Loading...
HomeMy WebLinkAboutPeconic Bay Vineyard 2024-39 �S51Fr`r RESOLUTION 2024-712 s?yy o a G} " ADOPTED DOC ID: 20524 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-712 WAS ADOPTED AT THE ANNUAL FISHERS ISLAND MEETING OF THE SOUTHOLD TOWN BOARD ON AUGUST 7,2024: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Peconic Bay Vineyard, to hold Special Event 2024-39 at the Peconic Bay Vineyards, 31320 Main Road, Cutchogue, New York as applied for in Application PBV5a for a Jazz in the Vines Concert on August 10, 2024 from 5:OOPM to 10:00PM,provided they adhere to all conditions on the . application, permit and the Town of Southold Policy for Special Events. All parking must be contained on site. This permit is subject to revocation if the applicant fails to comply with any of the conditions of the approval or is unable to properly control traffic flow into and out of the event. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER:Anne H. Smith, Councilwoman AYES: Doroski, Mealy, Smith, Krupski Jr, Doherty, Evans Special Events Committee Application Summary_ and Recommendations Application Name:: A)/C & =/�� Y Address: 2-0-- AA/^) (may 7 e 44 66V t5 Application Number: �° Picou,O&O Date(s) of Events):. ���a.� a Oa Date Received by Town Clerk', 002 Date Received by Committee,* Nature of Event: ,A ZZ a o.S —,-'� _(J�A)g A34y ,e 1 .Committee Comments Received,WV , Andrew Amakawa (Christina Hamm -SC) tit Gwynn Schroeder _Paul DeChance _Mike Verity Xchief Grattan Fred Visser _Michael Kerr (SC) Kevin Webster/Claire Glew V Heather Lanza .V Leslie Weisman Lillian McCullough Committee Recommendations:- Approved as applied ppr-oved.,wth aeldidona reco,m.m.eidatioris: _Public Hearing Held Denied Special Event No:. Resolution No` Date:-. Schroeder, Gwynn From: Leslie Weisman Forward Sent: Friday,August 2,2024 3:07 PM To: Schroeder, Gwynn Cc: Christina Hamm; DeChance, Paul;Glew, Claire;Grattan, Steven; Lanza, Heather; McCullough, Lillian;Verity, Mike;Visser III, Fredric,Webster, Kevin;Weisman, Leslie; Andrew Amakara; Mikael Kerr Subject: Re: PBV—Jazz:on,the•Vine These sorts of events have been held at this venue in the past and the only issue is to ensure that all parking is on site and not across the street at the King Kullen�parking lot which is dangerous for pedestrians trying to cross Main Road. In the past.they put up,signs;in'that perking lot saying.no parking for the,event, Leslie On Fri,Aug 2,2024 at 2:33 PM Schroeder, Gwynn< :wyriiis _:so'ptholtlto:wnnV=ryoV>wrote: Good afternoon, Please see the attached application which was just rec'd by the clerk's office today for the event on August 10`h,so it will have to go on the TB agenda this Wednesday for the mtg.on FI. Please weigh in. Thank you- hope you all have a nice weekend. i { t ' Best, i { Gwynn Schroeder Government Liaison Officer Office of the Supervisor Town of Southold { 631-765-5806 i 1 f s' Schroeder, Gwynn From: . Glew, Claire Sent: Friday,August 2, 2024 2:44 PM To: Schroeder, Gwynn Cc: 'Webster, Kevin Subject: RE: PBV..-Jazz on1116 Vine Hi Gwynn, There is not an exemption on the portion of the property being used for this event. The tax map number is incorrect on the application., It should be 103.-1-19.12 C zui,re,aLemr Assistant to Assessor Town of Southold Board of Assessors (631)765-1937 (0) (631)765-1356 (F) °v ww,`.southoldtow»ny.6V'. claireg@southoldtownny.gov From:Schroeder,Gwynn<gwynns@southoldtownny.gov> Sent: Friday,August 2, 2024 2:33 PM To:Christina Hamm <christina.ham m@suffolkcountyny.gov>; DeChance, Paul<pauld@southoldtownny.gov>;Glew, Claire<Claire.Glees@town.southold.ny.us>;Grattan,Steven<sgrattan@southoldtownny.gov>; Lanza, Heather <heather.lanza@town.southold.ny.us>; McCullough, Lillian<lillianm@southoldtownny.gov>;Verity, Mike <Mike.Verity@town.southold.ny.us>;Visser III, Fredric<fredv@southoldtownny.gov>;Webster, Kevin <kevin.webster@town.southold.ny.us>;Weisman, Leslie<lesliew@town.southold.ny.us> Cc:Andrew Amakara <andrew.amakara@suffolkcountyny.gov>; Mikael Kerr<mikael.kerr@suffolkcountyny.gov> Subject: PBV-Jazz on the Vine Good afternoon, Please see the attached application which was just rec'd by the clerk's office today for the event on August 10th,so it will have to go on the TB agenda this Wednesday for the mtg. on Fl. Please weigh in. Thank you- hope you all have a nice weekend: Best, Gwynn Schroeder Government Liaison Officer Office of the Supervisor Town of Southold �rl�'ti41111Sirt�'5C?ll��l Cl ldl.t)�1!Il rfl+.�f C11t. 631-765-5806 1 i 8/2/24,4:18 PM Secure Messaging Re::;PBV,'=Jazz on the Vine- g Hamm,Christina<Christina;Hamffi stiffolkcountyny.gov>. 08/02/2024 at 03:41 PM From: Hamm,Christina<Christina.Hamm@suffolkcountyny.gov> Sent: 08/02/2024 at 03:41 PM To: Schroeder, Gwynn<gwynns@southoldtownny.gov>, DeChance, Paul<pauld@southoldtownny.gov>, Glew, Claire <Claire.Glees@town.southold.ny.us>, Grattan,Steven<sgrattan@southoldtownny.gov>, Lanza,Heather<heather.lanza@town.southold.ny.us>, McCullough, Lillian <Illllanm@southoldtownny.gov>, Verity, Mike<Mlke.Verity@town.southold.ny.us>, Fred Visser-Southold Town<fredv@southoldtownny.gov>, Webster,Kevin<kevin.webster@town.southold.ny.us>, Weisman,Leslie<lesllew@town.southold.ny.us> Cc: Kerr,Mlkael<mikael.kern@suffolkcountyny.gov>, Amakawa,Andrew<andrew.amakawa@suffolkcountyny.gov> Dear Gwynn, With regard to,the Jazz'.0 tile.Vines:_event at,Peconic Bay Vineyards,on SCTM#1000-103.00-01.00- 019.012(and parking on SCTM#1000-103.00-01.00-019.013) scheduled for August 10, 2024;we have no comment. The parcels are not restricted by Suffolk County interests-such as purchase of development rights or other rights. Have a good weekend. Sincerely, CT'w6WLL w R a41imv Planner Suffolk County Department of Economic Development and Planning Division of Planning and Environment H. Lee Dennison Building - 2nd Floor 100 Veterans Memorial Highway Hauppauge, NY 11788-0099 (631) 853-6044 (phone) (631) 853-4044 From:Schroeder,Gwynn<gwynns@southoldtownny.gov> Sent:Friday,August 2, 2024 2:55 PM To: Hamm,Christina<christina.hamm@suffolkcountyny.gov>; DeChance,Paul<pauld@southoldtownny.gov>;Glew, Claire<Claire.Glew@town.southold.ny.us>;Grattan,Steven<sgrattan@southoldtownny.gov>; Lanza, Heather <heather.lanza @town.south old.ny.us>; McCullough,Lillian<111 Ila n m@southoldtown ny.gov>;Verity,Mike <Mike.Verity@town.southold.ny.us>; Fred Visser-Southold Town<fredv@southoldtownny.gov>;Webster,Kevin https://login-us.mimecast.com/m/secure/app/printjsp?sid=xphtT45K4xZf-_gwLD9f QeyJhbGcIOIJQQkVrMil1Uz11NitBMT14S1cILCJIbmMIO1JBMTI4R... 1/3 ._Schroeder, Gwrynn , , , From: Lanza,,Heather, Sent: Friday;August 2, 2024 4:03 PM f To: Schroeder,Gwynn;Christina Hamm;DeChance, Paul;Glew, Claire;Grattan,Steven; McCullough, Lillian;Verity, Mike;Visser III, Fredric;Webster, Kevin;Weisman, Leslie Cc: Andrew Amakara; Mikael Kerr Subject: RE:,PBV-Jazi`on:theNine' OK by me. Plenty of parking From:Schroeder,Gwynn<gwynns@southoldtownny.gov> Sent: Friday,August 2, 2024 2:33 PM To:Christina Hamm <christina.hamm@suffolkcountyny.gov>; DeChance, Paul<pauld@southoldtownny.gov>;Glew, Claire<Claire.Glees@town.southold.ny.us>;Grattan,Steven <sgrattan@southoldtownny.gov>; Lanza, Heather <heather.lanza@town.southold.ny.us>; McCullough, Lillian <lillianm@southoldtownny.gov>;Verity, Mike <Mike.Verity@town.southold.ny.us>;Visser III, Fredric<fredv@southoldtownny.gov>;Webster, Kevin <kevin.webster@town.southold.ny.us>;Weisman, Leslie<lesliew@town.southold.ny.us> Cc:Andrew Amakara<andrew.amakara@suffolkcountyny.gov>; Mikael Kerr<mikael.kerr@suffolkcountyny.gov> Subject: PBV-Jazz on the Vine Good afternoon, Please see the attached application which was just reed by the clerk's office today for the event on August 101h, so it will have to go on the TI3 agenda this Wednesday for the mtg. on FI. Please weigh in. Thank you- hope you all have a nice weekend: Best, Gwynn Schroeder Government Liaison Officer Office of the Supervisor Town of Southold n�ti''V Cti9;�ItitSCfit,,r,.�tllCklCII`t1�'V fl`Y'1�!;�ri)tr 631-765-5806 1 i E' Schroeder, Gwynn. From: Grattan;Steven Sent: Friday,August 2, 2024 3:02 PM To: Schroeder,Gwynn Subject: .,'.RE: PBV -,Ja&on,theVine H Gwynn, I spoke with the organizer of this event some time ago and told him we would provide assistance with traffic entering and exiting the vineyard. I have no objections. Have a great weekend. Steve From:Schroeder, Gwynn<gwynns@southoldtownny.gov> Sent: Friday,August 2,2024 2:55 PM To:Christina Hamm<christina.hamm@suffolkcountyny.gov>; DeChance, Paul<pauld@southoldtownny.gov>;Glew, Claire<Claire.Glew@town.southold.ny.us>; Grattan,Steven<sgrattan@southoldtownny.gov>; Lanza, Heather <heather.lanza@town.southold.ny.us>; McCullough, Lillian<lillianm@southoldtownny.gov>;Verity, Mike <Mike.Verity@town.southold.ny.us>;Visser III, Fredric<fredv@southoldtownny.gov>;Webster, Kevin <kevin.webster@town.southold.ny.us>;Weisman, Leslie<lesliew@town.southold.ny.us> Cc: Mikael Kerr<mikael.kerr@suffolkcountyny.gov>;Andrew Amakawa<andrew.amakawa@suffolkcountyny.gov> Subject: RE: PBV-Jazz on the Vine Hi, Claire pointed out that the event is being held on the lot 1000103000100019012, parking is taking place on 1000103000100019003. From:Schroeder,Gwynn Sent: Friday,August 2,2024 2:33 PM To:Christina Hamm<christihaWharriiii ..suffolkcauntyny:gov>; DeChance, Paul<R)auld't@southoldtownny=gov>;Glew, Claire<Claire_Glew.p`town:southal*d.ny.iis>;Grattan,Steven<sg'ratt66&61i.tholdtbwnriY:e�v>; Lanza, Heather <h°Bather:laii a"@toiri17:soutliold:inv us>; McCullough, Lillian <lili"timbsouthold,townny:gov>;Verity, Mike <fviike.Verity town:southo`Id ny_us c'� >;Visser III, Fredric<f6Ydv `sdiitltaldtow.rihV,0bv>;Webster, Kevin <;evin:iivebsterfo+rvn:soutfiotd:riy:us>;Weisman, Leslie<lelie6vntoi��nsoutfi'old:ny.us> Cc:Andrew Amakara<a:ncire4v:am lraragci.suffolkco.iintyriy.go Mikael Kerr<mikadl kei-r@s6ffoikcoui7tti!ny:Roy> Subject: PBV-Jazz on the Vine Good afternoon, Please see the attached application which was just rec'd by the clerk's office today for the event on August 10th,so it will have to go on the TB agenda this Wednesday for the mtg.on Fl. Please weigh in. a. Thank you- hope you all have a nice weekend:: j Best, Gwynn Schroeder Government Liaison Officer 5 1 1 t 1 Noncarrow, Denis From: Schroeder, Gwynn Sent: Monday,August 5, 2024 12:38 PM To: Noncarrow, Denis Cc: Rudder, Lynda Subject: Peconic Bay Vineyard -Jazz on the Vine Attachments: 20240805_PBV_Jazz Committee Comments.pdf Denis, Please prepare a resolution for the August 10th Jazz on the Vine event at PBV. Please see the attached committee comments—Leslie had some comments prohibiting parking at the King Kullen parking lot.Thanks. Best, Gwynn Schroeder Government Liaison Officer Office of the Supervisor Town of Southold gMnns@southoldtownLiy.gov 631-765-5806 1 Cz COD_ AU G =.2 2024 Southold Town Cterk 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 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$250 00 by-the Office of the Town Clerk, unless a waiver is obtained.. Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to_the Special Events.Committee for processing. The Committee will obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the. Town Board,with a recommendation as to whether to grant or deny the application. The Town reserves-the right to request additional information from an applicant to address.issues related to the health, safety,.and welfare of the community.. When is a Permit Required? All Special Events,per Southold Town Code Article I; Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as family gatherings, weddings, graduations; parties or not-for-profit fundraisers do not require permits. Any use of residential grope , for profit, such as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town. Cle : Please indicate submission of the following b checking off the boxes and signing below. A completed application form.signed.by the owner and the.event.manager. Applications without property-owner's signature/approval will be:rejected.: ❑ FEE: Is the application being submitted at least 60 days before the event/Yes [ ]No Y�If Yes,Fee of$ .� � has been submitted �j /Irjs ❑ If No,Fee of$ ' has been submitted Updated 8/7/2018 The a licarit/owner of the r pp p operty.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/Evenf 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 temp ray ee 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 ent.-(See application,form for details) Signature ofProperty 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. . . DatAd Sa 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 hold a.permit to operate issued by the Suffolk-County.Bureau of Public Health Food Protection Unit Updated 8/7/2018 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: Date of Submission I Name of Event ���� � `', '4-`Q_ C� SCTM#'s 1000-Section Block- Ids) L 1 3 ' L"�l - S Dates of Each Event: Q p o� If Multiple Dates are requested, applic ®ant must give all information for all dates. Nature of Event: ZJ \V- " �r&'\ '( ,I cc-,, (Please attach a detailed description of EACH event to this application) Time Period(Hours)of Event: From to 0 V-YN Town Services requested: (N4Yes ( )No If yes,Describe Police Dept./Highway Dept. Describe Services CrJS"\ EJA vcts J1f coy\" Maximum Number of Persons Attending At One Time. Jumber of cars expected h©d r' Is a Tent or other temporary structure being used? [ ]Yes [ ]No If yes provide size(s) Will food be served?[ ]Yes VNo 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) -TS 1 hZ Property Owner(name/address): Contact Person and Contact Tel.# ��' ( V Yvon zc-\ l (9) !� e-mail address A Event Location: Street-Hamlet Address: Q V y 1 Lo Cul-c� oS& '1Q i 1, ie\ 5 SCTM# Will any services be requested [ ]Yes [N4/No. If Yes describe Police Highway Other: Mailing Address to Send Event Permit to: ` Updated 8/7/2018 Have any of the development.rights been sold to the Town of Southold[ ] Yes [ ]No and/or Suffolk County Agricultural Program? .[ ] Yes- [ .]No If yes to either or both, also indicate on the attached plan the boundaries of the reserved area upon which the event will take place YOU MUST ATTACH A PARKING/EVENT PLAN TO THIS APPLICATION IF THE EXPECTED ATTENDANCE IS 300 OR MORE PEOPLE;YOU MUST ALSO ATTACH'A TRAFFIC CONTROL PLAN(see next page) A Parking/Event Plan may be a survey, site plan and/or aerial view (for damp oogle art )-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 existing buildings)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 fir'the event: (3) The location ofthe stage orr 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 all spaces must ow 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. 04) 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. . Updated.8/7/2018. . Furthermore,I hereby authorize Code Enforcement Personnel of the Town of Southold to enter the property during the hours of the permitted special event to make any and all inspections necessary in connection with this Special Event Print name of Owner Signature of Owner l W� cQx—e l 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. 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 Updated 8/7/2018 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 :i JL- �5 4k ADO ,� •4 M Jazz in the Vines Event 8/10/24 Aerial View of Peconic Bay Vineyards: Red Square- Indicated designated parking area on our East Lawn. The Light Blue Horse shoe-Indicates the flow of traffic where cars will enter and exit before the event and at conclusion. Yellow Square-The location of the Tent for the Event. Winship Media LLC dba Crush Wine Experiences,720 Greenwich St, New York, NY 10014 is putting on a Jazz in the Vines concert,which is part of a concert series across the NorthFork. Traffic control will be onsite for Entry and Exit and we will have multiple parking attendants on site for the event. We will have 4 parking attendants of our own to assist on our property. Crush Wine Experiences has secured traffic control and contracted Island Potables for restroom trailers and McBurnie for Tent services. Peconic Bay Vineyards is providing the site only. JOZEMCB•01 CERTIFICATE OF LIABILITY C'E INSURAN DATF(MMlODlTY'THIS CERTtFl WGJ2023 CATE 18 ISSUED-AS A MATTER OF INFORMATION''ONLY AND CONFERS NO'RIQHT8 UPON THE CERTIFICATE HOLgER.Tir CERTIFICATE DOES'NOT AFFIRMATIVELY OR NEGATIVELY AMEND .EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICI BELOW. THIS CERTIFICATE'OF INSURANCE DOES NOT OONGTITUTM A CONTRACT BETWEEN THE ISSUING INSVRER(S),AVTHORIZI REPRESENTATIVE OR.PRODUCER,AND THE CERTIFIOATE'HOLDER, IMPORTANT: -it the oertilloate'holder.Is en ADDITIONAL INSURED,the pollcypes)hluet have.ADDITIONAL INSURED provisions or be endor*t If SUBROGATION IS.WAIVED, subject to the,fermi and conditions of the policy,oerteln policies may require-an endorsement, A statement this certificate does not,00nfer rights to the oertilloate holder In lieu of such endorsement*, FRptWCER - ----a-m--e a onW-a--yUon LwLuce;Inc, 22 bo EII:i61727.411-4 244 •N•�o:_8 3_1•_7._2- 7.713ERiverhead,NY 11001 (DIU tonandlueooptm m INBURER(SIAPFOR ° E NAIL IN*URtA N-rthf Wd Insurance Company ANDURIne ubl FranklinIneuranoe Com any, 12,175 JOZefa MoBurnle DBA MoBurnie Tent Rental* PO Box 707 Cutchogue,NY 1105 Uill5lHgB R: ._�� ____ _�•_� NUMBER, JJIGURBRAIJ OMERAGKS REVISION NUMBER., THIS'.IS TO CERTIFY.THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN(,&SUED TO THE INSURED NAMED-ABOVE FOR THE POLICY PERIC. MDICATEO: NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH.RESPECT TO WHICH TH CERTIFICATE MAY BE ISSUED OR'MAY PERTAIN, THE INSURANCE'AFFORDED BY-THE POLICIES DESCRIBED HEREIN IS'SUBJECT TO ALLTHE TERM: EXCLUSIONS AND CONDITIONS OF SUCH POLICIES;LIMITSSHOWN MAY HAVE BEEN REDUCED SY.PAID CLAIMS. Lyn TYPE OPIN*URANCE AD°L SUB POLICY NUMBER POLIC FF POLICY EKP LIMITS A X COMMERCIAL GENERAL-UABILITY I 1;000 CLAIMS-MADE X OCCUR H N WS6503pi 0/12/2623 0/12/202.4 RENTED- X. 100 _0 man) 5 A D T,000: AGOJECT ppURRMppR� LJ LAC 1 PER A _ 2,000; X FOLICYY o P a S 2,000, 8 AUTOMOBILE UABILI Y MBINED SINGLE LIMIT ANY 500,. 0 FOULED 4531740 0 5/28I2023, �S/28/2024 ILY INJURY(Per mr4onl AUTOS ONLY X'. IUTOS it �R�p x yy��NN.opyyyy►N�EEDp DIL INJURY Per aeeidenl g X AUTOS ONLY AUTOSONLY i dtOgER n AMAGE' Is UMBRELLALIAO OCCUR s EXCEBBUAB CLAIMS-MADE EkCH OCCURRENCE pp K�D��EppD�� p E�R�erAEfNppn AN ANDREbiPLOCYtAB'UABIWT1 .ppY// PER OTH• p�pFPRIIETORlPCLUDED7ECIJTNE N/A IMsnd�e�oryPlrlACCIDB_NE_ _ _ If dnaft I under RATIONS— LL DISEASE'-EA MPLOY DISEASE POLICY LIMIT S LDE*CRIPT1oNOPOPERATIONe/LOCATIONti/VENIOLEB(ACORD1101,AddlllonilRrnelke =; --------- Csrdfloats holder Included as-Addlilonal Insured per the provielone of.attached form#00201Z 06/08,.e�0sle r°q°Ir.cq - r , E F SHOULD ANY OP THIS ABOVE DESCRIBED POLICIES BE OANOELLED BEFORE Town of Southold THE ISXPIRATION DATE' THEREOF, NOTICE WILL, Be DELIVERED' IN 63006 Route 26 AOOORDANOR WITH THE POLICY PROVISIONS. PO Box 1170 Southold,NY 11971 AUTHORIZED R!P !et NTATIV4 A ACORD 25(2010/03) 1080-2015 CORD'CORPORATION; All rights reserved The ACORD name and logo are reglstored marks of''ACORO i ' I — - NYSIF N*w York Stlto Infurnnoo Kund P0.8ox.88899,Albany,'NY 12 I nyslf,cc CERTIFICATE OF WORKERS' COMPENSATION INSURANCE j, n e n n a n 81332081,1 Q' � JOZEFA MCBURNIE ODA MCBURNIE TENT RENTAL. P,O,80X 767 , CUTCHOGUE NY-'I1836 SCAN TO VALIDATE [DBA YHOLDER' AND SUBSCRIBE FA MCBURNIE CERTIFICATE HOLDER MCBURNIE TENT RENTAL TOWN OFSOUTHOLBOX 787 53085 ROUTE 26HOGUE NY 11836 , PO BOX 1179 S.OUTHOLD .NY 11971 POLICY NUMBER CERTIFICATE NUMBER 12610-076.0 873552 POLICY-PERIOD DATE 03/10/2024' TO 03/19/2025 _174�912024 THIS It TO CERTIFY THAT THE 1*01.16'14OLOER.NAMED ABOVE IS-INSURED WITH THE NEW FUND UNDER POLICY N0, •2810.6704, 'COVERING� THE.- .ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR W YORK STATE INSURANCE WORKERS' COMPENSATION� UNDER THE NEW'•YORK WORKERS! 'COMPENSATION 'LAW WITH RESPECT TO ALL OPERATIONS IN =THE STATE` OF 'NEW'PORK, EXCEpr"A8 JNDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUT OF NEW YORK, TO THE POLICYHOLDER'S'REOULAR NEW-PORK:STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,.INCLUDING ANY NOTIFICATIONOF CANCELLATIONS OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPSr/1WWW,NYSIR, YORK STATE'INSURANCE FUND IS NOT LIABLE`IN THE EVENT OF FAILURE TO GIVE SUCHTNOTI CAT ONS7HE NEW • THIS POLICY DOES NOT COVER THE SOLE PR OPRIETOR,-PARTNERS.AND/OR MEMBERS OF A LIMITED LIABLE ITY COMPANY, THIS 'CERTIFICATE IS ISSUED. A8 A' MATTER OF, INFORMATION ONLY-AND CONFERS NO RIGHTS NOR INSURANCE �.r COVERAGE' UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND THE COVERAGE AFFORDED BY THE POLICY,' OR ALTER • v e NEW YORK-SWAT U-28,3 7NOE FUNI VALIDATION NUMBER;3002L;138 DIREOTOR,INSURA CE FUND UNDERWRITING I DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/01/2024 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 ORIALTER 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. I IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(fes)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 llael Blumenfeld NAME; MIC Mile Sqaure Insurance Agency, LLC PHONE FAX 117 Washington St. Suite 300 E-MAIL ' E 201 687-9950 'VC. Ic No:201-849-0490 Hoboken, NJ 07030 ADDRESS: team ms ia.com 1 INSURERS AFFORDING COVERAGE NAIC# Phone No. 201 687-9950 Fax No. 201 849-0490 INSURERA: AGL-American Guarantee and Liability Insurance Company 26247 INSURED Winship media INSURER B: ZAI-Zurich American Insurance Company 16535 122 south st INSURER C Greenport, NY 11944 INSURERD: INSURER E: Phone No.2016879950 Fax No. INSURERF: COVERAGES CERTIFICATE NUMBER:1122188 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 ADDLSUBRTYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY FOP LTR MM/DD POLICY EFF MMIDD LIMITS ZAI X COMMERCIAL GENERAL LIABILITY FLM6070161-00 03/04/2024 03/04/2025 EACH OCCURRENCE $ 1.000.000 DAMAGE To RENTED CLAIMS-MADE F OCCUR X X PREMISES Ea occurrence) $ 100.00 X Host Liquor MED EXP(Any one person) $ 5,00 X Full Liquor(1,000,000 Agg/Occ)_ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000 000 X POLICY PELT LOC PRODUCTS-COMP/OP AGG $ 1,000.00 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 $ AGL UMBRELLALIAB OCCUR SXS0621709-00 03/04/2024 03/04/2025 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DIED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ I I Inland Marine FLM6070161-00 03/04/2024 03/04/2025 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Coverage Location: United States&Canada Covered Events As Declared to and Accepted Certificate Holder is named as an Additional Insured as their interests may appear. by Carrier All coverages expire at 12:01 a.m.Standard Time. I i 'The actual event dates may be limited.Please review the Scheduled Events form attached to this certificate. CERTIFICATE HOLDER CANCELLATION I Peconic Bay Vineyards SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 31320 Main Rd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cutchogue, NY 11935 ACCORDANCE WITH THE POLICY PROVISIONS. United States Of America AUTHORIZED REPRESENTATIVE Phone No. Fax No. ' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD This certificate of insurance does not affirmatively or negatively amend,extend,or alter the i overage afforded by the insurance policy. DATE(MM/DD/YY) ADDITIONAL COVERAGE DETAILS 08/01/2024 INSURED winship media The following is attached to and made part of certificate number 1122188. Policy Details Coverage Limit Deductible Inland Marine Company: Zurich American Insurance Company Policy Number: FLM6070161-00 'Period: 03/04/2024-03/04/2025:365 Day(s) Equipment,props,sets,wardrobe(rented) 10,000 1,000 Equipment,Props,Sets,Wardrobe(owned) 10,000 1,000 Rented Furs,Jewelry,Art&Antiques Coverage Excluded Extra Expense Excluded Third Party Property Damage 1,000,000 2,500 Office Contents Excluded Business Income/Extra Expense Excluded Hired/Non-Owned Physical Damage-Aggregate Excluded Hired/Non-Owned Physical Damage-Per Vehicle Excluded Rental Cost Reimbursement Excluded EDP EDP(Electronic Data Processing Equipment) Excluded Limited Computer Virus Coverage Excluded Accounts Receivable Excluded Valuable Papers and Records Excluded Money&Securities Excluded Waiver of Subrogation Excluded Coverage Extension Endorsement Coverage Extension Endorsement Excluded Worldwide Coverage Excluded Terrorism Included General Liability Company: Zurich American Insurance Company Policy Number: FLM6070161-00 "Period: 03/04/2024-03/04/2025:365 Day(s) General Aggregate 2,000,000 Products/Completed Operations 1,000,000 Personal/Advertising Injury 1,000,000 Each Occurrence 1,000,000 Fire Legal 100,000 Medical Payments 5,000 Blanket Additional Insureds(other than city/special certs& Included waivers) City/Other Special Certificates Included Waiver of Subrogation Included Employee Benefits Liability-Policy Aggregate Excluded Employee Benefits Liability-Each Claim Excluded Host Liquor Included Liquor Liability-Aggregate 1,000,000 Liquor Liability-Each Common Cause Limit 1,000,000 Abuse&Molestation-Aggregate Excluded APM-CERT-DETAILS 1009 Certificate Number 1122188 I I I Policy Details .Coverage Limit Deductible Abuse&Molestation-Each Claim Excluded Cross Suits Exclusion See Exclusion Terrorism Included i *All coverages expire at 12:01 a.m.Standard Time. j I I I I I I - i i I i I i i i I i i i I APM-CERT-DETAILS 1009 Certificate Number 1122188 Scheduled Events Certificate Number: 1122188 Event Type Venue Dates Attendees Jazz in the Vines at Peconic Bay Vineyards 08/09/2024-08/10/2024 at 12:01 am(Setup) 400 Participants Peconic Bay Vineyards 31320 Main Rd 08/10/2024-08/11/2024 at 12:01 am Wine Tasting Cutchogue,NY 11935 08/11/2024-08/12/2024 at 12:01 am(Tear Down) ABANEV-SCHD(05/06) Page 1 of 1 SCHEDULE OF FORMS 08/01/2024 Insured: winship media This Schedule of Forms is attached to and made part of certificate number 1122188,as of 08/01/2024 at 10:27 AM PT,and lists the forms included in the policy(s)and subsequent endorsement(s)at the time this certificate was issued. Form# Ed. Name Special Event Package Notices U-GU-319-F 0109 Important Notice-In Witness Clause U-GU-874-BCW 0223 Notice of Disclosure for Agent and Broker Compensation UGU873ACW 0611 Disclosure Statement U-GL-1197-A CW 0104 Asbestos Exclusion Endorsement UGU742ACW 0906 Advisory Notice To Policyholders-Change in Carrier U-GU-1191-ACW 0315 Sanctions Exclusion Endorsement Common UGU727ACW 0806 Commercial Insurance Policy UGU1292ACW 0422 Notice Of Important Provisions UGUD310A 0193 Common Policy Declarations UGU619ACW 1002 Schedule of Forms and Endorsements UGU621ACW 1002 Schedule Of Named Insured(s) UGU618ACW 1002 Schedule Of Locations IL0017 1198 Common Policy Conditions UABI101ACW 0117 Definition Of Employee UAB100ACW 0117 Minimum Earned Premium Endorsement IL0185 0808 New York Changes-Calculation Of Premium IL0003 0908 Calculation of Premium U-GU-630-ECW 0120 Disclosure of Important Information Relating to Terrorism Risk Insurance Act Inland Marine UABMD104ACW 0117 Commercial Inland Marine Declarations Entertainment Program UGU619ACW 1002 Schedule of Forms and Endorsements CM0001 0904 Commercial Inland Marine Conditions UABM133ACW 0117 Common Conditions,Exclusions And Definitions UABM105ACW 0117 Miscellaneous Equipment Coverage Form UABM106ACW 0117 Props,Sets And Wardrobe Coverage Form UABM109ACW 0117 Third Party Property Damage Coverage Form UABM103ACW 0117 Loss Payable Endorsement UABM100ACW 0117 Stunt,Animal Exposure And Pyrotechnic Exclusion IL0268 0114 New York Changes-Cancellation and Nonrenewal IL0183 0808 New York Changes-Fraud Endorsement CM0104 0915 New York Changes U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism General Liability UABLD10OBCW 0119 Commercial General Liability Coverage Part Declarations UGU619ACW 1002 Schedule of Forms and Endorsements UABI110ACW 1020 Schedule of Events CG0001 0413 Commercial General Liability Coverage Form CG2011 1219 Additional Insured-Managers of Lessors of Premises CG2012 1219 Additional Insured-State or Governmental Agency or Subdivision or Political Subdivision-Permits or Authorizations CG2026 1219 Additional Insured-Designated Person or Organization CG2404 1219 Waiver of Transfer of Rights of Recovery Against Others to Us CG2028 1219 Additional Insured-Lessor of leased equipment U-GL-1327-BCW 0413 Other Insurance Amendment-Primary And Non-Contributory UABL128ACW 0117 Additional Insured-Owners Or Lessees Scheduled Person Or Organization Primary and Noncontributory Coverage UABL121ACW 0117 Limited Stationary Aircraft Coverage CG2106 0514 Exclusion-Access or Disclosure of Confidential or Personal Information and Data-Related Liability-With Limited Bodily Injury Exception U-GL-1178-A-CW 0703 Asbestos Exclusion CG2147 1207 Employment Related Practices Exclusion U-GL-1517-BCW 0413 Collection or Distribution of Material or Information in Violation of Law Exclusion UABL153ACW 1019 Annual Event Rating Schedule UABL151ACW 1019 Concessionaire/Exhibitor Rate Schedule UABL152ACW 1019 Certificate Rating Schedule UABL131ACW 0117 Non-Performing Animal Exclusion UABL102ACW 0117 Property Damage To Rented Premises Exclusion UABL129ACW 0117 Assault And Battery Exclusion UGL1250ACW 0905 Abusive Act Liability Exclusion UABL122ACW 0117 Newly Acquired Or Formed Entity Exclusion UABL107ACW 0117 Exclusion-Insureds Conducting Media,Entertainment,Or Internet Type Operations UABL130ACW 0117 Informational Content Exclusion UABL135ACW 0117 Media Content Exclusion UABL137ACW 0117 Cross Suits Exclusion UABL138ACW 0117 Personal And Advertising Injury-Exclusion Of False Arrest,Detention,Imprisonment,Libel,Slander,Right Of Privacy,Advertising Idea,And Copyright,Trademark Or Trade Secret UABL133ACW 0117 Partnership,Joint Venture And Limited Liability Company Limitation UABL106ACW 0117 Unscheduled Production,Presentation Or Event Exclusion UABL103ANY 0517 Stunt,Pyrotechnic And Animal Exposure Exclusion-New York UABL144ACW 1019 Event Conditional Exclusion CG2132 0509 Communicable Disease Exclusion APA-CERT FORMLIST 0914 Certificate Number:1122188 Page 1 of 2 SCHEDULE OF FORMS 08/01/2024 Insured: winship media This Schedule of Forms is attached to and made part of certificate number 1122188,as of 08/01/2024 at 10:27 AM PT,and lists the forms included in the policy(s)and subsequent endorsement(s)at the time this certificate was issued. Form# Ed. Name UABL146ACW 1019 Unscheduled Products Exclusion UABL145ANY 1019 Hazardous Activities,Pyrotechnic Activities and Animal Exposure Exclusion-New York UABL147ACW 1019 Loss Arising Out of Participation in a Sports or Athletic Event,Competition,Contest or Exhibition Exclusion UABL143ACW 1019 Moshing Exclusion UABL150ACW 1019 Camping Conditional Exclusion UGLD1036BCW 0904 Liquor Liability Coverage Part Declarations CGO033 0413 Liquor Liability Coverage Form UABL154ACW 1019 Liquor Rating Schedule CGO104 1204 New York Changes-Premium Audit IL0268 0114 New York Changes-Cancellation and Nonrenewal CG2603 0417 New York Changes-Liquor Liabilty Coverage Form CG2621 1091 New York Changes-Transfer of Duties When a Limit of Insurance is Used Up CG2635 1293 New York Changes-Transfer of Duties When a Limit of Insurance is Used Up UABL105ANY 0117 Commercial General Liability Changes-New York U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism Excess Liability Policy Excess Liability Notices U-GU-1191-ACW 0315 Sanctions Exclusion Endorsement U-GU-874-BCW 0223 Notice of Disclosure for Agent and Broker Compensation Forms U-SXS-104-ACW 0911 Straight Excess Liability Policy(jacket) UGU621ACW 1002 Schedule Of Named Insured(s) U-SXS-D-100-ACW 0911 Straight Excess Liability Policy Declarations U-SXS-101-ANY 0912 Schedule of Underlying Insurance-New York U-SXS-103-ACW 0911 Schedule of Forms&Endorsements U-GU-630-ECW 0120 Disclosure of Important Information Relating to Terrorism Risk Insurance Act U-SXS-100-ACW 0911 Straight Excess Liability Policy U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism U-SXS-1 1 7-BCW 0514 Professional Liability Limitation Endorsement UEXS319CCW 0514 Liquor Law Liability And Alcohol Consumption Health Hazards Exclusion U-EXS-115-CCW 0411 Communicable Disease Exclusion UEXS101 BCW 0411 Abuse Or Molestation Exclusion U-EXS-312-FCW 0514 Exclusion-Recording and Distribution of Material or Information in Violation of Law U-EXS-241-CNY 0213 New York Changes U-SXS-120-ACW-NY 0911 Total Pollution Exclusion with Hostile Fire Exception U-SXS-134-ANY 0912 New York Changes Disclaimers This Certificate of Liability Insurance includes the Type of Insurance,Limits,and Schedule of Forms in effect as of 08/01/2024 at 10:27 AM PT.It does not affirmatively or negatively amend,extend,or alter the coverage afforded by the insurance policy nor confer any rights upon the certificate holder.You may be required to request an updated certificate in the event of subsequent policy modifications. The Information included in this certificate that has been provided by Abacus Insurance Brokers,LLC is for your information only,and does not create a contract or agency relationship between the certificate holder or any insured and Abacus Insurance Brokers,LLC.By accepting this certificate the certificate holder acknowledges that Abacus Insurance Brokers,LLC is not the agent of the certificate holder or any insured,but is solely the agent of the listed carrier(s).Abacus Insurance Brokers,LLC makes no representation whether the coverages listed herein are appropriate for the certificate holder or any insured.Please review the listed coverages carefully and direct any questions to your broker.For a complete listing of coverages,terms,conditions and exclusions,please view the referenced Pollcy(s). APA-CERT-FORMLIST 0914 Certificate Number:1122188 Page 2 of 2 Date(MM/DD/YYM Certificate Verification 08/01/2024 Insured: winship media Abacus provides an efficient website lookup tool for certificate holders to verify the authenticity of certificates of insurance. 1. Navigate to the website and input the verification code OR Scan the OR code. 2. The actual certificate issued through the Abacus Platform will download. 3. Compare the details of the downloaded certificate to the certificate presented by the client. Website Verification Code www.abacus.net/verify-certificate OCOX081 KVW, oW �o 0 About Certificates Issued through the Abacus.net Platform • Abacus requires that all certificates be issued through the Abacus Platform. Certificates issued outside of the Abacus Platform are invalid. • Certificates may be issued through the Abacus Platform by either the named insured(if registered through the Abacus Platform)or their Abacus registered insurance broker. • Certificates with any stray marks,cross outs or alterations of any sort are invalid. • Each certificate is numbered and correlates to the document issued through the Abacus Platform. APA-CERTVER 0917 Certificate Number.1122188 Page 1 of 1 DATE(MWDDNYYY) A�o® CERTIFICATE OF LIABILITY INSURANCE 08/01/2024 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(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). CONTACT PRODUCER NAME: Michael Blumenfeld Mile Sqaure Insurance Agency, LLC PHONE FAX 117 Washington St. Suite 300 EMAIL° E 201 687-9950 AIc No:201-849-0490 Hoboken, NJ 07030 ADDRESS: teamc@-msqia.com INSURERS AFFORDING COVERAGE NAIC# Phone No. 201 687-9950 Fax No. 201 849-0490 INSURERA: AGL-American Guarantee and Liability Insurance Company 26247 INSURED Winship media INSURER B: ZAI-Zurich American Insurance Company 16535 122 south st INSURER C: Greenport, NY 11944 INSURERD: INSURER E: Phone No.2016879950 Fax No. INSURER F: COVERAGES CERTIFICATE NUMBER:1122185 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 POLICYNUMBER MM/DD MM/DD ZAI X COMMERCIAL GENERAL LIABILITY FLM6070161-00 03/04/2024 03/04/2025 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR X X PREMISES Ea occurrence $ 100.00 X Host Liquor MED EXP(Any one person) $ 5.00 X Full Liquor(1,000,000 Agg/Occ) PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 00O 000 X POLICY PELT LOC PRODUCTS-COMP/OP AGG $ 1,000,00 OTHER: $ AUTOMOBILE LIABILITY CEa aOMBINED SINGLE LIMITccident $ 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 AGL UMBRELLALIAB X OCCUR SXS0621709-00 03/04/2024 03/04/2025 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000.00 DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANYPROPRIETOR/PARTNERIEXEC"T ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ U yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I Inland Marine FLM6070161-00 03/04/2024 03/04/2025 See Attached DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES Coverage Location: United States&Canada Covered Events As Declared to and Accepted Certificate Holder is named as an Additional Insured as their interests may appear. by Carrier All coverages expire at 12:01 a.m.Standard Time. 'The actual event dates may be limited.Please review the Scheduled Events form attached to this certificate. CERTIFICATE HOLDER CANCELLATION Crossroads Wine LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1004 Willow Pond Drive THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Riverhead, NY 11901 ACCORDANCE WITH THE POLICY PROVISIONS. United States Of America AUTHORIZED REPRESENTATIVE Phone No. Fax No. 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD This certificate of insurance does not affirmatively or negatively amend,extend,or alter the coverage afforded by the insurance policy. DATE(MM/DDNY) ADDITIONAL COVERAGE DETAILS 08/01/2024 INSURED winship media The following is attached to and made part of certificate number 1122185. Policy Details Coverage Limit Deductible Inland Marine Company: Zurich American Insurance Company Policy Number: FLM6070161-00 "Period: 03/04/2024-03/04/2025:365 Day(s) Equipment,props,sets,wardrobe(rented) 10,000 1,000 Equipment,Props,Sets,Wardrobe(owned) 10,000 1,000 Rented Furs,Jewelry,Art&Antiques Coverage Excluded Extra Expense Excluded Third Party Property Damage 1,000,000 2,500 Office Contents Excluded Business Income/Extra Expense Excluded Hired/Non-Owned Physical Damage-Aggregate Excluded Hired/Non-Owned Physical Damage-Per Vehicle Excluded Rental Cost Reimbursement Excluded EDP EDP(Electronic Data Processing Equipment) Excluded Limited Computer Virus Coverage Excluded Accounts Receivable Excluded Valuable Papers and Records Excluded Money&Securities Excluded Waiver of Subrogation Excluded Coverage Extension Endorsement Coverage Extension Endorsement Excluded Worldwide Coverage Excluded Terrorism Included General Liability Company: Zurich American Insurance Company Policy Number: FLM6070161-00 *Period: 03/04/2024-03/04/2025:365 Day(s) General Aggregate 2,000,000 Products/Completed Operations 1,000,000 Personal/Advertising Injury 1,000,000 Each Occurrence 1,000,000 Fire Legal 100,000 Medical Payments 5,000 Blanket Additional Insureds(other than city/special certs& Included waivers) City/Other Special Certificates Included Waiver of Subrogation Included Employee Benefits Liability-Policy Aggregate Excluded Employee Benefits Liability-Each Claim Excluded Host Liquor Included Liquor Liability-Aggregate 1,000,000 Liquor Liability-Each Common Cause Limit 1,000,000 Abuse&Molestation-Aggregate Excluded APM-CERT DETAILS 1009 Certificate Number 1122185 Policy Details Coverage Limit Deductible Abuse&Molestation-Each Claim Excluded Cross Suits Exclusion See Exclusion Terrorism Included *All coverages expire at 12:01 a.m.Standard Time. APM-CERT-DETAILS 1009 Certificate Number 1122185 Scheduled Events Certificate Number: 1122185 Event Type Venue Dates Attendees Jazz in the Vines at Peconic Bay Vineyards 08/09/2024-08/10/2024 at 12:01 am(Setup) 400 Participants Peconic Bay Vineyards 31320 Main Rd 08/10/2024-08/11/2024 at 12:01 am Wine Tasting Cutchogue,NY 11935 08/11/2024-08/12/2024 at 12:01 am(Tear Down) ABANEV-SCHD(05/06) Page 1 of 1 SCHEDULE OF FORMS 08/01/2024 Insured: winship media This Schedule of Forms is attached to and made part of certificate number 1122185,as of 08/01/2024 at 10:24 AM PT,and lists the forms included in the policy(s)and subsequent endorsement(s)at the time this certificate was issued. Form# Ed. Name Special Event Package Notices U-GU-319-F 0109 Important Notice-In Witness Clause U-GU-874-BCW 0223 Notice of Disclosure for Agent and Broker Compensation UGU873ACW 0611 Disclosure Statement U-GL-1197-A CW 0104 Asbestos Exclusion Endorsement UGU742ACW 0906 Advisory Notice To Policyholders-Change in Carrier U-GU-1191-ACW 0315 Sanctions Exclusion Endorsement Common UGU727ACW 0806 Commercial Insurance Policy UGU1292ACW 0422 Notice Of Important Provisions UGUD310A 0193 Common Policy Declarations UGU619ACW 1002 Schedule of Forms and Endorsements UGU621ACW 1002 Schedule Of Named Insured(s) UGU618ACW 1002 Schedule Of Locations IL0017 1198 Common Policy Conditions UABI101ACW 0117 Definition Of Employee UAB100ACW 0117 Minimum Earned Premium Endorsement IL0185 0808 New York Changes-Calculation Of Premium IL0003 0908 Calculation of Premium U-GU-630-ECW 0120 Disclosure of Important Information Relating to Terrorism Risk Insurance Act Inland Marine UABMD104ACW 0117 Commercial