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HomeMy WebLinkAboutShamrock Christmas Tree Farm Southold Town Board - Letter Board Meeting of November 8, 2023 0. RESOLUTION 2023-932 Item 4 5.12 6� '� ADOPTED DOC ID: 19618 A THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2023-932 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NOVEMBER 8, 2023: RESOLVED that the Town Board of the Town of Southold hereby authorizes a refund in the amount of$300.00 for' two (2) special events that were applied for by Jonathan Shipman, for Shamrock Christmas Tree Farm, 20685 Main RD, Mattituck,New York as the events have been canceled. g1�4 x � Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Sarah E.Nappa, Councilwoman SECONDER:Jill Doherty, Councilwoman AYES: Nappa, Doroski, Mealy, Doherty, Evans,Russell Generated November 9, 2023 Page 24 CT Ar` � . � � RECEIVE® !'`l47 +aSh Sl `�YF` O CT 2 4 2023 Southold Towli Clerk ,. TOWN OF SOUTHOLD Town Code Chanter 205 "Public Eniertainment and Special Events" SPECIAL EVENT PERMIT INSTRUCTIONS AND APPLICATION FORM Applications for.a Special Event Permit are subject to an inter-departmental.coordinated review by the Southold Town Board,Town Attorney, Town Assessors, Land Preservation, Building, Planning,Zoning Board of Appeals and Police Departments, and the Suffolk County Planning Commission. Application fee: $150.00 per application. Up to six (6) multiple events of the same type, occurring.over a'period of three months,`may be permitted on one(1)application fob 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 made rejected or subject to a late processing fee of$250.00 by the Office of the Town Clerk, unless a waiver is obtained: Requesting an expedited review must be submitted in writing to the Town Clerk. The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health, safety, and welfare of the community. When is a Permit Required? All Special Events;per Southold Town Code Article I, Section 205-2 (Definitions)must obtain.a pen-nit.. Occasional events on private residential properties hosted by the owner thereof that are by invitation such , as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residentialrrooperty for profit. such as avenue for weddings or other events is prohibited. . This application is deemed complete once all the following requirements are submitted to the Town Clerk Please indicate submission of the following by checking off the boxes and signing below, A completed application form signed by the owner and the event manager. Applications without property owner's signature/approval'will be rejected. Ll FEE: Is the application being submitted at least 60 days before the event [ ] Yes [-�No ❑ If Yes, Fee of$ has been submitted 0 If No,Fee of$ has been submitted Updated 8/7/2018 xhe 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 in red 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-affinns that 1 have submitted all the information required above in connection with my application: �. bate'd' ature 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 I th rough the sale of development rights to the County of Suffolk with a permit issued by the Suffolk County Farmland Committee. If food is to be served,'it must be catered and prepared off-site by food vendors who hold a permit to operate issued by the Suffolk County Bureau of Public Health Food Protection Unit. Updated 8/7/2018 RECEIVED OCT 2 4 2023 Southold Town Clerk APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVENT Please provide ALL of the information requested below,Incomplete applications WILL NOT be reviewed. Special Event Permit# Applicant(s)name:Q : Date of Submission 10 oZ41A3 Name of EventfbWm Q/0/1 C HaQ Zs T>r 49d 7'11- 0,70y" SCTM#'s 1000-Section 41%358 q Block- /0 94 -6- Lot(s) 8/3: yH-H-6 Dates of Each Event: Aiy -j a 6 !a If Multiple Dates are requested, applicant must give all infortnation for all dates. Nature of Event:s NA„1 IRBG/.t C HAA 6T S 7%. F/90-Al JfA pn9 eR.s MA2fCe (Please attach a detailed description of EA H event to this application) Time Period(Hours)of Event: 'From 4.4—n —to A- P Yh Town Services requested: ( ) Yes (v)No If yes, Describe Police Dept._Highway Dept. Describe Services 5e e A '1'IA e.0 e>> Maximum Number of Persons Attending At One Time: a" Number of cars expected Is a Tent or other temporary structure being used? [✓] Yes-[ ]No If yes provide size(s) Will food be served? [ ]Yes L✓]No If yes provide number and name(s)of food vendor(s) Updated 8/7/2018 Born, Sabrina From: Born, Sabrina Sent: Tuesday, October 24, 2023 11:54 AM To: Mirabelli, Melissa; Noncarrow, Denis; Norklun, Stacey Subject: Special Event-Shamrock Christmas Tree Farm Attachments: Spcl Evnt-Shamrock_20231024115653.pdf Good Morning, Please see the attached application received today, October 24, 2023 from Shamrock Christmas Tree Farm. They paid for 2 applications because they have a total of 9 events. Thank you, a�vzi�a7?2�on�s Sabrina M. Born Sub-Registrar& Deputy Town Clerk Senior Account Clerk Southold Town Clerk's Office 53095 Route 25 P.O. Box 1179 Southold,NY 11971 Ph: 631-765-1800 ext. 1226 Fax: 631-765-6145 Your message is ready to be sent with the following file or link attachments: Spcl Evnt-Shamrock_20231024115653.pdf Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 1 Suffolk County permit#(s) Will other vendors be on the premises during the event? [/Yes '[ ]No If yes how many? �1. Describe Type of vendor(s) A ,�4 C 14 e,1, Property Owner(name/address): U e D 1j 1V qob S4 i,j A N 's L vyn,4-t r s J GIs Contact Person and Contact Tel.# y 19 y-A 4y ALL 6 S 1 2.-1 "/ 9 7 '3 e-mail address a.6 k;p MA N a e pr a g t- —v Event Location: Street-Hamlet Address: IM A i IJ 'I-4N 1K(.4 r i ryG!< CTM Mailing Address to Send Event Permit to: �(�, G i��if 1.5 to IM& r i I T >J t44 tN Y % Have any of the development rights been sold to the Town of Southold [ ] Yes [VT No and/or Suffolk County Agricultural Program? [.-'f Yes [ ] No If yes to either or both also indicate on the attached plan the boundaries of the reserved area upon which the event will take place. YOU MUST ATTACH A PARKINGIEVENT PLAN TO THIS APPLICATION IF THE EXPECTED ATTENDANCE IS 300 OR MORE PEOPLE YOU MUST ALSO ATTACH A TRAFFIC CONTROL PLAN (see next page) A Parking/Event Plan may be a survey, site plan and/or aerial view (for example Google Earth) of the subject Property. INDICATE ON THE PLAN ALL of the following information:_ A parking/event plan showing: (1) The size of the property and its location in relation to abutting streets or highways. (2) The size and location of any existing building(s) or structure(s)that will be in operation during the course of the event and any proposed building,structure,or signs to be erected temporarily for the.event. (3) The location of the stage or tents, if any. (4) The designated areas of use for spectators, exhibitors, vendors, employees and organizers. (5) Location of all entries and exits. (6) The location of all fire extinguishers and other fire safety equipment. . (7) The location of all temporary utilities to be installed for the event, if any. (8) The layout of any parking area for automobiles and other vehicles and the means of ingress and egress for such parking areas. The parking spaces must allow for 300 sq. ft. per car. (9) A traffic control plan for vehicles entering and leaving the site for the proposed event. (10) Plan for the use of live outdoor music, loudspeakers and other sounds which will be used, if any, and the type and location of speakers and other audio equipment. (11) A description of emergency access and facilities related to the event. (12) Provisions to dispose of any garbage, trash, rubbish or other refuse. (13) Location and'description of any additional lighting to be utilized in conjunction with the event. Updated 8/7/2018 (14) Location of sanitary facilities on site. Traffic Control Plan Events for three hundred(300) or more people also require submission and approval of a traffic control plan, acceptable to the Town of Southold, AND a qualified traffic controller must be provided Please attached a written description and/or notate on the'parking event plan the following: 1)Who will be conducting traffic,2)Where they will be stationed on site, 3) How they will direct the entrance, circulation, parking, and exiting of cars on site, and 4) Contact information for use by Southold Town Police. s OWNER'S SIGNATURE: I ani 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 lintited 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 n me of Owner 94nature of Owner Print name of Authorized Person/Representative Signature of Authorized Person/Representative PERMISSION IS HEREBY GRANTED,SUBJECTTO 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-pfemises" sign not larger.than six (6) square feet in size may be displayed not longer than. thirty (30) days before this event, and removed immediately after the event. Directional parking signs. shall be adequately displayed. 4. Applicant indemnifies and holds harmless the Town of Southold from all claims, damages, expenses, suits and losses including but not limited to attorney's fees arising from activities under this permit. 5. Tent proposals must receive permit approval from the Southold Town Building Inspector before placement on the property and must meet all fire and safety codes. 6. This permit is valid only for the time, date, place and use specified above, and for the designated event. Each additional day will require a separate permit application, fee, and related documents for review, etc. at least 60 business days prior to the scheduled event. -7. Adequate temporary sanitary facilities must be provided by applicant for this event and applicant agrees to remove the temporary facilities from the-premises within 48 hours after the day of the event. Updated 8/7/2018 i3'. 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, or temporary structure( or temporary sanitary facilities shall be conducted on Town of Southold . Purchase of Development Rights land 10. NO activities associated with this event, including but not limited toap rking, ingress/egress/access. „ tents, or temporary structure(s) or temporary_sanitary facilities shall be conducted on Suffolk County Purchase of Development Rights land without a permit issued by the Suffolk County Farmland Committee. 11. Issuance of this permit does not authorize in any manner the occupancy of any building exceeding the legal limitations under the fire code or other codes which would prohibit such increased occupancy. 12. Access shall be provided for emergency vehicles, to all public assembly areas, all buildings, all work areas and any additional area where emergencies may occur. Two emergency-fire exits and exit paths from the building(s) on the property, to a public way or remote safe area, shall remain open and unobstructed at all times. 13. `Owner assures full compliance with all fire, safety,building, and-other Town laws. 14. Music,when outdoors, is.required to stop at the time specified in the permit. Placement of the speakers must be in a location that affords the greatest protection from noise intrusion upon adjacent properties. 15. Owner will allow access to Code Enforcement Personnel of the Town of Southold during the hours of the special event to make any and all inspections necessary in connection with this Special Event. 16. ADDITIONAL CONDITIONS: ANY VIOLATIONS IN CONNECTION WITH THE CONDITIONS LISTED HEREIN.WILL TERMINATE THIS PERMIT. APPROVED Town of Southold Resolution Number: Date Issued: Updated 8/7/2018 Shamrock Christmas Tree Farm ' 20685 Main Road Mattituck, New York 11952 Choose And Cut Christmas Tree's 631-2984118 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 Yorks11947 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 A6 t= y VV( �. anA �� � Grp ,gc►r� ys"'c.�2S tip �- SFoo=>a 2 u► S �iVJb�� w..p �Q12i fl —pLvt ! 4 AGTR i LoT i f 1 r Y Ki A + T \ •C j.. - c a , 1♦� `r" ���+ .�,"-!` �..• �x e o �_�� .w rf .�_ � �:.;�i rf��;•. ^��r 'C...' :;'.te r. ,� _ ,�, � �'`�-r ��Y,,z; 3 • c S rte},— Lr,� - p'z`y,• �s S'i ar,E-'�''.s '�'^' !,;t; =?'3•Z��'�.� • ��.�-'--�� i•�a� f ��"t��+- �r�o:r i •.1' .i -+r-. _ '_° '?> v� �Y'�v.-�'" ��� �i�i•_ .{,�{�`a... �;e+_:.x��e_.. ,7�'S�• ,r'� .+.s•a t .:x' � J" ,;.'�' t. .x� �' .`St, x..-'�•,"-a'+ _ �. �.�. �ci ti- _ K � �•R ;�3 '�� p• rx -''moi �,� "'—:�b��r'° __ ,�'�< <r,> ��J•>�i�. -i,s�'x �>.++' �c'M a..... r�..>,;; 41-� r r <.a Al ^i 6 �.7 ' A S .yam- '• .thy ,; ; Y `tea r—ns -s.=-A _ �,•�''i. �. 1 � � fi _���, ��,� Y r: ��.x _ "F�` '±+'�,y`• .i i 1�'r �_ �,:Xrw+.�'si'� {•. a0'Sc," �!'.a�2 .� .�'�"��---�. w�S��'�� 'fit # _ � .� �� ,`�?�,�" x�� � -r r ���' ,f,.-:d,,:,�.+�y'.i`:�'-"r'.Y._ �""' '�ri`��-.� !• <a�3�Yi"sr�,a�%- ��_ _ _ � h �' ��y;ra'�•.YArii� . 151 -c• - "", sig g .7 NiINV •�� 1 r a �� � yip"-d i�r�p.W 'y'� '2_ „• :F' •>" A� .,� -. . s'.t _ .""E k .:£" .s=::•:a:; '-.lobs_ '_ '^--- „1t.' ,?� a"�,X �,".' Yn+p�Y�z017 OooQk Impery 02010 Mau Tdvgbqut New York OISAUp dm 6'2017 Urn`��Satca Tema S+md I•GG.>:> :.fi• ACORO® DATE(MMMDNYYY) `� CERTIFICATE OF LIABILITY INSURANCE 10/24/23 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 CDME:NTAcT ANTHONY RICCI NA KENNETH MACNISH PHONE 631-939 6060 FAX No: 631-693-3039 859 CONNETQUOTAVE AIESS: ANTHONY.RICCI ERICAN-NATIONAL.COM INSURER(S)AFFORDING COVERAGE NAIC# ISLIP TERRACE NY 11752 INSURERA: FARM FAMILY CASUALTY INSURANCE CO 13803 INSURED INSURERS: UNITED FARM FAMILY INSURANCE CO 29963 SHAMROCK CHRISTMAS TREE FARM INC INsuRERc: SHELTERPOINT DISABILITY INSURANCE 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. ILTR NSR ADDLTYPE OF INSURANCE I=SUBR POLICY NUMBER POLICY EFF MM/IDD ELICY XP LIMITS A COMMERCIALGENERALLIABILm Y 3101G8921 8/1112023 8/11/2024 EACH OCCURRENCE $ 1,000,000 rDAMAGE TO CLAIMS-MADE I OCCUR PREMISES EaENTED occurrence $ 100,000 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPUESPER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT F1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILELIABiLnY 310106177 8/11/2023 8/11/2024 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED �/ SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY (per aaadent a A X UMBRELLA LIAS OCCUR 3101E5262 8/11/2023 8/11/2024 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION 10,000 $ B WORKERS COMPENSATION 3104W6772 917/2023 4/24/2024 X I STATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE Y 1 N E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBEREXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yesdescribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 C SHELTERPOINT DISABILITY DBL61901 01/20/23 01/20/24 PFL 11 DBL DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space la 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 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 10/24/23 Receipt#: 315865 Quantity Transactions Reference Subtotal 2 Event Fee SCTF 1 a-f/2a-c $300.00 Total Paid: $300.00 Notes: Payment Type Amount Paid By CK#1670 $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: SABRINA Internal ID:SCTF 1a-f/2a-c .A6 m �' J(vj F �aea s qo 6D � .:. r �A��,►yx6 aoi � • wnA���N Gi4 Rc�.rK yS�G9lZS 3b 1014,6 d ,g7Nlab7 5 r019r�1� t+vG Ngw N'ass �s __ v � �__. _ 6lF=r /�,9xL�t ► G 3r _ CAVefc1�T Y_ c�l�ci9lz5 fL f 6 ,o' I�De Lid PDY1-l e's `s� oZ n►4i�+. 1 iil,�l 4S. �y a� �B� t. A A14i +v6 to i M TP - s 4 . 15 14 A 1670 SHAMROCK CHRISTMAS TREE FARM INC 985 ELIJAH'S LANE ��AEo�• MATTITUCK,NY 11952 50-666/214 DATE /'Zilaoaz _ PAYTOTHE - C&� l/ ORDER OF _ 1 +ZT3 `q Ylti i � c DOLLARS DIME FOR..:.. .f1,00 167011' 1:02 X406667,: 5000 2 103'B 'O '. Vendor No. Check No. Town of Southold, New York - Payment Voucher Vendor Name Vendor Address Entered by Jonathan Shipman 985 Elijahs lane Mattituck NY 11952 Audit Date Vendor Telephone Number Town Clerk Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount �AmountClaimed Number Description of Goods or Services General Ledger Fund and Account Number 11/9/2023 300.00 300.00 2023-932 Permit refund SR.2590.20 Payee Certification Dep t nt Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the ateri s above specified hav een received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condi'on wit ut subs' ion,the rv' pr erly been paid,except as therein stated,that the balance therein stated is actually performed and that t quanti es the o ave bee ified w' the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or d' crepan es a and pa t is appr ed. Signature Title Signature Company Name Date Title Date