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HomeMy WebLinkAboutPeconic Bay Vineyards - 2022-27 t Special Events Committee Application Summary and Recommendation Application name: . Oorh Address: 31x0 Mwn U. C i Uu-, Application number: ft Date of Event: 21 5 I aaa. Time: 5Prn -qPm Date Received by Town Clerk: -5125122— Date lerk: `J125122Date Received by Committee: 5 12(o 22Nature of Event (S): (ra c&Z Committee Comments Received by: Melissa Spiro Leslie Weisman Missy Mirabelli Chief Flatley August Ruckdeschel- County —JUI�e Heather Lanza k, James Easton Mike Verity X Claire Glew &"I)x(fy 101AA 6UAL . )( Kevin Webster Committee Recommendation's: X Approve as applied Approve with Additional conditions: Hold Public Hearing Deny Special Event No: 0IO_Z-V Resolution No:302 �04 Date: Y� JJy RECEIVED t FT M AY 2 5 2022 . 1 # S-cwthold 'Town TOWN OF SOUTHOLD T—ovm Cocle'Cliapiet-105 "Public Fntertainmetitand., ecial`Event " 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. Apn9 cation:-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$150.00. However, specific details of each event must be included with this application. ll amlicatioiia ntbst be .4ubmitted at lead 60 business days before the event Ais.. are encouraged-tc�:sulimit:ap licatiains a5 early as mssil�le. Any'saii teteil ap�ilicattufi "that is iiiaf sizl nutted 60 or nabre lousiness days``t tidr to alae scheduled- event-ma�bnrejected car subject to a late orocessing.fee of 250.00 bt`tlk Ofiace of the'I'own Clei�lr. unless.a Waizrer-N obtaln'ed Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing. i The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health, safety,and welfare of the community. �Zhen is a P'eriinit lEl`equirecl? All Special Events,per Southold Town Code Article I, Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of re—,identiaiR r'lirtifit sudli as veiiud foo-weddings or-ofhen events is proltil iced. This a0plication Is deemed complete once all the following requirements are snliri fitted t6 ilie TOWn Clerk' Please indicate submis5roo oI the<folioand signing beflaEv__ A completed a 3 lication fbin signed by the owner and the event manager. Applications without ? property owner's signature/approval will be rejected. FEE: Is the application being submitted at least 60 days before the event[ Yes [ ]No If Yes,Fee of$ has been submitted ElIf No,Fee of$ has been submitted Updated 8/7/2018 i 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 Soi-aliold as an additional insured t lurking/Eventflan: 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) LOH"Events for three hundred (300) or,more people require submission and approval of a traffic cont of 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. �j YD2rled q. �irre S 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 RECEIVED MAY 2 5 2022 Southold Town Clerk APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVENT eas"e r vicle:Al:L" t e inf4whtiQn: e" e i•belmti Inc to a 1`cati MILL NO e.. .rev�ewea. �-� � � • Special Event Permit# Applicant(s)name: Date of Submission -Name of Event I es SCTM#'s 1000-Section /G' 3 Block- f I:ot(s) !er_ i t Dates of Each Event: S."n.a- 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 ` i=•n to Town Services requested: ( )Yes (yt),.No If yes,Describe Police Dept._Highway Dept. i Describe Services Maximum Number of Persons Attending At One Time: o?7 5~ Number of cars expected /-5 Is a Tent or other temporary structure being used? [ V]Yes [ ]No If yes provide size(s): (0o V- Will food be served?[A]Yes 1 ''oto If yes provide number and name(s)of food vendor(s) Updated 8/7!2018 Suffolk County permit#(s) Will other vendors be on the premises during the event?[ ]Yes [V4No If yes how many? Describe Type of vendor(s) Property Owner(name/address): r'S A '�/o cx a'4'w'_ IQ CGYudg if.v ,r'S Contact Person and Contact Tel.#_ J o�e��/� .�r i t( 3 r —q 14- e-mail address Jo,e,r^,',cae�5r i z._)1,... r r s Event Location: Street-Hamlet Address: Pt c.5���c A�( �+�T,�re�S 1 Th 44 t ` BC 1 01.E co Mailing Address to Send Event Permit to: l ASF 0 l✓e '13 c Have any of the development rights been sold to the Town of Southold [ ]Yes [5(]No and/or Suffolk County Agricultural Program? , [ ]Yes [ ]No fives tto either m~both_also indicate on the atfacfied plan the b6undariek bf the"egerved aj�ea uponyvhicli the eyentzviIl take place :YCrU` tLTST' TTACI A PARIe ING EVENT PLAN TO"MS APPLICATION IFITI , l;1iP C 1'EI3 A'I'TIEIvII7A1 CT'TS 30t!'C?R N RE I'>LC313LE YQt l 1� UST A LS�7 ATTACH[ TRAFFW CONTRSL PLAN(see ne a e2' - -A Parking vent Plan site Mari nnclfc r aei ihl'vie�r ffor&offtle�(rookie Rhrtitl of th- o stii ` LAN LLotlie_ fallmyir.,g.irformationectik } d �ti 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. i (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(6ntrol.><'lan. Events for three hundred(3 00)or more people also require submission and approval of a traffic control plan,acceptable to the Town of Southold,AND-a'attalMed traffic.contro-ller: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. Q"Ek"S SMNATURE. 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 Sib atum of Owner Print name of Authorize-dPerson/Representative Sfguatui _o Authoi`tzed`Person/Representative PERMUSSIOI Y HER7+I3Y'�Ri NTFI 1�1S3TFeC'T T-0 TIF1i1Ka�+CAIl 6AVING('tlNI3I7CY®iyTS; 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-strictIv prohilaited orn ANY`T6Wb Cotmty nr State'RdA or Ribhts,i f Way 2. Traffic control at events for three hundred(3 00)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 i thirty (30) days before this event, and removed immediately after the event. Directional parking signs i shall be adequately displayed. mless the Town of Southold from all claims, damages, expen 4. Applicant indemnifies and holds harses, suits and losses including but not limited to attorney's fees arising from activities under this permit. t 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,-6 busittecfi dnys prior tc ilie selreduled event. i 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 t 3 8. On-site food preparation is NOT permitted, although food may be catered subject to all Suffolk County Department of Health regulations. 9. 'Nq acii viti6s".afi 6< ate&whiff this event .iticl i id in gc-but not I i mrited to_ arlc rtg, ingress'/egress/access., owill'old of"be mentiligh-island. Purchase —vefon 10. NO,'ActiViti6§'ii_§sodiat6d Mth this eVonL narktifte. or-temporaL-y,..q. -1 lk County jaiciure(�1 '0_1716m bAr�aMg6iiitarv:,,fadilitie-;4 ,sh6,11 conducted j)b, 8i&6 Develop -nitissued by the. Suffolk 06.6tity FAiWiliftid 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 KAITANG-01 6,4NCONA A�®" CERTIFICATE OF LIABILITY INSURANCE JDATE12120IY1 .. 5/1212022 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 of be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain;policias may require an endorsement A statement on this certificate does not confer di histo the certificate holder in lieu of such endor§einenf(s};,, ' ' 'C T CT' PRODUCER A 631)722-3500 22 3500 PAXNo.l 722-3591Neefus Stype Agency OEx ( Alc , _ 711 Union Ave. 15WAIL 'info nSainsure,com. Aquebogue,NY 11931 AD„Q� % INSUR ERiS)AFF'ORDING'COVERAdIt - NAI6n INs17Rert A GuideOne M itUal Ins..Co. J _ 15032 INSURED 14tSURER�'<.. ..- Kait's Angels/Friends of the INSUt2ERC': _ Mattituck Lions Club PO BOX 1081 tNSURERD::E Mattituck,NY 11952 INSURER . ... ._.. INSUIZ.ER.F• . . _. .- COVERAGES CERTIFICATE NUMBER: _ REVISEON.NUMSER:: _. _ 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` ADDL SUBRI POLICY:EFF' "POLICY.'EXP LIMBS TYPE OFINSURANCE1 r D: POLICY NUMBER :M I _ - - A X' COMMERCIAL GENERAL LIABILITY EACH fY CURRENOE' & ;1,000,000 CLAIMS-MADE r V I OCCUR X 10030544 2112/2022 211212023 ! 4I-FTOREN7ED.--_. _ 1,000;000 x oto' 5,000 I _ WELD E7€P{kny'ane aeraeliZ 15 PE 50NAL&ADV INALR S 1,00O,OOA €� �S 7000,000 :Gt LAGGREGATELIMITAPPLIESPER: G 1.AGGREGAiin ECT S 9.OQ` POLICY eIJPQ - :..AUTOMOBILE LIABILITY ICOMHINED.SINGLE LIMIT, ANY AUTO �SOf31t.V INJURI':{patl 'tcsrcl S .OWNED SCHEDULED &SOtLYiNIURY(Pxaccilent' S _ AUTOS ONLY AUTOS pp �� .pWN =pet0'aca entIAMAGE ... _..