's Lane from 2:00pm to approximately 3:30pm.
We are currently inviting Fire Dept's in the Town of Southold, school's with marching
bands,boy and girl scouts,Pipe Bands, Veterans groups,assorted politicians, church's
and various other civic organizations,to participate. We hope to have a firm account of
the groups involved by the end of February. We would also like to extend an invitation to
Supervisor Russell and the entire Town Board to march with us.
A 2 million dollar liability policy for the parade, which names the Town as an additional
insured is attached.
If you have any questions,I can be reached at 516-885-9138. We would be happy to
attend the Town Board meeting when this subject will be discussed so please advise us of
the date.
Sincerely,
Joseph C. Corso
North Fork Chamber of Commerce
No>lh'Foirk Chamber of Commerce,PC Box 04-T 5,Southold,lY IT 971
er, ww.no fFotrkehauB ber orrg 631-765-316T i nfb@naorThfbr kcLBflawber org
6 nun 11.1 &AMSER OF COMMEFCj-:
saa,.
} � � � �
RECEIVED
JAN 1 7 2020
Southold Touvn Clerk
Elizabeth A.Neville,MMC 1/20/20
Town Clerk .
Town Hall,53095 Main Rd
PO Box 1179
Southold,NY 11971
To the Office of the Town Clerk
Regarding the fee's required for special events;this is a formal request to waive the fee
for events with less than 1000 expected attendees. The Annual St Patrick's Day Parade is
a community based event which is not a fundraiser for either the North Fork Chamber or
the Cutchogue Fire Dept. All funds raised go towards payment of the Pipe Bands and
any advertising related to the parade: Typically,the Chamber absorbs a loss associated
with the event.
If you require any additional information, I would be happy to meet with the Board or
can be reached at 516-885-9138. Thank you for your consideration concerning this
matter.
Sincerely,
L .��c�
Joseph C. Corso
Board Member,Parade Chair
North Fork Chamber of Commerce
Nor&Tork Chamber of Commerce, PO Box 11415,Sont hoRd,NY 11971
631-765-3T6T infoChn®p-daforrkehar berrarg
{ Town of Southold
P.O Box 1179
Southold, NY 11971
(631) 765-1800
RECEIPT
#3/14/2020
07/08/2020
North, Fork Chamber Of Commerce
P O Box 1415
555 New Suffolk Rd.
Cutchogue, NY 11971
Received $ 250.00 for Event Fee, on 01/17/2020. Thank you for stopping by the Treasurer's Office.
As always, it is our pleasure to serve you.
Elizabeth A. Neville
Southold Town Clerk
�w
r d II
y .„ a IR111 TO 111 .
d
�7�.,�"'l','��'r✓JJu'ver�'»c.' u�kf'7' !air r
RECEIVED
9 )20
1/20/20
Southold lbvvii Clerk
To Whom It May Concern:
Please be advised that the North Fork Chamber of Commerce and the Ctcoe Fire
Department are in the process of planningthe WhAnnual St.Patrick's Day parade. The
proposed date of the parade is March 1 , 2020 with a start time of 2:00 pm. The route
will begin atEugene's Road and headwest to Cases Lane, ending t the village green.
The estimated time of the parade is 1 hour. At Chief Flatley's suggestion,we staged the
participants on Eugene's Road prior tot e step-off,and will do the same this year.
During the parade we would need to have the Main Roadshut down to traffic from Cox's
to v 's Lane from 2:00pm.to approximately 3:30pm.
We are currently inviting FireDept's in the Town of Southold, school's with marching
bands, boy and girl scouts,Pipe Bands, Veterans groups, assorted politicians, church's
d various other civic organizations,to participate. We hope to have a firm account of
e groups involved by the end of February. We would also like to extend an invitation to
Supervisor Russell and the entire Town Boardto march with us.
million liability olicy for the parade, which names the Town as an additional
insured is attached.
If you have any questions,I can be reached t 516-885-9138. Wewouldbehappyto
attend the Town Boardmeeting when this subject will be discussed so please advise us of
e date.
Sincerely,
Joseph C. Corso
North Fork Chamber of Commerce
1North Fark rhanilmr of Commerce, PO Box 1415, " otithol ,NYA 1971
wm�w.nortitfo °l l iliibi,-.or, 631-765-3161 info@n.oTthfbrkChamher.org
T1
URK
RECEIVED
dk`l 1 7 2;)20
Soufl,iold Imri Clerk
Elizabeth A.NeviII6, MMC 1/20/20
Town Clerk . -
Town Hall, 53095 Main Rd
PO Box 1179
Southold,NY 11971
To the Office of the To Clerk
Regarding the fee's required for special events; this is a formal request to waive the fee
for events with less than 1000 expected attendees. The Annual St Patrick's Day Parade is
a community based event which is not a fimdraiser for either the North Fork Chamber or
the Cutchogue Fire Dept. All fimds raised go towards payment of the Pipe Bands and
any advertising related to the parade. Typically,the Chamber absorbs a loss associated
with the event.
If you require any additional information, I would be happy to meet with the Board or
can be reached at 516-885-9138. Thank you for your consideration concerning this
matter.
Sincerely,
Joseph.C. Corso
Board Member,Parade Chair
North Fork Chamber of Commerce
Nivi-th.Foiric Cha iter ol'Commerce, PO Box 1415, So-tftltold, NY'01971
w-w-w.north,fo�irk,chaiiiiiibei.org 631-765-3161
ETown Hall,53095 Main Road
ELIZABETH A.NEVILLE, MMC
TOWN CLERK P.O.Box 1179
� 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 RECEIVED
TOWN OF SOUTHOLD
JAN 1 7 2020
APPLICATION FOR A PERMITTO HOLD A
Southold Town Clerk
SPECIAL EVItNT
Il ;as�` wide ALL of"the ir�l'ornatir� ret uesteil lrelor »Inccmr fetes alic.ttia� s "wI �L 1"wOT be
reviewed.
