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HomeMy WebLinkAboutMadwell, Inc;J Crew Group, Inc RECtIVED - AUG 1 4 2020 ELIZABETH A.NEVILLE,MMC ��► .�� Soaro l)p 530995 Ma Road ; TOWN CLERK �+b r ft Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p Fax(631)765-6145 MARRIAGE OFFICER �' !� RECORDS MANAGEMENT OFFICER ®1 .��® Telephone oldt 765-18ov FREEDOM OF INFORMATION OFFICER www southoldtownny.gov • j OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT NO: Please Print or Type APPLICATION DATE: 8/13/2020 NAME OF APPLICANT: John Perez MAILING ADDRESS: 322 West 52nd St, Ste 339, New York NY 10019 PHONE: BUSINESS: (212)203-8938 HOME: NAME OF ORGANIZATION/COMPANY: Madwell, INC/J Crew Group, INC MAILING ADDRESS: 30-30 47th Avenue, Floor 10, Long Island City, NY 11101 PHONE: (212)203-8938 FAX: DESCRIBE TYPE OF ACTIVITY(e.g. Motion Picture,Commercial,Television. Catalog, Magazine,etc.): Still Photography Print Shoot r DATE(S)AND TIMES)OF PROPOSED FILMING/PHOTOGRAPHY: 7a-5pm; 1 day on either August 19, 20, or 21, 2020-ideally Frid 6;;;21 w uld be best PROPOSED LOCATION(S)OF FILMING/PHOTOGRAPHY. (attach additional sheet, if necessary) ROCKY POINT BEACH—EAST MARION, NY NAME OF PERSON IN CHARGE AT SITE , John Perez, (212) 203-8938 NUMBER OF PERSONS AT LOCATION(cast&crew included): 10 crew and 2 models NUMBER AND TYPE OF VECHILES AT LOCATION:(1) motorhome, (2)sprinter pass vans, and (2) cars TYPE OF SPECIAL EQUIPMENT: camera, tripod, sun reflector, computer, and possibly 2k generator ANY SPECIAL REQUIREMENTS: . Refer to the attached photo of the areas of interest at the end of the application Madwell print would like to shoot two models wearing various clothing and accessory products. (John Perez) Signature Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P.O.Box 1179 Southold,NY 11971 APPLICANT'S CHECKLIST FOR FILMING PERMIT NOTE: A]I payments must be cash or certified check, X Completed application $100 nonrefundable application fee X 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. X 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): Film Fee-$100 per day of each day covered by the permit Cleanup deposit: Separate check for$250 for each day covered by the permit. i Traffic control fee-$1000 for each day covered by the permit if required by the Chief of Police. Beach Parking fee-$10 per vehicle,per day between May 1 and 1 September 30, ALL CHECKS MUST BE CERTIFIED C NOTE: Additional fees for Cleanup and Traffic Control may be required at the direction of the Chief of Police and Superintendent of Highways i I i r i I 1' I INDEMNIFICATION AGREEMENT i TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT ' r ' The Applicant shall indemnify and hold harmless the Town from and against all suits, claims,demands or actions for any damage and/or injury sustained or alleged to be sustained by any party or parties in connection with the performance of filming or still photography by the Applicant,his employees or agents or any subcontractor and in case of any such action brought against the Town,the applicant shall immediately take charge of and defend the same at his own cost and expense. In addition,the Applicant will name the Town as an additional insured on I any applicable policies. \w August 13, 2020 Signature— Date i John Perez Printed name Location Manager for Madewell, INC/J Crew Group, INC Title I i f I I ;�. .�• 'mss .,-� t.-, �+:�.—'� ' r.�, ,!�7' r 'C* +'�A, � g w Via:' xj! ,z:'�:5,•rt�'t�`-`"�v'"ay^j�. 1`�.�Sw;,?`t�.°��u.f�':r'r` w.a^�. 9 ,s.'••:.rr.,. -, k...i'r.k�°' t.° `u.�' Y':�%• 9� '7� � '� ::s';..F �� '.30: :�;k Y' - �.rvl.�.�� .. � '{-..`".,' 'f .,`'�wn.m; .d'• ,`!a8",q+rigor..,.. .. k' .dw >i : Ari v+k:5+�, t..:,• y.•.,3 ;fit- .>ay. "4' ,,S „5+.^w' �Q •' +a"' :hN✓`. .`h��i�' M'•,vw«, ,•i•"\°n �a„`z. :,w:y,:_,,:y`.Y = ,+�-..�r :',j',,� x hi,. siV•A'`°'..:r to :""°"$=';i,� ,r:,z'�•vK,? ''<<.?, •+,?b,: `a:�M�"•�'?w`''Ye =.-A•„e;,, .=yet.:>.>. �,<.�Z....�,•,�•: a�, _ _ . 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"•'.ek r.A>�,rv°i. w�. �..� ,.T.:. ;yM1 t ,"�.�L;+.« "i•b+„-•^�yh`..4's:.iw�°x-,.t �Y, .X;•'�'n P•I d:' .'„���mn� �P � � , ,)y I NYYY A ® DATE( 108/17/2020 ) CERTIFICATE OF LIABILITY INSURANCE 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. d 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). y PRODUCER CONTACT NAME Aon Risk Services Northeast, Inc. PHONE (FAX Stamford CT Office (A/c No Eaf) (866) 283-7122 A/c No) (800) 363-0105 v o 1600 Summer street Stamford CT 06907-4907 USA ADDRESS = INSURER(S)AFFORDING COVERAGE NAIC 19 INSURED INSURERA Safety National Casualty Corp 15105 J. Crew Group Inc. INSURER Liberty Insurance Corporation 42404 225 Liberty Street New York NY 10281 USA INSURER INSURER D INSURER E• INSURER F: COVERAGES CERTIFICATE NUMBER: 570083547595 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS, Limps shown are as requested INSR ADDL SUER POLICY EFF POLICY E%P LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYVYY) (MMIODIYYYY) LIMITS A X COMMERCIAL GENE RAL LIABILITY GLA4052209 12 18 2019 12 18 2020 EACH OCCURRENCE $2,000,000 I''�� G o $100,000 CLAIMS-MADE I X I OCCUR PREMISES(Ea occurrence) �l MED EXP(Any one person) $10,000 PERSONAL B ADV INJURY $2,000,000 N GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $15,000,000 POLICY RLOC PRODUCTS-COMP/OPAGG $4,000,000 m[J OTHER Per Loc Aggr $2,000,000 r A AUTOMOBILE LIABILITY CA 6675479 12/18/2019 12/18/2020 COMBINED SINGLE LIMIT $2,000,000 m (Ea accident) ANY AUTO BODILY INJURY(Per person) C OWNED AUTOS SCHEDULED BODILY INJURY(Per accident) Z +� AUTOS ONLY PROPERTY DAMAGE v HIRED AUTOS NON-OWNED (Per accident) ONLY AUTOS ONLY .1 Datl 1000 ComplCall U B X UMBRELLALIABX OCCUR TH7631508818059 12/18/2019 12/18/2020 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1,000,000 DED I X RETENTION $10,000 A WORKERS COMPENSATION AND LDc4052205 12/18/2019 12/18/2020 X I PER STATUTE I ETRH- EMPLOYERS'LIABILITY Y/N workers Compensation (AOS ANY PROPRIETOR/PARTNER/ N NIA P54052206 12/18/2019 12/18/2020 EL EACH ACCIDENT $1,000,000 A EXECUTIVE OFFICER/MEMBER (Mandatory in NH) workers Compensation (WI) EL DISEASE-EA EMPLOYEE $1,000,000 U Yes,describe under E L DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more apace Is required) �y Certificate Holder is included as Additional Insured in accordance with the policy provisions of the General Liability and - Automobile Liability policy. J 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. s_ ;'} ZJ southhold Town Hall AUTHORIZED REPRESENTATIVE J PO Box 1179 53095 Main Road �y �f_ p �/� zle Southold NY 11971 NY 11971 USA f�'� ij:tdlC��fivsrreD /�/IGt> d�, r��za ©1988-2015 ACORD CORPORATION.All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Rudder, Lynda From: Flatley, Martin Sent: Monday,August 17, 2020 12:48 PM To: Rudder, Lynda; Blasko, Regina; Doroski, Melanie; Foote, Nancy; Kruszeski, Frank; Norklun, Stacey; Sepenoski,John; Spiro, Melissa; Standish,Jeff; Burke,John; Duffy, Bill; Hagan, Damon; Silleck, Mary Subject: RE:J Crew Film Application I have no objections to this permit being issued. Please have them display special parking permits on their vehicle dashboards during their approved time slots. Martin Flatley, Chief of Police Town of Southold Police Department 41405 State Route 25 Peconic, N.Y. 11958 Tel: 631-765-3115 -----Original Message----- From: Rudder, Lynda <lynda.rudder@town.southold.ny.us> Sent:'Monday,August 17, 202012:09 PM ` To: Blasko, Regina <rblasko@town.southold.ny.us>; Doroski, Melanie<Melanie.Doroski@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Foote, Nancy<nancy.foote@town.southold.ny.us>; Kruszeski, Frank <fkruszeski@town.southold.ny.us>; Norklun, Stacey<Stacey.Norklun @town.southold.ny.us>;Sepenoski,John <johnsep@town.southold.ny.us>; Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Standish,Jeff <jeffs@town.southold.ny.us>; Burke,John <johnbu@southoldtownny.gov>; Duffy, Bill <billd@southoldtownny.gov>; Hagan, Damon<damonh@southoldtownny.gov>;Silleck, Mary<marys@town.southold.ny.us> Subject:J Crew Film Application Importance: High Please approve/disapprove ASAP. 1 I Rudder, Lynda From: Duffy, Bill Sent: Monday,August 17, 2020 2:12 PM To: Rudder, Lynda Subject: RE:J Crew Film Application No objection William M. Duffy, Esq. Town Attorney Town of Southold Southold Town Annex 54375 Route 25 (Main Road) P.O. Box 1179 Southold, New York 11971-0959 Office: 631.765-1939 Fax: 631.765.6639 Email:,billd@southoldtownny.gov -----Original Message----- From: Rudder, Lynda <lynda.rudder@town.southold.ny.us> Sent: Monday,August 17, 2020 12:09 PM To: Blasko, Regina <rblasko@town.southold.ny.us>; Doroski, Melanie<Melanie.Doroski@town.southold.ny.us>; Flatley, Martin<mflatley@town.southold.ny.us>; Foote, Nancy<nancy.foote@town.southold.ny.us>; Kruszeski, Frank <fkruszeski@town.southoId.ny.us>; Norklun,Stacey<Stacey.Norkiun@town.southoId.ny.us>;Sepenoski,John <johnsep@town.southold.ny.us>; Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Standish,Jeff <jeffs@town.southold.ny.us>; Burke,John <johnbu@southoldtownny.gov>; Duffy, Bill<billd@southoldtownny.gov>; Hagan;Damon <damonh@southoldtownny.gov>; Siileck, Mary<marys@town.southoid.ny.us> Subject:J Crew Film Application Importance: High Please approve/disapprove ASAP. I 1 Rudder, Lynda From: 'Spiro, Melissa Sent: Monday,_August 17, 2020 2:15 PM To: Rudder, Lynda; Blasko, Regina; Doroski, Melanie; Flatley, Martin; Foote, Nancy; Kruszeski, Frank; Norklun, Stacey; Sepenoski,John; Standish,Jeff, Burke,.John; Duffy, Bill; Hagan, Damon; Silleck;Mary Subject: RE:J Crew Film Application This is not preserved under the Town open space program. Melissa -----Original Message----- From: Rudder, Lynda i Sent: Monday,August 17, 202012:09 PM To:'Blasko, Regina <rblasko@town.south'old.ny.us>; Doroski, Melanie<Melanie.Doroski@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Foote, Nancy<nancy.foote@town.southold.ny.us>; Kruszeski, Frank <fkruszeski@town.southold.ny.us>; Norklun„Stacey<Stacey.Norklun@town.southold.ny.us>; Sepenoski,John <johnsep@town.southold.ny.us>; Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Standish,Jeff <jeffs@town.southold.ny.us>; Burke,John <johnbu@southoldtownny.gov>; Duffy, Bill'<billd@southoldtownny.gov>; Hagan, Damon <damonh@southoldtownny.gov>; Silleck, Mary<marys@town.southold:ny.us> Subject:J Crew Film Application Importance:-High Please approve/disapprove ASAP. 1 TOWN CLERK'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check Applicant: Job �je—re?— J (Ir er-O Gro Date Received: H Completed application $100 nonrefundable application fee V Certificate of insurance that evidences a public liability insurance policy covering the town as an additional insured in the amount of$1,000,000 (one million dollars) per occurrence for the duration of the filming or still photography. Indemnification agreement stating the applicant agrees to assume all liability for and will indemnify and hold the town harmless of and free from any and all damages that occur to persons or property by reason of said filming or still photography. All Forward completed application to Chief of Police for approval or disapprov�Wnd determination if Traffic Control Fee is required Approved Disapproved ` No Fee Required / Fee in the amount of$ required Forward certificate of insurance and indemnification agreement to Town Attorney fora roval Approved Disapproved COLLECT FEES AS FOLLOWS: + Permit Fees (Prior to issuance of permit): C-I/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. Beach Parking fee - $10 per vehicle, per day between May 1 and September 30. ISSUED PERMIT Countersign application �� 0 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 l 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. Rudder, Lynda From: perezlocations <perezlocations@yahoo.com> Sent: Monday, August 17, 2020 5:23 PM To: Rudder, Lynda Subject: Re: Madewell Shoot Inquiry Rocky Point Beach, East Marion NY Hi Lynda, That you for the call today! Can you mail the original'permit to my address please? John Perez Locations, INC 322 West 52nd St, Ste 339 New York,NY 10019 Thanks again!-, John Sent from my iPhone johnperez I Location Manager & Scout 322 West 52nd Street, 339 1 New York,NY 10019 C 212-203-8938 1 F 718-247-5982 j ohngj ohn-perez.com On Aug 14, 2020, at 12:23 PM, John Perez<perezlocationl@yahoo.com> wrote: Hi Lynda, I will get a COI over here shortly. Thanks l johnperez I Location Manager&Scout 322 West 52nd Street, 339 1 New York, NY 10019 C 212-203-8938 1 F 718-247-5982 Lohn john-perez.com On Aug,14, 2020, at 12:11 PM, Rudder, Lynda <Lynda.ruddergtown.southold.ny.us>wrote: I got this however I need the insurance as explained in section 44A-11 in the Town Code , I sent you before I can send it around for approval. From:John Perez<perezlocations@vahoo.com> Sent:Thursday,August 13, 202012:50 PM To: Rudder, Lynda <Ivnda.rudder@town.southold.ny.us> Cc:john <perezlocations@vahoo.com> Subject: Madewell Shoot Inquiry I Rocky Point Beach, East Marion NY Attachment available until Sep 12,2020 Hi Lynda, Good Morning Tim, Thank you again for taking the time to speak today. I have attached the application below along with photos of the areas. Here is a quick rundown for this Madewell woman's clothing still photography. He client is interested in shooting a the Rocky Point Beach in East Marion NY on either Wednesday, August 19, 20, or 21, 2020, ideally Friday. They shooting be shooting two models wearing various clothing and accessory products. The area of interest are the rocky beach areas - refer the attached areas below. The production detail as follows: Date: Wednesday, August 19, or Friday, August 21, 2020. Hours: 7a- 5p Crew: 10 Talent: 2 Equipment: Minimal photo eq, tripod, and cart with computer Vehicles: (1) motorhome, (2) sprinter pass vans, and (2) personal cars Let me know the best way to pay for the application fee and I can also get a certificate of insurance over as well. Thanks, John johnperez I Location Manager&Scout 322 West 52nd Street, 339 1 New York, NY 10019 C 212-203-89381 F 718-247-5982 Lohn aa�ohn-perez.com ,click to Download ! g MadewellFilming permit Application-merged.pdf _# _._.___..._. _._......,. __._._..._... -1- _ 24.4„MB 2 ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. 3 ELIZABETH A.NEVILLE,MMC �� ��, Town Hall,53095 Main Road TOWN CLERK ® P.O.Box 1179 CA 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ® Fax(631)765-6145 MARRIAGE OFFICER y RECORDS MANAGEMENT OFFICER ®d ��® Telephone FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov 765-1800 www.southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT 1 of 2 DATE: FRIDAY, AUGUST 21, 2020 TIME: 6:30 AM — 5:00 PM LOCATION: Beach at end of Rocky Point Road, East Marion John Perez / Madwell, Inc/J CrewGroup Inc Fashion Photo Shoot & Filming PERMIT # 068 Place this Permit on the Dashboard, Passenger side of Vehicle IL ELIZABETH A.NEVILLE,MMC �� �,� Town Hall,53095 Main Road TOWN CLERK ® P.O.Box 1179 C Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ® Fax(631)765-6145 MARRIAGE OFFICER � RECORDS MANAGEMENT OFFICER Telephone(631)765-1800 FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT 2 of 2 DATE: FRIDAY, AUGUST 21, 2020 TIME: 6:30 AM — 5:00 PM LOCATION: Beach at end of Rocky Point Road, East Marion John Perez / Madwell, Inc/J CrewGroup Inc Fashion Photo Shoot & Filming PERMIT # 068 Place this Permit on the Dashboard, Passenger side of Vehicle ELIZABETH A.NEVILLE,MMC �� r �. Town Hall,53095 Main Road TOWN CLERK ® P.O.Box 1179 '- Southold,New York 11971 REGISTRAR OF VITAL STATISTICS "' `'. " '= Fax(631)765-6145 MARRIAGE OFFICER °f✓ RECORDS MANAGEMENT OFFICER ®a( * Telephone 765-1800 FREEDOM OF INFORMATION OFFICER www.southoldtldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT # 068 Issued to: John Perez, Madwell, Inc/ J Crew Group Inc Date: August 21, 2020 Time: 6:30 AM — 5:00 PM Location: ROCKY POINT ROAD, EAST MARION Permit No. 068 Issue Date: August 17, 2020 Elizabeth A.Neville Southold Town Clerk (Town Seal) IS ELIZABETH A.NEVILLE,MMC �� x, 1� Town Hall, 53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR,OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER ®,` ��® Telephone 765-1800 FREEDOM OF INFORMATION OFFICER www•southoldtldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT 1 of 4 DATE: FRIDAY, AUGUST 219 2020 TIME: 6:30 AM — 5:00 PM LOCATION: Beach at end of Rocky Point Road, East Marion John Perez / Madwell, Inc/J CrewGroup Inc Fashion Photo Shoot & Filming PERMIT # 068 Place this Permit on the Dashboard, Passenger side of Vehicle ®� ®�' 53095 Main Road ELIZABETH A.NEVILLE,MMC Town Hall�� y , TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR,OF VITAL STATISTICS Q Fax(631)765-6145 MARRIAGE OFFICER �P Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �®� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT 2 of 4 DATE: FRIDAY, AUGUST 219 2020 TIME: 6:30 AM — 5:00 PM LOCATION: Beach at end of Rocky Point Road, East Marion John Perez / Madwell, Inc/J CrewGroup Inc Fashion Photo Shoot & Filming PERMIT # 068 Place this Permit on the Dashboard, Passenger side of Vehicle