__�..-.-- .AUTOS ONLY AUOTOS ONVY - UMBRELLA LIAR ,.... OCCUR _ - - - +PJ;CH OCCURftE,NGE... ':S ' EXCESS LIAB CLAIMS MADE - :S t DED.I [RETENTION$ - PSTEATIR-t7E I WORKERS COMPENSATION COMPENSATION - I AND EMPLOYERS'LIABILITY Y I N AANFYPROPRIIETOR/PARTNERIEXECUTIVE ❑ N/A E .EAGHACLYDE S: -. (NianCat M In NHj EXCLUDED? O EL SrASE-E EM Y Z. If�Ve�,describe under_ G_SCRIPTION OF OPERAT iO1dS'Ealirit: 1 F'L.DISEASE-P LtC LiM S DESCRI"ON OPOPERATIONSm /LOCATIONS r VEHICLES(ACORD 101,Additional Remarks Schedule may be attached If ore space is required) Peconic.Bay Vineyards is"included as additional insured with respect to General Liability as required by written contract. CERTIFICATE HOLDER: :GANOELLATION.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Peconic Bay Vineyards ACCORDANCE WITH THE POLICY PROVISIONS. 31320 Main Rd Cutchogue,NY 11935 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. I The ACORD name and logo are registered marks of ACORD KAITANG-01 GANCON QA-- �- DATE(MMYYJ CERTIFICATE OF LIABILITY INSURANCE 5/12120222022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain,poll cles may require an endorsement. A statement on this certificate does not confer ri hts.to the certificate holder in lieu of such cendbrsement s. CO TACT PRODUCER Neefus,Stype.Agency jArkco i .Exty (631)722-3500 j FAx,, . 711 Union"AAve (Atc;No):(631)722-3591 E-MAIL jnfo nsainsure.com - - Aquebogue„11Y 1,1931 ADD INSURERIS}gFFORDlhc;COVERAGE •NAIC# INSURERd.:GuideOne Mutua.Ins;Go. __ 15032 ii .-.. INSURED INSURERS: Kait's Angels/Friends of the INSURER e Mattituck Lions Club T—u� PO Box 1081 vtasuRFtz D° ii — Mattituck,NY 11952 INSURERS: I •4NSUREW2 :- ... .:: .. ... COVERAGESCERTIFICATE NUMBER: REVISION NUMBERa ._ 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 CONTRACTOR 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, ADOL SUBttI POLICY NUMBER - -- 'POLICY POLICY.EXP TYPE OF INSURANCE b wVb ,,. - LIMITS A .X .COMMERCIAL GENERAL LIABILITY ,EA:: OCCi1P,RENG>: $ 1,000,000 CLAIMS-MADE a.00CUR X 11)030544 211212022.. 2/1212023 ' F anceur>fer qp� 1,000,000 _._ _.._. €-MI: EXP Wi one oersorij, S 6,000 !.. .1,00_FER0,U00 SONAL'8 ADV NlUR S 019LAGG.R€,G_A�T-LI MIT APPLIES PER: ENFJtht AGCzRECJ E. S U0010110 X POLICY i I PRO LOC PRdDU TS CCIMPIOPr1Gu` S 2 000,1}Op I! _ Ctw —__ _OTHER-, S . ...AUTOMOBILE LIABILITY ANY AUTO ('BQbILY INJURY Per ers. S OWNED SCHEDULED 54JDllt Y(N„IJR_N jP `accid>?€rt) - . AUTOSONLY AUTOS - HIRED NON.OyyNED t) A � 5- AUTOS ONLY "AUTOS ONLY I =S UMBRELLA LIABOCCUR EftCH 4CCtIRREd GE S _ . EXCESS LIAB I i CLAIMS-MADE '{a{aGGREGi57E S ..:i ..DED ,RETENTIONS • -WORKERS COMPENSATION - _ IPER I E, QTI't= AND EMPLOYERS'LIABILITY ;f-1 N. [- IANYPROPRIETOR/PARTNER/EXECUTIVE NIA IOFFICERIMEMBEREXCLUDED7 wL.DISEASE.'-E0.EPAPLC!YE S (Mandatory in NH) _ _ i I10,clesufhe under DESCRIPTION OF'OPGf ATIONS bolo^N. 'EL-DlSclSE' POLICY I IMIT' S: 4ESCRIPTION.QEOPERATION57LOCATIONS l VEHICLES(ACORD 141 Aitdtttonat Reinarlis Schedule mdY beattacfiedir'more s Leis required)' Town of Southold 1's,lnciudecl as;addihortal Insufed.vtith rospectto General Liability as irequired b. writtten contract;, CERTIFICATE HOLDER CANCELLATION- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Southold ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KAITANG-01 GANCO A: CERTIFICATE OF LIABILITY INSURANCE DAT11212D/Y 5/1 212 0 22 2 THIS CERTIFICATE IS ISSUED ASA 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 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 suc�hp'(e(Trs ndoement s PRODUCER _ A44 ACT PHONE` FAX: Neefus Stype Agency 0;36,61);(631 722 3500 iAIe.No}(831}722-3591 711 Union Ave. Aquebogue,NY 11931 D°RLF,� <tnfo nsalnsure com INSORER&'AFFOWNG'COVERAGE •.MAIC.# rlsua>aA GuideOne"Mutual Ins.-Co. 15032' INSURED. _ it 1B:__ Kait's Angels/Friends of the INsuffEric; Mattituck Lions Club INSURER'Q::_ PO Box 1081 - Mattituck,NY 11952 *misu`RER'E: ,INSURER F: GOVERA'GES 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 CONTRACTOR 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. ':'POLICY EFF-., .POLICY,EXP LIMITS ~- TYPE OF INSURANCE D POLICY NUMBER .- _ M ' A X COMMERCIAL GENERAL LIABILITY - AgM0H,W.GiiRfiET•7CE s 1t7.00'DD0 CLAIMS-MADE X s OCCUR X '10030544 2112/2022 2/12/2023 ;p TSD 1,000,000 F `r o c�P�tin'o e ad s 5,000 pCRsoNAC&E+OV'It;LIRY S 1,000,00 CsEfILnGGRECAEE.LIMITAPP�:ESPER: GENEfxl.L•AGGtcGTE` S 2;DDO00D X, POLICY �Ea �f LOC ;,Qs?CSDUCTS OP:AG!_s S Z000,OD0 . AUTOMOBILE LIABILITY rrs Id ' _ .. S .. ANY AUTO '.BOOILY'INJ4JRY{P0 drssm? 5 OWNED 'SCHEDULED BvGILY.III RY.Pera clfranl 5 AUTOS ONLY AUTOS E � AURTOS ONLY ,A�; VPERTY, Ai1dAGE $ N _ UMBRELLA LIAR OCCUR EACH OCWP,RBNCE_ EXCESS LU1B CLAIMS-MADE C, � SREGA 5 _H DED ,RETENTION$ I WORKERSEOMPENSA N P OTH AND Eh1PLOYER5 LiAl UTY, Y t N a -ANY PROPRIETOR/PARTNERtEMUTNIf .Ef.•EACNACC{DEi�tl' S ,- FKFICERAI E%CLUDED�. ❑ N I A Mana3furyInIPR - EL,.DISEASB^EAEMPL'DYE S IrYeY,describe u, r DESCRIP.T.IONGr.ORERATICNSDelrw' EL_DISEASE-FOUCY ) IT, 5 } DESCRRiPTION;OF OPERATIONS 1 LOCATIONS%VEHICLES�ACORD 101,Addruonal.Romarks Schedule may bo a4Mthed if morb:t pace Is rdquired) Unitetl Rentals is included as aAilittonal insure With respect to General Liability as required by writtein.contract.. GEQTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN United Rentals ACCORDANCE WITH THE POLICY PROVISIONS. 4 250 Orchard Rd i East Patchogue,NY 11772 'AUTHORIZED REPRESENTATIVE I, ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * Date: 05/25/22 Receipt#: 299154 3 Quantity Transactions Reference Subtotal Event Fee _ PBV 1a $150.00 Total Paid: $150.00 y Notes: i Payment Type Amount Paid By Credit Card-Ref# $150.00 Joseph Doorhy Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 r f E. i i i Name: Peconic, Bay Vineyards Po Box 709 Cutchogue, NY 11935 i Clerk ID: SABRINA Internal ID:PBV 1a i 10 YARDS . 168 ' . ' YA Parking area for 150 vehicles >t. public entry treat _ a t driveway Ati pu dic vehicle property from Marr acc ess to event This entrance for ;. ency use only Erorrt west driveway St prop ray's Main Rd.entrance to parking for f vehicles from west driveway a3 owl 'st rx" 11 y J QA CN" h e UZZ.� I 04 t rrn� i t 86 0 nSq5g 6 �!i G n.a a. Mirabelli, Melissa From: Spiro, Melissa Sent: Wednesday, May 25, 2022 2:55 PM To: Mirabelli, Melissa Subject: RE: Special Event Peconic Bay Vineyard This is not preserved land. Melissa S. From: Mirabelli, Melissa Sent:Wednesday, May 25, 202212:55 PM To: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>; Killean,Jade <Jade.Killean@suffolkcountyny.gov> Cc:Amakawa,Andrew<And rew.Amakawa @suffolkcountyny.gov>; Ruckdeschel,August <August.Ruckdeschel@suffoikcountyny.gov> Subject: Special Event Peconic Bay Vineyard Please send comments and or questions to me Z , Melissa JV1 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 This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. ******************************************************************************************* 1 Mirabelli, Melissa From: Leslie Weisman <lesliekweisman@gmail.com> Sent: Wednesday, May 25, 2022 1:56 PM To: Mirabelli, Melissa;Verity, Mike; Flatley, Martin; Lanza, Heather,Weisman, Leslie; Burke, John Subject: RE: Special Event at Peconic Bay Vineyards Vendor information is incomplete and parking plan listed as"on file" should be included along with a brief description of the fundraiser. Leslie From: Mirabelli, Melissa [mailto:melissa.mirabelli@town.southold.ny.us] Sent: Wednesday, May 25, 2022 12:40 PM To: Verity, Mike; Flatley, Martin; Lanza, Heather; Weisman, Leslie; Burke,John Subject: Special Event at Peconic Bay Vineyards Please send any questions or comments to me 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 ******************************************************************************************* This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. ******************************************************************************************* 1 Mirabelli, Melissa From: Glew, Claire Sent: Wednesday, May 25, 2022 2:17 PM To: Mirabelli, Melissa Subject: RE: Special Event Peconic Bay Vineyard Hi Missy, There is not an exemption where the event is being held on this property. Cl.aCrerClew Assistant to Assessor Town of Southold Board of Assessors (631)765-1937 Phone (631)765-1356 Fax www.southoldtownnV.gov claireg@southoldtownny.gov From: Mirabelli, Melissa<melissa.mirabelli@town.southold.ny.us> Sent:Wednesday, May 25, 2022 12:55 PM To: 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>; Killean,Jade <Jade.Killean@suffolkcountyny.gov> Cc:Amakawa,Andrew<Andrew.Amakawa@suffolkcountyny.gov>; Ruckdeschel,August <August.Ruckdeschel@suffolkcountyny.gov> Subject:Special Event Peconic Bay Vineyard Please send comments and or questions to me Alelassa.Al Alipabellr Secretary to the Town Attorney Town of Southold Southold Town Hall Annex 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY l 1971 Office (631) 765-1939 Fax(631)765-6639 1 This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. 2 Mirabelli, Melissa From: Flatley, Martin Sent: Thursday, May 26, 2022 7:47 AM To: Mirabelli, Melissa Subject: RE: Special Event at Peconic Bay Vineyards I have no objections to this event being approved Martin Flatley, Chief of Police Town of Southold Police Department 41405 State Route 25 Peconic, N.Y. 11958 Tel: 631-765-3115 r,r . 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. From: Mirabelli, Melissa<melissa.mirabelli@town.southold.ny.us> Sent:Wednesday, May 25, 2022 12:40 PM To:Verity, Mike<Mike.Verity@town.southold.ny.us>; Flatley, Martin<mflatley@town.southold.ny.us>; Lanza, Heather <heather.lanza@town.southold.ny.us>; Weisman, Leslie<lesliew@town.southold.ny.us>; Burke,John <johnbu @southoldtownny.gov> Subject:Special Event at Peconic Bay Vineyards Please send any questions or comments to me Afelissa Al. Ttirrabelli 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 ******************************************************************************************* This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply ' 1 transmission and delete the message without copying or disclosing it. 2 Mirabelli, Melissa From: Easton,James Sent: Thursday, May 26, 2022 8:34 AM To: Mirabelli, Melissa Subject: RE: Special Event Peconic Bay Vineyard I have no objection to this event taking place. Thank you, James Easton Fire Marshal jaYnese c southoldtownny.gov (W) 631-765-1802 PRIVELEGE.D AND CONFIDENTIAL COMMUNICATION CONFIDENTIALITY NOTICE-: This electronic mail transmission is intended only for the use of the individual or entity to which it is addressed and inky contain confidential information belonging to the sender which is protected by privilege. If you are not the intended recipient,you are hereby notified 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 notify the sender immediately by e-mail and delete the original message. From:Mirabelli, Melissa<melissa.mirabelli@town.southold.ny.us> Sent: Wednesday, May 25, 2022 12:55 PM To: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>; Killean,Jade <Jade.Killean @suffolkcountyny.gov> Cc:Amakawa, Andrew<And rew.Amakawa @suffolkcountyny.gov>; Ruckdeschel,August <August.Ruckdeschel@suffoIkcountyny.gov> Subject: Special Event Peconic Bay Vineyard Please send comments and or questions to me :11elissca 11. 111irabelli 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 This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply 1 transmission and delete the message without copying or disclosing it. ******************************************************************************************* 2 Mirabelli, Melissa From: Killean,Jade <Jade.Killean@suffolkcountyny.gov> Sent: Tuesday, May 31, 2022 8:37 AM To: Mirabelli, Melissa Cc: Amakawa,Andrew Subject: RE: Special Event Peconic Bay Vineyard Good morning Missy, Regarding the event at the Peconic Bay Vineyards,we do not have any comments as the property is neither SC PDR nor is it adjacent to County holdings. Thank you, Jade XiCCean Planner Suffolk County Dept. of Economic Development&Planning Division of Planning&Environment 100 Veterans Memorial Highway,2°d Floor Hauppauge,NY 11788 631-853-6044 Tel g €'0 � . jr t 1 }' p r a c t i C e G R E E N Save a tree.Read:don't print,emaiis. CONFI DENTIALI TY NOTI CE. This electronic mail transmission is intended solely for the use of the individual/entity to whom it is addressed and may contain confidential information belonging to the sender. If you are not the intended recipient,you are hereby notified 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 notify the sender immediately by e-mail and delete the original message. X Vaccination = Freedom from COVID-19 Help Suffolk County get back to normal COVID vaccines are safe, effective and free From: Mirabelli, Melissa<melissa.mirabelli@town.southold.ny.us> Sent: Wednesday, May 25, 2022 12:55 PM 1 To: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>; Killean,lade <Jade.Killean@suffolkcountyny.gov> Cc:Amakawa,Andrew<And rew.Amakawa @suffolkcountyny.gov>; Ruckdeschel,August <August.Ruckdeschel@suffolkcountyny.gov> Subject:Special Event Peconic Bay Vineyard ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. Please send comments and or questions to me Yfelissa hf. Ifirabelli 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 ******************************************************************************************* This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. ******************************************************************************************* 2 Mirabelli, Melissa From: Lanza, Heather Sent: Wednesday,June 1, 2022 11:29 AM To: Mirabelli, Melissa;Weisman, Leslie; Flatley, Martin;Verity, Mike; Burke,John Subject: RE: Peconic Bay Vineyards Special Event Application with site map They have plenty of parking for this event. From: Mirabelli, Melissa Sent: Friday, May 27, 2022 3:43 PM To: Lanza, Heather<heather.lanza@town.southold.ny.us>;Weisman, Leslie<lesliew@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>;Verity, Mike<Mike.Verity@town.southold.ny.us>; Burke,John <johnbu@southoldtownny.gov> Subject: Peconic Bay Vineyards Special Event Application with site map Hello All Attached is the application( again) but with the maps.The description of the event is BINGO games and prizes are designer handbags for the winners of the BINGO games Have a Happy and Safe Holiday Weekend Melissa Al 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 This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. ******************************************************************************************* 1 P � gUFFO(4° RESOLUTION 2022-484 jO� OG ADOPTED DOC ID: 18148 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2022-484 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 7,2022: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Joseph Doorhy,to hold Special Event 2022-27 at the Peconic Bay Vineyards, 31320 Main Road, Cutchogue,New York as applied for in Application PBV Ia for Kaits Angels Fundraiser on August 5, 2022 from 5:OOPM to 9:00 PM, provided they adhere to all conditions on the application, permit and the Town of Southold Policy for Special Events. All parking must be contained on site. 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. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Sarah E.Nappa, Councilwoman SECONDER:Brian O. Mealy, Councilman AYES: Nappa, Doroski, Mealy, Doherty, Evans, Russell Vol P6 y / al RECEIVED MAY 2 5 2022 l Southold T yawn MWO i 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 co»zpleted application that is not submitted 60 or more business days prior to the scheduled event maybe rejected or subject to a late processing fee of$250.00 by the Office of the Town Clerk, unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk. The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health, safety, and welfare of the community. When is a Permit Required? All Special Events,per Southold Town Code Article I, Section 205-2 (Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residential 12ropeLty grope . for profit, such as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk: Please indicate submission of the following by checking off the boxes and signing below. A completed application form signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. FEE: Is the application being submitted at least 60 days before the event[ Yes [ ]No ❑ If Yes,Fee of$ has been submitted El If No,Fee of$ has been submitted Updated 8/7/2018 $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 ,,p FiLa A Parking/Event Plan: consistingof 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) F7 '0" l= .fQ LV+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 O�Aa&fre 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 RECEIVE® MAY 2 5 2022 Southold Town Clerk APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVENT Please provide ALL of the information requested below.Incomplete applications WILLrNOT be reviewed. i7 � ? � Special Event Permit# Applicant(s)name: Date of Submission Name of Event .�*s o'lve,- Aj:.05, SCTM#'s 1000-Section 1(,13 Block- f Lot(s) �- Dates of Each Event:J-S-.2 a- If Multiple Dates are requested, applicant must give all information for all dates. Nature of Event: r•A:se-r (Please attach a detailed description of EACH event to this application) Time Period (Hours)of Event: From 5 to Town Services requested: ( )Yes (, No If yes, Describe Police Dept._Highway Dept. Describe Services Maximum Number of Persons Attending At One Time: o?7 S— Number of cars expected %Scp Is a Tent or other temporary structure being used? [ uC] Yes [ ]No If yes provide size(s) & a V /'J00 Will food be served?[ a]Yes 'No If yes provide number and name(s)of food vendor(s) Updated 8/7/2018 Suffolk County permit#(s) Will other vendors be on the premises during the event?[ ]Yes [,)4JNo If yes how many? Describe Type of vendor(s) Property Owner(name/address): ,s .5'�/ u a'd` [ I eCOOWG S a/ V A(yA;c�S Contact Person and Contact Tel.#_ J®j c.�f� � :� � i N 4;�-- s-s d S� e-mail address Jor0P ov-)L, -4T Event Location: Street-Hamlet Address: P'a cc),3.C: Q A'( VA;t-r.r.'CLS /zo yh a rc-l. PI-C O C"4. SCTM# Mailing Address to Send Event Permit to: 0 L e TV Ie- P.4 NMA-r%'.-v C_kJ_ ��. � ,�•c,-elf Have any of the development rights been sold to the Town of Southold [ ] Yes [V( 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 PARKINGIEVENT 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) of 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 11L 4-- �G�V, J C -2— Print Print name of Authorize- Person/Representative Signa o 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, tent(s) or temporary structure(s) or temporary sanitary facilities, shall be conducted on Suffolk Count 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 KAITANG-01 GANCONA ACORO" DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE F5/12/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Neefus Stype Agency 711 Union Ave. (A/CC,Nr o,Ext):(631)722-3500 jAAic,Ne):(631)722-3591 Aquebogue,NY 11931 AI oa'Ess:info@nsainsure.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:GuideOne Mutual Ins.Co. 15032 INSURED INSURER B: Kait's Angels/Friends of the INSURER C: Mattituck Lions Club PO Box 1081 INSURER D: Mattituck,NY 11952 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 10030544 2/12/2022 2/12/2023 DAMAGETO S( RENTED 1,pp0,000 X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 0 jRa, FILOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY Ee. ",d.ntSINGLE LIMIT $ ANY AUTO BODILY INJURY PerPerson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ERH ANY PROPRIETORIPARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) . E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule may be attached if more space is required) Peconic Bay Vineyards is included as additional insured with respect to General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Peconic Ba Vineyards THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y Y ACCORDANCE WITH THE POLICY PROVISIONS. 