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HomeMy WebLinkAboutShamrock Christmas Tree Farm 2022-46 & 47 "j �opsurret�¢y RESOLUTION 2022-789 �y. f,�Baa ADOPTED DOC ID: 18440 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2022-789 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 4,2022: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Jonathan Shipman,to hold Special Event 2022-47 at Shamrock Christmas Tree Farm, 20685 Main RD, Mattituck,New York as applied for in Application SCTF3a-f a for Choose and Cut Trees on November 25,November 26 November 27, December 3, December 4 and December 10, 2022 from 9AM- 5PM. All parking must be contained on site. Provided they adhere to all conditions on the application,permit and to the Town of Southold Policy for Special Events. 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: Brian O. Mealy, Councilman SECONDER:Sarah E.Nappa, Councilwoman AYES: Nappa, Doroski, Mealy, Doherty, Evans, Russell ,90F, ..c Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Office: (631) 765-1939 SPECIAL EVENT COMMITTEE TOWN OF SOUTHOLD October 5, 2022 Shamrock Christmas Tree Farm 985 Elijah's Lane Mattituck,NY 11952 Attn.: Jonathan Shipman Re: Special Event Permit Event#: 2022-47 Dear Jonathan, Enclosed please find a copy of the Town of Southold adopted resolution. Please note there may be conditions to this event as stated in the adopted resolution. These conditions are an executive order from the Governor of the State of New York failure to comply with these conditions will result in revocation of your Special Event Permit. Sincerely, l Melissa M Mirabelli, Secretary to Town Attorney Special Events Committee Application Summary and Recommendation Application name:, �hin~S Nlf► - -C,ht�S�'Y�1�Tr1�2 %M, Address:?Df o s mMA Td,MA&(a . 14 Application number: SC. r F Aa--P Date of Event: AIM , l I 11a l 1XI, 1 a13 Gly Time: � AM - Epm Date Received by Town Clerk: �- Date Received by Committee: Nature of Event (S): NOOSE Committee Comments Received by: Melissa Spiro Leslie Weisman Missy Mirabelli - - - Fla_ C0Le-&ftr1Gs August Ruckdeschel- County Heather Lanza James Easton Mike Verity Claire Glew BtH-BttfFy''Sdhh�ul� Kevin Webster Committee Recommendation's: Approve as applied Approve with Additional conditions: Hold Public Hearing Deny Special Event No: aaaa - H t Resolution No:30o3 - 1 Date: 101 t4 I aOo-\ , SEP 1:2 222 'Cn, 9.t office ice Attorney S F-RECEIVED ptertainment 9ncl Special Rv-ents" �:��'�' t �� 1 s 2022 w,."...:TIONS AND APPLICATTI NFO Applic ._ r ninter-departmental cgord" aE South s,Land Preservation,Bttildi &Rlani� - tr '��`� Board A y_ .,. Ke Molk County Planning Commission. multiple events of the same type, occurring over a perio6----....e.. —. ..--•aplication for a fee of$150.00. However,specific details c }......_ -"".-• - on. gyp_-- . s .Casi'tiiD`buAnecs day- be-fore•the event Ap limos. are encs agcu is submit applications as early as possible Any i7efitatder dent inlay be rejected or Object to a ltate.processing fee of$250.00 by the Otlice 4 the Townbe unless a waivef is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing. ' The Committee will,obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health, safety,and welfare of the community. When iia Permit&wed?. All Special Events,per Southold Town Code Article 1, Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residentW!:v=eahr profit such as a venue for weddinks . r other s This apmlic ttion is deemed complete once all the Wlowing re4bireinents are submitted to the Town submission(lierk: Please indica . A completed awlieation form signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. FRF.: Is the application being submitted at least 60 days before the event[aYes [ j No If Yes,Fee of$ has been submitted If No,Fee of$ has been submitted Updated 8/7/2018 APPLICATION FOR A PER-AM TO MOLD A SPECIAL EVENT fiilifor reviewed. Special Event Permit# Applicant(s)name:-,�Aa&a42,t� Date of Submission Name of Event�N a�!/tB - �trtzt;;7'r rt Tta. FAnr: .z d»rn.s (VAq SCTM#'s 1000-Section I31oek- /Od 3 Lot 15- #q- Dates of Each Event: rl "-_i/ -itW) If Multiple Dates are requested,applicant must give all information for all dates. Nature of Event:CM9 e- " 401L CV-r- 4-6A-'17 i�ryleNi (Please attach a detailed description of EACH event to this application) Time Period(Hours)of Event: From: f AW! to .�S-6?klll� Town Services requested: ( )Yes (r-)No If yes,Describe Police Dept. Highway Dept. Describe Services Maximum Number of Persons Attending At One Time: '1.0.0 Number of cars expected / D Is a Tent or other temporary structure being used?[e/]Yes [ ]No If yes provide Will food be served?[ )Yes [tel No If yes provide number and name(s)of food vendor(s) Updated 8nnoi8 8. On-site food preparation is NOT permitted, although food may be catered subject to all Suffolk County Department of Health regulations. 9. v' 4 s.sociated vJ limiu, tQ naking. 'cr ,/ 'sS Purchase of 12eVelot2IneritRigbt4.land 10. i g s ss/ 1, ,r. r t.. n. :l. , ri ....ff tv P rch s of , Yvclo m n Riai s 1 d: with t rrrii t iss ed 'b �e �uffo k C6-un I rml nd Crirtirnrttee. - - 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(�mcrgency 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:pn forcement 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 TERIVIINATE THIS PERMIT. APPROVED Town of Southold Resolution Number: . Date Issued: Updated 8/7/2018 (14) Location of sanitary facilities on site. -raftSl nfroalm 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 qualifiedMIMC c litr611 inuct"he�rovided 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. O TP1 VAI`G..STA 7't71a,�• 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 regurrditig 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 MAI Printname of Owner ` " �ttir "of owner ..tom Irk / �iitirM t tR.use Print name of AuthonzedYPgrso�mRepresentative `patuie of Authorized Pe onll epreseatat re pt DOW _.`RE-BYGRANTEDi SURA TO TIMUGUOWING`CODWITLOM. 1. By acceptance of this permit, applicant agrees to adequately supervise and direct all parking to be on t the premises or at another site, and to provide parking assistants and any additional traffic controls necessary for this-event.dark*-is strict y_l}rrihilitted,on ANYTniviivCohn cir;: ta-tc kbads cir ikht_o 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:fit h0 ►iiipe 's lar"nor tci the schedilled 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 F ' Suffolk County permit#(s)' Will other vendors be on the premises during the event?[VI Yes [ ]No If yes how many?�_Describe Type of vendor(s) 5 e G A TT A C 4 e 1, Property owner(name/address): 4:rb yC-014 t rlsl AI ►ug'�15.Cr L r:�,e,71_fr5_L.,u ; },e�;- 4'-vC-K Contact Person and Contact Tel.# �.3 6 r Z ' ��,�.sy 6 zl e-mail address. 06ki�A! MAP -d&, 7 t)OL I AJ tzr Event Location:Street-Hamlet Address:_—_o2D G 8?S iM 14 1 N AA, M/F -T 17-V G /{ Mailing Address to Send Event Permit to:^ t 0 C,14 Have any of the development rights been sold to the Town of Southold[ ]Yes [v}No and/or Suffolk County Agricultural Program? [ ]Yes [ ]No 1f yes to either or hotb also indkak on the ataac beWa flipkrir�nda-rie -thG reserved area uncin Wbicihthi,Oveht Willtake 11>acr YQU MIDST ATTACH A PAI2KINGIEV IINI,F FLAN'T0,MSAPi'U- A-DON V IIIE JKXPECTED AT ITE, 'JS300 OR MORE EE PU,i0-LM-USJLA8O fiI2AT+ iC C(?l�I`�i(?L 'C:AN(seg nex :tta-g A Par'ittal�'vent Plan: ¢a �=stte glan atld/ok aerial vae tyr examp1 ,. gl����rthl of idji&I-PbOM� CA'➢' i. 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 The applicant/owner of the property where the special event is proposed to take place must provide a :: =fieate-nf`insurance not less than 2 million dollars naming the'Iiiwo of So�ffiol&a` an addi i final {,insured t- .jA '.arkig/f ven -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;trOc:cniinol. 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. D ed. _ b;tature Activities associated with outdoor public events are strictly prohibited from taking place on land preserved through the sale of deviebPment rights to the Town of Southold, and can only take place on land preserved through the sale of rlevelgpmeent rights to the County of Suffolk with a permit issued by the Suffolk County Farmland Committe& 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 Shamrock Christmas Tree Farm 20685 Main Road Mattituck, New York 11952 Choose And Cut Christmas Tree's 631-298-4118 North Fork Potato Chips 2010 Oregon Road Mattituck, New York 11952 10 Varieties Homemade Potato Chips 631-298-8631 Harbor Lights Oyster Company •.200 Harbor Light's Drive Southold, New York 11971 Mr.Ted Bucci Private Harvested Oysters 631-740-0985 Greenport Jerky Company Greenport, New York711947 } Homemade Jerky Mr.Vincent Macchirole 516-319-1002 Backyard Brine Inc. 8595 Cox Lane Cutchogue, New York 11935 Homemade Pickles 631-754-1050 Pellegrini Vineyards 23005 Main Road Cutchogue, New York 11935 John 631-734-4111 Salt Bird Cellars 2885 Peconic Lane Peconic, New York 11958 631-871-3204 Woodside Orchards 729 Route 25 Aquebouge, New York 11931 631-722-5770 . ,•••• •,n .a.n,.w anu ncaiuy NmcrN ,` "< , '-wa 'r,y � .r^ ry� �'�� xis`i��`� s.' i. , d' .' °`v.art`,-%• ' ov _ '1 it+e�'. d,..iT'' f> Y Ax� i` .'$qF� r' (�'Ci wC,e {n• x r*Pny" )gn.'ayt.+Y;,. •fl � `•I,(X,i� �`�. � '$ !'xf+,':i. �', sry �'" t•' �.1.'•: '•i cl,• •+�;r'r'Gh.'�R ;3•q,."""e.�"a:4.t�u. r�c�,6k".��', 6 �"" }.4`�F:•�:arst;' i °=+J,?z 4 �' _ 1"tti•,„a.�t�".`.r� 'y,a"6.9a".{:,5 ,'"n;�7F<'e.�:t% 5 -i 4Y`-.,xr�:.... n'F.-4».;..wi�X :1", �, .t vi.,,.e,t,«.I'r'1� 's'S's'YM, ti;:. ,... ,,r�c��e;,, 'iCv;, r•,L'� 'u• fl.�J '�. ..s4•., •;'-` ,rt ..rr.. .;,,:;i:T?`•3;C;:i�'S:49. `s.+. .!`�w• `,�t >. �- L' -�' rr �+`�,ay;L°...x�r.: Pt ,^.�..$.:.,��,, •��•'.-� �i � :i �,,..Mi,� .e�r,{� , �^ �'t =}r, +.:�+•.H- •,t;�,d:�•--. ^I. iyq< .•�� `'}:,. 5�a �' 's•;.'.' _ 's;r":{T`"" i� a`ar d'\' .t� ':�.. r..r �\(�'t'-:;Y.^:.r �i.'.m.. ee '"A' .'t +,�4i'•�� 's,�• ++,v��` ,a. i h :✓.._�- .t �,¢'r` r{+xC. 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'a_` 4iP :.v:Y( ';4i.eilA it+='.4 ..S�r-eW�ar;p,,, '.+► -.�" ,r I d 'Merf /in 4e k,f iti V V j 57 -9 Z' CPT;5 9 ry 1 ---jp7 1/5 vy v-v J Awl vVP CA TTI F- zi1 t'v JAA DATE(MMlDD/YYYY) A�® CERTIFICATE OF LOAMLIT'Y.WSU, NCE 09/07/2022 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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. 0 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 COn%r rights to the certificate holder In lieu of such endorseme"hi(s). PRODUCER NAMES ANTHONY RICCI PHOKENNETH MACNISH WC.N 631-939-6060 aC Nc; 631-693-3039 859 CONNETQUOT AVE 'AD REL ANTHQNY:RICCI@AMERIGAN-tdAl`IONAL COM 1NSIJRER S AFFORDING COVERAGE 'NA(C h` ISLIP TERRACE NY 11752 wsURERA, FARM FAINLY CASUALTY INSURANCE CO 13803 INSURED INsuRER B:'UNITED FARM FAMILY INSURANCE CO 29963 SHAMROCK CHRISTMAS TREE FARM INC INSURER C: 985 ELIJAHS LN INSURERD: INSURERE: MATTITUCK NY 11952 1NSURERF: COVERAGES CERTIFICATE NUMBER: REWSION 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. ILS�R POLICYEFF POLICY EXP TYPE OF INSURANCE POLICYNUMBER MID tMNUDp jimns; A COMMERCIAL GENERAL LIABILITY Y 310108921 8/11/2022 8/11/2023 EACHOCCURRENCE $ 1,000,000 CLAIMS MADE ❑X OCCUR unmSAie i u rctnitu MISES(Es_a=r nca $ 100,000 MED EXP(Any one person) $ 5,000. YERSONALBADVINJURY $ 1,000,000 �GEEN`LAGGREGATE LIMITAPPLIESPER: GENERAL AGGREGATE - $ 2,000,000 \. POLICY❑JECo-T LOC -PRODUCTS-COMP/OPAGG $ 2,000,000 B AUTOMOBILELIABI ITY 3101C8177 8111/2022 8/11/2023 COMBIIINEDSINGLELIMIT ($ 1,000,000... ANY AUTO BODILY INJURY(Perpopm) S OWNEDSCHEDULED NLY AUTOS O AUTOS BODILY INJURY(Parscddent) $ HIRED NON-0AG WNED PROPERTYDAME AUTOS ONLY AUTOS ONLY a debt $ $ A X uMBRELLALIAeOCCUR 3101E5262 8111/2022 '8111/2023' EACH OCCURRENCE $_ 1,000,000 EXCESS UAB CLAIMS!4(ADE AGGREGATE $ .1,000,000 : ; DED , RETENTION$ 10,000 $ i WORKERS COMPENSATION S�TLJiE ER AND EMPLOYEIM'LIA91LTTY Y/N -- ANYPROPMETOR/PARTNERrcD(ECUTNE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUOED?: Ll NIA (Ma6datm In NH) E.L DISEASE-EA EMPLO $ Ifyyeess dascdhe under DESCRIPTION OF OPERATIONS Nil. E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCAT(ONSI VEHICLES(ACORD 101,Addi0onel Remarks Schedule,may be atWhed If more apace Is requlmd) CERTIFICATE:HOLDER;IS LISTED AS ADDITIONAL INSURED. CER.TIF[CATE HOLDER CAN:ELL T 10N TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 ROUTE 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 9179 ACCORDANCE 4111TH THE POLICY PROVISIONS. SOUTHOLD, NY 11971 ADTHORIZEDREPRESENTA„VE 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and loco are reoistered marks of ACORD Workers' CERTIFICATE OF YORK .STATE Compensation p NYS WORKERS' COMPENSATiON INSURANCE COVERAGE AT Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured (631)298-4619 SHAMROCK CHRISTMAS TREE FARM INC 985 ELIJAHS LN MATTITUCK, NY 11952 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(only required ifcoverageisspecifically limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security Number 88-1467893 2. Name and Address of Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage FARM FAMILY CASUALTY INSURANCE CO. (Entity Being Listed as,the Certificate Holder) 3b. Policy Number of Entity Listed in Box"1a" TOWN OF SOUTHOLD 3c. Policy effective period 53095 ROUTE 25 9/7/2022 to .4/24/2023 PO BOX 1179 - SOUTHOLD,NY 11971 3d. The Proprietor,Partners or Executive Officers are o included. (Only check box if all partners/officers included) X all excluded or certain partners/officers excluded. This;certifies that the insurance carrier indicated above in box"W,insures the business referenced above in box"9 a"for workers'cornperisaticin-under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity fisted above as the certificate holder in box"2". The insurance carrier must,iiotify the°albove`certlficatii holder-and the W-orkers'Compensation Board within 10 days4F a policy is eangeled.due fo noiipayirient of premiums or.withlri°30 days 1E there are reasons othdr:than nappayinenfiof.prgnJiurbt that caridet the policy oretiiiiinate,th,6 insuied.from the covorage indii ted oo thls Gefifigate.(Mese notices maybe senf:by1.regular maiQ Otherwisse,this Cetttfioate;is valid for one gear after this form is, .approved by_the insurance oamer or its'iicedsetl agent,or until the 0o icy, expiration date listed in box"3c",whlcheyer'is earlier: This:certificate is issued as a matter of information only and confers;no rights upon the certifiicate holder.This certificate does.not amend,extend or alter the coverage afforded by the policy listed,nor c3aes.iic6nfer any rights br responsibilities beyond.thosd odritained in thereferer<ded.policy This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect- Please Note:Upon cianceilatian of the.y{orkers`coiripensatioit poliq} lndicated on this form,if the,business continues to ba,named on a permit;. license or contract issued by a certificEite h"older;the business-must provide:ttrat.aerfificate.tiofdef vuifh_a neur`Certificate of'Workers' Compensation Coverage other authorix+d proof that the business--is complying with the-mandatory coverage requirements of the Flew York State Warkere Cornpensation UW.- Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured.has the coverage as depicted on this form. Approved by: Kenneth E.MacNish (Print name of authorized representative or licensed agent of insurance carrier) Approved by: '��`"'� 9/12/2022 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier:, 631-939-6060 • r - 4c� ttSi� c ai 13: VH AM CK R•C H- Rt ST T- RE E' FAR KIN <- t4tl e IN - - - 9t35 J�► ��`yNE - S A _ t ATTIT ry r- C le ,ryi•. 'Y It'• E- L[i� �.r A L*a} r"fix � r "' Y3T _ ori T6 I]`6621 --- e \ - : -�HEi IRDEEVOF r t �t _ 4 'h !tom~ �L�A r Yi r t.. Rs _ dd< ry�.t3. =R� k Filo �F t✓� �t. t` �1 K . r w`.4 .'ta '.-_y,r - 'i',r a'i(.�1 ',a. : ,• ..r,• ....i �Y.- '�,,;i i t -t t rn - 7 ♦�Z 16 'r 1•'ti Ii. r I - Q.. _3 n - O ryry C• 6 6' - ,,..�.'-':_F.„� - •,::�.., .,_,its ,,. r t �'',,..; -•, a Mirabelli, Melissa From: Lanza, Heather Sent: Thursday, September 15, 2022 1:23 PM To: Leslie Weisman Forward; Mirabelli, Melissa Cc: Weisman, Leslie;Verity, Mike; Ginas,James; Burke,John Subject: RE: shamrock Christmas Tree Farm - Farmers market Ok with me From: Leslie Weisman Forward <lesliekweisman@gmail.com> Sent:Thursday,September 15, 2022 1:12 PM To: Mirabelli, Melissa<melissa.mirabelli@town.southold.ny.us> Cc:Weisman, Leslie<lesliew@town.southold.ny.us>; Lanza, Heather<heather.lanza@town.southold.ny.us>;Verity, Mike<Mike.Verity@town.southold.ny.us>; Ginas,James<jginas@town.southold.ny.us>; Burke,John <johnbu@southoldtownny.gov> Subject: Re: shamrock Christmas Tree Farm- Farmers market Same as usual. Okay with me. Leslie On Thu, Sep 15, 2022 at 11:48 AM Mirabelli, Melissa <melissa.mirabelli@town.southold.nv.us>wrote: As always please send any questions or comments to me 1 I Thank you I 4 i lVelissa ill tMirahelli Secretary to the Town Attorney i Town of Southold I s } Southold Town Hall Annex i 54375 Route 25 (Main RD) P.O. Box 1179 Southold,NY 11971 i Office (631) 765-1939 Fax(631)765-6639 I P 1 This electronic mail transmission may contain confidential or privileged information. If you I Ibelieve 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 z Mirabelli, Melissa From: Spiro,, Melissa Sent: Thursday, September 15, 2022 1:27 PM To: Mirabelli, Melissa Subject: RE: Shamrock Christmas Tree Farm - Farmers Market This is not preserved land. Melissa S. From: Mirabelli, Melissa<melissa.mirabelli@town.southold.ny.us> Sent:Thursday,September 15, 2022 11:51 AM 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.Killea n@suffolkcountyny.gov> Cc: Kerr, Mikael<Mikael.Kerr@suffolkcountyny.gov> Subject:Shamrock Christmas Tree Farm- Farmers Market As always please send me any questions or comments Thank you r'Z i Allelissa NI 11irabelli 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: Easton,James Sent: Thursday, September 15, 2022 1:11 PM To: Mirabelli, Melissa Subject: RE: Shamrock Christmas Tree Farm - Farmers Market I have no objection to this event taking place. Thank you, James Easton Fire Marshal jaiuese@so-Litholdtowiuiy.gov (W) 631-765-1802 PRiVELEGED AND CONFIDENTIAL COMMUNICATION CONFiDENTI_ALiTY NOTICE: This electronic mail trvismission is intended only for the use of the individual or entity 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 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:Thursday,September 15, 2022 11:51 AM 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: Kerr, Mikael<Mikael.Kerr@suffolkcountyny.gov> Subject:Shamrock Christmas Tree Farm - Farmers Market As always please send me any questions or comments Thank you CZ, Afelissa Al. 31irabelli 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 1 Special Events Committee Application Summary and Recommendation Application name: � OMShiftrAMI([SM%T(tMA Address: QD( 85 McLto Application number: SCTFF L CA - C Date of Event: la]11 iai ri . lai iii aaaa- Time: Q AM-540 11) Date Received by Town Clerk: CI 1151 Date Received by Committee: q ual a-01- Nature of Event (S): Ir*,^pcp A & IT Committee Comments Received by: Melissa Spiro Leslie WeismanC Missy Mirabelli COLO. -ItnaS August Ruckdeschel- County Heather Lanza James Easton Mike Verity Claire Glew RwU 'ZOhn I&JAU J( Kevin Webster Committee Recommendation's: Approve as applied Approve with Additional conditions: Hold Public Hearing Deny Special Event No: am- Resolution m -Resolution No: aon"a~ _-Y58 Date:_ la 1 LA aoaD. RECEIVE 022 Town Attorney's office SOUTHOLD E ". lie Lntertainnient and Special Events" JL 'RUCTIONS AND APPLICA. ION FOI PNX 1 5 2022 Applications for a Special Event Permit are suoject to an inter-departmental coo d 'ateclev`V by the Southold Town Board,Town Attorney,Town Assessors,Land Preservation,Bti u� , r ,' ,.' r, Board of Appeals and Police Departments, and the Suffolk County Planning CommisSibri, C.�er� :A.pplical.ion fte: $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$150.00. However, specific details of each event must be included with this application. All applications must be submitted at least 60 business days before the event. Applicants are encouraged 'to submit applications as early as possible. Any oniiilefed application that is not submitted 60 or more business days prior to the scheduled event may be reiected or subject to a late processing:fee of S250.00 by.the-Office of ihe ,own Cleric, utl.less a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk. The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain..comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health, safety, and welfare of the community. When is a.Pcr.mit Renuired? All Special Events, per Southold Town Code Article 1; Section 205-2 (Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations; parties or not-for-profit fundraisers do not require permits. Anyy,Ilse"e)f residelttiaLprolaar L(ir_p alit. such as a ti.nue for�ayeddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk: `Please indicate submission of the follovdna by checking off the boxes and signing below. A completed aj�pljcatjoi1 NEW signed by the owner and the event manager. Applications without -� property owner's signature/approval will be rejected. FEE: Is the application being submitted at least 60 days before the event[/Yes [ ] No If Yes, Fee of$ has been submitted D. If No, Fee of$ has been submitted Updated 8/7/2018 QThe applicant/owner of the property where the special event is proposed to take place must provide a certificate of insuianc:4 not less than 2 million dollars naming the Town of Southold as an additional insured ® A ParkinglEvent: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) u 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 'ice rattrre Activities associated with outdoor public events are strictly prohibited from taking place on land preserved throrrglt the sale of development rights to the Town of Southold, and-can ontjJ take place on land preserved tltrorrgh the sale ofdevelopment rights to the'Countja..of Suffnik with o permit issrted by the Suffolk County Farmland Committee. If food is to be.served, ii rirtrst.�be caterred and prepared off-site:#y food ventlors who (told a permit to ,operate issued Gy the Soffolk Co.uifo B:ureacr.of Public Health food Protectidti Unit: Updated 8/7."-Ol8 - . APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVENT Please provide ALL of the information requested below. Incomplete applications'WILL NOT.be reviewed. i Special Event Permit# Applicant(s)name: ©S e— w Date of Submissiona� Name of Event�j� �tOGft G tf a�5"Y�.4g 5 i R•(=RRy►�I��R� e_,Q S ( 4AX C'7 SCTM#'s 1000-Section N73'9'9 1 .__Block- iBAl-3-3 Lot(s) 143 *rl- q.-5 Dates of Each Event: If Multiple Dates are requested, applicant must give all information for all dates. Nature of Event:G14ov&e 4ri1. c,v-r r)*zees ArJb 19621TA1Nri1e8Vr (Please attach a detailed description of EACH event to this application) Time Period (Hours) of Event: From rY1 to c5 P Town Services requested: ( ) Yes ( -)No If yes,Describe Police Dept._Highway Dept. Describe Services Maximum Number of Persons Attending At One Time: SPD Number of cars expected /sfIt, Is a Tent or other temporary structure being used? [ ✓J Yes [ ]No If yes provide size(s) 1t ID oZ. Will food be served? [ ] Yes [i/] No If yes provide number and name(s)of food vendor(s) Suffolk County permit4(s) Will other vendors be on the premises during the event? [�]Yes [ ]No If yes how many? _Describe Type ofvend or(s), SeeT�aC.f� 1Z Property Owner(name/address)* Contact Person and Contact TeL# e-mail address J1 Updated 8/7/3018 Event Location: Street-Hamlet Address:_gyp 6 f.5 dNI-A—t, a kb 1 r i ! r d G IL SCTAI � Will any services be requested Yes [.,r No. If Yes describe Police Highway Other: Mailing Address to Send Event Permit to: - �a� 1N l 7�-1 r t I Lf g 6 •C� f I�(cS Have any of the development rights been sold to the Town of Southold [ ] Yes [✓rNo and/or Suffolk County Agricultural Program? [ J Yes [ ]No Ifkes-to:eitlter or,both,also-indicate on the attached plan the mound, jes of the reserved area upon which the event will t�iace.. YOU MUST ATTACH A pAR1!jNG/EYENT PLAN.TO THIS APPLICATION IF THE EXPECTEIJ.ATTENDANCE IS 300 OR MORI:PEOPLE,YOU MUST ALSO ATTACH A `F—,k r,IC CONTROL PLAN(see next pale). ,~,; PnrkinWEI"011 Plan may be a survey,situ plan and/or aerial vi6Y (for example.Goode Earth) of the subiect property INDICATE ON TIIE PIAN ALL of the follol'Olm 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. (I 1) 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. (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 tiotitroller must..hc'provided. Please attached a Nvritten 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, parkin.?, and exiting of cars on site, and 4) Contact information for use by Southold Town Police. Updated 802013 OII tNER'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 affrrm that the information colifdirted herein and altachinents hereto are true and c0rreet46 the best Of iiry knowledge, and agree to provide notice to the Town immediately should there be ttity'material changes regarfliuy 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. r Print name of Owner ignafure of Owners Jam_ CU— ' Print name of Authorized ersan/itepresentative Signature of Authorized PorsoriMp aresentative p1 R°NMSSION IS REiI2LBS(CIt=ANTr;,D,_SUB.TECT TO TJ!E, '. LOWIN+G COI I)MONS: 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'T;own Colony or State'Roads or Rights-cif 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 ineltidin�but not limited to attorney's fees arising from activities under this l3ermit. 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 husirress.days prior to the scheduled event. 7. Adequate temporary sanitary facilities must be pi'oy.ided, by applicant far this event and applicant agrees to reirnove the temporary facilities from the preniises.within 48 hours after the day ofthe event. 8. On-site food preparation is NOT permitted, although food may be catered subject to all Suffolk- County uffolkCounty Department of Health regulations. 9. NU.�tcti�!ties associated with this event. including.but not limited to parking. ingress,e resslaccess. tca7tfs� or temporary su°uaturets'). or temi�arary sanitary facilities; shall be conducted'on Town of Southold Piirchase.of Develo�nent Rialits land. Updated 5i7i201.3 10. NO`tictivities associated with this event. inctudina but not limited to liarkina, inQress/caress/access, tent(s) or tempof,iy, strttcture(s), Or tenttnoraty sanitary facilities; shrill be conducted on Suffolk C-,oun1y Put°chase of bevel nciit 1 lets land without a. liermii issued by the Sitiif -, County .Fimrniabd eommiltee.. 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: t ANY VIOLATIONS IN CONNECTION WITH THE CONDITIONS LISTED HEREIN WILL TERMINATE THIS PERMIT, APPROVED Town of Southold Resolution Number: Date Issued: tpclatcd 817!2018 ,e -�' ��� °-1'.'r ;�s��"tr�;s•',s`3s "s'S:i, .,�, ,ti, '' .ti, �x' � ,�c"^.7.i q,s,'�r w< s �� .. rt- h-•-v,•�pJw�' u� i;�'�� e 4"=Y ,r+;�$+'�ww.¢`",`'L��'`� '$i"�:;'":a, .x ��� - .t 's� r a -' _ .•�f..�r,.;.•Araya ,i -` 'h' yt,�, .i :'s,>_,•.:. r;rr i*� -7' te=a ,� 1: -.., ����+"•• �i. �^' .;'4 ,tci `,�* ' "�e "%'�Y�•'��. .,,,; ,.E;.• .r,£. zY+'�• y� _ •rti .y ->4 M t := ?Gau e i ,'h' .F .�,ir•.J�ti� .^wr,,"';y;�. •t: L„i{•. .'.` r. _ ..`�'t nj :;f;� �`p`s�,_ fir.^.§' .,i'3' \t .:'• `s. siy. +.. , �+: ;w¢. .£ �. 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N !1 Y; LOT �A�t[ w6 i Lo i TP A-12 I y � 3 1 4 � � p DATE(fiWDDIYvrY) CERTIFICATE OF LIABILITY INSURANCE .--�� 09/07/2022 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 pollcy(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 such endorsenrbrit(s). PRODUCER CONTACT AAv: ANTHONY RICCI KENNETH MACNISH PHONE . 631-939-8060 FAX Noy 631-693-3039 859 CON NETQUOT AVE ons Ruesse ANTHONY RICCI MERICAN-NATIONAL.COM INS RERt$AFFORDINGCOVERAGE NAIC4 ISLIP TERRACE NY 11752 INSURERA: FARM FAiCRILYCASUALTY INSURANCE CO 13803 INSURED INSURER B: UNITED FARM FAMILY INSURANCE CO 29963 SHAMROCK CHRISTMAS TREE FARM INC INSURER C: 985 ELIJAHS LN INSURER D: INSURER E MAT 1 ITUCK NY 11952 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 %AAY 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 ADUL TYPE OF INSURANCE POUCYNUMSFR woDYEFF M D EXP LTR Limas A ComMERC1ALGENERALLIABIL17Y Y 3i016892i 8/11/2022 8/11/2023 EACH OCCURRENCE $ 1.000,000 CLAIMS-MADE �OCCUR vm AA N NtIFU ES(Ea occu $ 100.000 MED EXP(Any one person) $ 5,000 PERSONAL BADVINJURY S 1000,000 rrGEN'LAGGREGATE L1MMAPPLIESPEP: GENERALAGGREGATE $ 2,000,000 I� JECT LOC PRODUCTS-COMP/OPAGG S 2,000,000 POLICY❑ OTHER: $ B AUTONOMLELIABIUTY 3101C8177 8/11/2022 8/11/2023 (CEO NdTtSINGLELIMIT $ 1,000,000. ANY AUTO BODILY INJURY(Per person) !S OWNED SCHEDULED AUTOS ONLY BODILY INJURY(Par accident) S HIRED NON-OWNED PROPERtYDAMAG,E AUTOS ONLY AUTOS ONLY Par acod�t $ $ A X umm;tELLALIAMoccuR 3101E5262 8/11/2022 8/11/2023 EACIIOCCURRENCE $ 1,000,000 IXCE33LIAB CLAWS-MADE AGGREGATE $ 1,000,000 DED X I RETENTION S 10,000 $ WORI(=RS COMPENSATION AND EmoyEnl r as LITY YIN STATLRE ER AN`(PROPRIEiO.R1PARTNERIE)(ECUTIVE ❑ EL EACH ACCIDENT S OFFICER/MeMEREXCLUDEDT N!A (Mandatory In NH) EL DISEASE-EA EMPLO $ Mesaibe.under 11110N of OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule,may be atlacW If mora space Is required) CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI IF BEFORE 53095 ROUTE 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1179 ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD, NY 11971 AUMORIZEDREPRESENTATIVE 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(20161031 The ACORD name and l000 are registered marks of ACORD �rhw Workers' CERTIFICATE OF STAT p NYS WORKERS COMPENSATION INSURANCE COVERAGE STAT Compensation ' -- Board 1a. Legal Name&Address of Insured(use Street address only) 1b. Business Telephone Number of Insured (631)298-4619 SHAMROCK CHRISTMAS TREE FARM INC 985 ELIJAHS LN MATTITUCK, NY 11952 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if co—geisspecifically limited to certain locations in New York State,i.e.,a wrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security Number 88-1467893 2.Name and Address of Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage FARM FAMILY CASUALTY INSURANCE CO. (Entity Being Listed as the certificate Holder) 3b.Policy Number of Entity Listed in Box"1a" TOWN OFSOUTHOLD 3c. Policy effective period 53095 ROUTE 25 9/7/2022 to 4/24/2023 PO BOX 1179 SOUTHOLD,NY 11971 3d. The Proprietor,Partners or Executive Officers are o included. (only check box if all partners/officers included) X all excluded or certain partners/officers excluded. This-certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box'l a"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box 7'. The insurance carrier must notify the above certificate holder-and the Workers'Compensation Board within 10.d6ys IF a policy is canceled due to nonpayrrientof:premiums or within$0 days IF there are reasons other than nonpayment of premiums that candei the.policy or eiir»inate the:.insured from the -coverage indicated on this Cefiflcate:(These notices maybe sent by regular mail.)Otherwise;this Certificate is valid for one year after this form is approved by'the insulrzincecarrier orits licensed agent,.or until the policy expiration date listed'in box"3c";whicheveris earlier. This certificate is issued as a matter of information only and confers.no rights upon the certificate holder_This certificate does not amend,extend or after the cdverage afforded by the policy listed,nor does.ii confer any rights or responsibilities beyond those contained in the referended policy: This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect_ Please.Note:Upon cancellation of the_workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide.that certificate holder with a rreinr Certificate of Workers' compensation coverage;or other authorized proof.that the business is'complying with.the mandatory coverage requirements of the New York State Workers'compensation Cavi. Under peralty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this.form. Approved by: Kenneth E.MacNish (Print name of authorized representative or licensed agent of insurance carrier) Approved by: ��`" ✓�1� ��^ 9/12/2022 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier:. 631-939-6060 Mirabelli, Melissa From: Easton, James Sent: Thursday, September 15, 2022 1:11 PM To: Mirabelli, Melissa Subject: RE: Shamrock Christmas Tree Farm - Farmers Market I have no objection to this event taking place. Thank you, James Easton Fire Marshal jatnese@southoldtownny.gov (W) 631-765-1802 PRIVELEGED 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 may 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 c-mail and delete the original message. From: Mirabelli, Melissa<melissa.mirabelli@town.southold.ny.us> Sent:Thursday,September 15, 2022 11:51 AM 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: Kerr, Mikael <Mikael.Kerr@suffolkcountyny.gov> Subject: Shamrock Christmas Tree Farm- Farmers Market As always please send me any questions or comments Thank you Ifelissa AI 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 1 Mirabelli, Melissa From: Spiro, Melissa Sent: Thursday, September 15, 2022 1:27 PM To: Mirabelli, Melissa Subject: RE: 2nd Application Shamrock Christmas Tree Farm This is not preserved land. Melissa S. From: Mirabelli, Melissa<melissa.mirabelli@town.southold.ny.us> Sent:Thursday,September 15, 2022 12:09 PM To: Glew, Claire<Claire.Glew@town.southold.ny.us>;Webster, Kevin<kevin.webster@town.southold.ny.us>; Spiro, Melissa<Melissa.Spiro@town.southold.ny.us>; Easton,James<jamese@southoldtownny.gov> Subject: 2nd Application Shamrock Christmas Tree Farm As always please send me any questions or comments Melissa 11. 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. ******************************************************************************************* Mirabelli, Melissa From: Lanza, Heather Sent: Thursday, September 15, 2022 1:24 PM To: Leslie Weisman Forward; Mirabelli, Melissa Cc: Verity, Mike; Ginas,James; Burke,John;Weisman, Leslie Subject: RE: 2nd Application for Shamrock Christmas Tree Farm - Farmers Market OK with me From: Leslie Weisman Forward<lesliekweisman@gmail.com> Sent:Thursday,September 15, 2022 1:14 PM To: Mirabelli, Melissa <melissa.mirabelli@town.southold.ny.us> Cc:Verity, Mike<Mike.Verity@town.southold.ny.us>;Ginas,James<jginas@town.southold.ny.us>; Burke,John <johnbu@southoldtownny.gov>; Lanza, Heather<heather.lanza@town.southold.ny.us>;Weisman, Leslie <lesliew@town.southold.ny.us> Subject: Re: 2nd Application for Shamrock Christmas Tree Farm - Farmers Market okay Lesliei On Thu,Sep 15, 2022 at 11:53 AM Mirabelli, Melissa <melissa.mirabelli@town.southold.ny.us>wrote: Same with this application please send any questions or comments to me ( Thank you r Melissa,4I 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 i Office (631) 765-1939 t Fax(631)765-6639 1 i l 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 Itransmission and delete the message without copying or disclosing it. I 2 RESOLUTION 2022-788 ADOPTED DOC ID: 18439 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2022-788 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 4,2022: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Jonathan Shipman,to hold Special Event 2022-46 at Shamrock Christmas Tree Farm, 20685 Main RD, Mattituck,New York as applied for in Application SCTF4a-c for Choose and Cut Trees on December 11, December 17 and December 18, 2022 from 9AM - SPM. All parking must be contained on site. Provided they adhere to all conditions on the application,permit and to the Town of Southold Policy for Special Events. 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. r Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER:Brian O. Mealy, Councilman AYES: Nappa, Doroski,Mealy, Doherty, Evans, Russell =.D Town Hall Annex � , 543 75 Route 25 P.O. Box 1179 Southold, NY 11971 Office: (631) 765-1939 SPECIAL EVENT COMMITTEE TOWN OF SOUTHOLD October 5, 2022 Shamrock Christmas Tree Farm 985 Elijah's Lane Mattituck,NY 11952 Attn.: Jonathan Shipman Re: Special Event Permit Event#: 2022-46 Dear Jonathan, Enclosed please find a copy of the Town of Southold adopted resolution. Please note there may be conditions to this event as stated in the adopted resolution. These conditions are an executive order from the Governor of the State of New York failure to comply with these conditions will result in revocation of your Special Event Permit. Sincerely, Melissa M Mirabelli, Secretary-,to Town Attorney "j �opsurret�¢y RESOLUTION 2022-789 �y. f,�Baa ADOPTED DOC ID: 18440 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2022-789 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 4,2022: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Jonathan Shipman,to hold Special Event 2022-47 at Shamrock Christmas Tree Farm, 20685 Main RD, Mattituck,New York as applied for in Application SCTF3a-f a for Choose and Cut Trees on November 25,November 26 November 27, December 3, December 4 and December 10, 2022 from 9AM- 5PM. All parking must be contained on site. Provided they adhere to all conditions on the application,permit and to the Town of Southold Policy for Special Events. 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: Brian O. Mealy, Councilman SECONDER:Sarah E.Nappa, Councilwoman AYES: Nappa, Doroski, Mealy, Doherty, Evans, Russell ,90F, ..c Town Hall Annex 54375 Route 25 P.O. Box 1179 Southold, NY 11971 Office: (631) 765-1939 SPECIAL EVENT COMMITTEE TOWN OF SOUTHOLD October 5, 2022 Shamrock Christmas Tree Farm 985 Elijah's Lane Mattituck,NY 11952 Attn.: Jonathan Shipman Re: Special Event Permit Event#: 2022-47 Dear Jonathan, Enclosed please find a copy of the Town of Southold adopted resolution. Please note there may be conditions to this event as stated in the adopted resolution. These conditions are an executive order from the Governor of the State of New York failure to comply with these conditions will result in revocation of your Special Event Permit. Sincerely, l Melissa M Mirabelli, Secretary to Town Attorney Special Events Committee Application Summary and Recommendation Application name:, �hn—S p�►rat,�.ChrrS-h�4t�TrL2 %M, Address:?Df o s mMA Td,MA&(a . 14 Application number: SC. r F Aa--P Date of Event: AIM , l I 11a l 1XI, 1 a13 Gly Time: � AM - Epm Date Received by Town Clerk: �- Date Received by Committee: Nature of Event (S): NOOSE Committee Comments Received by: Melissa Spiro Leslie Weisman Missy Mirabelli - - - Fla_ C0Le-&ftr1Gs August Ruckdeschel- County Heather Lanza James Easton Mike Verity Claire Glew BtH-BttfFy''Sdhh�ul� Kevin Webster Committee Recommendation's: Approve as applied Approve with Additional conditions: Hold Public Hearing Deny Special Event No: aaaa - H t Resolution No:30o3 - 1 Date: 101 t4 I aOo-\ , SEP 1:2 222 'Cn, 9.t office ice Attorney S F-RECEIVED ptertainment 9ncl Special Rv-ents" �:��'�' t �� 1 s 2022 w,."...:TIONS AND APPLICATTI NFO Applic ._ r ninter-departmental cgord" aE South s,Land Preservation,Bttildi &Rlani� - tr '��`� Board A y_ .,. Ke Molk County Planning Commission. multiple events of the same type, occurring over a perio6----....e.. —. ..--•aplication for a fee of$150.00. However,specific details c }......_ -"".-• - on. gyp_-- . s .Casi'tiiD`buAnecs day- be-fore•the event Ap limos. are encs agcu is submit applications as early as possible Any i7efitatder dent inlay be rejected or Object to a ltate.processing fee of$250.00 by the Otlice 4 the Townbe unless a waivef is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing. ' The Committee will,obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health, safety,and welfare of the community. When iia Permit&wed?. All Special Events,per Southold Town Code Article 1, Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residentW!:v=eahr profit such as a venue for weddinks . r other s This apmlic ttion is deemed complete once all the Wlowing re4bireinents are submitted to the Town submission(lierk: Please indica . A completed awlieation form signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. FRF.: Is the application being submitted at least 60 days before the event[aYes [ j No If Yes,Fee of$ has been submitted If No,Fee of$ has been submitted Updated 8/7/2018 APPLICATION FOR A PER-AM TO MOLD A SPECIAL EVENT fiilifor reviewed. Special Event Permit# Applicant(s)name:-,�Aa&a42,t� Date of Submission Name of Event�N a�!/tB - �trtzt;;7'r rt Tta. FAnr: .z d»rn.s (VAq SCTM#'s 1000-Section I31oek- /Od 3 Lot 15- #q- Dates of Each Event: rl "-_i/ -itW) If Multiple Dates are requested,applicant must give all information for all dates. Nature of Event:CM9 e- " 401L CV-r- 4-6A-'17 i�ryleNi (Please attach a detailed description of EACH event to this application) Time Period(Hours)of Event: From: f AW! to .�S-6?klll� Town Services requested: ( )Yes (r-)No If yes,Describe Police Dept. Highway Dept. Describe Services Maximum Number of Persons Attending At One Time: '1.0.0 Number of cars expected / D Is a Tent or other temporary structure being used?[e/]Yes [ ]No If yes provide Will food be served?[ )Yes [tel No If yes provide number and name(s)of food vendor(s) Updated 8nnoi8 8. On-site food preparation is NOT permitted, although food may be catered subject to all Suffolk County Department of Health regulations. 9. v' 4 s.sociated vJ limiu, tQ naking. 'cr ,/ 'sS Purchase of 12eVelot2IneritRigbt4.land 10. i g s ss/ 1, ,r. r t.. n. :l. , ri ....ff tv P rch s of , Yvclo m n Riai s 1 d: with t rrrii t iss ed 'b �e �uffo k C6-un I rml nd Crirtirnrttee. - - 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(�mcrgency 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:pn forcement 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 TERIVIINATE THIS PERMIT. APPROVED Town of Southold Resolution Number: . Date Issued: Updated 8/7/2018 (14) Location of sanitary facilities on site. -raftSl nfroalm 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 qualifiedMIMC c litr611 inuct"he�rovided 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. O TP1 VAI`G..STA 7't71a,�• 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 regurrditig 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 MAI Printname of Owner ` " �ttir "of owner ..tom Irk / �iitirM t tR.use Print name of AuthonzedYPgrso�mRepresentative `patuie of Authorized Pe onll epreseatat re pt DOW _.`RE-BYGRANTEDi SURA TO TIMUGUOWING`CODWITLOM. 1. By acceptance of this permit, applicant agrees to adequately supervise and direct all parking to be on t the premises or at another site, and to provide parking assistants and any additional traffic controls necessary for this-event.dark*-is strict y_l}rrihilitted,on ANYTniviivCohn cir;: ta-tc kbads cir ikht_o 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:fit h0 ►iiipe 's lar"nor tci the schedilled 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 F ' Suffolk County permit#(s)' Will other vendors be on the premises during the event?[VI Yes [ ]No If yes how many?�_Describe Type of vendor(s) 5 e G A TT A C 4 e 1, Property owner(name/address): 4:rb yC-014 t rlsl AI ►ug'�15.Cr L r:�,e,71_fr5_L.,u ; },e�;- 4'-vC-K Contact Person and Contact Tel.# �.3 6 r Z ' ��,�.sy 6 zl e-mail address. 06ki�A! MAP -d&, 7 t)OL I AJ tzr Event Location:Street-Hamlet Address:_—_o2D G 8?S iM 14 1 N AA, M/F -T 17-V G /{ Mailing Address to Send Event Permit to:^ t 0 C,14 Have any of the development rights been sold to the Town of Southold[ ]Yes [v}No and/or Suffolk County Agricultural Program? [ ]Yes [ ]No 1f yes to either or hotb also indkak on the ataac beWa flipkrir�nda-rie -thG reserved area uncin Wbicihthi,Oveht Willtake 11>acr YQU MIDST ATTACH A PAI2KINGIEV IINI,F FLAN'T0,MSAPi'U- A-DON V IIIE JKXPECTED AT ITE, 'JS300 OR MORE EE PU,i0-LM-USJLA8O fiI2AT+ iC C(?l�I`�i(?L 'C:AN(seg nex :tta-g A Par'ittal�'vent Plan: ¢a �=stte glan atld/ok aerial vae tyr examp1 ,. gl����rthl of idji&I-PbOM� CA'➢' i. 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 The applicant/owner of the property where the special event is proposed to take place must provide a :: =fieate-nf`insurance not less than 2 million dollars naming the'Iiiwo of So�ffiol&a` an addi i final {,insured t- .jA '.arkig/f ven -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;trOc:cniinol. 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. D ed. _ b;tature Activities associated with outdoor public events are strictly prohibited from taking place on land preserved through the sale of deviebPment rights to the Town of Southold, and can only take place on land preserved through the sale of rlevelgpmeent rights to the County of Suffolk with a permit issued by the Suffolk County Farmland Committe& 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 Shamrock Christmas Tree Farm 20685 Main Road Mattituck, New York 11952 Choose And Cut Christmas Tree's 631-298-4118 North Fork Potato Chips 2010 Oregon Road Mattituck, New York 11952 10 Varieties Homemade Potato Chips 631-298-8631 Harbor Lights Oyster Company •.200 Harbor Light's Drive Southold, New York 11971 Mr.Ted Bucci Private Harvested Oysters 631-740-0985 Greenport Jerky Company Greenport, New York711947 } Homemade Jerky Mr.Vincent Macchirole 516-319-1002 Backyard Brine Inc. 8595 Cox Lane Cutchogue, New York 11935 Homemade Pickles 631-754-1050 Pellegrini Vineyards 23005 Main Road Cutchogue, New York 11935 John 631-734-4111 Salt Bird Cellars 2885 Peconic Lane Peconic, New York 11958 631-871-3204 Woodside Orchards 729 Route 25 Aquebouge, New York 11931 631-722-5770 . ,•••• •,n .a.n,.w anu ncaiuy NmcrN ,` "< , '-wa 'r,y � .r^ ry� �'�� xis`i��`� s.' i. , d' .' °`v.art`,-%• ' ov _ '1 it+e�'. d,..iT'' f> Y Ax� i` .'$qF� r' (�'Ci wC,e {n• x r*Pny" )gn.'ayt.+Y;,. •fl � `•I,(X,i� �`�. � '$ !'xf+,':i. �', sry �'" t•' �.1.'•: '•i cl,• •+�;r'r'Gh.'�R ;3•q,."""e.�"a:4.t�u. r�c�,6k".��', 6 �"" }.4`�F:•�:arst;' i °=+J,?z 4 �' _ 1"tti•,„a.�t�".`.r� 'y,a"6.9a".{:,5 ,'"n;�7F<'e.�:t% 5 -i 4Y`-.,xr�:.... n'F.-4».;..wi�X :1", �, .t vi.,,.e,t,«.I'r'1� 's'S's'YM, ti;:. ,... ,,r�c��e;,, 'iCv;, r•,L'� 'u• fl.�J '�. ..s4•., •;'-` ,rt ..rr.. .;,,:;i:T?`•3;C;:i�'S:49. `s.+. .!`�w• `,�t >. �- L' -�' rr �+`�,ay;L°...x�r.: Pt ,^.�..$.:.,��,, •��•'.-� �i � :i �,,..Mi,� .e�r,{� , �^ �'t =}r, +.:�+•.H- •,t;�,d:�•--. ^I. iyq< .•�� `'}:,. 5�a �' 's•;.'.' _ 's;r":{T`"" i� a`ar d'\' .t� ':�.. r..r �\(�'t'-:;Y.^:.r �i.'.m.. ee '"A' .'t +,�4i'•�� 's,�• ++,v��` ,a. i h :✓.._�- .t �,¢'r` r{+xC. 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'a_` 4iP :.v:Y( ';4i.eilA it+='.4 ..S�r-eW�ar;p,,, '.+► -.�" ,r I d 'Merf /in 4e k,f iti V V j 57 -9 Z' CPT;5 9 ry 1 ---jp7 1/5 vy v-v J Awl vVP CA TTI F- zi1 t'v JAA DATE(MMlDD/YYYY) A�® CERTIFICATE OF LOAMLIT'Y.WSU, NCE 09/07/2022 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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. 0 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 COn%r rights to the certificate holder In lieu of such endorseme"hi(s). PRODUCER NAMES ANTHONY RICCI PHOKENNETH MACNISH WC.N 631-939-6060 aC Nc; 631-693-3039 859 CONNETQUOT AVE 'AD REL ANTHQNY:RICCI@AMERIGAN-tdAl`IONAL COM 1NSIJRER S AFFORDING COVERAGE 'NA(C h` ISLIP TERRACE NY 11752 wsURERA, FARM FAINLY CASUALTY INSURANCE CO 13803 INSURED INsuRER B:'UNITED FARM FAMILY INSURANCE CO 29963 SHAMROCK CHRISTMAS TREE FARM INC INSURER C: 985 ELIJAHS LN INSURERD: INSURERE: MATTITUCK NY 11952 1NSURERF: COVERAGES CERTIFICATE NUMBER: REWSION 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. ILS�R POLICYEFF POLICY EXP TYPE OF INSURANCE POLICYNUMBER MID tMNUDp jimns; A COMMERCIAL GENERAL LIABILITY Y 310108921 8/11/2022 8/11/2023 EACHOCCURRENCE $ 1,000,000 CLAIMS MADE ❑X OCCUR unmSAie i u rctnitu MISES(Es_a=r nca $ 100,000 MED EXP(Any one person) $ 5,000. YERSONALBADVINJURY $ 1,000,000 �GEEN`LAGGREGATE LIMITAPPLIESPER: GENERAL AGGREGATE - $ 2,000,000 \. POLICY❑JECo-T LOC -PRODUCTS-COMP/OPAGG $ 2,000,000 B AUTOMOBILELIABI ITY 3101C8177 8111/2022 8/11/2023 COMBIIINEDSINGLELIMIT ($ 1,000,000... ANY AUTO BODILY INJURY(Perpopm) S OWNEDSCHEDULED NLY AUTOS O AUTOS BODILY INJURY(Parscddent) $ HIRED NON-0AG WNED PROPERTYDAME AUTOS ONLY AUTOS ONLY a debt $ $ A X uMBRELLALIAeOCCUR 3101E5262 8111/2022 '8111/2023' EACH OCCURRENCE $_ 1,000,000 EXCESS UAB CLAIMS!4(ADE AGGREGATE $ .1,000,000 : ; DED , RETENTION$ 10,000 $ i WORKERS COMPENSATION S�TLJiE ER AND EMPLOYEIM'LIA91LTTY Y/N -- ANYPROPMETOR/PARTNERrcD(ECUTNE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUOED?: Ll NIA (Ma6datm In NH) E.L DISEASE-EA EMPLO $ Ifyyeess dascdhe under DESCRIPTION OF OPERATIONS Nil. E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCAT(ONSI VEHICLES(ACORD 101,Addi0onel Remarks Schedule,may be atWhed If more apace Is requlmd) CERTIFICATE:HOLDER;IS LISTED AS ADDITIONAL INSURED. CER.TIF[CATE HOLDER CAN:ELL T 10N TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 ROUTE 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 9179 ACCORDANCE 4111TH THE POLICY PROVISIONS. SOUTHOLD, NY 11971 ADTHORIZEDREPRESENTA„VE 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and loco are reoistered marks of ACORD Workers' CERTIFICATE OF YORK .STATE Compensation p NYS WORKERS' COMPENSATiON INSURANCE COVERAGE AT Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured (631)298-4619 SHAMROCK CHRISTMAS TREE FARM INC 985 ELIJAHS LN MATTITUCK, NY 11952 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(only required ifcoverageisspecifically limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security Number 88-1467893 2. Name and Address of Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage FARM FAMILY CASUALTY INSURANCE CO. (Entity Being Listed as,the Certificate Holder) 3b. Policy Number of Entity Listed in Box"1a" TOWN OF SOUTHOLD 3c. Policy effective period 53095 ROUTE 25 9/7/2022 to .4/24/2023 PO BOX 1179 - SOUTHOLD,NY 11971 3d. The Proprietor,Partners or Executive Officers are o included. (Only check box if all partners/officers included) X all excluded or certain partners/officers excluded. This;certifies that the insurance carrier indicated above in box"W,insures the business referenced above in box"9 a"for workers'cornperisaticin-under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity fisted above as the certificate holder in box"2". The insurance carrier must,iiotify the°albove`certlficatii holder-and the W-orkers'Compensation Board within 10 days4F a policy is eangeled.due fo noiipayirient of premiums or.withlri°30 days 1E there are reasons othdr:than nappayinenfiof.prgnJiurbt that caridet the policy oretiiiiinate,th,6 insuied.from the covorage indii ted oo thls Gefifigate.(Mese notices maybe senf:by1.regular maiQ Otherwisse,this Cetttfioate;is valid for one gear after this form is, .approved by_the insurance oamer or its'iicedsetl agent,or until the 0o icy, expiration date listed in box"3c",whlcheyer'is earlier: This:certificate is issued as a matter of information only and confers;no rights upon the certifiicate holder.This certificate does.not amend,extend or alter the coverage afforded by the policy listed,nor c3aes.iic6nfer any rights br responsibilities beyond.thosd odritained in thereferer<ded.policy This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect- Please Note:Upon cianceilatian of the.y{orkers`coiripensatioit poliq} lndicated on this form,if the,business continues to ba,named on a permit;. license or contract issued by a certificEite h"older;the business-must provide:ttrat.aerfificate.tiofdef vuifh_a neur`Certificate of'Workers' Compensation Coverage other authorix+d proof that the business--is complying with the-mandatory coverage requirements of the Flew York State Warkere Cornpensation UW.- Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured.has the coverage as depicted on this form. Approved by: Kenneth E.MacNish (Print name of authorized representative or licensed agent of insurance carrier) Approved by: '��`"'� 9/12/2022 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier:, 631-939-6060 _el RECEIVED SEP 1,;1 2022 Town Attorney's Office TOWN OF SOUTHOLD RECEj Town Code Chapter 205 "Public Entertainment and Specii I Events" VED -Ci SPECIAL EVENT PERMIT INSTRUCTIONS AND APPLICA ION FO; 15 2022 Applications for a Special Event Permit are subject to an inter-departmental coo d* ed teview by the in Southold Town Board,Town Attorney, Town Assessors,Land Preservation,B tmthelame" Clerk Board of Appeals and Police Departments, and the Suffolk County Planning Commission.11 Application fee: $150.00 per application. Up to six (6) multiple events of the same type, 6ccurring 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 completed 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$250.00 by the Office of the Town Clerk, unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk. The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health, safety, and welfare of the community. When is a Permit Required? All Special Events, per Southold Town Code Article 1, Section 205-2 (Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residential property for profitsuch as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk: Please indicate submission of the following by checking off the boxes and signinff, below. ❑ sigby the owner and the event manager. Applications without A completed application form sitl property owner's signature/approval will be rejected. ❑ FEE: Is the application being submitted at least 60 days before the event [/Yes No ElIf Yes, Fee of has been submitted ❑ If No. Fee of$ has been submitted Updated 8/7/2018 QThe 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 ® A Parking/Event Plan: consisting of a survey, site plan and/or aerial view of the subject property that includes the locations of on-site parking, sanitary facilities, and tents or other temporary structure(s). (See application form for details) © Events for three hundred (300) or more people require submission and approval of a traffic control plan acceptable to the Town of Southold AND a qualified traffic controller must be provided at the event. (See application form for details) 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. q as Dated i nature 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 (told a permit to operate issued by the Suffolk County Bureau of Public Health Food Protection Unit. Updated 8/7/2018 U VID 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:%4 0 S e- 14 P- 6�� � vhI¢w Date of Submission I b o?02;2,Name of Event-4#/;mAsGl1 effRF6 rm.4s TA-6401w)f 15KAjeme-a S MffRKt°7 SCTM#'s 1000-Section 47-1991___Block-1p f- 3-Y Lot(s) 43 1441- ys� Dates of Each Event: 1 a- 11 aoa a 0-11-712,2--a 12- if ao a _;L If Multiple Dates are requested, applicant must give all information for all dates. Nature of Event:LFlooSe i9NU c.v-r Yt2e-e.5 ANO /961ZITR1Nrne'V 7 (Please attach a detailed description of EACH event to this application) Time Period (Hours) of Event: From Ji vM to 6- P Town Services requested: ( )Yes ( -)No If yes, Describe Police Dept._Highway Dept. Describe Services IIS/9 Maximum Number of Persons Attending At One Time: 400 Number of cars expected /#0 Is a Tent or other temporary structure being used? [ ✓f Yes [ ] No If yes provide size(s) fX 10 101— Will oZ.Will food be served? [ ] Yes [V]No If yes provide number and name(s)of food vendor(s) Suffolk County permit# (s) Will other vendors be on the premises during the event? [✓]Yes [ ]No If yes how many? Describe Type of vendor(s) S e_e A I T CA -k`l Property Owner(name/address): J 06KAMAN rl�.S �C i�AN'� Gti! 1M�41-r►�,�G/l Contact Person and Contact Tel.# 63i ati I- 1373 e-mail address b T a L Pi Updated 8/7/2018 Event Location: Street-Hamlet Address: 6 5 on A to ft b m 4 Y i t r V G/L SCTM# qj;?V Q to 3 : b �{3 Will any services be requested [ ] Yes [✓j'No. If Yes describe Police Highway Other: Mailing Address to Send Event Permit to: q?S C ',S!a 14 •S i-yo mQ 3'T (7- UL JL �•� 1 IQ� Have any of the development rights been sold to the Town of Southold [ ] Yes [VfNo 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 pate) A Parkinj4/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. (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: l)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. Updated 8/7/2018 OWNER'S SIGNATURE: 1 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. (� n -,1 D b e-iP 14 1:7 n✓y1 A N Print name of Owner ignature 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. 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. Updated 8/7/2018 10. NO activities associated with this event including, but not limited to parking ingress/egress/access, tent(s)or temporary structure( 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 VFFO��c® ,,AECEIV'E �� ® ® SEP 12 2022 town Attorney's office TOWN OF SOUTHOLD RECEIVED lown Code Chapter 205 "Public Entertainment " SPECIAL EVENT PERMIT INSTRUCTIONS AND APPLICATI N FORIVJCEP 1 5 2022 Applications for a Special Event Permit are subject to an inter-departmental coord' a t o�l11 ldlere4 Southold Town Board,Town Attorney,Town Assessors,Land Preservation,Build' , 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 enco;raged to submit applications as early as possible Any cdtnpleted application that is not submitted 60 or more business days prior to the scheduled exe nt drejected ay be or subject to a late processing fee of$250 00 by the Office of the Town Clerk, unless/a waiver is obtained. Requesting an expedited review must be submitted in writing to the--Town Clerk. The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health, safety,and welfare of the community. When is a Permit Required? All Special Events,per Southold Town Code Article I, Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residential lLpea for=fit, such as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk: Please indicate submission of the following by c_, hecking_off the boxes and signing below. A completed application form signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. ❑ FEE: Is the application being submitted at least 60 days before the event[t/fYes [ ]No A-.V,o- 0-0 El If Yes,Fee of$ P6 has been submitted ❑ If No,Fee of$ has been submitted Updated 8/7/2018 APPLICATION FOR A PERNUT TO HOLD A SPECIAL EVENT Please provide AIL of the information requested below,Incomplete applications WILL NOT be reviewed. Special Event Permit# Applicant(s)name:`o��;� 14► n-�.4 Date of Submission Name of Event,6H19r 12,94-.[ Q&2,Srry7,4.5 TR• F.gnm A�,Q r»r/2s (VIWAc SCTM#'s 1000-Section y7 XfW Block- 167:9- .7-6- Lot(s) y - icy- Hy- Dates of Each Event: 11 - 111.2 " a ave x If Multiple Dates are requested, applicant must give all information for all dates. Nature of Event:L'HO 0.5 a r9 N U CGy?' rA e C S 14 N l�!, .9 G R t 7.4 yV yw e N (Please attach a detailed description of EACH event to this application) Time Period(Hours)of Event: From ?A M to S 6?lM Town Services requested: ( )Yes (a -)No If yes,Describe Police Dept. Highway Dept. Describe Services IV,�7• Maximum Number of Persons Attending At One Time: c;L Number of cars expected /df D Is a Tent or other temporary structure being used? [&,'] Yes [ ]No If yes provide size(s) f I!fl Will food be served? [ ]Yes [4]No If yes provide number and name(s)of food vendor(s) 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 narking, jng er ss/egress/access. nt W orop rmy structure(s), or to s,tempo=rani a fa ili i shall be conducted on Town of Southold Purchase of DevelopmentRights land. 10. NO antivities associated with this event_ including but not limited to marking, inmss/egress/access_ tent(s) or tem on rara structure(s), oron��sanita facilities, shall be conducted on Suffolk County Purchase of Development Rights land without a permit issuedby 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 (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 atur of Owner JOS '-�If �S �i,<J✓Yl�� Print name of Authorized erson/Representative gnature of Authorized Per on/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 pmhibited on ANY Tow*+, County or State Roads or Rights of 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 allomey'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 Suffolk County permit#(s) Will other vendors be on the premises during the event?[✓J Yes [ ]No If yes how many?_�Describe Type of vendor(s) 5 l°G A T T A C 14 1✓1' Property Owner(name/address): 4l 6 5 C Q l4 1'2Sh i 0 rn 4 ►u g!5 c5L i 3 All t.5 L N m.4 rT 7 r vc e Contact Person and Contact Tel.# J® G .5�. ✓✓?..Q ��/ 63r aU 1 - /.;?,7--3 e-mail address 0_ i 9 ,M,4 0 7- ®F.9 I-1 N I^ , 1J c-r Event Location: Street-Hamlet Address: oZ D 6 eS ✓ A I IJP An l'1'1/f r 1 t t V G I{ 3J /os- Mailing Address to Send Event Permit to: Q �b l� �S Liu VVI0 i T o- J LlL C�• 1 �S 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 takeIn-ace. 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 suney, site plan and/or aerial view or example Google Earth) of the sub' pro- .- MI ATF 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 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 lieA 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. aoa :, 'Dated S'ghature 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 DATE(MMIDDIYYYY) AcoREP CERTIFICATE OF LIABILITY INSURANCE 16... 09/07/2022 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(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 such endorsement(s). PRODUCER c'""E r;r ANTHONY RICCI NAMFAX KENNETH MACNISH PHONE , 631-939-6060 (AIC No: 631-693-3039 859 CONNETQUOTAVE E-MAIL ANTHONY.RICCI ERICAN-NATIONALCOM INSURERS AFFORDING COVERAGE NAIC# ISLIP TERRACE NY 11752 INSURERA: FARM FAMILY CASUALTY INSURANCE CO 13803 INSURED INSURER B: UNITED FARM FAMILY INSURANCE CO 29963 SHAMROCK CHRISTMAS TREE FARM INC INSURER C: 985 ELIJAHS LN INSURER D: INSURER E MATTITUCK NY 11952 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. ILTRR TYPE OF INSURANCE 0 SUBR POLICYNUMBER M1DD1 EFF MSD EXP LIMITS A COMMERCIAL GENERALLMSIL17Y Y 3101138921 8/11/2022 8/11/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE �OCCUR PREMISES a occurrence $ 100,000 MED EXP(Any one Penson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEMLAGGREGATE LIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JPECaT 7 LOC PRODUCTS-COMP/OP AGG $' 2,000,000 OTHER: $ B AUTOMoBILELIABiLITY 310106177 8/11/2022 8/11/2023 COMBINED SINGLE LIMIT $ 1,000,000 a accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per acadent) $ X XHIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY X AUTOS ONLY er eociderrt $ $ A X UMBRELLALIAB OCCUR 3101E5262 8/11/2022 8/11/2023 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETORIPARTNERIEXECUTNEE.L.EACH ACCIDENT $ ❑ OFFICER/MEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 ROUTE 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1179 ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD, NY 11971 AUTHOMMDREPRESENTATIVE ©1988 2015 ACORD CORPORATION. All rights reserved. ACORD 25(20161031 The ACORD name and l000 are registered marks of ACORD INEwRK Workers' CERTIFICATE OF TE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a. Legal Name&Address of Insured (use street address only) 1b. Business Telephone Number of Insured (631)298-4619 SHAMROCK CHRISTMAS TREE FARM INC 985 ELIIAHS LN MATTITUCK, NY 11952 1c. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(only required if coverage is specifically limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 1d. Federal Employer Identification Number of Insured or Social Security Number 88-1467893 2. Name and Address of Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage FARM FAMILY CASUALTY INSURANCE CO. (Entity Being Listed as the Certificate Holder) 3b. Policy Number of Entity Listed in Box"1a" TOWN OF SOUTHOLD 3c. Policy effective period 53095 ROUTE 25 9/7/2022 to 4/24/2023 PO BOX 1179 SOUTHOLD, NY 11971 3d. The Proprietor, Partners or Executive Officers are o included. (Only check box if all partners/officers included) X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend,extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Kenneth E. MacNish (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �`` ` ` ` ��L- 9/12/2022 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 631-939-6060 Shamrock Christmas Tree Farm 20685 Main Road Mattituck, New York 11952 Choose And Cut Christmas Tree's 631-298-4118 North Fork Potato Chips 2010 Oregon Road Mattituck, New York 11952 10 Varieties Homemade Potato Chips 631-298-8631 Harbor Lights Oyster Company .200 Harbor Light's Drive Southold, New York 11971 Mr.Ted Bucci Private Harvested Oysters 631-740-0985 Greenport Jerky Company Greenport, New York'11947 Homemade Jerky Mr.Vincent Macchirole 516-319-1002 Backyard Brine Inc. 8595 Cox Lane Cutchogue, New York 11935 Homemade'Pickles 631-754-1050 Pellegrini Vineyards 23005 Main Road Cutchogue, New York 11935 John 631-734-4111 Salt Bird Cellars 2885 Peconic Lane Peconic, New York 11958 631-871-3204'--, Woodside Orchards 729 Route 25 Aquebouge, New York 11931 631-722-5770 I� - rF-. SH ,=. AMRO 134 - CK,CHRI - .7 STlUTAS:T - -.... L� REE F AR 985 ELIJAH'S,L, MATTITUCK NYid 952. SE�ZS J HI a� 4�a` 't n - E - ELDa' Fs ' f 50- AY' - 6 ss/ — 21 4 `D AT- 1. E�` ill":J+ ;O THE' IRDER'OF i K> r•,n s. D- : ct� dli OLLARg' Mf- 't =�7 I• _ .i 4. II - 2 - 1!o4glo .27 2'1 00 - aF -5' .;•, 0.,'2,1,0.38 _��- '� ,� .r � .r��, `mow y � ; \ •a . °�, �, - - -M v •'� � 1{� Ott a _ -�, ;�' ,�. .'".- :.,.1-�� ' t y, y.^1! t '�:� _ ,rrr x..� '+s f 5s;; .i� + y. y.,2�•= _Y � t~� �a ��"'" � 'i���u �:'.k+ � lJ�•y� �"����� � � Y ~,''r<•'"'n;`�a r. t 4Fv...,rL . 1 - _,«,' �, .; � :, .q�•�,�•. -. � _, .€. �'ti � } � :��`� `rte r j� - dY.', M� _ ,_9 .{'A-7g3 S ,s-� ♦a,. . x'�" ,+',�y` �y -`'"� t '.d` sv:.: �•+. • � �` �`� � ��` �� 7 �"�� a. r� -��:sr..L '3'r�r, � -k � Y ,"y`t�L.: S".' "'-;`� i .�t..f„✓�+.�..,,�r�aSF��trua �'!; s. �:. '.,r, r �,��s<•Ly,. 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M [.� •yp }� ,`� >,� `t: �_ ra..3 � - _ "�"K -' ems,=•«s»::�or:•:>�-s;.-. ir;'#^ _ CStSr::' r '' +'+�' -i d;�':;.� RNp�ty®2Q79 Ooopl�,Impay OZ019 Mau T.ehrwloghR Hnv Ya46IS MiP dm E201 G Untod Stater Terme 5mnd FnaAac4 2�F VV( �{ r e h t�CL y� p flh(ZK%%v6 for ��3��w � c�4 RG►rK y�s✓�c.A2s .Srof� cvY* —r ,�- a j2 1-,4 �e 5 9L INA cl Iwr A A t4 6 P P j t,- 14 8 A X J � Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 09/15/22 Receipt#: 305796 Quantity Transactions Reference Subtotal 1 Event Fee 9 $300.00 Total Paid: $300.00 Notes: Payment Type Amount Paid By CK#1347 $300.00 Shamrock, Christmas Tree Farm Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Shamrock, Christmas Tree Farm 985 Elijahs Lane Mattituck, NY 11952 Clerk ID: DENISN Internal ID:9