Loading...
HomeMy WebLinkAboutEventpower Vendor No. j Check No. Town of Southold, New York - Payment Voucher 11 Vendor Name Vendor Address Entered by Eventpower 162 Long Island Avenue, #179 Audit Date Vendor Telephone Number Holtsville, NY 11742 312-952-7732 Town Clerk Vendor Contact Marc sokoi Invoice Invoice Invoice !Amount Purchase Order Number Date Total - Discount ,Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 2020-431 7/2/2020 1,500.00 ; 1,500.00 CAST Mighty NF T1.030 Triathlon i i j i i Total ; 1,500.00 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 Signatur Title Signatu Company Name Date 1 ' �.�� Title Date Southold Town Board - Letter Board Meeting of July 14, 2020 RESOLUTION 2020-431 Item# 5.18 ADOPTED DOC ID: 16285 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2020-431 WAS ADOPTED AT THE REGULAR MEETINGi OF THE SOUTHOLD TOWN BOARD ON JULY 14,2020: 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 EventPower 11/1/19 $1,500.00 162 Long Island Avenue, #179 Holtsville,NY 11742 Mattituck Lions Club 1/31/20 250.00 PO Box 91 Mattituck,NY 11952 Mattituck American Legion Post 861 2/7/20 250.00 PO Box 861 Mattituck,NY 11952 Bicycle Shows USA 3/3/20 1,500.00 230 Smith Hughes Road Narrowburg,NY 12764 Southold Village Merchants 3/12/20 250.00 PO Box 1356 Southold,NY 11971- L 1971L I Antique Power Assoc. 2/14/20 250.00 PO Box 1134 Riverhead,NY 11901 Generated July 17; 2020 Page 29 Southold Town Board - Letter Board Meeting of July 14, 2020 7V a Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Robert Ghosio, Councilman SECONDER:Jill Doherty, Councilwoman AYES: Nappa, Doherty, Ghosio, Evans, Russell ABSENT: James Dinizio Jr u r Generated July 17, 2020 Page 30 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 11/01/19 Receipt#: 261001 Quantity Transactions Reference Subtotal 1 Clean-Up Deposit 5.31.2020 $1,500.00 Total Paid: $1,50000 Notes: Payment Type Amount Paid By CK#3014 $1,500.00 Event, Power Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Event, Power 162 Long Island Avenue, #179 Holtsville, NY 11742 Clerk ID: BONNIED Internal ID 5.31 2020 ®�®�11FFO��co ELIZABETH A.NEVILLE,MMC y� l✓y Town Hall,53095 Main Road TOWN CLERK C2 P.O.Box 1179 C2 Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS cow - .F Fax(631)765-6145 MARRIAGE OFFICER 'y� ��� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER ' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD November 12, 2019 Vicki Ventura Event Power 162 Long Island Avenue, #179 Holtsville,NY 11742 Dear Ms. Ventura: The Southold Town Board, at its regular meeting held on November 6, 2019, granted permission to the CAST/Event Power to hold its Mighty North Fork Triathlon on May 31, 2020. A certified copy of this resolution is enclosed along with the Town of Southold Policy for Special Events on town Properties and Roads Failure to heed the policy may result in the loss of Clean-up deposit. An insurance policy naming the Town of Southold as additionally insured has NOT yet been filed with this office. Please contact Captain Kruszeski at the Police Department, as soon as possible, to coordinate traffic control. If you have any questions please contact me at the Town Clerk's office at 631-765-1800. Good Luck with your event. Sincerely, 4pkynz�a—� Lynda M Rudder Deputy Town Clerk enc Southold Town Board - Letter Board Meeting of November 6, 2019 RESOLUTION 2019-922 Item# 5.17 �3 �y'°fes y°ate ADOPTED DOC ID: 15692 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO.2019-922 WAS _ ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NOVEMBER 6, 2019: RESOLVED that the Town Board of the Town of Southold hereby grants permission for CAST to hold the "The 20t11 Annual Mighty North Fork Triathlon", at Cedar Beach Park, Southold,New York, on Sunday, May 31,2020 using the following roads: Cedar Beach Road,Paradise Point Road, Bayview Road North,Anchor Lane,Pine Neck Road, Jacobs Lane and Main Bayview Road. and provided they file with the Town Clerk a Two Million Dollar Certificate of In naming the Town of Southold as an additional insured; a$250.00 filing fee; $1500.00 deposit for clean-up (deposit to be returned after event upon recommendation of Chief Flatley, Southold Town Police Department)provided they comply with the Town of Southold's Policy for Special events on Town Properties and Roads. Elizabeth A.Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Robert Ghosio, Councilman SECONDER-Louisa P. Evans, Justice AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Evans, Russell J Generated November 7, 2019 Page 28 %s D Community ration Southold Town RECEIVED �'���` � f MIGHTY NORTHF FORK 500mswim-8mibike-35mirun Southold Town Clerk Date: November 1, 2019 To: Honorable Scott Russell, Town Supervisor Town of Southold Board Members Elizabeth A. Neville, Town Clerk From: Marc Sokol President, Community Action Southold Town Vicki Ventura, Race Director, EventPower Re: CAST Mighty North Fork Triathlon Community Action Southold Town and EventPower are partnering to launch the 20th Annual CAST Mighty North Fork Triathlon. Our collaborative goal is to: • Produce a safe and profitable event • Integrate community • Donate directly to the community In past years the CAST: Mighty North Fork Triathlon has raised money to help the residents of Southold. In 2020 we look forward to teaming up again to help those in need. In addition, funds were donated to Southold Fire Department and Cornell Marine. Enclosed please find the signed permit application for the 20th Annual CAST Mighty North Fork Triathlon scheduled for May 31,2020 at Cedar Beach in Southold, NY. The Triathlon begins at 6:50AM and is completed by 10:OOAM. The parking lot, beach and roads will be cleaned and the race site will be emptied by 11:OOAM. The race consists of a 500 meter swim, an 8 mile bike ride, and a 3.5 mile run. The course will be the same as it has been over the previous years. A map of the course is attached. Enclosed is a $250 check for the application fee, a $1500 check for the clean up deposit. We will forward the insurance certificates once received. If you have any questions, please contact either Marc Sokol (312) 952-7732 or Vicki Ventura (516) 313-8329. ®�SUFFot/(-edm Zbwn HA 53095 Main Road RT VARETH A.Nom.MKC �� P.O.Box 1179 TOWN CLERK Southold,Newyork 11971 REGISTRAR OF VITAL Fax Q � .�' RATAL STATISTICS (631)765-6145 RARLAGE OFFICER �j ®@ Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER Ol www sontholdtownnggov r FREEDOM OF INFORMATION OFFICER. OFFICE OF THE TORN CLERK TOWN OF SOUTHOLD APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVENT Pleaserovide ALL of the information reanegted below.Incom Tete 202lications WILL NOT be reviewed. Date of Submission , 1 2 o \LA _ n � Name of Event '. Name of Organization: C A S C Is this a Not-For-Profit Event?Yes/N`o Contact's Name: CA e rn Y b Mailing Address: Contact's Phone Number: O coq- Contact's Email Address: Event Location and Site Diagram: ° Z `` f\'�G S (Use additional paper if necessary) I �v � OGa'r ' 3i 2.0 Civ-cln�' Event Date(s): �1( .� 0 Z e') (Include set up and shutdown times and dates) P Nature of Event \ j a v n �k UCv�'t A ►�Yt� �•� (Please attach a detailed description to this application) t M c I,\ Time Period(Hours)of Event: From to YY1 Maximum Number of Expected Attendees: L1® Specify any special requirements(i.e.road closure,police presence): C.