Date of Submission
N r,j1 W
Name of Event .mm,.... . ..._ " L
..� m (... .._ 6 . ._.A.
Name of Organization: Ka
Is this a Not-For-Profit Event?Yes/N0�1�fS__._.._ _ �...—
Contact's Name:
Mailing Address:
Contact's Phone Number: —u...
Contact's Email Address:
Event Location and Site Diagram: ... L. t 114 `
(Use additional paper if necessary)
Event DaInclude�se u and
( p
shutdown times and dates)
Nature of Event: to t
m. ' ppli.
(Please attach a del��t � d � ka��t iz�"� cation)
Time Period (Hours) of Event: From to31,3 D o w
Maximum Number of Expected Attendees: 6
Specify any special requirements (i.e. road closure, police presence) �±Le_
ye
t11 � - n....,e m mow. ... ..,iu....r�•.....
If a Tent or other temporary structure will be used please contact the Southold Town Building Department
at 631-765-1802 p
Mailing Address to Send Event Permit to: I
Event Fees:
_$250 for events with less than 1000 expected attendees
$500 for events with 1000 or more expected attendees
Clean-up Fees (Can NOT be waived):
$1,500.00 Clean-up for Bicycle and/or I unrjing Special events(ONLY)
$250 or more Clean-up deposit all other events
CERTIFICATE T OF IN'SC.TRANC E ISE 1U1RED: Not less than$2,000,000 naming the Town of
Southold as an additional insured.
***NOTE: PLEASE SEE ATTACHED REVISED ADOPTED TOWN
POLICY***
Additional information and requirements may be required as deemed necessary by the Town Board,
X,
Print name of Authorized Person filling out Signat e of Athorized Person filling out application
application
*Upon the request by applicant,the Town Board may waive in whole or in part any of the application
requirements.
2
sa
CERTIFICATE OF LIABILITY INSURANCE LIATEItIro11DkYI
T'i IS ZERWICATE 16 ISSUED AS A MATTER OF INFORMATION ONLY ANIS CONFERS NO RIGHTS UPON THE CERT'IF'ICATE HOLDER,THIS
TIFI S",NOTAFFIMATIVELY ORNEOAXVELYAM' END, EXTEND OR ALTER THECOVERAGEAFIORDEUI
�EP�bCICiES
�A CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING R(8),AUTHORIZED
.,
I RIS NTATIVE-OR PROQIUCER,AND THE CERTIFICATE HOLDER.
IMRORTAfi R y(�" RED pro rv9lsfna Dr tl ,gnd;or;Ied
T. If the...cerllfiucat�l llttldal~II>an ADDITIONAL INSURED,tits OIiC tis)Rulu;at have ACdDIT1 NAI..INSURED
th editlfi at 1 does not confer rightstothe certificate holder n lieu off suchlandorsamen,tla)les m require An endaarslslTl nt. A statemeritbn
.1 Po AY . .. ,
PR,ODUCER.. 707" AleXandrla 11'ilrillney
Mclv%11rlrtPrice A®dncy.'lnc. PHONE (031)477-1880 I0�1I4,7'711000
,.. P
ADDI ..._ AI No ..._ ...
arc.N�
826cFrdlnt Slr t L alexandrie mcmenn rICE.CorT
s. . .. '... ADDS^ . . ,." •„.•” .N
PO B(JA 2Ct1 -
}NStIRI~RIS1AFFORDING COVERAGE'
ISr NY 11944- H'Drff.ord firel
nl Co,
"u..� ;'. • 0876 Ihl'SURF.Fi.A; p. —198112--� ..,, ... . 10,882,_ ..;
INSVD INSURER e e '
s•The North Fork Chamber of Commerce IN SURER,c
..
INSURER D
,..eJ.. P'.)Boit 141.5 _. INSURER Eu
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CO1 I� ItOE CERTIFICATE NUMBER: CL2011302710 AEVISIOWN M IETt. "-"
T"1$70 CERTWYTHAT THE.POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE.INSURED NAMEDABOVE FOR•THE POLICY PFAIOD
-mbirATED. NO'1"wTHSTANOoIr5aA,NY,REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO k ICH f-HIS Ce "
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I ATF MAYBE ISSUED OR MAY PERTAIN"THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT.TOALL THE TERIAS .
E1tt�bSI`6N5 ND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR L TYPE or INOORANCE INED WVO POLICY NUMBER MMfO MIM1AIOINYYTY
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WORKERS COMPENSATION'
AND EMPLOYERT LL'ABILITY YIN 4,N En, .,,.,... ....w..., . ....,.
ANY PROPA^kfOOJPART 1ERIEXECUTIVE NIA E L.EAGHAfiO&DENT .. 1k n�
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'(Minditory In NHl • ,. .MSFAIE-EA EMPLOYEE, $ _
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DESCRIPTION OFOPERATIONS below E.L.DISEASE-POLICY UNIM 5
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DESCRIPTION OF DPE N&
TIO1 LOOATION9 B VEHICLES(ACORD 107,AddNionel Rem;de Schsdule,maybe anached 0 more apace le required)
With reaped to the St.PaideMs Day Parade being heed on Saturday"March 14th,2020 in CutChogue.Certificate holder is listed as additional insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DE3CIEp PCILICIE3 BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVER ED I
Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 1179
'AUTHORIZED RE.PRES ATYVE
Southold NY 11871
1988-016 ACORD CORPORATION. All rights erred.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD