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HomeMy WebLinkAboutCutchogue/New Suffolk Historical Council Vendor No. C1ie*No` _ 's a ................................... Town of Southold New York - Payment Voucher Vendor Name Vendor Address ............_..... ............ Cutchogue-NS Historical Council PO Box 714 ` ...... ............................:............... Vendor Telephone Number -:::::•:;::: :: :::;::::::::: 631-379=7494 Cutchogue, NY 11935 T60 i eleirk; : :;:;:_ :: ?' Vendor Contact Marc MacNish. Invoice Invoice 'Invoice Net Purchase order Number Date Total Discount Amount Iblaimed Number Description of Goods or Services '.'General I edger Fund anilAcctitiini IiTrimlie 2024-748 8/27/2024 $750.00 $750.00 Summer Concert Series 7/25 8/8`8/22-2024 :••::::::::::::::::::::::::::-:::::::::::::::::: ..........._..............................._..... ...... ?`.s. '. TOTAL: $750.00 ; ' '` Payee Certification Department Certification' The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above,specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as-therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved. Signature :ACWTitle Deputy Town Clerk Signature Comp yafi Name LOU Town Clerk Date 8/28/2024 Title puty.Town erk Date 8/28/2024 . °``° RESOLUTION 2024-748 A gar �'�°`<< � ADOPTED DOC ID: 20519 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-748 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON AUGUST 27,2024: WHEREAS the following groups have supplied the Town of Southold with a refundable Clean- up Deposit fee, for their events and WHEREAS the Southold Town Police Chief, Steve Grattan,has informed the Town Clerk's office that this fee may be refunded,now therefore be it RESOLVED that Town Board of the Town of Southold hereby authorizes a refund be issued in the amount of the deposit made to the following Name Date Received Amount of Deposit Southold Historical Society June 26, 2024 $ 250.00 PO Box 1 Southold,NY 11971 Mattituck-Laurel Historical Society March 18, 2024 $250.00 PO Box 766 Mattituck,NY 11952 East Marion Fire District Dec. 8, 2023 $250.00 PO Box 162 East Marion,NY 11939 Southold Yacht Club May 17, 2024 $750.00 (3 events) PO Box 546 Southold,NY 11971 North Fork Reform Synagogue May 22, 2024 $250.00 c/o Ellen Zimmerman PO Box 105 East Marion,NY 11939 Cutchogue-NS Historical Council May 10, 2024 $750.00 (3 events) PO Box 714 Cutchogue,NY 11935 Southold Historical Society July 29, 2024 $250.00 PO Box 1 Southold,NY 11971 Resolution 2024-748 Board Meeting of August 27,2024 Denis Nonearrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Greg Doroski, Councilman SECONDER:Brian O. Mealy, Councilman AYES: Doroski,Mealy, Smith,Krupski Jr, Doherty, Evans Updated: 8/26/2024 9:52 AM by Sabrina Born Page 2 le- 3 0-PP1 l cO, TC Checklist for Parade/5K*/Bicycle*/Town Property/Road l Closure Special Events Applications Name of Organization: Name of Event: Cr i J Date(s) of Event: a5 8f3A a� *No 5K and Bicycle events during the period of June 1 to November 1* Event fee check(or request to be waived) 2 'V Road clean-up check (CANNOT BE WAIVED) X J Current Insurance certificate Application sent for approvals to the following Depts.: PD LHwy V Land Pres. V TA Records Mngmnt/TC fApproval from Chief of Police V Cost Analysis from Chief of Police Approval from Land Preservation \ / Approval from Highway Dept. Y TB Resolution for approval (once approval and cost analysis comes from Chief of PD) Town Board.Reso. #: 90A" q`►"T Approval letter to Organization's contact person w/copy of TB resolution After Event: Confirmation from Chief of PD to release clean-up fee TB Resolution to refund clean-up fee QqTB Clean-up Reso. #: 6. ,/ Voucher and copy of TB clean-up Reso. to Accounting Dept. Whole application file to Records Management(include copy of voucher& reso.) RESOLUTION 2024-444 ADOPTED DOC ID: 20255 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-444 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MAY 21, 2024: RESOLVED that the Town Board-of the Town of Southold hereby grants permission to the Cutchogue-New.S.uffolk Histor-icahCouncil, for the closure of Case's Lane adjacent to the Village Green, for the 19ummer C cno ert"s von the Cutchogue Village Green, on Thursday, Ffiday­affersafd ul_X2�h, Au tsu 8" and August 22rd-2024,�from 7:00 PM to 8:3.0 PM. ( Rain dates are the dates) with the following provisions: 1. They file with the Town Clerk a Two Million Dollar Certificate of Insurance naming the Town of Southold as an additional insured; 2. Coordinate traffic control upon notification of the adoption of this resolution with Captain Grattan. 3. Comply with Southold Town Special event regulations. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER:Greg Doroski, Councilman AYES: Doroski, Mealy, Smith, Krupski Jr, Evans ABSENT: Jill Doherty - DENIS NONCARROW o� G.y� Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 y = Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O Fax(631)765-6145 MARRIAGE OFFICER O aQ� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER 1 �► www.southoldtownnygov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD May 23, 2024 Mark MacNish PO Box 714 Cutchogue ,NY 11935 Dear Mark, The Southold Town Board at its regular meeting held May 21,2024 granted permission to The Cutchogue New Suffolk Historical Council to hold their Summer concerts on July 251,August 81h and 22", 2024 as applied for.A certified copy of the resolutions are enclosed. An insurance policy naming the Town of Southold as additionally insured has been filed with this office. Please contact Captain Grattan at the Southold Town Police Department as soon as possible to set up traffic control. If you have any further questions, please do not hesitate to contact the Town Clerk's office at(631) 765- 1800. Best o uc with yo r event. inc y, D is Noncarrow Town Clerk Enc. DENIS NONCARROW o� °y� Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 02 Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O •'�� Fax(631)765-6145 MARRIAGE OFFICER �'�� ��'. Tel 1)-765 I-goo. RECORDS MANAGEMENT OFFICER wV .soutav FREEDOM OF INFORMATION OFFICER ,, OFFICE OF THE TOWN CLERK MAY 2024 TOWN OF SOUTHOLD Southold own Clerk APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVLNT Please provide ALL of the information requested below.Incomplete applications WILL NOT be reviewed. Date of Submission AOL&IR, Z� Name of Event 11 • - e P Vl l' 0fc��K-Wv Name of Organization: C V« � N� C j6 6tw�.C�.�l Cd Is this a Not-For-Profit Event? e o Contact's Name: 84*4 - Z Mailing Address: 0•o buy, 71 Contact's Phone Number: &3t- 3'l l- 1 4 Contact's Email Address: _ I l /�Gl U�• C- AM Event Location and Site Diagram: U1� &Xex\, Gt 118�) (Use additional paper if necessary) Event Date(s): d 24) Zth � (Include set up ind shutdovhi times and dates) Nature of Event: �� �G�ff"lL, 0 C(� -e�O �i\AGI AD i'V�3 �I,C� (Please attach a detailed description to thi application) UC Time Period(Hours)of Event: From :U o p oh to VVk J Maximum Number of Expected Attendees: Specify any special requirements(i.e. road closure, police presence): 0I1W,661 !I Va4k Cow 0 CWIA C If a Tent or other temporary structure will be used please contact the Southold Town Building