` yt �►,v �v\� S' I��C c�Sz &C c +� tic h ccl a�t��� Q 1G ►r1 Revised 8/5/15 9t/IZ/£Pastna)l Z -amuiagnbax ut ao a o e%m a Lpm�CSm pxeog umoi,ogt`�ndde ' o f l* IIoq�gdde a��o tae aced 1 � uouwgdde uogmgdde Ino 2umg aosiad !S mo x!113 nosrad P=u-Ow!d3n ante !Jd - oa uaol o*fqu pawaap se paunbai oq gvmsWa P=ao�cgm-p ogWPy NAsO Q�,Ld04� Q�SIA QMO'U V M pamsaa puop►ppe ue se piooS ssa Io �HtlNfISNi,dO�.L �� 3o annoy Q*�um 000`o00`Z$' I x SJaaea jm*o Qe psodap do ueao aatom 10 OSS (�7IdO)quaea lmwdS Smaaag Jud aAL-!S jol do-u=D WOOS`%T— (paW^aq ZON=J)saaA do neap -�nv� '1j"Yov ,,v� saapaa bra aao�a.10 NOT 10m. s1 =03 OOSS smpums pdxa 0(101 �OI wo SM maw so;pcZ� � WIN ��� \ :ot7�d WDAU PtMS MVPV SOWN �.,.,daQ 9-PL-9-01 PI—►oS=R IMWW esiiqdpass a4 n!b OMPMP tieiodma4YatRo m�J.g3I CAST Mighty North-Fork TRIATHLON INCIDENT ACTION PLAN The purpose of this Incident Action Plan (IAP) is to identify and mitigate any potential risks associated with the planning, implementation and successful completion of the above referenced event. The parties that are planning and coordinating this event are committed to,ensuring that all participants,sponsors,community members and emergency personnel are able to partake in the event in a safe and organized manner.The procedural information contained herein will be strictly adhered to. Title of Event: The 20th Annual CAST Mighty North Fork Triathlon Date of Event: May 31,2020- Start Time:6:50 AM(RAIN or SHINE) Event Description: Sprint Distance Triathlon,Swim:500 meters,Cycle:8 miles,Run 3.5 miles Location: 1) Swim:Cedar Beach, rectangle swim 2) Cycle-Exit cedar beach rd heading North, Right turn onto Paradise Point Rd, Left turn onto N Bayview, Right turn at intersection Bayview&Jacobs Lane continuing on Bayview rd, Left Turn at intersection of Bayview and anchor Lane continue on Bayview, Left turn onto Pine Neck rd, Left Turn onto Main Bayview Rd,continue back to Cedar Beach 3) Run- Exit cedar beach rd heading North, Right turn onto Paradise Point Rd, Left turn onto N Bayview, left turn at Jacobs Lane, Left Turn onto Main Bayview Rd,continue back to Cedar Beach Command Post Location: Town of Southold Police Captain Kruszeski:- fkruszesklown.southold.ny.us 631-765-2600 Coordinator/Chairperson- Name: Vicki Ventra Phone Number: 516-313-8329 Email Address: vicki@eventpowerli.com Course Director- Name: Mark Amodio Phone: 631-433-3812 Email Address: Lcasa98@aol.com Staff Coordinator- Name: Tara Hohlman Phone: 516-840-7259 Email Address: tara@eventpowedi.com Medical Emergencies Procedure All medical emergencies will be reported to the Command Post by use of Radios, cell phones or by verbal means. The Event Coordinator will call directly to the Command Post and report the incident/problem.The EMT(s)will report to the Command Post, as appropriate, when entering the event and notify the Command Post when leaving the event. The event coordinator will make sure an area is open to allow EMS personnel,vehicles and equipment access to the event grounds wherever emergency assistance is needed. The nearest hospital for receiving patients is East Long Island Hospital Police Emergencies Procedure For all police emergencies, Notification to the command post. Police enforcement will be provided by the Town of Southold Police with be station at position listed in the attached Course control document. Lost Child Procedure Police will be notified. In the event of a lost child, he/she should be taken to the Command Post. The child, if able, will be asked to provide parent/guardian information. Lost child announcements will be made from Stage, informing the crowd of the situation. The child will remain under the supervision of the Command Post who will ensure the child is comfortable and safe until his/her parent/guardian arrives. Police should be present to check identification of adult claiming to be the parent/guardian before release. Communication Plan We will be using cell phones and a police radio if supplied Important Phone Numbers: Event Coordinator: Vicki Ventura 516-313-8329 vicki@eventpoweeli.com Ambulance&Emergency Services: Southold Ambulance 631-765-3385 © A-) Community