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HomeMy WebLinkAboutSummer Art Show @ Osprey's Dominion RECEIVED JUL 1 3 20M C eM Southold Town Clerk co � A TOWN OF SOUTHOLD Town Code Chanter 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 asosn sible• Any cQnkled 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$250.00 by the Office of the Town Clerk, unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health,safety,and welfare of the community When is a Permit Required? All Special Events,per Southold Town Code Article I,Section 205-2(Defmitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations,parties or not-for-profit fundraisers do not require permits. Any use of residential proper for profit,such as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk. Please indicate submission of the followingby checking off the boxes and signing below. A completed application form signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. / EM- Is the application being submitted at least 60 days before the event[ ] Yes [yJ No ElIf Yes,Fee of$ has been submitted u If No,Fee of$ has been submitted Updated 8/7/2018 u The applicant/owner of the property where the special event is proposed to take place must provide a certificate of insurance not less than 2 million dollars naming the Town of Southold as an additional (�( insured u A Parking/Event Plan: consisting of a survey, site plan and/or aerial view of the subject property that includes the locations of on-site parking, sanitary facilities,and tents or other temporary structure(s). (See application form for details) Events for three hundred(300) or more people require submission and approval of a traffic control plan acceptable to the Town of Southold AND a qualified traffic controller must be provided at the event. (See application form for details) 0 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. -T /13/ 0 Dated :gnature 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. i1 . 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 APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVENT Please provide ALL of the information requested below.Incomplete applications WILL NOT be reviewed. Special Event Permit# (�+�-32 Applicant(s)name: a-g-1 1Rl'Q- 1 Date of Submission - - Game of Event�1 mxmn ld SCTM#'s 1000-Section —fcJ Block- Lot(s) 2� r Dates of Each Event: ea""' 2-C)`-c) If Multiple Dates are requested,applicant must give all information for all dates. Nature of Event: t (Please attach a detailed description o ACH-event to this application) Time Period(Hours)of Event: From f CVY-r') to Town Services requested: ( )Yes '�k)No If yes,Describe Police Dept. Highway Dept. Descnbe Services Maximum Number of Persons Attendmg At One Time: © Number of cars expected 2f3 Is a Tent or other temporary structure being used? [)C] Yes[ ]No If yes provide size(s) r�na1 .�-�, ►�In x Will food be served?[ ]Yes [SCJ No If yes provide number and name(s)of food vendor(s) Updated 8/7/2018 Will other vendors be on the premises during the event?K Yes [ ]No If yes how many? VZ Describe Type of vendor(s) �� ,t_��� [7[�a/lcRd Property Owner(name/address): 'V�-QJU C--�e lamK0.0 ��Q �C c- Ny Contact Person and Contact Tel.# Qrj — e-mail address L L ci� r GV0 9� Event Location: Street-Hamlet Address: A 4 0-15 1gnc�c>�5e�L' , `—t� Mailing Address to Send Event Permit to: LLQ Have any of the development rights been sold to the Town of Southold[ ]Yes [ ]No and/or Suffolk County Agricultural Prograi4? M Yes [ ]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,YOUMUST ALSO ATTACH A TRAFFIC CONTROL PLAN(,see next page) A Parking[Event Plan may be a survey, site plan and/or aerial view ( or example Google Earth)of the subject propedY.INDICATE ON THE PLAN ALL of the following information: A parking/event plan showing: (1) The size of the property and its location in relation to abutting streets or highways. (2) The size and location of any existing building(s)or structure(s)that will be in operation during the course of the event and any proposed building, structure,or signs to be erected temporarily for the event. (3) The location of the stage or tents,if any. (4) The designated areas of use for spectators,exhibitors,vendors,employees and organizers. (5) Location of all entries and exits. (6) The location of all fire extinguishers and other fire safety equipment. (7) The location of all temporary utilities to be installed for the event,if any. (8) The layout of any parking area for automobiles and other vehicles and the means of ingress and egress for such parking areas. The parking spaces must allow for 300 sq. ft. per car. (9) A traffic control plan for vehicles entering and leaving the site for the proposed event. (10) Plan for the use of live outdoor music,loudspeakers and other sounds which will be used, if any,and the type and location of speakers and other audio equipment. (11) A description of emergency access and facilities related to the event. (12y Provisions to dispose of any garbage,trash,rubbish or other refuse. �'3) 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. OTi'VER'S SIGNATURE: I am fire Owner of the Property?where this event is to be held and I agree to comply midi the Imes, rules, regulations,conditions, and requirements of the Code of the Town of Southold,including but not limited to the conditions listed belons,as well as all other applicable agency miles and regulations Pertaining to the activities under this event. Furthermore,I hereby swear or affirm that the information contained herein and attachments hereto are trate and correct to the best of my knowledge, and agree to provide notice to the Toren innnrediatelj,should there be anp material changes regarding to this application.. Furthermore,I hereby authorize Code Enforcement Pers noel o th Tor ►r of Sout1 Id to enter the Proper v during the hours of the permitted special event o ma a► �an all in ctivns nece ail}in connection with this Special Event. Piint uame of Owner Signalure of Owner/,-Ll Print nanne of Authorized Persort/Representative Signature of Authorized Person/Representative PERIMISSION IS HEREBY GRANTED SUBJECT TO THE FALLOWING CONDITIONS: 1. By acceptance of this permit, applicant agrees to adequately supervise and direct all parking to be on the premises or at another site, and to provide parking assistants and any additional traffic controls necessary for this event. Parking is strictly prohibited on ANY Town. Counjy or State Roads or Rights of «Y. 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 `bin-premises" sign not larger than sit (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 pernit. 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 pernit is valid only for the time, date, place and use specified above, and for the designated event. Each additional day will require a separate permit application, fee, and related documents for review,etc. at least 60 business days prior to the scheduled event. 7. Adequate temporary sanitary facilities must be provided by applicant for this event and applicant agrees to remove the temporary facilities from the premises within 48 hours after the day of the event. Updated 8/7/2018 8. On-site food preparation is NOT permitted, although food may be catered subject to all Suffolk County Department of Health regulations. 9. NO activities associated with this event, including but not limited toan rking,,�i gress/egress/access. tents, or I=oraiy structure(s),, or temporary sanit=facilities shall be conducted on Town of Southold Purchase of Dove1gymgmt Rights land. 10. NO activities associated with this event, including but not limited to ar g, ingress/e=ss/access tent(sl or temmorary structure(s) or temmoL= sanitary facilities shall be conducted on Suffolk Co Into Purchase of Development Rights land without a permit issued by the Suffolk Co Farmland Committee, 11. Issuance of this permit does not authorize in any manner the occupancy of any building exceeding the legal limitations under the fire code or other codes which would prohibit such increased occupancy. 12. Access shall be provided for emergency vehicles,to all public assembly areas,all buildings,all work areas and any additional area where emergencies may occur. Two emergency-fire exits and exit paths from the building(s) on the property, to a public way or remote safe area, shall remain open and unobstructed at all times. 13. Owner assures full compliance with all fire,safety,building,and other Town laws. 14. Music,when outdoors,is required to stop at the time specified in the permit.Placement of the speakers must be in a location that affords the greatest protection from noise intrusion upon adjacent properties. 15. Owner will allow access to Code Enforcement Personnel of the Town of Southold during the hours of the special event to make any and all inspections necessary in connection with this Special Event 16. ADDITIONAL CONDITIONS: ANY VIOLATIONS IN CONNECTION WITH THE CONDITIONS LISTED HEREIN WILL TERMINATE THIS PERMIT. APPROVED Town of Southold Resolution Number: Date Issued: Updated 8/7/2018 LONG ISLAND ART SHOW,LLC 5301 TOWNE WOODS RD. CORAM, NY 11727 (516)458-0742 WWW.LIARTSHOW.COM LIARTSHOW®GMAIL.COM JULY 10,2019 DETAILED DESCRIPTION OF EVENT LONG ISLAND ART SHOW, LLC IS HOSTING AN ART SHOW ON JULY18TH, 2020 AT OSPREY'S DOMINION VINEYARDS,LOCATED AT 44075 MAIN RD, PECONIC,NY 11958 FROM 11AM TO 5PM FEATURING 10-12 LOCAL ARTISANS SELLING EXCLUSIVELY HANDMADE ITEMS, INCLUDING POTTERY, PAINTINGS, PHOTOGRAPHY, JEWELRY, WOOD AND METAL HOME DECOR, AND NATURAL SOAPS AND CANDLES. ONLY LOCAL ARTISTS AND CRAFTERS OF HANDMADE ITEMS ARE ACCEPTED TO PARTICIPATE IN THE EVENT. ARTISTS WILL ARRIVE ON THE MORNING OF THE EVENT TO SET UP IN THEIR ASSIGNED 10'X 10' LOCATIONS.TENTS WILL BE SPACED 6'TO 10'APART.THE ARTIST'S SPACES HAVE BEEN MARKS WITH RED SQUARES ON THE GOOGLE MAPS IMAGE, WHICH IS THE LAWN AREA ADJACENT TO THE VINEYARD'S TASTING ROOM. ARTIST WILL BREAK DOWN THEIR AREA AT 5PM, LEAVING THE PREMISES CLEAN OF ANY DEBRIS. Long Island Art Show, LLC has implemented a list of protocols for the Art Show, to comply with current safety guidelines,for the protection of everyone,including: -Limiting the number of artisans to 50%of capacity. -Tents will be spaced a minimum of 6'to 10'apart as space allows. -Everyone associated with the Art Show must wear masks for the duration of the day. -Artist will allow 1-2 people of the same group into their tent at a time. -There will be a Sanitation Station at each entrance to the Art Show area consisting of:signs enforcing social distancing of 6'must be adhered to&masks must be worn at all times,will be posted throughout art show area (See below), large pump bottles of hand sanitizer,disposable face masks,paper towels and a trash bin.-Each artist will have a bottle of pump sanitizer available for patron use upon entering their tent. -An attendant will monitor and control the number of people in the Art Show area with a tally counter. -We have minimized advertising by 50%. -Artisans have committed to adhering to all safety measures. Thank you for your consideration, Tracy Marlowe Event Organizer Long Island Art Show, LLC ST r +'''��~�y` �~��M1l•�, yea, .F' LONG ISLAND ART SHOW, LLC 5301 TOWNE WOODS RD. CORAM, NY 11727 (516) 458-0742 WWW.LIARTSHOWCOM LIARTSHOW@GMAIL.COM JULY 10, 2019 REQUEST FOR EXPEDITED REVIEW Dear Leslie Kane Weitzman, Chairperson Long Island Artshow, LLC will be holding it's 7th Annual Art Show at Osprey's Dominion at 44075 Main rd in Peconic on July 18, 2020 from 11am to Spm. The purpose of this letter is to request an expedited review. Our intention was to apply for this permit in March, when we began booking shows for the upcoming season. With the announcement of the Coronavirus, we were doubtful we'd be able to hold any of our shows. When Suffolk County achieved Phase 111 status, we began accepting artisan applications, but withheld from invoicing. In preparation for Phase IV status, we implemented a list of safety protocols for the artists, that they have committed to. (detailed list on permit application &as an addendum to this letter.) Due to the unpredictable nature of our circumstances regarding social distancing guidelines, and the recent achievement of Phase IV status, we are respectfully requesting an expedited review of our application, and a waiver of the $250 late fee. Thank you for your consideration, Tracy Marlowe Event Organizer Long Island Art Show, LLC ADDENDUM TO REQUEST FOR EXPEDITED REVIEW SUBMITTED BY LONG ISLAND ART SHOW LLC Long Island Art Show, LLC has implemented a list of protocols for the Art Show, to comply with current safety guidelines, for the protection of everyone, including: -Limiting the number of artisans to 50% of capacity. -Tents will be spaced a minimum of 6' to 10' apart as space allows. -Everyone associated with the Art Show must wear masks for the duration of the day. -Artist will allow 1-2 people of the same group into their tent at a time. -There will be a Sanitation Station at each entrance to the Art Show area consisting of: signs enforcing social distancing of 6' must be adhered to & masks must be worn at all times, will be posted throughout art show area (See below), large pump bottles of hand sanitizer, disposable face masks, paper towels and a trash bin.-Each artist will have a bottle of pump sanitizer available for patron use upon entering their tent. -An attendant will monitor and control the number of people in the Art Show area with a tally counter. -We have minimized advertising by 50%. -Artisans have committed to adhering to all safety measures. July 10, 2020 To whom it may concern, Please be advise that I give permission to Peter Carey to represent me in all matters relating to the Art Show which will be held on property owned by me at Osprey's Dominion Vineyards, 44075 Main Rd., Peconic, NY 11958 Very truly yours, C Frederick W. Koehler, Jr. Owner MMD CERTIFICATE OF LIABILITY INSURANCE DATE 07/1(M3/2020 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(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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). PRICER E• Will Maddux East Main Street Insurance Services,Inc. PHONE (530)477-6521 IA_FA NXLm No. No Will MadduxD IL AES&. info@theeventhelper.com PO Box 1298 INSURER AFFORDING COVERAGE MAIC# Grass Valley CA 95945 INSURERA: Lloyds Syndicate 2623 AA-1128822 INSURED INSURER e: Lloyds Syndicate 623 AA-112662; LONG ISLAND ART SHOW,LLC INSURER C: TRACY MARLOWE INSURER D: 5301 TOWNE WOODS RD INSURERE: CORAM NY 11727 INSURERF: 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 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. TYPE OF INSURANCE ° B vn OLICY NUMBER POLICY EFF POLICY EI(P LIMITS COMMERCIALGENERALLIASILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-07ADE OCCUREDAMAGE To S ° $ 100,000 Host Liquor Liability MED EXP&Y one rson $ 5,000 A Retail Liquor Liability Y EH-771320-L2685978 07/17/2020 07/19/2020 PERSONAL aADvINeuRY $ 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER* 12:01 AM 12:01 AM GENERAL AGGREGATE $ 2,000,000 POLICY❑PRCT O ❑LOC PRODUCTS-COMP/OPAGG $ INCLUDED JE OTHER, Deductible $ 1,000 Aln'OM060.ELU161LITY CB ee SINGLELIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per seddent) $ AUTOS ONLYAUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY r etcideM S UMBRELLALIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAO CLAIMS-MADE AGGREGATE $ DED RETENTION S $ -77 WORKERS COMPENSATION A FTH - ANDEMPLOYERS'LIABILITY Y/N ANYPROPRIETORMARTNERIEXECUTAIEE.LEACHACCIDENT $ OFFICERIMEMBEREXCLUDED? � R/A (MendMW In NH) E L DISEASE-EA EMPLOYEE$ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIFnONOFOPERATiONS/LOCATIONS/VEHICLES(ACORD 101,AdBNonalRarAftSehodulamay boe0aehedOrnmapa:elsreQWred) Certificate holder fisted below is named as additional Insured per attached CG 20 26 07 04. Attendance:50,Event Type:Art Festival and Show. 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. TOWN OF SOUTHOLD AUTHORIZEDREPRESENTATNE PO BOX 1179 //����f,� SOUTHOLD NY 11971 (� ®1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2018/03) The ACORD name and logo are registered marks of ACORD Policy Number:EH-771320-1-2685978 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Or anization s TOWN OF SOUTHOLD PO BOX 1179 SOUTHOLD,NY 11971 Information required to complete this Schedule K not shown above,will be shown in the Declarations. Section If —Who Is An Insured is amended to in- clude as an additional insured the person(s)or organi- zations)shown in the Schedule,but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part,by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations;or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ©ISO Properties,Inc.,2004 Page 7 of 1 D AC V CERTIFICATE OF LIABILITY INSURANCE DATE(NMIDD/YYYY) 111%� 1 07/13/2020 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(1es)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 NAME: WIII Maddux East Main Street Insurance Services,Inc. PHONE (530)477-6521 10. Will Maddux ADDRESS: info@theeventhelper.00m PO Box 1298 INSURERS AFFORDING COVERAGE NAICS Grass Valley CA 95945 INSURER A: Lloyds Syndicate 2623 AA-1128629 INSURED INSURER e: Lloyds Syndicate 623 AA-1126623 LONG ISLAND ART SHOW,LLC INSURER C: TRACY MARLOWE INSURER D: 5301 TOWNE WOODS RD INSURERE: CORAM NY 11727 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 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 TYPE OF INSURANCE ADDL POLICY EFF POLICY EXP LTR POLICY NUMBER M LIMBS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 7 OCCUR PREMISES $ 100,000 Host Liquor Liability MED EXP one n $ 5,000 A Retail Liquor Liability Y EH-771320-L2685978 07/17/2020 07/19/2020 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER, 1201 AM 12.01 AM GENERAL AGGREGATE $ 2,000,000 PqPOLICY❑JEST LOC PRODUCTS-COMPIOPAGG $ INCLUDED OTHER' Deductible $ 1,000 AUTOMOBILELIABILITY COMBINED SGLELI IT $ Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY PeraM AUTOS ONLY AUTOS ( ) $ HIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ UMBRELLALIASOCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I PER OTH AND EMPLOYERS'LIABILITY YIN STATUTE ANYPROPRIETORIPARTNERIEXECUTIVEE.LEACH ACCIDENT $ OFFICEWMEMBEREXCLUDED4 F-1 N/A (Mandatory In NH) E L DISEASE-FA EMPLOYE $ if yes,desanbeunder DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additblrsl Remarks Schedule,may be attached If more apace Is required) Certificate holder listed below is named as additional Insured per attached CG 20 26 07 04. Attendance:50,Event Type:Art Festival and Show 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 OSPREY'S DOMINION VINEYARD AUTHORIZEDREPRESENTATIVE�� 44075 MAIN RD PECONIC NY 11958 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number:EH-771320-L2685978 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) OSPREY'S DOMINION VINEYARD 44075 MAIN RD PECONIC,NY 11958 Information required to complete this Schedule if not shown above will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s)or organi- zations)shown in the Schedule,but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' caused, In whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations;or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ©ISO Properties,Inc.,2004 Page 1 of 7 D DECLARATIONS SPECIAL EVENTS LIABILITY CLAIMS MADE AND REPORTED INSURANCE THIS IS A CLAIMS MADE AND REPORTED POLICY.SUBJECT TO ITS TERMS,THIS POLICY APPLIES ONLY TO ANY CLAIM FIRST MADE AGAINST THE INSURED AND REPORTED IN WRITING TO THE UNDERWRITERS DURING THE POLICY PERIOD OR EXTENDED REPORTING PERIOD(AS SET OUT IN CLAUSE V.OF THE POLICY),IF APPLICABLE.DAMAGES AND CLAIMS EXPENSES SHALL BE APPLIED AGAINST THE DEDUCTIBLE.CLAIMS EXPENSES ARE WITHIN AND REDUCE THE LIMIT OF LIABILITY UNDER THIS POLICY.THE UNDERWRITERS SHALL NOT BE LIABLE FOR ANY DEFENSE COSTS OR FOR ANY JUDGEMENT OR SETTLEMENT AFTER THE LIMIT OF LIABILITY HAVE BEEN EXHAUSTED.PLEASE READ THIS POLICY CAREFULLY. THESE DECLARATIONS ALONG WITH THE COMPLETED AND SIGNED APPLICATION AND THE POLICY WITH ENDORSEMENTS SHALL CONSTITUTE THE CONTRACT BETWEEN THE NAMED INSURED AND THE UNDERWRITERS UNDERWRITERS: CERTAIN UNDERWRITERS AT LLOYDS,LONDON MASTER POLICY NUMBER:EH-771320UNIQUE MARKET REFERENCE NUMBER: B0572YF19ST21 CERTIFICATE NUMBER: 2685978 INSURED EVENT: Art Festival and Show ITEM 1. NAMED INSURED: PARTICIPATING MEMBERS OF THE EVENT HELPER,INC.,MEMBERS OF THE OUTDOOR RECREATIONAL INSURANCE PROGRAM ADDRESS:ONE NORTH FRANKLIN,SUITE 3600,CHICAGO,IL 60606 CERTIFICATE HOLDER: LONG ISLAND ART SHOW, LLC,TRACY MARLOWE EVENT ADDRESS: 44075 MAIN RD,PECONIC, NY 11958 ITEM 2. A) POLICY PERIOD: B) INSURED EVENT PERIOD: FROM: 12/31J2019 TO: 12/30/2020 FROM:07/17/20 TO: 07/19/20 BOTH DATES AT 12.01 Am LOCAL TIME AT THE ADDRESS BOTH DATES AT 12.01 ANI.LOCAL TIMEAT THE ADDRESS STATED IN ITEM 1 STATED IN ITEM 1. ITEM 3. LIMIT OF LIABILITY A. BODILY INJURY,PROPERTY DAMAGE,PERSONAL INJURY AND ADVERTISING INJURY: a. LIMIT OF LIABILITY EACH ACCIDENT OR/AND OFFENSE INCLUDES CLAIMS EXPENSES DURING EACH INSURED EVENT PERIOD $ 1,000,000 b. AGGREGATE LIMIT OF LIABILITY INCLUDES CLAIMS EXPENSES DURING EACH INSURED EVENT PERIOD $ 2,000,000 B. MEDICAL PAYMENTS TO ANY ONE PERSON $ 5,000 C. DAMAGE TO PREMISES RENTED TO YOU $ 100,000 D. POLICY AGGREGATE LIMIT OF LIABILITY INCLUDES CLAIMS EXPENSES FOR EACH INSURED EVENT $ 2,000,000 E. HIRED AUTO AND NON-OWNED AUTO LIABILITY COVERAGE INCLUDES CLAIMS EXPENSES DURING EACH INSURED Excluded EVENT PERIOD $ ITEM 4. EACH CLAIM DEDUCTIBLE INCLUDES CLAIMS EXPENSES: $ 1,000 ITEM5. SEE RECEIPT PREMIUM: (FULLY EARNED) $ SURPLUS LINES TAX: $ SEE RECEIPT STAMPING FEE: $ SEE RECEIPT RPG FEE: $ SEE RECEIPT TOTAL: $ SEE RECEIPT ITEM 6. EXTENDED REPORTING PERIOD: 24 MONTHS-INCLUDED ITEM 7. NOTIFICATION UNDER THIS POLICY: EMAIL:CLAIMS@BEAZLEY.COM US FAX:(866)910-1397 ATTENTION:CLAIMS DEPARTMENT ITEM 8. TERRORISM COVERAGE: N/A ITEM 9. SERVICE OF PROCESS FOR INSURED'S DOMICILED IN ALL STATES EXCLUDING IL,,CA&KY: MESSRS,MENDES&MOUNT 750 SEVENTH AVENUE NEW YORK,NEW YORK 10019-6829 UNITED STATES OF AMERICA FOR INSURED'S DOMICILED IN IL: LLOYD'S ILLINOIS,INC., 181 WEST MADISON STREET,SUITE 3870 CHICAGO,IL 60602-4541 FOR INSURED'S