Department at 631-765-1802 Mailing Address to Send Event Permit to: oj WAK / ew W �� Event Fees: , r $250 for events with less than 1000 expected attendees $500 for events with 1000 or more expected attendees Clean-up Fees(Can NOT be waived): , $1,500.00 Clean-up for Bicycle and/or Running Special events(ONLY) 5C $250 or more Clean-up deposit all other events CERTIFICATE OF INSURANCE REQUIRED: Not less than$2,000,000 naming the Town of Southold as an additional insured.G���G'•_ l ***NOTE: PLEASE SEE ATTACHED REVISED, ADOPTED TOWN POLICY*** Additional information and requirements may be required as deemed necessary by the Town Board. Mj,k Aac'k , all Print name of Authorized Person filling out S' $eo e r filling out application application , *Upon the request by applicant,the Town Board may waive in whole or in part any of the application requirements. 2 »c ,tn°fir. hE '• - "'S.w..,,,"'�• is f'fl.EMf925� •� j�C ' � � ,. ' y�,` 1 �;� i �/ � .•t0'� `,\ ,OAS o.� 'i%,� ._-,�•to ors lid.,, / „/�/�y L� �`• S ,ter .• .. (� ''•l �IS. `q�,bb �� TO BEk SFsT 01TF"• y,4N A , � ' y 6 curcira,su� fx�&Cr9rtsky) Z<� C A o 3 n a6 t{aSdinc� � ,fin D roO N J m n Village garage 0 ro otd Mcan ti �y� 5.79.59,SO"`7L Urriagd House i 5"79* alter a7.e9 MAP OF LAND,: _ '• 19"a9?c Y " MADE t=0i2 - �,Horton - INDEPENDENT CONGP . GAT(.O,NAL CHU2CH & SQCIETY .0P- ,GUTCHQ: UF_' AT n ry- , pULEA..EAsr. op• GA SE 5 LANE: !,.},!}J:AG } S CA L E= SO'=!" to monomthf k' �, ,•,, h . ,i ;� �: :5uollt CAttri}q TqK Parc�lS. .loao ! i:Ly'j 'i Z. �44�+�'draiw,eS`. : 'Aib dYi�'• '(.gfi�. �retni�es ,aNe iri SuiEdirtr� `tone 'fi'.` VAN CUTCNEW-01 MEICHLER ACORDR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 5/2/2024 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 MP CT End Insurance Agency PHO NE FAX P.O.Box 1406 A/C,No,Ext:(631)765-3811 A/C,No:(631)765-3846 Southold,NY 11971 E-MAIL ADDRESS, INSURERS AFFORDING COVERAGE NAIC# INSURER A:MARKEL INSURANCE COMPANY INSURED INSURER B: Cutchogue New Suffolk Historical Council&Old House INSURER C: Society P.O.BOX 714 INSURER D: Cutchogue,NY 11935 INSURERE: 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 ADSD SUER POLICY NUMBER POD(DY EFF POLNYYYI ICY EXPLTR ffYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FA]OCCUR X MKP0000501393000 5/1/2024 5/1/2025 DAMAGE TO RENTED $ 100,000 i 5,000 MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F7 JEC LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: HIRED NON OWN A 11000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ A rX UMBRELLA LIAB X OCCUR EACH OCCURRENCE 1,000'O00 EXCESS LIAB CLAIMS-MADE MKX0000501393100 5/1/2024 5/1/2025 AGGREGATE $ DED I X I RETENTION$ 10,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/NSTATUTE ANY PROPRIETOR/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 E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured for all events held by the named insured during the policy term per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Po Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION'. All rights reserved. The ACORD name and logo are registered marks of ACORD b Thi series is bein + held in the style of our past / Memorial and Douglas Moore concerts on the Green. Bring a picnic & a chair, relax & enjoy. A_e. n Even�n of Chamber Musics ` AnEenm ofF�CitamberµMus c with the ., with me Sound Symphony Chamber Musicians Sound Symph-ony.Cfiamber+ r ■an Mus1cvans On the North Side of the Garage �`} � } g :<<" On the North Side of the Garage ,. July 25th 7pm-8:15pm (rain date July26th) 1r '";Au ust=2p2nd' 7 m.-gp F .8::15pm� rain�dateAug,rz3ra):w: ; �.