31320 Main Rd Cutchogue,NY 11935 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KAITANG-01 GANCONA ACORN" DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/12/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Neefus Stype Agency 711 Union Ave. (A/c°,Nn o,Ext):(631)722-3500 FAX No):(631)722-3591 Aquebogue,NY 11931 A DRIEss:info@nsainsure.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:GuideOne Mutual Ins.Co. 15032 INSURED INSURER B: Kait's Angels/Friends of the INSURER C: Mattituck Lions Club PO Box 1081 INSURER D: Mattituck,NY 11952 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MMIDD/YYYY MMIDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 10030544 2/12/2022 2/12/2023 DAMAGETO S( RENTED 1,000,000 X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000-00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY DJECT D LOC PRODUCTS-COMP/OPAGG $ 2, 00,000 OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ AUTOS ONLY AUUTOS ONLY PROPERTY DAMAGE Peracadent $ UMBRELLALIA13 HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY OFFICER/MEMBER/EXCLUDED?ECUTIVE [7NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Town of Southold is included as additional insured with respect to General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of SouBox THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TO To BOX 1179 ou ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KAITANG-01 GANCONA ACORO® DATE(MMIDD/YYYY) `1 CERTIFICATE OF LIABILITY INSURANCE 511212022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS- CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Neefus Stype Agency PHONE 711 Union Ave. (A/C,No,Ext):(631)722-3500 FAX No):(631)722-3591 Aquebogue,NY 11931 E-MAIL SS:info@nsainsure.com INSURERS AFFORDING COVERAGE NAIC i/ INSURERA:GuideOne Mutual Ins.Co. 15032 INSURED INSURER B: Kait's Angels/Friends of the INSURER C: Mattituck Lions Club PO BOX 1081 -INSURER D Mattituck,NY 11952 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MMIDD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR10030544 2/12/2022 2/12/2023 DAMAGE TO RENTED 1000,000 X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5'000 PERSONAL&ADV INJURY $ 1'000'000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000 X POLICY FI JECOT F] LOC [PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBED SINGLE LIMIT Ea accINident $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY NON-OWNED ONLYY peri ccd DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED F I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE. EORH ANY PROPRIETOR/PARTNER/EXECUTIVE F7E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ eh DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESACORD 101,Additional Remarks Schedule,may be attached if more space is required) United Rentals is included as additional insured with respect to General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE United Rentals THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 250 Orchard Rd n East Patchogue,NY 11772 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/25/22 Receipt#: 299154 Quantity Transactions Reference Subtotal 1 Event Fee PBV 1a $150.00 Total Paid: $150.00 Notes: Payment Type Amount Paid By Credit Card-Ref# $150.00 Joseph Doorhy Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Peconic, Bay Vineyards Po Box 709 Cutchogue, NY 11935 Clerk ID: SABRINA Internal ID: PBV 1a Born, Sabrina From: Born, Sabrina Sent: Wednesday, May 25, 2022 12:02 PM To: Mirabelli, Melissa; Noncarrow, Denis; Norklun, Stacey Subject: Emailing: SE-PBV 1 a_20220525115402.pdf Attachments: SE-PBV 1 a_20220525115402.pdf Good Afternoon, Please find attached, a special event application received from Joseph Doorhy for an event for Kait's Angels held at Peconic Bay Vineyards. Thank you, Deputy Town Clerk Southold Town Clerk's Office 53095 Route 25 P.O. Box 1179 Southold,NY 11971 Ph: 631-765-1800 ext. 1226 Fax: 631-765-6145 Your message is ready to be sent with the following file or link attachments: SE-PBV 1a_20220525115402.pdf 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