DOMICILED IN CA: FLWA SERVICE CORP.C/O FOLEY&LARDNER LLP 555 CALIFORNIA ST.,SUITE 1700 SAN FRANCISCO,CA 94107-1520 FOR INSURED'S DOMICILED IN KY: LLOYD'S KENTUCKY,INC. 314 WEST MAIN STREET FRANKFORT,KY 40601.1808 ITEM 10. CHOICE OF LAW: NEW YORK ITEM 11. ENDORSEMENTS EFFECTIVE AT INCEPTION: SLC-3 USA NMA 2868 EH 2001 COVERAGE PART DECLARATIONS CG 00 02 0413 COMMERCIAL GENERAL LIABILITY COVERAGE FORM IL 0017 1198 COMMON POLICY CONDITIONS EH1017 COMMON POLICY CONDITIONS AMENDMENT ERP 1027 1218 EXTENDED REPORTING PERIOD ENDORSEMENT EH1015 DEDUCTIBLE LIABILITY INSURANCE VDP01810 0118 LIMITATION OF COVERAGE TO DESIGNATED PREMISES,PROJECT OR OPERATION EH1016 BLANKET ADDITIONAL INSURED ENDORSEMENT CG2026 0413 ADDITIONAL INSURED-DESIGNATED PERSON OR ORGANIZATION CG2107 05 14 EXCLUSION-ACCESS OR DISCLOSURE OF CONFIDENTAIL INFORMATIONUSION CLAUSE EH 2005 EXCLUSION-DRUG LIABILITY CG 84 810414 EXCLUSION-ORGANIC PATHOGINS CG 90 29 05 16 EXCLUSION OF INTELLECTUAL PROPERTY CG 8015 07 98 ABUSE,MOLESTATION,HARASSMENT OR SEXUAL CONDUCT EXCLUSION EH 2006 EXCLUSION-AIRCRAFT PRODUCTS AND GROUNDING LIABILITY IL 70 69 0316 EXCLUSION-ASBESTOS CG 84 70 0110 ASSAULT&BATTERY EXCLUSION CG2101 1185 EXCLUSION-ATHLETIC OR SPORTS PARTICIPANTS EH2O07 EXCLUSION-EMPLOYERS LIABILITY CG 2147 12 07 EMPLOYMENT RELATED PRACTICES EXCLUSION CG 77 94 07 98 EXCLUSION-LIABILITY ARISING OUT OF LEAD EH2O08 EXCLUSION-METAL GAS,FUME AND METAL BY-PRODUCT CG 83 66 06 05 NUCLEAR,BIOLOGICAL OR CHEMICAL EXCLUSION EH2O09 EXCLUSION-PRE-EXISTING DAMAGE EH2O10 EXCLUSION-PROFESSIONAL LIABILITY ERRORS AND OMISSIONS EH1018 PUNITIVE,EXEMPLARY OR MULTIPLE DAMAGES EXCLUSION EH1013 EXCLUSION-GOLF CART,UTV,ATV EH1014 EXCLUSION-CHILD CARE VWE 0310 12 18 WEAPONS EXCLUSION CG2149 09 99 TOTAL POLLUTION EXCLUSION EH2O11 EXCLUSION-UNMANNED AIRCRAFT PERSONAL AND ADVERTISING INJURY CG 217101 15 EXCLUSION-CERTIFIED ACTS OF TERRORISM CG 2176 0115 EXCLUSION-PUNITIVE DAMAGES RELATED TO CERTIFIED ACTS OF TERRORISM EH2O12 EXCLUSION-DESIGNATED OPERATIONS,PRODUCT OR WORK NMA 2918 WAR AND TERRORISM EXCLUSION ENDORSEMENT LMA5020 SERVICE OF SUIT CLAUSE NMA 1256 NUCLEAR INCIDENT EXCLUSION CLAUSE EH2O04 SYNDICATE PERCENTAGE ENDORSEMENT LMA3100 SANCTIONS AND LIMITATIONS CLAUSE EH2O20 COMMUNICABLE DISEASE,EPIDEMIC AND PANDEMIC EXCLUSION 12/31/2019 AIITHOIUMD REPRESENTATIVE DATE EH 2001 ti. r rt' PARKING `Ir TENT d J i z � • s - all I ■ ■ 6=TS FARM AREA 71V 177x2 I ass>.s Ono SURVEY FOR " AREA &wV A� f OSPREY DOMMON VAEYARQ LM AT PECOMC TOWN OF SOUTHOLD SUFFOLK COtNVTY, N Y vw-75-01-20 scal&I-=vir An Ap4 INM?L4dalwO > 'vow BAY_ Rte- 25) sa "woe Ap MAIN it V � / ARE4=5it8M Aare ENE ]w ° �\ Epp SGC Hit GdO �K\ »�• ,r 'i ^ «.a....« --..o...—«.i.^.—«.� ... «��^ r .w��. �,.... :`.xSnfi. � °A• �!1 y� � 1• '� o;`1°a; ���{��" �♦jyl���� « y \` f r'� •t'2 aEYft .ix..awtu A! o �e ✓k ♦ .i' 49w N' 'f„T A`"•y� /� , S'DTSti \ /91/ erg 't i Inz.a Ut r ; aGto�{t yam' MWa v Wa ✓` i •�" E e 1 C OadxRe0�3 +'�! ir �,�, \ +ori• �:J ., •� !a' `+. r n 1'i, °• J {� f a �► .',�v`' i' � � �1 i ,;,wti °.%'„♦�gr'S++ na t�,r °�3 Cy l i♦ + G '1»Y(�, ` 11�, e`S} ♦5 +� e Y 1011, Ar1t + ° M.tel ��y'jy� •1\SIS YrA �' �}{} 1 11 ; t rn� !� r y,l l{� + AA 4 � � wntw+rnraE.rn �rN� Y� e��xuxa 44 Q. n> te'a, ., yr" ±± 4 e 1, �y)PpaA't N rM n 1¢' eer i xPhIC +e � 4 i1�4ur4 IN y ] + Im YeG E� Maa pxeay aT iu 4 °1 aF ..]Exr ,fi 'e y'] ar°Vnn`i.nx�a�rx �q�•• ppx MST *3 V" IG4{ w dist x Y'PGNna+xwmN +�� �lrHPiM lPo�y 4 Mvhd.uWNSW*L p�� � tOwN CP SeyrxMO ,� of mm v to r � + � ,tlxeHi r Yu 5+4 Ia�jjj,,, ]4x W 5 , MEMO S r9' t eu�Yt s ' BI°J�I1 cobto JU 3 2115 r 1 CtA�CY GCUHNI � anm,Ab u] 1 ZONI 5C'ARD OM APFf:A1 F h( + tf eda ypt.Na pEp pen.No EMU ]] I�" rea aai wa ) x MR-1 6pS-1 F ti&tll-0YEr] Apfi23EC,N0. 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CtCEtVELS ..MnAw hkn.Ffe.^2h+.,ylrmfaa,u w,r+In.r. •rdwauro enol +dnvcn, • • HtCaa aWRnf Mp�gEta.FtxrlOwU.MRf Ya MNAa� nry�µF••w �v v s*oRwerRFt>•t ae va +..'>tixea�+euwD'narvro ram PHp+emuae, lu a.ef.mF F.a echtk,tw nnteO t"3fOA!h © ARO CP APPCA1.5 :Y V.a e+UnF W.•ryntWR'[•w aaNe,M» ��' WW IRdbl Lure 'Irn(ha^+ae�.nu rlP;�fl1ns w, �jA' ePL#.',L:.+.L 15T.AWi�lk:v.1a�R'C'L NM iNVN P4FINFGt Y9F4 navmKP IaIK• bWY aA�ilbra?at WF`S!}wn�'� WalYlif��!`�Wz..fa ui4 MACW. a4MA1 Ih �Vltl U U �l+'J rflrl rfr.,f Yl•If}I YI+JT+Nlan .yn� tlfV•Inar n1aN W1+PP. TarK VM IyA4 aGD. efa V. (1 Of+h) •+�• 1}f,t VF. G#P�IU.6011faIP.{f w.:a.\«rme••+aP'"�'saw�arw b.ue.a}necan.sn+,»a}n.r aw^ ate' ar°M«ra t'a+' v°+°°,°!m.,e anuvarw lrru�.uv. —� - - - INCA bOARDOF APPEALS •-^�-.+•y+P4FNGr Lnd n .!a r Frfm+l,n w.wr -:w +xa a.a f a+m m7.o. GLENN D. PRINCE CORAM, NY (631) 987-4867 GPRINCE28@ICLOUD.COM I LINKEDIN.COM/IN/GLENNDPRINCE Heavy Equipment Use / Truck Driver / Sales SKILLS US Army veteran with 20 years civilian experience in customer relations in a variety of fields ranging from corporate recruiting to cemetery/grave digging supervision. • MANAGEMENT • PROCUREMENT • COMMUNICATION • CLIENT ASSESSMENT • CDL LICENSE • LEADERSHIP • MANUFACTURING • SUPERVISION EXPERIENCE DIRECTOR OF SUPPLY CHAIN RECRUITING 2019 - Present SHEPHERD SEARCH GROUP, Woodbury, NY • Responsible for identifying and placing impact player talent for supply chain industry. • Communicate with clients to identify needs. • Partner with clients to resolve identified short and long-term business challenges, place necessary critical talent. • Manage multiple position openings, providing sense of urgency on high priority searches. • Complete initial candidate screening, in-depth interview, skill and experience assessments, negotiate salary, extend offers of employment, coordinate onboarding. INTERMENT ASSOCIATE 2010- 2018 CALVERTON NATIONAL CEMETERY CALVERTON,NY • Responsible for all phases of interment, including providing guidance and information concerning memorial, dedication, tribute and remembrance stones, plaques, benches, monuments. • As team member, conducted outreach to clients concerning burials, ordering headstones. • Heavy equipment driver. • Grave digging and heavy equipment driver as required, supervising 4-8 cemetery caretakers, as needed. Glenn D. Prince Page 2 EXECUTIVE ACCOUNT REPRESENTATIVE 2002 - 2009 COMMERCIAL ENVELOPE MANUFACTURING,DEER PARK,NY Envelope sales for direct mail programs to non-profits, credit card companies, others • Developed and maintained strong customer base from initial contact to closing, resulting in sales of$5.5 million annually. • Ranked number one in new account acquisition; consistently ranked in top 3 for sales volume. • Recognized annually for largest national sales increase. COMMUNICATIONS TEAM LEADER UNITED STATES ARMY,82ND AIRBORNE DIVISION • Kept battalion advised of all communications between officers/enlisted men to ensure timely action and safety. • Supervised 6 member communications team in all activities. • Responsible for equipment used by communications team. EDUCATION Nassau Comminute College, Garden City, NY Courses In Criminal Justice Town of Southold P O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 07/13/20 Receipt#: 271589 Quantity Transactions Reference Subtotal 1 Event Fee OD 1A $150.00 1 Late Fee OD-late fee $25000 Total Paid: $400.00 Notes: Payment Type Amount Paid By CK#982 $400.00 Osprey's, Dominion Vineyards Ltd Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Osprey's, Dominion Vineyards Ltd P. O. Box 198 Peconlc, NY 11958 Clerk ID: BONNIED Internal ID OD-late fee