Action Southold Town f IIdIGHTY NORTIiF FORK 500m swim-8mi bike-3 5mi run November 1, 2019 Dear Town of Southold,, This letter is to explain the mission of the CAST: Mighty North Fork to be held on May 31, 2020. This will be the 20th annual Mighty North Fork Triathlon. Our mission is to fight poor health through a culture of care on Long Island. Focusing on goal setting, health, fitness and wellbeing we want to promote and grow the competitive sport of triathlon through the safe and fair conduct of races. We are looking to educate the community about physical and mental health and generate funds for research and local community outreach. The triathlon would start at 6:50 AM and be over by 10:00 AM. We will clean up the parking lot, beach, and roads, and leave the race site by 11:00 PM. The race consists of a 500 meter swim, an 8 mile bike, and a 3.5 mile run. EventPower is proud producers of triathlons across Long Island. We produce 13 adult events and 3 youth events per season. We encourage participation from anyone interested in athletics. Please visit us at www.eventpowerli.com -,MtNF Sviunn Map 11/5/15,8:53 PM E-M34 Of 777"'� 1SII(i$Ty NORTH FORK A4 Innovative research and design is FINIS'highest priority.This dedication has resulted in truly innovative products such as:the Swimmers Snorkel which is recognized as the paramount tool to improve a swimmer's technique,the,SVAMP3 that uses bone conduction technology to play music instead of using ear buds,and the Z2 ZOOMOrs fms which demonstrate intimate knowledge ZSWIM COURSE of swimming M-SCUlaturo,hydrodynamics and engineering. Use the CODE:-eventpower when Purchasing Items from EINISInc,com and receive 26%off your order SbMM MAP V, ---- - - R v r name t Ighty North Fork-. Swim.Course:500,meters_ 'ondj, L of Cedar Beach Harbor f fond Fop ' s VhDJ- r Westest N, e Dry cur _j 5"101.8008 1 httP:/hvww.eventpowerli.Com/raCeStMighty%20NorthVo2OForklmnf-svAm-map Page 1 of 2 MNF BiVeMap 11/5/15,8:53 PM E-Mall a A Click Image for interactive BIKE map, —7– Jockey Creek El :t- "8 miles'. J ei' Stato.KWY 2. -orwi C. 1P, % % Of law Ave r- 4r Q 7�, Shepard Or 'Basin I 4� /0. e A. X ItbinsOr 010 1 % conamed Stee l P4 12 b If PPecheeA 04 '1 Itz, 110t: Or QrC1jL,, > IV, D C1 Scale 1:15000 ago. copyrigth www.eventpowerli.com http://www.eventpoweril-com/racWM!ghty%2ONorth%2OForktmnf-bike-map Page 1 of 2 MNF Ru¢Map 11/5/15,8:53 PM C A S hIIG NOFORK :t t� _ •:£`�'-:- _.�>. �>-moi;_ - i.•;;� r Y�:i'�ta:�r,"t:. ► i�.,h� iaa:"�'rs�ix, Click Image for interactive RUN map. VLLO nPondWght� North Fork � t ��- ��.; Run Course:3.5 miles anamQ�t eet= r C � t j �,-777fir` n 'f 'ebb" _ i Q BrCt Pond har��te OKc7aq •c -j' Cedar Beach Coon Park Fp4r Cedar Beach Harbor Pond _ � .11 r�. i Pond ._l___._���Qi_ •' -'�°� `a''' - ` :_.=5�..,�� swto+RpUo mim copyright www.eventpoworll.com httpJ/www.eventpowedi.Com/races/Mighty%20North%20Forklmnf-run-map Page 1 of 2 MNF TKANSITION MAP 11/5/15.8:53 PM E-mail IventPower' 04 ost � 7 t^^HTY NORTH rnp�p�pv 11iiA1 CV14O Homo R3y?tf,_ ;� ► `i:;rit�?�:�[:4.;'tY:� � ;:rs�; ► �=F�"%'�_.C,'Git� ► �3�y' "'?4'-!'Yi t?!v Mfgi: i.`North Foy!: ,"Fvfsitf0%ity L�.3a.I1 AllA All ll ow Terms View MigIft North Fork Transition Mao in a larger map ftn up fw WR' E d t��Yll.�iQ 7 http:/Avww.eventpowerli.com/moes/Mighty%2ONorth%2OForknTMS-MAP Page 1 of 2 Town of Southold P0Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 11/01/19 Receipt#: 261000 Quantity Transactions , Reference Subtotal 1 Event Fee 5.31 2020 $250.00 Total Paid: $25000 Notes: Payment Type Amount Paid By CK#3007 $250.00 Event, Power Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Event, Power 162 Long Island Avenue, #179 Holtsvllle, NY 11742 Clerk ID: BONNIED Internal ID.5 31.2020 Town of Southold Police Department Special Event Cost Analysis Event: Mighty Nork Fork