Inland Marine Declarations Entertainment Program UGU619ACW 1002 Schedule of Forms and Endorsements CM0001 0904 Commercial Inland Marine Conditions UABM133ACW 0117 Common Conditions,Exclusions And Definitions UABM105ACW 0117 Miscellaneous Equipment Coverage Form UABM106ACW 0117 Props,Sets And Wardrobe Coverage Form UABM109ACW 0117 Third Party Property Damage Coverage Form UABM103ACW 0117 Loss Payable Endorsement UABM100ACW 0117 Stunt,Animal Exposure And Pyrotechnic Exclusion IL0268 0114 New York Changes-Cancellation and Nonrenewal IL0183 0808 New York Changes-Fraud Endorsement CM0104 0915 New York Changes U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism General Liability UABLD10OBCW 0119 Commercial General Liability Coverage Part Declarations UGU619ACW 1002 Schedule of Forms and Endorsements UABI110ACW 1020 Schedule of Events CG0001 0413 Commercial General Liability Coverage Form CG2011 1219 Additional Insured-Managers of Lessors of Premises CG2012 1219 Additional Insured-State or Governmental Agency or Subdivision or Political Subdivision-Permits or Authorizations CG2026 1219 Additional Insured-Designated Person or Organization CG2404 1219 Waiver of Transfer of Rights of Recovery Against Others to Us CG2028 1219 Additional Insured-Lessor of leased equipment U-GL-1327-BCW 0413 Other Insurance Amendment-Primary And Non-Contributory UABL128ACW 0117 Additional Insured-Owners Or Lessees Scheduled Person Or Organization Primary and Noncontributory Coverage UABL121ACW 0117 Limited Stationary Aircraft Coverage CG2106 0514 Exclusion-Access or Disclosure of Confidential or Personal Information and Data-Related Liability-With Limited Bodily Injury Exception U-GL-1178-A-CW 0703 Asbestos Exclusion CG2147 1207 Employment Related Practices Exclusion U-GL-1517-BCW 0413 Collection or Distribution of Material or Information in Violation of Law Exclusion UABL153ACW 1019 Annual Event Rating Schedule UABL151ACW 1019 Concessionaire/Exhibitor Rate Schedule UABL152ACW 1019 Certificate Rating Schedule UABL131ACW 0117 Non-Performing Animal Exclusion UABL102ACW 0117 Property Damage To Rented Premises Exclusion UABL129ACW 0117 Assault And Battery Exclusion UGL1250ACW 0905 Abusive Act Liability Exclusion UABL122ACW 0117 Newly Acquired Or Formed Entity Exclusion UABL107ACW 0117 Exclusion-Insureds Conducting Media,Entertainment,Or Internet Type Operations UABL130ACW 0117 Informational Content Exclusion UABL135ACW 0117 Media Content Exclusion UABL137ACW 0117 Cross Suits Exclusion UABL138ACW 0117 Personal And Advertising Injury-Exclusion Of False Arrest,Detention,Imprisonment,Libel,Slander,Right Of Privacy,Advertising Idea,And Copyright,Trademark Or Trade Secret UABL133ACW 0117 Partnership,Joint Venture And Limited Liability Company Limitation UABL106ACW 0117 Unscheduled Production,Presentation Or Event Exclusion UABL103ANY 0517 Stunt,Pyrotechnic And Animal Exposure Exclusion-New York UABL144ACW 1019 Event Conditional Exclusion CG2132 0509 Communicable Disease Exclusion APA-CERT-FORMLIST 0914 Certificate Number:1122185 Page 1 of 2 SCHEDULE OF FORMS 08/01/2024 Insured: winship media This Schedule of Forms is attached to and made part of certificate number 1122185,as of 08/01/2024 at 10:24 AM PT,and lists the forms included in the policy(s)and subsequent endorsement(s)at the time this certificate was issued. Form# Ed. Name UABL146ACW 1019 Unscheduled Products Exclusion UABL145ANY 1019 Hazardous Activities,Pyrotechnic Activities and Animal Exposure Exclusion-New York UABL147ACW 1019 Loss Arising Out of Participation in a Sports or Athletic Event,Competition,Contest or Exhibition Exclusion UABL143ACW 1019 Moshing Exclusion UABL150ACW 1019 Camping Conditional Exclusion UGLD1036BCW 0904 Liquor Liability Coverage Part Declarations CGO033 0413 Liquor Liability Coverage Form UABL154ACW 1019 Liquor Rating Schedule CGO104 1204 New York Changes-Premium Audit IL0268 0114 New York Changes-Cancellation and Nonrenewal CG2603 0417 New York Changes-Liquor Liabilty Coverage Form CG2621 1091 New York Changes-Transfer of Duties When a Limit of Insurance is Used Up CG2635 1293 New York Changes-Transfer of Duties When a Limit of Insurance is Used Up UABL105ANY 0117 Commercial General Liability Changes-New York U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism Excess Liability Policy Excess Liability Notices U-GU-1191-ACW 0315 Sanctions Exclusion Endorsement U-GU-874-BCW 0223 Notice of Disclosure for Agent and Broker Compensation Forms U-SXS-104-ACW 0911 Straight Excess Liability Policy(jacket) UGU621ACW 1002 Schedule Of Named Insured(s) U-SXS-D-100-ACW 0911 Straight Excess Liability Policy Declarations U-SXS-101-ANY 0912 Schedule of Underlying Insurance-New York U-SXS-103-ACW 0911 Schedule of Forms&Endorsements U-GU-630-ECW 0120 Disclosure of Important Information Relating to Terrorism Risk Insurance Act U-SXS-100-ACW 0911 Straight Excess Liability Policy U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism U-SXS-117-BCW 0514 Professional Liability Limitation Endorsement UEXS319CCW 0514 Liquor Law Liability And Alcohol Consumption Health Hazards Exclusion U-EXS-115-CCW 0411 Communicable Disease Exclusion UEXS101 BCW 0411 Abuse Or Molestation Exclusion U-EXS-312-FCW 0514 Exclusion-Recording and Distribution of Material or Information in Violation of Law U-EXS-241-CNY 0213 New York Changes U-SXS-120-ACW-NY 0911 Total Pollution Exclusion with Hostile Fire Exception U-SXS-134-ANY 0912 New York Changes Disclaimers l This Certificate of Liability Insurance includes the Type of Insurance,Limits,and Schedule of Forms in effect as of 08/01/2024 at 10:24 AM PT.It does not affirmatively or negatively amend,extend,or alter the coverage afforded by the insurance policy nor confer any rights upon the certificate holder.You may be required to request an updated certificate in the event of subsequent policy modifications. The information included in this certificate that has been provided by Abacus Insurance Brokers,LLC is for your information only,and does not create a contract or agency relationship between the certificate holder or any insured and Abacus Insurance Brokers,LLC.By accepting this certificate the certificate holder acknowledges that Abacus Insurance Brokers,LLC is not the agent of the certificate holder or any insured,but is solely the agent of the listed carrier(s).Abacus Insurance Brokers,LLC makes no representation whether the coverages listed herein are appropriate for the certificate holder or any insured.Please review the listed coverages carefully and direct any questions to your broker.For a complete listing of coverages,terms,conditions and exclusions,please view the referenced Policy(s). APA-CERT-FORMLIST 0914 Certificate Number:1122185 Page 2 of 2 Date(MM/DD/YYW) Certificate Verification 08/01/2024 Insured: winship media Abacus provides an efficient website lookup tool for certificate holders to verify the authenticity of certificates of insurance. 1. Navigate to the website and input the verification code OR Scan the QR code. 2. The actual certificate issued through the Abacus Platform will download. 