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HomeMy WebLinkAboutBreeze Hill Farms 2024-13 �wFFo`" RESOLUTION 2024-342 ADOPTED DOC ID: 20154 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-342 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON APRIL 9,2024: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Breeze Hill Farms,to hold Special Event 2024-13 at Breeze Hill Farms, 31215 County Road 48, Peconic,New York as applied for in Application BHF 1 a-d for events on 4/20/24 12 pm to 4 pm, 6/1&2/24 10 am to 4 pm and 5/25/24 6pm to 11 pm. This event is approved with the following conditions: 1. All parking of vehicles for this event must be as shown on the plan submitted with the special event application. 2. No parking for this event is permitted on County Road 48 3. No parking for this event is permitted on land where development rights have been sold to the Town 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: Jill Doherty, Councilwoman SECONDER:Greg Doroski, Councilman AYES: Doroski, Mealy, Smith, Krupski Jr, Doherty, Evans Permit TC Checklist for Special Events (Farms/Wineries/Private Events) r` Applicant Name: to �7''V � !� --Yar rn' Date Received: a Number of Events on Application: (max of 6 per application) JApplication(all 6 pages completed) Fees to be collected: Application fee($150.00) Late Application fee($250.00-if application is received less than 60 days) Current Certificate of Ins. 6P Lf 1 I J Application sent for approvals to the following people: , ( Gwynn Schroeder I Denis Noncarrow Stacey Norklun After emailing application and all applicable paperwork to the people above, put application in `pink' pending folder. I Franke, Diana From: Franke, Diana Sent: Thursday,April 4, 2024 11:58 AM To: Schroeder, Gwynn _ Cc: Sabrina Born (sabrina.born@town.southold.ny.us); Noncarrow, Denis; Norklun, Stacey Subject: Special Event: Breeze Hill Farm Attachments: Breeze Hill Farm.pdf J Good Morning, Please see attached the Application for a Special Event Permit rom_Br_eeze Hill Farm & Preserve received on March 04, 2024 . Thank you, Account Clerk Southold Town Clerk's Office (631)765-1800 Ext 1228 A} � .�s� RECEMED ifY tiX���t p•� ivy' 'l © CAA „"Y t^S$; APR - 4 2024 Southold Town Clerk TOWN OF SOUTHOLD Town Code Chapter 205 "Public Entertainment and Special Events" SPECIAL EVENT PERMIT INSTRUCTIONS AND APPLICATION FORM Applications for a Special Event Permit are subject to an inter-departmental coordinated review by the Southold Town Board, Town Attorney, Town Assessors, Land Preservation, Building,Planning,Zoning Board of Appeals and Police Departments, and the Suffolk County Planning Commission. Application fee: $150.00 per application. Up to six (6) multiple events of the same type, occurring over a period of three months, may be permitted on one (1) application for a fee of$150.00. However, specific details of each event must be included with this application. All applications must be submitted at least 60 business days before the event. Applicants are encouraged to submit applications as early as possible. Any 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$250.00 by the Office of the Town Clerk, unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk. The Town Clerk will forward all applications to the Special Events Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The Town reserves the right to request additional information from an applicant to address issues related to the health, safety, and welfare of the community. When is a Permit Required? All Special Events, per Southold Town Code Article I, Section 205-2 (Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residential propeLty for profit such as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk: Please indicate submission of the following by checking off the boxes and signing below. A completed application forth signed by the owner and the event manager. Applications without property owner's signature/approval will be rejected. ❑ FEE: Is the application being submitted at least 60 days before the event [ ] Yes [�No ❑ If Yes, Fee of$ has been submitted L. If No, Fee of$ has been submitted Updated 8/7/2018 xThe 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. Dated S �atre 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 Foil( 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: ,T� (,�I Date of Submission Name of Event 3MA 0/\ SCTM#'s 1000-Section _ __Block- Lot(s) Dates of Each Event: 4-- 2 S- 2�- (07 (l — 2 If Multiple Dates are requested, applicant must give all information for all dates. Nature of Event: ���- C vuf 11 (Please attach a detailed description of EACH event to this application) Time Period (Hours) of Event: From to Town Services requested: ( )Yes (X )No If yes, Describe Police Dept._Highway Dept. Describe Services Maximum Number of Persons Attending At One Time: Number of cars expected Is a Tent or other temporary structure being used? [X] Yes [ ]No If yes provide size(s) Will food be served? Y] Yes [ ]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 c [ ]No If yes how many? Describe Type of vendor(s) Id al ���If'U a-'s ,,Q(:)C) Property Owner(name/address): _J0111 J ��` lam[�P Ck Contact Person and Contact Tel.#(: �,ev e-mail address jre C 1_Vl \�1 l� :►/�v� L'�111xJ'�� �� k am Updated 8/7/2018 Event Locati on: Street-Hamlet Address: � Jr C SCTM# Will any services be requested [ ] Yes No. If Yes describe Police Highway Other: Mailing Address to Send Event Permit to:AMM 3tZA Q CoU,I t\4 W (i4a Pf-C r n W. RQ2, Have any of the development rights been sold to the Town of Southold [ ] Yes [ ] No and/or Suffolk County Agricultural Program? [ ] Yes [ ] No If yes to either or both, also indicate on the attached plan the boundaries of the reserved area upon which the event will take place. YOU MUST ATTACH A PARKING/EVENT PLAN TO THIS APPLICATION IF THE EXPECTED ATTENDANCE IS 300 OR MORE PEOPLE,YOU MUST ALSO ATTACH A TRAFFIC CONTROL PLAN (see next page) A Parkiinj!/Event Plan may be a survey, site plan and/or aerial view (for example Goole 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: 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. Updated 8/7/2018 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. C"f C&1T,7 Py_,r G�, W. Print name of Owner Signature of Owner. .�b �.e Print name of Authorized Person/Representative Qture Authorize erson/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 temporal 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(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 •+ D -S^'a� y0 46i a •O O' �n `4 O'' b 0 r<-`0 � 'a. f•f'S � e♦ f s .E • aL 'za ;�.i��, 4"f'^ ,�, � F.' � '@. c-r•,y.°a "a ">a°' '`"a!• s-.a° ^�ri .:�e �Q°'s�-.� i•`f, > •"'h:' `�'y- +e _ �. f.-�.,.,� .:' - a'z :>p a� ,rj R� >a•'-�-zw „t °.i :�', <.rq.. { d ;� \ ;i pa f$•:,,-;.l ';� �� ''�i ,s� :;ca''� Pte 4� "a NN i �• :Re auran ' r ` ' : E ec tiv�e'•D ate�04/t 01/ 2 4� x iration'.Date03/31/2026,'State . quo r,Licen s e•ID.0340-22-11.1702` :E Coun Suffolk �< , b.. t Le'ac Serial#: 1293036 '�� ;',''• =�= •,a A u �t h:o r it: 1; S- 4 f' LICENSEE DESIGNATED BELOW IS,HEREBY.GRANTED PERMISSION;~UNDER THE`ALC'OHOLiC BEVERAGE CONTROL'LA,IN;TO:TRAFFIC IN ALCONOLIC,'BEVERAGE PURSUANT TO THE TYPE OF LICE_ NSE�INDICATED'7N;>THE UPPER LEFT HAND CORNER.OF THIS"CERTIEICA'TE:AND ACCORDING TO:THE STATUTES AND,,REGULATION_ S.PERTAl1V1NGTMERETO THIS LICENSE SHALL'NO.T BE.TRANSFERABLE TO ANY OTHER PERSON OR':TO:ANYOTHER PREMISES OR-TO AN}Y OTHER�PART OF„THE.- `- BUILDING CONTAINING SUCH LICENSED.PREQISES:,'IT SHALL=NOT BE DEEMED A PROPERTY OR;VESTED RIGHT AND MAY BE,REVOKED-AT` .. ; ANY-'TIME-PURSUANT'TO'LAW - r f I f' (t F �METHOD OF OPERATIO 't N•Res auiant'Servin Li uor--=8 �r, i , , I. J _ E I L TTLE D LLC !t \I L I. Y� :MAPLE'TREE�B 8 Q , t'. 1r• 3 a °s't o� .t �. 820 W MAIN `c( I £, „'ley t�: RIVERHE'AD New_Y rk :3 0 11901• - t ,E E_ 1 _ Y , E @y .S{ t't - a s.{ 4 / 1 ,u y. t i 1 s y , q.: , , F� £i d" } ❑� Vt i 4t O O - ,1. .f'• } 4- r' ti i , 4 B j rtificate-No.0340-22-1.117 2 e 0 r J if M Fan Ce •;` ■ �L fF • •J }i Ch'a'ir°• k: i a.. ref 1 L ce se` i u i his cha'n s sscied nde f ter:'shall�cb� 'main-=in"addition to:an•.further"inforrimation ormaferlal.-Ito' �"e' . - p. b prescribed.by'if .'..._, „y- „ _ he�rules`of fheaiquor"authority;the , , ; d"":'follow/ng information:,(a).lVame o'f'person to whom'license:is issued;,(b)kind of-.:license and'what:kind of traffic in alcohelic beverages:is thereb einiitted;. '','• �� < YP, t S,J.4ption by st�eef and number or otherwise;of licensed;`premises'(d) aatatement ri substance that`such;license,shall riot be"deemed a propecty`or' s'f k' 4• - - } y - ste'd ii ht and'that if,rima be 1 ek k' at:en` time ursuanf to law`> �" �•°< g. Y. Y. i., r ,t , J. - i=w/ �, `v�,: 4' iT ,' c,;.,' -.r,. i r =<`•;c 'tea;� -' • .a� �4 �c:.S4 ;Z^,;:oe�c c r.•`e • b-= s k t+ei �`,i..i oy "� �e '�.�" :>•+e.;o� +a°` Q`e ao»"-„ "sr�'b ♦.� -9 CERTIFICATE OF INSURANCE ISSUE DATE 2/22/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE.CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:IF THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED,THE POLICY(IES)MUST BE ENDORSED.IF SUBROGATION IS WAIVED, SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY,CERTAIN POLICIES MAY REQUIRE AN ENDORSEMENT.A STATEMENT ON THIS CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH ENDORSEMENT(S). PRODUCER INSURER(S)AFFORDING COVERAGE Northeast Agencies,Inc Attn: Ivantage INSURER A: Mesa Underwriters Specialty Insurance Company PO Box 660610 Dallas,TX 75266 INSURER B: N/A INSURED INSURER C: N/A East End Event Caterers Inc c/o Christopher Richards INSURER D: N/A 71 Washington Avenue INSURER E: Mesa Underwriters Specialty Insurance Company Patchogue,NY'11772 COVERAGES 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. INS1 TYPE OF POLICY POLICY POLICY LIMITS LTRI INSURANCE NUMBER EFFECTIVE DATE EXPIRATION DATE A GENERAL LIABILITY MP0031004008273 1/26/2024 1/26/2025 GENERAL AGGREGATE 2.000,000 PRODUCTS-COM/OP AGG. 1,000,000 PERSONAL&ADV.INJURY 1,000,000 EACH OCCURRENCE 1,000,000 DAMAGE PREM RENTED TO YOU 100,000 MED EXPENSE(Any one person) 10,000 B PERSONAL LIABILITY COMBINED'SINGLE LIMIT MEDICAL PAYMENTS TO OTHERS C EXCESS LIABILITY EACH OCCURRENCE AGGREGATE D E PROPERTY MP0031004008273 1/26/2024 1/26/2025 BUILDING CONTENTS 50,000 BUSINESS INCOME THE INSURER($) NAMEDHEREIN IS(ARE) NOT LICENSED BY THE STATE OF NEW YORK, NOT SUBJECT TO ITS SUPERVISION,AND IN THE EVENT OF THE INSOLVENCY OF THE INSURER(S), NOT PROTECTED BY THE NEW YORK STATE SECURITY.FUNDS. THE'POLICY MAY NOT I BE.SUBJECT TO ALL OF THE REGULATIONS OF THE DEPARTMENT OF FINANCIAL SERVICES PERTAINING TO POLICY FORMS: DESCRIPTION OF OPERATIONS/SPECIALTY ITEMS Caterers,Warehouses private Other than Not-For-Profit,General"Storage Warehouses CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED e Hill Far 8 Preserve BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Breez m Breez County 48 ACCORDANCE WITH THE POLICY PROVISIONS. Peconic,NY 11958 AUTHORIZED SIGNATURE } ACO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/20/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY AND CO FERS O R GHTS UPON THE CERTIFICATE OLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: HISCOX Inc. PHONE FAX 5 Concourse Parkway IAIC.E-MAINo,L Ex ` (888)202-3007 A/c No): Suite 2150 ADDRESS: contact@hiscox.com Atlanta GA,30328 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER B Rogue Kitchens Inc INSURER C 316 Woodhollow Road Great River,NY 11739 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER MM/DD/YYYY MMIDD/VYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000 000 TO CLAIMS-MADE Fx_1 PREMISES OCCUR DAMAGE PREMISES 0 Ea occurrence $ X CGL is on BOP Form MED EXP(Any one person) $ 10,000 A Y P102.265.680.1 09/13/2023 09/13/2024 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY EPR - CT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE Per. $ AUTOS accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (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 I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION Breeze Hill Farms,LLC 31215 County Road 48 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Peconic,New York 11956 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYI) `� 04/01/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND.CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Richard Maylott HAWK Advisers Inc.SafeparkUSA PHONE (800)700-6873 FAX, Ne: (860)627-8695 206 Williamson Rd Suite 100 E-MAILESS: rand@safeparkusa.com ADDR INSURERS AFFORDING COVERAGE NAIC# Roanoke VA 24011 INSURER A: KINSALE INSURANCE CO INSURED INSURERB: Philadelphia Indemnity Insurance Co. Alpha Axe Throwing Inc.dba Alpha Axe Throwing INSURER C: 358 W Fulton Street Apt 2 INSURER D: INSURER E: Long Beach NY 11561 1 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO TED CLAIMS-MADE IX-1 OCCURP REM SES Ea oNcurrence $ 100,000 MED EXP(Any one person) $ Excluded A 0100131635-3 11/10/2023 11/10/2024 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 0 PRO ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY OFFICER/EIM ER EXCLUDED?ECUTIVE ❑ N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Accident Medical Expense Maximum Benefit $25,000 B (Full Excess) PHPA45200 11/10/2023 11/10/2024 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Event Date:5.25.2024 Mobile Axe Throwing Location:31215 County Rd 48,Peconic,New York 11958 Certificate Holder is afforded additional insured status per form CAS5010-0420-(Additional Insured as Required by Written Contract-Managers or Lessors of Premises)but within respect to the named insureds operation for event date. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Breeze Hill Farm ACCORDANCE WITH THE POLICY PROVISIONS. 31215 County Rd 48 AUTHORIZED REPRESENTATIVE Peconic,New York 11958 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NORTFOR-01 VGEORGE ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/1/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIEICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights'to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Neefus Stype Agency PHONE FAX 711 Union Ave. (A/C,No,E:t):(631)722-3500 (A/c,No):(631)722-3591 Aquebogue,NY 11931 ADDRESS:info@nsainsure.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Utica National Assurance Co 10687 INSURED INSURER B:Utica National Insurance Group North Fork Restaurant Group LLC dba Amano Osteria&Wine INSURER C: Bar PO Box 673 INSURER D: Mattituck,NY 11952 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AIDDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR CPP5518614 6113/2023 6/13/2024 DAMAGE TO RENTED 100,000 PREMISES Roc urrence $ X LIQ$1/1M MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ ANY AUTO 5520303 6/13/2023 6/13/2024 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS Ep BODILY INJURY Per accident $ X AUTOS ONLY X AUTOS ONNLY Pe�accident AMAGE $ B X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE CULPS525042 6/13/2023 6/13/2024 AGGREGATE $ DED I I RETENTION$ Aggregate $ 1,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) With respect to event on Saturday,April 20,2024 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Breeze Hill Farm THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 31215 Rt.48 Peconic,NY 11958 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i 31215 county rd RT 48 Peconic NY 11958 Name(s)Event �1�1 Event Date 20_-ZH Guests Hours Cars Music vendor �� Caterer(s) ��� C d -F6(U-- I Music Duration f Tent Vendor ���� l -hp t-y�tS 31215 county rd RT 48 Peconic NY 11958 Name(s) Event (-� Event Date ICJ, c 202f' 2 2-2a Guestslf&sk�- n [�� Hours " Cars Music vendor Caterers) �~ local 60OCK Music Duration Tent Vendor A:• 31215 county rd RT 48 Peconic NY 11958 r Name(s) Event t 1 oV lli go bt 1-111 Event Date ` � 1 Guests V Hours `o pni — I tpvk Cars S-3r L �� Music vendor moo, Caterer(s) affinu:0 I Music Duration p VVI Tent Vendor �� 1 Path to the t' 4,Long Island Sound A \ Work Shp f' a4" Quonset Hut . � Gid_e;r17 House , ,Main house f v .a%�'' �� "`� t. Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 04/04/24 Receipt#: 325133 Quantity Transactions Reference Subtotal 1 Event Fee BHFP-1 $150.00 1 Late Fee BHFP-1 Late $250.00 Total Paid: $400.00 Notes: Payment Type Amount Paid By CK#1351 $400.00 Breeze, Hill Farm Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Breeze, Hill Farm Po Box 246 Peconic, NY 11958 Clerk ID: DIANAF Internal ID: BHFP-1 Late Noncarrow, Denis From: Noncarrow, Denis To: breezehillfarmevents@gmail.com Subject: Special Event Permits Attachments: Printout-20154-1034-M63273.doc Please see attached resolution on Your special event permits. Thank you. Have a great day. Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisn@southoldtownny.gov 631-765-1800 CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. 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