Triathalon I I I Date(s): May 31, 20201 1 1 1 Location: Cedar Beach/Bayview Area, Southold I — - 'Patrol;AQ 6 cate'66-6.'fo!,E 'e"n t"' _ Reg Hours — 'OT ArsHrly Wage Total" Cornl;e�rits Sgt. Brewer 2 1 $288.92 P.O. Bopp 1 $71.79 P.O.Johnson 1 $40.72 Reg Hours OT Hirs Total Comments bA-u PO Simmons 2 $140.52 b11""' --'-t--'-1"R- cvdIeTa ro" Highway.Patrol �_K.. PO Onufrak 3 $207.27 Marine Units' BC Kirincic µ 2 $73.70 BC Dimon 2 $55.05 Traffic Cdnfi6f'- -- Reg Houri OTHrs Hrly Wa–ge-1--'r -�Total Comments' TC Officer#1 3 $17.47 $52.41 TC Officer,#2 3 $17.47 $62.41 TC Officer#3 3 $17.47 $52.41 TC Officer TC Officer 7 7-7 PD Vehicles #of vehicles $/hr Total 7 $10.00 $180.00 $180.00 Command Van Marine Patrol Boats 1 $20/hr $40.00 $40.00 Total Department Cost for Event = i�—$1,255.20 I Prepared by Chief M Flatley 11/4/2019 Page 1 Rudder, Lynda From: Flatley, Martin Sent: Monday, November 4, 2019 2:42 PM To: Rudder, Lynda; Blasko, Regina; Doroski, Melanie; Duffy, Bill; Fisher, Robert; Hagan, Damon; Kruszeski, Frank; Norklun, Stacey; Silleck, Mary; Spiro, Melissa Subject: RE: Cast- Event Power Attachments: MF Triathalon.xls I have no objections to this event being held, my cost analysis is attached Martin Flatley, Chief of Police Town of Southold Police Department 41405 State Route 25 Pecbnic, N.Y. 11958 Tel: 631-765-3115 -----Original Message----- From: Rudder, Lynda <lynda.rudder@town.southold.ny.us> Sent: Monday, November 4, 2019 9:22 AM To: Blasko, Regina <rblasko@town.southold.ny.us>; Doroski, Melanie<Melanie.Doroski@town.southold.ny.us>; Duffy, Bill <billd@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.south'old.ny.us>; 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.ny.us>; Silleck, Mary <marys@town.southold.ny.us>; Spiro, Melissa <Melissa.Spiro@town.southold.ny.us> Subject: Cast- Event Power Please provide approval/disapproval and cost.Thanks 5 i A�" CERTIFICATE OF LIABILITY INSURANCE DATE(M M2020 ) 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 Insurance Office of America, Inc PHONE FAX 1855 West State Road 434 a/c Io Ext): AIC No Longwood FL 32750 ADDRESS INSURER(S)AFFORDING COVERAGE NAIC# License# OE67768 INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED USATRIA-01 INSURERB:Federal Insurance Company 20281 USA Triathlon of Colorado 5825 Delmonico Dr INSURERC: Colorado Springs CO 80919 INSURER D. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:206352246 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 ILTR TYPE OF INSURANCE IVSD WVQ ADDLSUBR POLICY NUMBER MMIDDPOLICY� MMIDDY/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK2067499 12/1/2019 12/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGES(RENTED PREMISES Ea occurrence) $1,000,000 X Part Legal Liab MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY D PRO ❑ LOC PRODUCTS-COM P/OPAGG $2,000,000 JECT X OTHER Event $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLA LIAB X OCCUR PHUB702336 12/1/2019 12/1/2020 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ B Participant Accident 99062167 12/1/2019 12/1/2020 Accident Medical 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) .� Evidence of Coverage Only as respects to the USA Triathlon sanctioned or approved event specified on this certificate. Coverage applies to USAT race directors,event owners,regions,clubs,official sponsors,committee members,race officials,volunteers,lifeguards and race participants,severally as their Interests may appear In the business of USAT,functioning on behalf of the Named Insured or performing In a"sanctioned"or approved event Event Name.Mighty North Fork Triathlon Event Date 05/30/2020-05/31/2020 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CAST'Commun)ty Action Southold Town PO Box 159 AUTHORIZED REPRESENTATIVE Greenport NY 11944 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD