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HomeMy WebLinkAboutMattituck Lions Club - Strawberry Festival ELIZABETH A.NEVILLE,MMC Town Hall,53095 Main Road TOWN CLERK ` P.O.Box 1179 � <, ;, Southold,New York 11971 631 REGISTRAR OF VITAL STATISTICS � -r.��= Fax( )765-6145_ MARRIAGE OFFICER � '�- i Telephone(631)765-1800 RECORDS MANAGEMENT OFFICERwww.southoldtownn .gov FREEDOM OF INFORMATION OFFICER % �. , E:- ' �,�V OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD MAR 1 0 2021 APPLICATION FOR A PERMIT TO HOLD ---- -- --- _ SPECIAL EVENT 'Please- provide ALL of the informaetiou ►'ec uested helmv.It1Cpm tete:t lie'tians WILL NOT be reviewed: Date of Submission �� 0 Name of Event _ 7�i2 AW - F=e,r e S Name of Organization: ���`���`.tC Lc�®�' s a l v ip Is this a Not-For-Profit Event?�`lo Contact's Name: us L' �'!� °�'2 F4 Mailing Address: Contact's Phone Number: 4j q Contacts Email Address: Event Location and Site Diagram: S'%�'-��-��� `� Ar-1"I5 . .-(Use-additional paper if necessary) Event Date(s): P �`- - Z (include set up and shutdown times and dates) Nature of Event: d 'n %.S4i` (Please attach a detailed description to this application) Time Period (Hours) of Event: From f�''` - Maximum Number of Expected Attendees:r-- --- a policepresence): Specify any special requirements(i.e. road closure, p Revised 8/5/15 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; vi Event Fees: %I& e- $250 for events with less than 1000 expected attendees RIwt- $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) —$250 or more Clean-up deposit all other events CERTIhICATL+' Or INSURANCK,RCOVllt .D: Not less than $2,000,000 naming the Town of ,S6uthoid-as an additional iRsured, ***NOTE, TACHED RtVISED ADOPTED TOWN POLICY*** Additional information and requirements may be required as deemed necessary by the Town Board, Print name of Authorized Pers filling out Signat eAfAhorized Person fill' gout application application *Upon the request by applicant,the Town Board may waive in whole or in part any of the application requirements. 2 Revised 3/21/16 AcCOREP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) 03/05/2021 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 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 John Adams DSP Insurance IQHONN 1-800-316-6705 1 a No: 847-934-6186 1900 E. Golf Road, Suite 660 ADDRESS: lionsclubs@dspins.com Schaumburg, IL 60173 INSURERS AFFORDING COVERAGE NAlcs INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: Mattituck Lions Club INSURER C: Mattituck New York INSURER D: INSURER E: 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 L BR POLICY EFF POLICY EXP LIMITS LTR c POLICY NUMBER MM1DD MM1DD A GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COWMERCAL GENERAL LIABILITY BDOG71445999 09/01/2020 09/0112021 PREMISESIEao�urrence 5 1,000,000 CLAWS.MADE EK OCCUR MED EXP LApy one person) S 5,000 X Agg.Per Named Insured PERSONAL s ADV INJURY s 1,000,000 Js$2,000,000 GENERAL AGGREGATE s 10,000,000 GENtAGGREGATE LIMIT APPLIES PER PRODUCTS-COMROPAGG S 2,000,000 X POLICY I PRO LOC S A AUTOMOBILE LIABILITY CEOat BIINED SINGLE LIMIT S1,000,000 ANY AUTO ISAH25314141 09/01/2020 0910112021 BODILY INJURY(Per person) S ALL O NED SCHEDULED BODILY INJURY(Per accident) S NON-OWNED PROPERTY DA6.IAGE S HIREDAUros )( AUTOS Peracddent S UMBRELLA UABOCCUR EACH OCCURRENCE S EXCESS UAB HCLAIMS-tAADE AGGREGATE S DED I I RETENTIONS S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS LIABILITY YIN TORY LIMITS ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT S OFFICERIMEfIBER EXCLUDED? El N I A (Mandatory In NH) EL DISEASE-EA EMPLOYEE S If yes describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above 2021 Mattituck Strawberry Festival The following persons or organizations granting use of real property,including structures thereon are included as Additional Insured(s),but only with respect to General Liability arising out of the use of premises by the insured shown above and not out of the sole negligence of said additional insured Town of Southold"' CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 1179 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold New York 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD ACOP CERTIFICATE OF LIABILITY INSURANCEDATE(&IPVDDNYYY) 03/05/2021 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 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 NA AE CT John Adams DSP Insurance PHONE 1-800-316-6705 Fac No): 847-934-6186 1900 E- Golf Road, Suite 650 ADDRESS: lionsclubs@dspins.com Schaumburg, IL 60173 INSURER AFFORDING COVERAGE NAZCA INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: Mattituck Lions Club INSURER C: Mattituck New York INSURER D: INSURER E: I 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 IL7R TYPE OF INSURANCE D U POLICY EFF POLICY EXP LIMBS G POLICY NUMBER MM1OD MMIDD A GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 X CON'MERCtALGENERAL LIABILI Y 13DOG71445999 09/0112020 09/01/2021 PREMISES R S 1,000,000 cIAIMS 4ADE 0 OCCUR NIED EXP oneperson) s 5,000 X Am,Per Named Insured PERSONAL BADV INJURY S 1,000,000 is$2,000,000 GENERAL AGGREGATE S 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/0P AGG S 2,000,000 X POLICY PRO LOC s COMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY ISAIi25314141 09/0112020 09/01/2021 Eaacadent S1,000,000 ANY AUTO BODILY INJURY(Per person) S AALLL OVINED SUTOS CHEDULED BODILY INJURY(Per accident) S HIRED AUTOS NON-0WNED PROPERTY DAMAGE S AUTOS Per acddent S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS S WORKERS COMPENSATION I 4VC STATU OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOWPARTNERtEXECUnVE EL EACH ACCIDENT S OFFICER/11EMBER EXCLUDED? El N/A (Mandatory In NH) EL DISEASE-EA EMPLOYEE S ttYes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required) Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above:2021 Mattituck Strawberry Fetival The following persons or organizations granting use of real property,including structures thereon are included as Additional Insured(s),but only with respect to General Liability arising out of the use of premises by the insured shown above and not out of the sole negligence of said additional insured. ***Suffolk County— PROVISIONS ounty***PROVISIONS OF THE POLICY DO NOT APPLY TO THE SALE OR SERVING OF ALCOHOLIC BEVERAGES CERTIFICATE HOLDER CANCELLATION Suffolk County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 6100 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hauppauge New York 11788 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE da4_ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD *Vy VID TOWN OF SOUTHOLD Town Code Chapter 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 as possible. Any com-pleted 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$250.00 by the Office of the Town Clerk, unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health, safety, and welfare of the community. When is a Permit Required? All Special Events,per Southold Town Code Article I, Section 205-2 (Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residential prope , for profit,such as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk: Please indicate submission of the following by checking off the boxes and signing below. ❑ A completed application form signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. ❑ FEE: Is the application being submitted at least 60 days before the event LNil N Yes [ ]No If Yes,Fee of$ has been submitted If No,Fee of$ has been submitted Updated 8/7/2018 ElThe 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 ElA 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) ❑ 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. Dated Signature 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. 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 V, RECEIVED MAR - 5 2021 Southold Town Clerk 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# Applicant(s)name: I11/97r TU C'e jLaw5 C/✓4 Date of Submission 2/ Name of Event i 2,ey Fes�.✓a SCTM#'s 1000-Section Block- Lot(s) Dates of Each Event: 7 L 1 If Multiple Dates are requested,applicant must give all information for all dates. Nature of Event: (Please attach a detailed description of EACH event to this application) Time Period(Hours)of Event: From /U,',j-5 f9yr to d/,.J ::;, r'9'it Town Services requested: ( )Yes ( )No If yes,Describe Police Dept._Aghway Dept. Describe Services �✓'a-"eZ:, 6er14" Maximum Number of Persons Attending At One Time: Number of cars expected .4-0 Is a Tent or other temporary structure being used? [ VrYes [ ] No If yes provide size(s) 6 t4- /a& 6:9 v /-.a-® 'j- 610 .t '(v Will food be served?[L r'fes [ ]No If yes provide number and name(s)oef_food vendor(s) Updated 8/7/2018 C/190&0 r"' .sTJ^�w�t✓r•� r .-s',6, ,dt,-ol Com. lG� Suffolk County permit#(s) Will other vendors be on the premises during the event? [O]—Yes [ ]No If yes how many? ? Describe Type of vendor(s) Cr, Property Owner(name/address): �1� Contact Person and Contact Tel.# CJa7sQy h C --2 So e-mail address J o e. d.o-or ky Event Location: Street-Hamlet Address: f'rea� Es{o�,t�s 4eye. -r ew- c TVC e. SCTM# Mailing Address to Send Event Permit to: C) 4'*-V Have any of the development rights been sold to the Town of Southold[ ]Yes [ ]No and/or Suffolk County Agricultural Program? [ ] 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,YOU MUST ALSO ATTACH A TRAFFIC CONTROL PLAN(see next page) A Parking/Event Plan may be a survey, site plan and/or aerial view (for example Google Earth) o the subject property.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. (12) Provisions to dispose of any garbage,trash,rubbish or other refuse. (13) Location and description of any additional lighting to be utilized in conjunction with the event. Updated 8/7/2018 (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. OWNER'S SIGNATURE: I am the Owner of the Property where this event is to be held and I agree to comply with the laws, rules, regulations, conditions, and requirements of the Code of the Town of Southold, including but not limited to the conditions listed below, as well as all other applicable agency rules and regulations pertaining to the activities under this event. Furthermore,I hereby swear or affirm that the information contained herein and attachments hereto are true and correct to the best of my knowledge, and agree to provide notice to the Town immediately should there be any material changes regarding to this application. . Furthermore,I hereby authorize Code Enforcement Personnel of the Town of Southold to enter the property during the hours of the permitted special event to make any and all inspections necessary in connection with this Special Event. Print name of Owner Signature of Owner Print name of Authorized Person/Representative Signature of Authorized Person/Representative PERMISSION IS HEREBY GRANTED,SUBJECT TO THE FOLLOWING 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. County or State Roads or Rights of Way. 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 "on-premises" sign not larger than six (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 permit. 