ELIZABETH A.NEVILLE,MMC �� �� Town Hall,53095 Main Road TOWN CLERK ® P.O.Box 1179 C Southold,New York 11971 REGISTRAR.OF VITAL STATISTICS %;�S 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 TOWN OF SOUTHOLD PARKING PERMIT 3 of 4 DATE: FRIDAY, AUGUST 21, 2020 TIME: 6:30 AM — 5:00 PM LOCATION: Beach at end of Rocky Point Road, East Marion John Perez / Madwell, Inc/J CrewGroup Inc Fashion Photo Shoot & Filming PERMIT # 068 Place this Permit on the Dashboard, Passenger side of Vehicle ELIZABETH A.NEVILLE,MMC �� ®� Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 COD Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER@ RECORDS MANAGEMENT OFFICER Telephone(631)765-1800 FREEDOM OF INFORMATION OFFICER www•southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT 4 of 4 DATE:, FRIDAY, AUGUST 219 2020 TIME: 6:30 AM — 5:00 PM LOCATION: Beach at end of Rocky Point Road, East Marion John Perez / Madwell, Inc/J CrewGroup Inc Fashion Photo Shoot & Filming PERMIT # 068 Place this Permit on the Dashboard, Passenger side of Vehicle ELIZABETH A.NEVILLE,MMC Town Hall,53095 Main Road TOWN CLERK ® P.O.Box 1179, I Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER �� ® Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING PERMIT INVOICE Madwell, Inc/J Crew Group Inc 322 West 52nd Street, Ste 339 New York,NY 10019 Contact: John Perez Nonrefundable Filming Permit Application $100.00 Filming Fee @ $100 per day $100.00 August 21, 2020 5 parking permits @ $10.00 ea. $ 50.00 Clean-up Deposit @ $250.00 per day $250.00 Total $500.00 PAID via Credit Card 8/17 Town of Southold, New York - Payment Voucher Vendor No. Check No. Vendor Name Vendor Address Entered by Audit Date Vendor Telepl me sNumber Ol l`1 � �I�4•E� `Q Town Clerk Invoice Invoice Invoice Net Purchase Order Number Date Total Discount ,Amount Claimed Number Description of Goods or Service,. General Ledger Fund and Account Number Total 250.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the owlet ials 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 pet funned and(flat the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. -or discrepuncics noted,and payment is approved Sign ore Titl Signuuu _ �► Company Name Date Ck-I fr •2.6_� Title. )ate q p`� Southold Town Board - Letter Board Meeting of September 8, 2020 RESOLUTION 2020-559 Item # 5.19 C ADOPTED DOC ID: 16415 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2020-559 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON SEPTEMBER 8, 202 0: 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 American Legion Post 803 8/3/20 250.00 Griswold_ Terry, Glover PO Box591 Southold_NY 11971 of-nn Perez 8/17/20 250.00 322`t. 52nd Street. y339 New York_ NY 10019 Freebird Productions 7/13/20 250.00 7 Mair_ Street_ =7A Brooklyn_ NY 1 !201 Dina Gundy & vilarcy Lee 8/7/20 250.00 13 NtL 1?ls jTee_ I !th 1 Innr New York_ NY 10018 Elizabeth A. Neville Southold ToNvn Clerk f 20?0 Page 28 4� Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 08/17/20 Receipt#: 273680 Quantity Transactions Reference Subtotal 1 Application Fee- Non-Refund 68 a $100.00 5 Beach Permits 68 d $50.00 1 Clean-Up Deposit 68 c $250.00 1 Daily Filming Permit 68 b $100.00 Total Paid: $500.00 Notes: Payment Type Amount Paid By Credit Card-Ref# $500.00 Perez, John Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Perez, John 322 W 52nd Street#339 New York, NY 10019 Clerk ID: LYNDAR Internal ID 68 b