3. Compare the details of the downloaded certificate to the certificate presented by the client. Website Verification Code www.abacus.net/verify-certificate 0001OL16VT • 0 About Certificates Issued through the Abacus.net Platform • Abacus requires that all certificates be issued through the Abacus Platform. Certificates issued outside of the Abacus Platform are invalid. • Certificates may be issued through the Abacus Platform by either the named insured(if registered through the Abacus Platform)or their Abacus registered insurance broker. • Certificates with any stray marks,cross outs or alterations of any sort are invalid. • Each certificate is numbered and correlates to the document issued through the Abacus Platform. APA-CERTVER 0917 Certificate Number:1122185 Page 1 of 1 ACORO0 DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 08/01/2024 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 Michael Blumenfeld Mile Washiqaurengton Inston St. eite300Agency, LLC PHCNN E 201 687-9950 a No:201-849-0490 117 Washington St. Suite 300 E-MAIL Hoboken, NJ 07030 ADDRESS: team(@msclla.com INSURERS AFFORDING COVERAGE NAIC# Phone No. 201 687-9950 Fax No. 201 849-0490 INSURER A: AGL-American Guarantee and Liability Insurance Company 26247 INSURED INSURER B: ZAI-Zurich American Insurance Company 16535 Winship media 122 south st INSURERC: Greenport, NY 11944 INSURERD: INSURER E: Phone No.2016879950 Fax NO. INSURERF: COVERAGES CERTIFICATE NUMBER:1122220 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 LTR POLICY NUMBER MMIDD MM/DD LIMITS ZAI X COMMERCIAL GENERAL LIABILITY FLM6070161-00 03/04/2024 03/04/2025 EACH OCCURRENCE $ 1,000,000 DAMAGE 111111111 CLAIMS-MADE Fx-]OCCUR X X PREMISES Ea occurrence) ccurrrence $ 100.00 X Host Liquor MED EXP(Any one person) $ 5.00 X Full Liquor(1,000,000 Agg/Occ) PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PO- JECT 7 LOC PRODUCTS-COMP/OP AGG $ 1,000.00 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 $ AGL UMBRELLALIAB X OCCUR SXS0621709-00 03/04/2024 03/04/2025 EACH OCCURRENCE $ 2,000.00 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETOR/PARTNERIEXECUTIVE Y/N OFFICERIMEMBEREXCLUDED7 N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ZAI Inland Marine FLM6070161-00 03/04/2024 03/04/2025 See Attached DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES Coverage Location: United States&Canada Covered Events As Declared to and Accepted Certificate Holder is named as an Additional Insured as their interests may appear. by Carrier All coverages expire at 12:01 a.m.Standard Time. 'The actual event dates may be limited.Please review the Scheduled Events form attached to this certificate. CERTIFICATE HOLDER CANCELLATION Town of Southold 53095 Route 25, PO Box 1179 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southold, NY 11971 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WrrH THE POLICY PROVISIONS. United States Of America AUTHORIZED REPRESENTATIVE Phone No. Fax No. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD This certificate of insurance does not affirmatively or negatively amend,extend,or alter the coverage afforded by the insurance policy. DATE(MMOD") ADDITIONAL COVERAGE DETAILS 08/01/2024 INSURED winship media - The following is attached to and made part of certificate number 1122220. Policy Details Coverage Limit Deductible Inland Marine Company,: Zurich American Insurance Company Policy Number: FLM6070161-00 *Period: 03/04/2024-03/04/2025:365 Day(s) Equipment,props,sets,wardrobe(rented) 10,000 1,000 Equipment,Props,Sets,Wardrobe(owned) 10,000 1,000 Rented Furs,Jewelry,Art&Antiques Coverage Excluded Extra Expense Excluded Third Party Property Damage 1,000,000 2,500 Office Contents Excluded Business Income/Extra Expense Excluded Hired/Non-Owned Physical Damage-Aggregate Excluded Hired/Non-Owned Physical Damage-Per Vehicle Excluded Rental Cost Reimbursement Excluded EDP EDP(Electronic Data Processing Equipment) Excluded Limited Computer Virus Coverage Excluded Accounts Receivable Excluded Valuable Papers and Records Excluded Money&Securities Excluded Waiver of Subrogation Excluded Coverage Extension Endorsement Coverage Extension Endorsement Excluded Worldwide Coverage Excluded Terrorism Included General Liability Company: Zurich American Insurance Company Policy Number: FLM6070161-00 *Period: 03/04/2024-03/04/2025:365 Day(s) General Aggregate 2,000,000 Products/Completed Operations 1,000,000 Personal/Advertising Injury 1,000,000 Each Occurrence 1,000,000 Fire Legal 100,000 Medical Payments 5,000 Blanket Additional Insureds(other than city/special certs& Included waivers) City/Other Special Certificates Included Waiver of Subrogation Included Employee Benefits Liability-Policy Aggregate Excluded Employee Benefits Liability-Each Claim Excluded Host Liquor Included Liquor Liability-Aggregate 1,000,000 Liquor Liability-Each Common Cause Limit 1,000,000 Abuse&Molestation-Aggregate Excluded APM-CERT-DETAILS 1009 Certificate Number 1122220 Policy Details Coverage Limit Deductible Abuse&Molestation-Each Claim Excluded Cross Suits Exclusion See Exclusion Terrorism Included *All coverages expire at 12:01 a.m.Standard Time. APM-CERT DETAILS 1009 Certificate Number 1122220 Scheduled Events Certificate Number: 1122220 Event Type Venue Dates Attendees Jazz in the Vines at Peconic Bay Vineyards 08/09/2024-08/10/2024 at 12:01 am(Setup) 400 Participants Peconic Bay Vineyards 31320 Main Rd 08/10/2024-08/11/2024 at 12:01 am Wine Tasting Cutchogue,NY 11935 08/11/2024-08/12/2024 at 12:01 am(Tear Down) ABANEV-SCHD(05/06) Page 1 of 1 SCHEDULE OF FORMS 08/01/2024 Insured: winship media This Schedule of Forms is attached to and made part of certificate number 1122220,as of 08/01/2024 at 10:45 AM PT,and lists the forms included in the policy(s)and subsequent endorsement(s)at the time this certificate was issued. Form# Ed. Name Special Event Package Notices U-GU-319-F 0109 Important Notice-In Witness Clause U-GU-874-BCW 0223 Notice of Disclosure for Agent and Broker Compensation UGU873ACW 0611 Disclosure Statement U-GL-1197-A CW 0104 Asbestos Exclusion Endorsement UGU742ACW 0906 Advisory Notice To Policyholders-Change in Carrier U-GU-1191-ACW 0315 Sanctions Exclusion Endorsement Common UGU727ACW 0806 Commercial Insurance Policy UGU1292ACW 0422 Notice Of Important Provisions UGUD310A 0193 Common Policy Declarations UGU619ACW 1002 Schedule of Forms and Endorsements UGU621ACW 1002 Schedule Of Named Insured(s) UGU618ACW 1002 Schedule Of Locations IL0017 1198 Common Policy Conditions UABI101ACW 0117 Definition Of Employee UAB100ACW 0117 Minimum Earned Premium Endorsement IL0185 0808 New York Changes-Calculation Of Premium IL0003 0908 Calculation of Premium U-GU-630-ECW 0120 Disclosure of Important Information Relating to Terrorism Risk Insurance Act Inland Marine UABMD104ACW 0117 Commercial Inland Marine Declarations Entertainment Program UGU619ACW 1002 Schedule of Forms and Endorsements CM0001 0904 Commercial Inland Marine Conditions UABM133ACW 0117 Common Conditions,Exclusions And Definitions UABM105ACW 0117 Miscellaneous Equipment Coverage Form UABM106ACW 0117 Props,Sets And Wardrobe Coverage Form UABM109ACW 0117 Third Party Property Damage Coverage Form UABM103ACW 0117 Loss Payable Endorsement UABM100ACW 0117 Stunt,Animal Exposure And Pyrotechnic Exclusion IL0268 0114 New York Changes-Cancellation and Nonrenewal IL0183 0808 New York Changes-Fraud Endorsement CM0104 0915 New York Changes U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism General Liability UABLD10OBCW 0119 Commercial General Liability Coverage Part Declarations UGU619ACW 1002 Schedule of Forms and Endorsements UABI110ACW 1020 Schedule of Events CG0001 0413 Commercial General Liability Coverage Form CG2011 1219 Additional Insured-Managers of Lessors of Premises CG2012 1219 Additional Insured-State or Governmental Agency or Subdivision or Political Subdivision-Permits or Authorizations CG2026 1219 Additional Insured-Designated Person or Organization CG2404 1219 Waiver of Transfer of Rights of Recovery Against Others to Us CG2028 1219 Additional Insured-Lessor of leased equipment U-GL-1327-BCW 0413 Other Insurance Amendment-Primary And Non-Contributory UABL128ACW 0117 Additional Insured-Owners Or Lessees Scheduled Person Or Organization Primary and Noncontributory Coverage UABL121ACW 0117 Limited Stationary Aircraft Coverage CG2106 0514 Exclusion-Access or Disclosure of Confidential or Personal Information and Data-Related Liability-With Limited Bodily Injury Exception U-GL-1 1 78-A-CW 0703 Asbestos Exclusion CG2147 1207 Employment Related Practices Exclusion U-GL-1517-BCW 0413 Collection or Distribution of Material or Information in Violation of Law Exclusion UABL153ACW 1019 Annual Event Rating Schedule UABL151ACW 1019 Concessionaire/Exhibitor Rate Schedule UABL152ACW 1019 Certificate Rating Schedule UABL131ACW 0117 Non-Performing Animal Exclusion UABL102ACW 0117 Property Damage To Rented Premises Exclusion UABL129ACW 0117 Assault And Battery Exclusion UGL1250ACW 0905 Abusive Act Liability Exclusion UABL122ACW 0117 Newly Acquired Or Formed Entity Exclusion UABL107ACW 0117 Exclusion-Insureds Conducting Media,Entertainment,Or Internet Type Operations UABL130ACW 0117 Informational Content Exclusion UABL135ACW 0117 Media Content Exclusion UABL137ACW 0117 Cross Suits Exclusion UABL138ACW 0117 Personal And Advertising Injury-Exclusion Of False Arrest,Detention,Imprisonment,Libel,Slander,Right Of Privacy,Advertising Idea,And Copyright,Trademark Or Trade Secret UABL133ACW 0117 Partnership,Joint Venture And Limited Liability Company Limitation UABL106ACW 0117 Unscheduled Production,Presentation Or Event Exclusion UABL103ANY 0517 Stunt,Pyrotechnic And Animal Exposure Exclusion-New York UABL144ACW 1019 Event Conditional Exclusion CG2132 0509 Communicable Disease Exclusion APA-CERT-FORMLIST 0914 Certificate Number:1122220 Page 1 of 2 SCHEDULE OF FORMS 08/01/2024 Insured: winship media This Schedule of Forms is attached to and made part of certificate number 1122220,as of 08/01/2024 at 10:45 AM PT,and lists the forms included in the policy(s)and subsequent endorsement(s)at the time this certificate was issued. Form# Ed. Name UABL146ACW 1019 Unscheduled Products Exclusion UABL145ANY 1019 Hazardous Activities,Pyrotechnic Activities and Animal Exposure Exclusion-New York UABL147ACW 1019 Loss Arising Out of Participation in a Sports or Athletic Event,Competition,Contest or Exhibition Exclusion UABL143ACW 1019 Moshing Exclusion UABL150ACW 1019 Camping Conditional Exclusion UGLD1036BCW 0904 Liquor Liability Coverage Part Declarations CGO033 0413 Liquor Liability Coverage Form UABL154ACW 1019 Liquor Rating Schedule CGO104 1204 New York Changes-Premium Audit IL0268 0114 New York Changes-Cancellation and Nonrenewal CG2603 0417 New York Changes-Liquor Liabilty Coverage Form CG2621 1091 New York Changes-Transfer of Duties When a Limit of Insurance is Used Up CG2635 1293 New York Changes-Transfer of Duties When a Limit of Insurance is Used Up UABL105ANY 0117 Commercial General Liability Changes-New York U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism Excess Liability Policy Excess Liability Notices U-GU-1191-ACW 0315 Sanctions Exclusion Endorsement U-GU-874-BCW 0223 Notice of Disclosure for Agent and Broker Compensation Forms U-SXS-104-ACW 0911 Straight Excess Liability Policy(jacket) UGU621ACW 1002 Schedule Of Named Insured(s) U-SXS-D-100-ACW 0911 Straight Excess Liability Policy Declarations U-SXS-101-ANY 0912 Schedule of Underlying Insurance-New York U-SXS-103-ACW 0911 Schedule of Forms&Endorsements U-GU-630-ECW 0120 Disclosure of Important Information Relating to Terrorism Risk Insurance Act U-SXS-100-ACW 0911 Straight Excess Liability Policy U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism U-SXS-117-BCW 0514 Professional Liability Limitation Endorsement UEXS319CCW 0514 Liquor Law Liability And Alcohol Consumption Health Hazards Exclusion U-EXS-115-CCW 0411 Communicable Disease Exclusion UEXS101 BCW 0411 Abuse Or Molestation Exclusion U-EXS-312-FCW 0514 Exclusion-Recording and Distribution of Material or Information in Violation of Law U-EXS-241-CNY 0213 New York Changes U-SXS-120-ACW-NY 0911 Total Pollution Exclusion with Hostile Fire Exception U-SXS-134-ANY 0912 New York Changes Disclaimers This Certificate of Liability Insurance includes the Type of Insurance,Limits,and Schedule of Forms in effect as of 08/01/2024 at 10:45 AM PT.It does not affirmatively or negatively amend,extend,or alter the coverage afforded by the insurance policy nor confer any rights upon the certificate holder.You may be required to request an updated certificate in the event of subsequent policy modifications. The information included in this certificate that has been provided by Abacus Insurance Brokers,LLC is for your information only,and does not create a contract or agency relationship between the certificate holder or any insured and Abacus Insurance Brokers,LLC.By accepting this certificate the certificate holder acknowledges that Abacus Insurance Brokers,LLC is not the agent of the certificate holder or any insured,but is solely the agent of the listed carrier(s).Abacus Insurance Brokers,LLC makes no representation whether the coverages listed herein are appropriate for the certificate holder or any insured.Please review the listed coverages carefully and direct any questions to your broker.For a complete listing of coverages,terms,conditions and exclusions,please view the referenced Policy(s). APA-CERT FORMLIST 0914 Certificate Number:1122220 Page 2 of 2 Date(MM/DD/YYM Certificate Verification 08/01/2024 Insured: winship media Abacus provides an efficient website lookup tool for certificate holders to verify the authenticity of certificates of insurance. 1. Navigate to the website and input the verification code OR Scan the QR code. 2. The actual certificate issued through the Abacus Platform will download. 3. Compare the details of the downloaded certificate to the certificate presented by the client. Website Verification Code www.abacus.net/veriN-certificate OX02OH1 PWS i L About Certificates Issued through the Abacus.net Platform • Abacus requires that all certificates be issued through the Abacus Platform. Certificates issued outside of the Abacus Platform are invalid. • Certificates may be issued through the Abacus Platform by either the named insured(if registered through the Abacus Platform)or their Abacus registered insurance broker. • Certificates with any stray marks,cross outs or alterations of any sort are invalid. • Each certificate is numbered and correlates to the document issued through the Abacus Platform. APA-CERTVER 0917 Certificate Number:1122220 Page 1 of 1 HOLD HARMLESS AGREEMENT The applicant �C'C �C vV :�of this Special Permit shall defend, indemnify and hold harmless the Town of Southold, its officers, employees, and representatives from and against any and all damages, liability,judgments, losses, and expenses, including but not limited to attorney's fees, including damages arising from injuries or death of persons and damage to property which arise from or are connected with the event or events authorized by resolution of the Town Board of the Town of Southold, or caused by the negligent misconduct, and/or omissions under this Agreement and that of applicant's agents, servants and/or employees. If this Agreement is being executed in a representative capacity, the individual executing this Agreement hereby represents that this action has been authorized. Dated: Signature: Name: ,Authorized Agent iur �hZ On behalf of: C�C� (Nam of Business Entity) Dates of event(s): l C2 Sworn to before me this Day of , �, 200. JOHN A. MAKI Notary Public-State of New York No. 01 M Qualified in SuffolkSuffolk County My Commission Exp. 04/30/202.7 Mudd, Jennifer From: Noncarrow, Denis Sent: Friday,August 2, 2024 2:05 PM To: Schroeder, Gwynn Cc: Born, Sabrina; Mudd,Jennifer; Franke, Diana;Johnson, Benjamin Subject: Jazz on the Vine Attachments: jazz on the vine_20240802133406.pdf See if this worked. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.qov denisnC@southoldtownny.gov_ 631-765-1800 CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. It is solely for the use of the intended recipient(s). Unauthorized interception, review, use or disclosure is prohibited and may violate applicable laws including the Electronic Communications Privacy Act. If you are not the intended recipient, please contact the sender and destroy all copies of the communication. 1 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 08/05/24 Receipt#: 333770 Quantity Transactions Reference Subtotal 1 Event Fee PBV 5a $0.00 Total Paid: $0.00 Notes: Payment Type Amount Paid By Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Peconic, Bay Vineyards 31320 Main Road Cutchogue, NY 11935 Clerk ID: JENNIFER Internal ID:PBV 5a Noncarrow, Denis From: NONCARROW, DENIS664 To: peter@pbvineyards.com Cc: Sabrina Born (sabrina.born @town.southold.ny.us); Mudd,Jennifer Subject: Special event Attachments: Printout-20524-1034-M63895.doc HI Peter, See attached resolution for the special event permit. Have a good day. Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisn@southoldtownny.pov 631-765-1800 CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. It is solely for the use of the intended recipient(s). Unauthorized interception, review, use or disclosure is prohibited and may violate applicable laws including the Electronic Communications Privacy Act. If you are not the intended recipient, please contact the sender and destroy all copies of the communication. l 1