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 permit 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 to parking, ingress/egress/access, tent(s)or temporary structure(s), or temporary sanitary facilities,shall be conducted on Town of Southold Purchase of Development Rights land. 10. NO activities associated with this event, including but not limited to parking, ingress/egress/access, tents or temporary structure(s). or temporary sanitary facilities, shall be conducted on Suffolk County Purchase of Development Rights land without a permit issued by the Suffolk County 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 Doroski, Bonnie From: Flatley, Martin Sent: Thursday, March 11, 2021 10:06 AM To: Doroski, Bonnie; Duffy, Bill; Burke,John; Hagan, Damon; Kruszeski, Frank Cc: Blasko, Regina; Mirabelli, Melissa Subject: RE: Emailing: spec evnt-strwbry fest_20210310154647 We have always supported this event and will support this year, but I am going to need more details on how the Lions Club will be accommodating the COVID restriction in place (crowd size, social distancing, testing?)to plan for this event and ensure it meets the NYS guidelines in place. Martin Flatley, Chief of Police Town of Southold Police Department 41405 State Route 25 Peconic, N.Y. 11958 Tel: 631-765-3115 The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient,you are hereby notified that any review, retransmission, conversion to hard copy, copying, reproduction, circulation, publication, dissemination or other use of, or taking of any action, or omission to take action, in reliance upon this communication by persons or entities other than the intended recipient is strictly prohibited. If you have received this communication in error, please (i) notify us immediately by telephone at 631.765.2600, (ii) return the original message and all copies to us at the address above via the U.S. Postal Service, and (iii) delete the message and any material attached thereto from any computer, disk drive, diskette, or other storage device or media. -----Original Message----- From: Doroski, Bonnie<Bonnie.Doroski@town.southold.ny.us> Sent:Wednesday, March 10, 20213:48 PM To: Flatley, Martin <mflatley@town.southold.ny.us>; Duffy, Bill <billd@southoldtownny.gov>; Burke,John <johnbu@southoldtownny.gov>; Hagan, Damon<damonh@southoldtownny.gov>; Kruszeski, Frank <fkruszeski@town.southold.ny.us> Cc: Blasko, Regina <rblasko@town.southold.ny.us>; Mirabelli, Melissa<melissam@southoldtownny.gov> Subject: Emailing: spec evnt-strwbry fest_20210310154647 Please find attached the application received from the Mattituck Lions Club re: Strawberry Festival. Please provide any comments/cost analysis to this office. Thank you. Your message is ready to be sent with the following file or link attachments: spec evnt-strwbry fest_20210310154647 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 Doroski, Bonnie From: Doroski, Bonnie Sent: Wednesday, March 10, 2021 3:48 PM To: Flatley, Martin; Duffy, Bill (billd@southoldtownny.gov); Burke,John; Hagan, Damon (damonh@southoldtownny.gov); Kruszeski, Frank Cc: Blasko, Regina (rblasko@town.southold.ny.us); Mirabelli, Melissa Subject: Emailing: spec evnt-strwbry fest_20210310154647 Attachments: spec evnt-strwbry fest_20210310154647.pdf Please find attached the application received from the Mattituck Lions Club re: Strawberry Festival. Please provide any comments/cost analysis to this office. Thank you. Your message is ready to be sent with the following file or link attachments: spec evnt-strwbry fest_20210310154647 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. r aFsourl, Janet Douglass 970 Peconic Lane Recreation Supervisor P.O. Box 267 Town of Southold Peconic,NY 11958 JanetD@SoutholdTownNY.gov 631.765.5182 TOWN OF SOUTHOLD RECREATION DEPARTMENT APPLICATION FOR USE OF SOUTHOLD PARKS FACIILITIES PLEASE PRINT LEGIBLY APPLICATIONS DUE AT LEAST TWO (2) MONTHS BEFORE EVENT Payment is due at time of application Today's Date: 9-- S- 0,->a- Requesting Organization: /9 c.i/— Applicant's Name: cis-eey � ?� t3caf ! Address: t/A s' os.�" 1 �• � �Ut�-1`� )'VC,dG, ��. . OI Ira, Home Phone: /U- Business: 4111 E-mail Address: ;- i P-A,, 4 , — e 4�a--/— Facility Requested: i®'tt� �- ke.,e,tj -e�e.I c/9 Day(s)and date(s)of use: —Z ( kk In tl1� Requested Time for Field/Park/Court/Use: From:. To: / C-lee I-S Requested time for lights to be on (if applicable). Field/court lighting will not be available from January 1—March 1. From: To: NOTE: LIGHTS MUST BE TURNED OFF BY 10:00 P.M. Reason For Use(Please be specific and give details): Is admission being charged? Yes No If yes,how much is being charged? 0✓ Please provide a detailed explanation off how/the proceeds are to be used: ® �C ewesL.,.-P Applicant's Signature: A HOLD HARMLESS AGREEMENT The applicant/group/organization agrees to indemnify and hold harmless the Town of Southold, its officials, employees, and/or agents from all claims, lawsuits, hospital and/or doctor bills, actions, proceedings, and liabilities for the loss or damage to property, or any injury, the death of a person, including any expenses incurred by the Town of Southold defending any claims, lawsuits, or action that may arise as a result of the conduct, actions, f including the negligence of the applicant/group/organization to the fullest extent permitted by applicable law. I have read the attached "SOUTHOLD TOWN FACILITY RULES AND REGULATIONS" and agree to abide by them. Name of Organization: -rr i -J-U Z.x l i d%-s C tri✓ t Please Print Date Please Print(Principal/Authorized Representative) Applicant's Signature: We are glad that we are able to provide your group/organization league with a facility. Your group is required to make certain that tlae field is free of debris when you leave for the day. Our staff has maintenance schedules exclusive of outside groups who use our facilities and we need to make sure that the field is ready for future groups and activities. Thank you for your time and cooperation regarding this matter. l�l�l�l�f�l-�/�l�t�/-�l-�l-�/�!-,l�l�l�l�l�/�l-�l-�/-�1-�1�✓�I�l-�l-�l-�l-�l-�l-�l-�I�I�I-,l-�l-�l�l-1!�/�/�1-�1-�1�1-�t�l�l�I�t�/�l�l�l�/-�l1l�l�1�1�1�� r FOR OFFICE USE ONLY Certificate of Insurance Required? EfYES UNO Special Events Application Required? LfYES 13NO If yes,please fill out the attached application. Facility Is: Request Is: Available' {X Approved Not Available { } Denied110ea d, { } y r"Itcreation Depart it Supervisor �0 SOUTHOLD TOWN FACILITY RULES AND REGULATIONS e > ^C V CERTIFICATE 4F LIABILITY INSURANCE DATE(MMiDOmYY) �,.. 03/05/2021 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 pollcy(ies)must 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 CCONT CNAMJohn Adams DSP Insurance PHo E , 1-800-316-6705- FSC----------- No: 847-934-6186 1900 E. Golf Road, Suite 650 ADDRESS: lionsciubs@dspins.com Schaumburg, IL 60173 INSURER(S) AFFORDING COVERAGE we# INSURER A: ACE American Insurance Company 22667 INSURED INSURER B Mattituck Lions Cluli INSURER C: Mattituck New York INSURER D INSURER E: 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 'LTR TYPE OF INSURANCE , ADDL SUBR POLICY EFF POLICY EXP c POLICY NUMBER MWD MMIDD LIMITS A GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY BDOG71445999 09/01/2020 09/01/2021PREMIMI ETORER7 5 1,000,000 SES Ea ocaff sece CLALIM1S MADE K OCCUR ABED EXP one ) S 5,000 X 6g.Per Named insured PERSONAL a ADV INJURY S 1,000,000 is$2,000,000 GENERAL AGGREGATE S 10,000,000 GEt&AGGREGATE LIMIT APPUESPER. PRODUCTS-COMPiOPAGG S 2,000,000 X POLICY PRO LOC S A AUTOM081LELIABILITY COMBINEDIsINGLELIMfr S 1,000,000 ISAH25314141 09/01/2020 09101/2021 ANY AUTO BODILY INJURY(Per Person) S ALL AUTOS SCHEDULED BODILY[NJURY(Per=dent) S HIRED AUTOS U1 AWNED PROPERTYDAMAGE S S UMBRELLA LIAO OCCUR EACH OCCURRENCE S EXCESS LIAB, CLAIMS4AACE AGGREGATE S DED I I RETENTION S S WORKERS COMPENSATION I VYC STATU I 10TH AN THAND EMPLOYERS'LIABILITY YIN FR ANY PROPMETOPWARTNERIEXECUiIVE EL EACH ACCIDENT S OFFECERIMEMBEREXCLUDED? NIA (Mandatory in NH) F-L DISEASE-EA EMPLOYE S lir desulbe under DESCRIPTION OF OPERATIONS W11 E.L.DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attaeh ACORD 101,Additional Remarks Schedule,If more space is required) Provisions of the policy apply to the named Insureds participation in the following activity during the policy period shown above:2021 Mattituck Strawberry Festival The following persons or organizations granting use of real property,including structures thereon are included as Additional Insured(s),but only with respect to General Liability arising out of the use of premises by the insured shown above and not out of,the sole negligence of said additional insured. ***Town of Southold*** CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 1179 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold New York 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD ACCM0� CERTIFICATE OF LIABILITY INSURANCE DATE IMMtIDDIYYYY) lk*. 03/05/2021 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 pollcy(ies)must 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). PRODUCER NAME CONTACT John Adams DSP Insurance P19 o Ex • 1-800-316-6705 FAAIC No• 847-934-6186 1900 E. Golf Road, Suite 650 ADDRIESS: lionsclubs@dspins.com Schaumburg, IL 60173 INSURER(S)AFFORDING COVERAGE NAlcu INSURER A: ACE American Insurance Company 22667 INSURED INSURER B Mattituck Lions Club INSURER C.- Mattituck New York INSURER D: INSURER E: 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 IEXP LTR TYPE OF INSURANCE IN L S B POLICY NUMBER M MILDID EFF MMIDD/YYYYY LIMITS A GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X CONWERCIAL GENERAL LIABILITY EDOG71445999 09/01/2020 09/0112021 Dm-1AGi`:10PREMISES Ea occurrence S 1,000,000 cLAIM&MADE OX OCCUR MED EXP one n) s 5,000 X Aga Per Named Insured PERSONAL&ADV INJURY S 1,000,000 is$2,000,000 GENERAL AGGREGATE s 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-CO}6P10P AGG S 2,000,000 X POLICY E PRO LOC S A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ISAR25314141 09101/2020 09/01/2027 Ea accident S1,000,000 ANY AUTO BODILY INJURY(Per person) S ALULTOS ED SCHEDULED ABODILY INJURY(Per accident) S NON-OWNED PROPERTY OAi tAGE HIRED AUTOS )( AUTOS Per acatlent S � 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DED I I RETENTIONS S WORKERS COMPENSATION I tfATU- I TH- ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETORtPARTNERIEXECUTIVEEL EACH ACCIDENT S OFFICERAMIABER EXCLUDED? D N!A (Mandatory in NH) E.L DISEASE-EA EMPLOYEE S Iryt descnbeunder DESCRIPTION OF OPERATIONS Wiwi I E L DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space is required) Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above.2021 Mattituck Strawberry Fetival The following persons or organizations granting use of real property,including structures thereon are included as Additional Insured(s),but only with respect to General Liability arising out of the use of premises by the insured shown above and not out of the sole negligence of said additional insured. ***Suffolk County'** PROVISIONS OF THE POLICY DO NOT APPLY TO THE SALE OR SERVING OF ALCOHOLIC BEVERAGES CERTIFICATE HOLDER CANCELLATION Suffolk County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 6100 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hauppauge New York 11788 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Strawberry Fields . py r Applicant: Mattituck Lions Club Note: The Lions Club is looking to extend the Strawberry Festival this year to two weeks. They are waiting for guidance from NYS, but are considering running the carnival for one week and the vendors for the second week. This application is part of a Special Events application filed with the Town Clerk. Completed b Title: Date: Special Events Committee Application Summary and Recommendation Application name: MA+uck Uom Nub Address: &h-aa&ffjA Application number: Date of Event: Time: I Pm Date Received by Town Clerk: 3 I a I aoa Date Received by Committee: Nature of Event (S): "�'j Committee Comments Received by: Denis Noncarow v/ Melissa Spiro Leslie Weisman Missy Mirabelli Chief Flatley ✓ August Ruckdeschel- County Heather Lanza James Easton Mike Verity Claire Glew Bill Duffy Kevin Webster Committee Recommendation's: X Approve as applied Approve with Additional conditions: Hold Public Hearing Deny Special Event No: Resolution No: aca Date: 3 a3 aoa RECEIVED MAR 11 r t ,{ OWN AT OYo� T§;R5 Main Road ELIZABETH A.NEVILLE,MMC P.0,� ��� 'd P.O.Box 1179 CLERK *�• � 1: r TOWN Southold,New York 11971 . f � , #' x Fax(631)765-6145 REGISTRAR OF VITAL STATISTICSa �. - MARRIAGE OFFICER " '+t• Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER w�vw.&outholdtownng°V__ - FREEDOM OF INFORMATION OFFICER _ " OFFICE OF THE TOWN CLEF TOWN OF SOUTHOLD MAN 1 0 20,21 APPLICATION FOR 4,rFRMIT, TO BOLD A B1?ECIAL 'VENT Please wovidc,tL_or the-i�iformation i•et uested 13610 �.1"C01" late n lications WILL NOT be 'L reviewed. Date of Submission Name ofEvent s and i✓`°-' " 5ba✓�c. Name of Organization: f ' ''�`f`�� �.r`°`L' 5 C •Lh Is this a Not-For-Profit Evenf? —Lr?,0 }�) t m Contact shame: - Mailing Address: - /rl Contact's Phone Number: - _ 'v-@ �t,c,{�_�I_ G► o*..l�:� ._ tit-'':� Contact's Email Address: i Event Location and Site Diagram: (Use additional paper if necessary) Event Date(s): 1X_!2 — - - Z (Include set up and shutdown times and dates) Nature of Event: (Please attach a detailed description to this application) Time Period(Hours)of Event: From A PTO Maximum Number of Expected Attendees: �. a -1�"'��• "��' Specify any special requirements(i.e.road closure,police presence): Revised 8/5/15 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: f 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): $17500.00 Clean-up for Bicycle and/or Running Special events(ONLY) $250 or more Clean-up deposit all outer events oi? INSURANCEREC}U11Ztrl): Not less than$2,000,000 naming the Town of Southold as an additional insured. -ICy*** - Add itionai'information and requirements may be required as deemed necessary by the Town Board, 4flngout Print name of AWIorized Per.s. filliSigna a iorized Person fill' gout appticati6n application *Upon the request by applicant,the Town Board may waive in whole or in part any of the application requirements. 2 Revised 3/21/16 DATE(MWDDIYYYY) �® CERTIFICATE OF LIABILITY INSURANCE 03/05/2021 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 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 rcjAWE C John Adams DSP Insurance P" a 1-800-316-6705 j Noll 847-93,4-6186 1900 E. Golf Road, Suite 650 ADRREESS, lionsclubs@dspins.com I L 60173 INSUR s AFFORDING COVERAGE NAIL K Schaumburg, INSURERA: ACE American Insurance Company 22667 INSURED INSURER B: Mattltuck Lions Club INSURER C: - Mattituck New York INSURER D: INSURER E. 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 INS A L R POLICY EFF POLICYEXP L1MiT5 TYPEOFINSURANCE POLICY NUMBER 1WDD .''JDD A GENERAL LIABILITY EACH OCCURRENCE R2RENCE S 1,000,000 X COMMERCULL.GENERAL LIABILrrY EDOG71445999 09/01/2020 09/0112021 p�ryyS ' S 1,000,000 ctAiMs-nvwE ❑X OCCUR MEED EXP Wu one perw s 5,000 X Ana.Per Named insured PERSONAL a ADV INJURY S 1,000,000 is$2,000,000 GENERAL AGGREGATE x_10,000.000 GENl_AGGREGATr_Dm1TAPPLIESPER 'PROOUCTS-COMP/OPAGG S 2,000,000 X PV.1CY PRO LOC- S A AUTOMOBILE LIABILITY Wi S,NGLEt_INIII S 1,000.000 ANY AUTO ISAH25314141 09101/2020 09/01/2021 13COLYINJURY(Per pdson) 'S ALL AUTOS AUTOS ODI ED BLY INJURY(PLY acddent) S NON-OWNED �O UAMA(3= S HIREDAUTOS accuJUM X AUTOS S UMBRELLA LIAR EACH OCCURRENCE S EXCESS LIAR �p�OCCUR�,fADE AGGREGATE S DED RETENTIONS WORKERS COMPENSATION VK;SIAIU• bra AND EMPLOYERS'LLABILITYTf?!�Y Lt ANY PROPRIETOR)PARTNER.EXEGUTIVE(v j NIA E.L.EACH ACCIDENT S OFFiCERJMEMBER EXCLUDED? �J (Mandatory In NH) EL DISEASE-EEA EMPLOYE _S I�t�yy,S dP NWtlEr DESCR1PT14h'OF OPERATIONS belor/ E L DISEASE-POLICY LIMB 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule.If more space Is requhed) Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above:2021 Mattituck Strawberry Festival The following persons or organizations granting use of real property,including,structures thereon are included as Additional Insured(s),butonly with respect to General Liability arising out of the'use of premises by the insured shown above and not out of the sole negligence of said additional Insured. "`Town of Southold*" O I I C CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To To ofSout THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold New York 11 971 x 1179 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I 01988-2010 ACORD CORPORATION,-All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD - DATE IrAA1ID01YYYY) CERTIFICATE OF LIABILITY INSURANCE D3105r2D21 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 pollcy(les)must 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 CN10iFNAEz C Jnhti Adams DSP Insurance E 1-600-31"705 T A' N®: 847-93"186 C-M1900 E- Golf Road, Suite 650 ADDRESS; lionsclubs@d§pin's.com Schaumburg, IL 60173 INSUR AFFORDING COVERAGE NAICS- INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: INSURER C- Mattituck Lions Club Mattituck New York INSURER D: INSURER E; INSURER F CCOtRAGES CBRTll11CATE,NUA11BER! REVISIONMMBER: 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 TYPEOF,INSURANCE DLSUSR POLICY NUMBER MPOtICYEFF M I)Q EXP LIMITS LTR A GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILtiY EMOG71445999 09/01/2020 09/0112021 Lw ' S-1,000,000 CLAIMS-MADE ❑X OCCUR MED EXP WH.parse') S 5,000-- Ana.Per Named Insured PERSONAL&ADVINURY S 1,000,000 is$2,000,000 GENERAL AGGREGATE S 10,000,000 C,ER"LAGOR TE LIMITAPPLIES;PER- PRooucTS-comptoPAGG S 2,000,000 X PWCY 10C S A AUTOMOBILE LIABILITY C�OM!IM FD SING LELIN9IY s 1,000,000 ANY AUTO ISAH25314141 09/01/2020 09/01/2021 �pmw) S BODILY INJURY( ALL ALLOWS ED AUTOS OWNSCHEDULED BODILY INJURY(Per acddent) S HIREDAUTOS NON-OWNED Per S - S - UMBRELLA LIAROCCUR EACH OCCURRENCE S EXCESS LIARHCLAIMS-MAJ)E AGGREGATE S DED_ RETENTIONS S 'WORKERS COMPENSATION 'nk^STATf1 OTH- ANO EMPLOYERS'LIABILITY YIN O t ANY PROPRIEro9,PARTNMEXEcumvE: EL EACH ACCIDENTS OFFICERIMEMBER EXCLUDEDI N I A (MandazM In NN) E L-DISEASE-EA EMPLOYEE S. n d wier F'TK?:iOFdOPERATiONSbebw-.- E„4DISEASE-POLICY LIMIT -5 _ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach'ACORD 101,Addliiwel Remmki Schedule-it more epee*is required) Provisions of the policy apply to the named insureds participation in the following activity during the policy period shown above:2021 Mattituck Strawberry Fetival The following persons or organizations granting use of real property,including structures thereon are included.as Additionallnsured(s),but only with respect to General Liability arising out of the usB,flf premises by the insured shown&bOVe and n9t out of the sole negligence of,. d additional insured. Suffolk County PROVISIONS OF THE POLICY DO NOT APPLY TO THE SALE OR SERVING OF ALCOHOLIC BEVERAGES ,CISR110CATB HOLDER 'CANCELLATION Suffolk County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 6100 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hauppauge New York 11788 ACCORDANCE NTH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Mirabelli, Melissa From: Leslie Weisman Forward Sent: Thursday, March 11, 2021 9:50 AM To: Mirabelli, Melissa Cc: Noncarrow, Denis;Weisman, Leslie; Flatley, Martin; Lanza, Heather;Verity, Mike; Duffy, Bill; Spiro, Melissa; Easton,James; Glew, Claire;Webster, Kevin Subject: Re: Special Event - Lyons Club - Strawberry Festival This annual popular event has always been supported by the town. No issues from me Leslie Sent from my Pad On Mar 11, 2021, at 9:40 AM, Mirabelli, Melissa <melissam@southoldtownny.gov>wrote: Good morning everyone here is our next event everyone please remember to use the reply all so everyone on the committee can see responses and questions. Melissa III Mirabelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office (631) 765-1939 Fax(631)765-6639 <spec evnt-strwbry fest_20210310154647.pdf> 1 Mirabelli, Melissa From: Easton,James Sent: Thursday, March 11, 2021 10:30 AM To: Mirabelli, Melissa; Noncarrow, Denis;Weisman, Leslie; Flatley, Martin; Lanza, Heather; Verity, Mike; Duffy, Bill; Spiro, Melissa; Glew, Claire; Webster, Kevin Subject: RE: Special Event - Lyons Club - Strawberry Festival I have no objections to this application. I have received and approved the tent pen-nit application for this event. James Easton Fire Marshal,Town of Southold �SOF04�o JamesE omsoutholdtownny.gov (W)631-765-1802 h .Y oy �� PRIVELEGED AND CONFIDENTIAL COMMUNICATION COA'FIDENTIALITY NOTICE- This electronic mail transmission is intended only for the use of the individual or enth),to which it is addressed and may contain confidential information belonging to the sender which is protected by privilege. If you are not the intended recipient,you are hereby not{Ted that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited If you have received this transmission in error,please note the sender immediately 41,e-mail and delete the original message. From: Mirabelli, Melissa<melissam@southoldtownny.gov> Sent:Thursday, March 11, 20219:40 AM To: Noncarrow, Denis<denisn@southoldtownny.gov>;Weisman, Leslie<lesliew@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Lanza, Heather<heather.lanza@town.southold.ny.us>;Verity, Mike <Mike.Verity@town.southold.ny.us>; Duffy, Bill<billd@southoldtownny.gov>;Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Easton,James<jamese@southoldtownny.gov>; Glew,Claire <Claire.Glees@town.southold.ny.us>;Webster, Kevin<kevin.webster@town.southold.ny.us> Cc: Mirabelli, Melissa<melissam@southoldtownny.gov> Subject: Special Event-Lyons Club-Strawberry Festival Good morning everyone here is our next event everyone please remember to use the reply all so everyone on the committee can see responses and questions. .Melissa 11. Yfirahelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office (631) 765-1939 Fax (631)765-6639 1 Mirabelli, Melissa From: Glew, Claire Sent: Thursday, March 11, 2021 10:23 AM To: Mirabelli, Melissa; Noncarrow, Denis;Weisman, Leslie; Flatley, Martin; Lanza, Heather, Verity, Mike; Duffy, Bill; Spiro, Melissa; Easton,James;Webster, Kevin Subject: RE: Special Event- Lyons Club - Strawberry Festival The Assessors have not objection to this event. From: Mirabelli, Melissa<melissam@southoldtownny.gov> Sent:Thursday, March 11, 20219:40 AM To: Noncarrow, Denis<denisn@southoldtownny.gov>;Weisman, Leslie<lesliew@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Lanza, Heather<heather.lanza@town.southold.ny.us>;Verity, Mike <Mike.Verity@town.southold.ny.us>; Duffy, Bill<billd@southoldtownny.gov>;Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Easton,James<jamese@southoldtownny.gov>; Glew,Claire <Claire.Glew@town.southold.ny.us>;Webster, Kevin<kevin.webster@town.southold.ny.us> Cc: Mirabelli, Melissa<melissam@southoldtownny.gov> Subject:Special Event-Lyons Club-Strawberry Festival Good morning everyone here is our next event everyone please remember to use the reply all so everyone on the committee can see responses and questions. Melissa M. Mirabelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office (631) 765-1939 Fax(631)765-6639 1 Mirabelli, Melissa From: Spiro, Melissa Sent: Thursday, March 11,2021 10:22 AM To: Mirabelli, Melissa; Noncarrow, Denis;Weisman, Leslie; Flatley, Martin; Lanza, Heather, Verity, Mike; Duffy, Bill; Easton,James; Glew, Claire;Webster, Kevin Subject: RE: Special Event- Lyons Club - Strawberry Festival This property is owned by the County and is active parkland. The Strawberry Festival is an allowed use of this property. Melissa S. From: Mirabelli, Melissa Sent:Thursday, March 11, 20219:40 AM To: Noncarrow, Denis<denisn@southoldtownny.gov>; Weisman, Leslie<lesliew@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Lanza, Heather<heather.lanza@town.southold.ny.us>;Verity, Mike <Mike.Verity@town.southold.ny.us>; Duffy, Bill<billd@southoldtownny.gov>;Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Easton,James<jamese@southoldtownny.gov>; Glew,Claire <Claire.Glees@town.southold.ny.us>;Webster, Kevin<kevin.webster@town.southold.ny.us> Cc: Mirabelli, Melissa<melissam@southoldtownny.gov> Subject:Special Event- Lyons Club-Strawberry Festival Good morning everyone here is our next event everyone please remember to use the reply all so everyone on the committee can see responses and questions. Melissa K Afirabelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office (631) 765-1939 Fax (631)765-6639 1 Mirabelli, Melissa From: Lanza, Heather Sent: Thursday, March 11, 2021 10:43 AM To: Leslie Weisman Forward; Mirabelli, Melissa Cc: Noncarrow, Denis;Weisman, Leslie; Flatley, Martin;Verity, Mike; Duffy, Bill; Spiro, Melissa; Easton,James; Glew, Claire;Webster, Kevin Subject: RE: Special Event - Lyons Club - Strawberry Festival No issues from me either. From: Leslie Weisman Forward Sent:Thursday, March 11, 20219:50 AM To: Mirabelli, Melissa <melissam@southoldtownny.gov> Cc: Noncarrow, Denis<denisn@southoldtownny.gov>;Weisman, Leslie<lesliew@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Lanza, Heather<heather.lanza@town.southold.ny.us>;Verity, Mike <Mike.Verity@town.southold.ny.us>; Duffy, Bill<billd@southoldtownny.gov>;Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Easton,James<jamese@southoldtownny.gov>; Glew,Claire <Claire.Glew@town.southold.ny.us>;Webster, Kevin<kevin.webster@town.southold.ny.us> Subject: Re:Special Event- Lyons Club-Strawberry Festival This annual popular event has always been supported by the town. No issues from me Leslie Sent from my iPad On Mar 11, 2021, at 9:40 AM, Mirabelli, Melissa<melissam@southoldtownny.gov>wrote: Good morning everyone here is our next event everyone please remember to use the reply all so everyone on the committee can see responses and questions. Melissa K Virabelfi Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office (631) 765-1939 Fax(631)765-6639 <spec evnt-strwbry fest_20210310154647.pdf> i Mirabelli, Melissa From: Mirabelli, Melissa Sent: Wednesday, March 17, 2021 2:12 PM To: Flatley, Martin Subject: RE: Special Events Perfect thank you ! I am still hoping to talk to the woman at the County Dept of Health.Thank you for getting clarification from Joe Melissa M Mirabelli Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 Office (631) 765-1939 Fax (631)765-6639 From: Flatley, Martin<mflatley@town.southold.ny.us> Sent:Wednesday, March 17, 20211:53 PM To: Mirabelli, Melissa <melissam@southoldtownny.gov> Subject:Special Events I have spoken to Joe Doorhy of the Mattituck Lions regarding the Strawberry Festival special event application and I have no objections to this event being granted.They will be abiding with whatever restrictions that are in place at the time of their event and cannot provide anymore particulars than that. Martin Flatley, Chief of Police Town of Southold Police Department 41405 State Route 25 Peconic, N.Y. 11958 Tel: 631-765-3115 The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s)and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient you are hereby notified that any review,retransmission, conversion to hard copy,copying,reproduction,circulation,publication, dissemination or other use of,or taking of any action,or omission to take action,in reliance upon this communication by persons or entities other than the intended recipient is strictly prohibited. If you have received this communication in error,please(i)notify us immediately by telephone at 631.765 2600, (h)return the original message and all copies to us at the address above via the U.S.Postal Service, and(iii)delete the message and any material attached thereto from any computer, disk drive,diskette,or other storage device or media. 1 • Y RESOLUTION 2021-225 SCHEDULED DOC ID: 16907 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2021-225 WAS SCHEDULED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MARCH 23,2021: RESOLVED that the Town Board of the Town of Southold does hereby grant permission to the Mattituck Lions Club to use Strawberry Fields in Mattituck,NY from June 12 through July 3, 2021 for the Annual Strawberry Festival and be it further RESOLVED that the Town Board of the Town of Southold authorizes the Town Clerk to issue a Special Events Permit to the Mattituck Lions to hold its Annual Strawberry Festival at Strawberry Fields Mattituck,NY from June 12 through July 3,2021 provided 1. They file with the Town Clerk a Two Million Dollar Certificate of Insurance naming the Town of Southold and the County of Suffolk as an additional insured; 2. Coordinate traffic control upon notification of the adoption of this resolution 3. No permanent markings be placed on town, county or state roads or property for the event; 4. Any road markings or signs for the event be removed within twenty-four(24) hours of the completion of the event. Some of the requirements for issuing a Special Permit may be waived. Provided they adhere to all conditions on the application and permit and to the Town of Southold Policy for Special Events and subject to the applicant's compliance with all executive orders of the State of New York. This permit is subject to revocation if the applicant fails to comply with any of the conditions of the approval or is unable to properly control traffic flow into and out of the event. Elizabeth A. Neville Southold Town Clerk Rudder, Lynda From: Douglass,Janet Sent: Tuesday, June 22, 2021 4:52 PM To: Abrams,Tim Cc: Rudder, Lynda Subject: Strawberry Fields Security Deposit It has been brought to my attention that there are several metal stakes in the ground on the Northwest corner about 100 from the woods, where the Zipper was sitting today. It appears that the stakes were sawed off just about an inch off the ground. They are freshly cut as if it just occurred. (My guess is they weren't able to pull them,out so they just cut them) As we use the fields for lacrosse and soccer, so we should look into the issue further. -Janet 0 !C 40 Sent from my Verizon, Samsung Galaxy smartphone 1 ` ELIZABETH A.NEVILLE,MMC ��® � 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 ®! ��®t' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD March 26, 2021 Joseph Doorhy Mattituck Lions Club 1125 Ole Jule Lane Mattituck,NY 11952 Dear Mr. Doorhy: The Southold Town Board, at its regular meeting held on March 23, 2021, granted permission to the Mattituck Lions Club to hold its Annual Strawberry Festival from June 12 to July 3, 2021. 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 been filed with this office. Applicant must comply with all executive orders of the State of New York. 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, Lynda M Rudder Deputy Town Clerk enc Southold Town Board - Letter Board Meeting of March 23, 2021 RESOLUTION 2021-225 Item 9 5.16 y3p�a� ADOPTED DOC ID: 16907 r THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO.2021-225 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MARCH 23, 2021: RESOLVED that the Town Board of the Town of Southold does hereby grant permission to the Mattituck Lions Club to use Strawberry Fields in Mattituck,NY from June 12 through July 3, 2021 for the Annual Strawberry Festival and be it further RESOLVED that the Town Board of the Town of Southold authorizes the Town Clerk to issue a Special Events Permit to the Mattituck Lions to hold its Annual Strawberry Festival at Strawberry Fields Mattituck, NY from June 12 through July 3, 2021 provided 1. They file with the Town Clerk a Two Million Dollar Certificate of Insurance naming the Town of Southold and the County of Suffolk as an additional insured; 2. Coordinate traffic control upon notification of the adoption of this resolution 3. No permanent markings be placed on town, county or state roads or property for the event; 4. Any road markings or signs for the event be removed within twenty-four(24) hours of the completion of the event. Some of the requirements for issuing a Special Permit may be waived. Provided they adhere to all conditions on the application and permit and to the Town of Southold Policy for Special Events and subject to the applicant's compliance with all executive orders of the State of New York. This permit is subject to revocation if the applicant fails to comply with any of the conditions of the approval or is unable to properly control traffic flow into and out of the event. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER:Jill Doherty, Councilwoman AYES: Nappa, Dinizio Jr, Doherty, Ghosio, Evans, Russell Generated March 25, 2021 Page 26 Vendor No. _ Check No. Town of Southold, New York - Payment Voucher Vendor Name Vendor Address Entered by_ —PL0 1 u V D 5 Audit Date Vendor Telephone Number lY I ^ C-'` pV�1�11� l �_C� Town Clerk Invoice Invoice Invoice Net Purchase Order Number Date rTotal Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and-Account Number tl-2 -�I 5� 50� led.,Yi U 'T1.030 J V) i i Q i CW Total i 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 ve d with the exceptions due and owing,and iat axes from which the Town is exempt are excluded. or discrepancies noted,and payment app oved -11 Signaure Le•Deputy Town Clerk Signat re 1 v Company Name Date__JI1 - 2'(-2( oA Clerk Date 1 ' 2 u-2 Southold Town Board - Letter Board Meeting of November 16, 2021 RESOLUTION 2021-889 Item # 5.29 �•* �°�� ADOPTED DOC ID: 17536 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO.2021-889 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NOVEMBER 16, 2021: 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 Mattituck Lions Club 3/12/21 $1,500.00 PO Box 595 Mattituck,NY 11952 Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS) MOVER: Jill Doherty; Councilwoman SECONDER:Louisa P. Evans, Justice AYES: Nappa, Dinizio Jr, Doherty, Evans, Russell ABSENT: Robert Ghosio Generated November 17. 20211 Page 41 Town of Southold P O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 03/12/21 Receipt#: 278557 Quantity Transactions Reference Subtotal 1 Clean-Up Deposit 2021 Stawberry F $250.00 Total Paid: $250.00 Notes: Payment Type Amount Paid By CK#10004 $250.00 Mattituck, Lions Club Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Mattituck, Lions Club PO Box 595 Mattituck, NY 11952 Clerk ID: BONNIED internal ID 2021 Stawberry Festi