• E� Full Orchestral Music! �� v •, with the F Long Island Sound Symphony r r � f` s August 8th 7pm-8:15pm (rain date Aug. 9th) tt �.'✓ya ii. � �� �/ }•^ts, j,_"µ _ r�. `,- --�_ - a tip"`" _=tom�, ./',� ��1�` t �',•=�"� +v +€'>� ;'"may �. =f.-;'e' :t ::r•." �� ~ r •�� ^;� ,.�� x° � a sr.. .;" �.a�,1 f �. .,,w"�yw ..day P' �'9,y}� t�?v'��$"•'.-_{:*� ��.•.,�•�.e� �,� n`<.:.4i,M-• R L' `.fir``�,.s,� ."',,;•'e �`�,=., _>•:=,:.; '_�,,,t '`'ri€�-:',,�'�",?�:.; ��:yam 4v„«°y�:��•:t�:_'.,��, "X x.*.,.t�"+a.��.�v �."'°" r+ � '+'L 9"•'-,?s? �.��. !}� ,yPyrd � �� 'Sa`!�"k' 'fir, �'�"'{ '. 1,y^da,,�"^^" '.dam )'„?• J���'�"f-�G.'',�M�S�`n �+��a. Fa` _ _�.�-i^rea s4" � ,-c�,.�a>- s-�...°'�,'{��t���c ',�S• x - S7.a.,_-sty" �,., �.. �;�", _f .o `^f'-��.�� r'�:ti ���www---~x�ti:iz�s4 a:':�„ '7• ..r,-V""" ';:.+�'�:��',v-S���ryy�`�'•.' .,y `�.�' - ib- a,..�{A{,�. "', - ��� J'.r.r^��,�-�> d.s^8:'3"•' s .y,�.... Jt'��_ R'y�i ,�`}""�r :v-� _ `�'�_�" 4 r^rt` .� .y M.,'. ta;�.,4r';A.'«:+"'x •....�' �ry vrX%". � ;�{^r �yf;. N 1 # ©�®SUFFO�,��, DENIS NONCARROW �� �G Town Hall,53095 Main Road TOWN CLERK p P.O.Box 1179 cri Z Southold,New York-11971 REGISTRAR OF VITAL STATISTICS d Fax(631)765,.6145 MARRIAGE OFFICER 'f' t°• RECORDS MANAGEMENT OFFICER �vj , ��� Telephone oldt -any.gov FREEDOM OF INFORMATION OFFICER www.southoldtow-any.gov ov RECEN ED OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD M AY 1 0 2024 APPLICATION FOR A PERMIT TO HOLD k3cutholld Town Uork SPECIAL E'VI'`NT -- Please provide ALL of the information requested below.Incomplete applications WILL NOT be reviewed. Date of Submission 2j" Name of Event 11 Fla&1 WWL�C•o `T - Name of Organization: ( 1 Is this a Not-For-Profit Event. e Contact's Name: Mailing Address: �•Q • � A t I 1 i Contact's Phone Number: l� �l—;—7-1- Contact's Email Address: L(f)1,• Event Location and Site Diagram: r� W (Use additional paper if necessary) / Event Date(s): A T (, •� (Include set u"""�h�and shutdown tim,ee h and dates) '�5kW- INature of Event: u m RA k` ec, Lk U ?Ubt t& (Please attach a detaile description to this application)Q �Q�Al�tCG\ Time Period(Hours)of Event: From (T." to U ••l�J Maximum Number of Expected Attendees: Specify any special requirements(i.e. road closure, police presence): CVu (1� If a Tent or other temporary structure will be used please contact the Southold Town Building Department at 631-765-1802 Mailing Address to Send Event Permit to: Event Fees: $250 for events with less than 1000 expected attendees $500 for events with 1000 or more expected attendees Clean-up Fees(Can NOT be waived): $1,500.00 Clean-up for Bicycle and/or Running Special events(ONLY) X$250 or more Clean-up deposit all other events CERTIFICATE OF INSURANCE REQUIRED: Not less than$2,000,000 naming the Town of Southold as an additional insured. ***NOTE: PLEASE SEE ATTACHED REVISED, ADOPTED TOWN POLICY*** Additional information and requirements may be required as deemed necessary by the Town Board. vd Print name of Authorized Person filling out S'g a of o ' d erson filling out application application *Upon the request by applicant,the Town Board may waive in whole or in part any of the application requirements. 2 fi++�• �Y I Soo, !u Nam. ! ry( tT a5 7. bb ••",4 •. vn To 66 SBT ORF ,% + � f►_� -il ly_6 6 6. p h iY C ti • • 9 s m � 1`Gtf.YGNa,SUI: �EEff tlSRAC7� �� - ��¢ tt�tA.o•+�� IQ s Village garage ..-•�• -p t� .. �O kOfiftCt7 gar r�lr ' cr ,• S' y y A t Y 1-�7C6%1 - 0 6+ � iya S�9'99• C.JrriagA f House 50"W hq.5 --49' MAP OF,LAND,; MADE Fora' Horton ( INDEPENDENT CONGREGATIONAL CHURCH & SQCI ETY .0E -CUTCN0:6UL AT :AXISA_.££A_ST• OF CASE'S -LAWas 1.4.41, Ar ' 5CALEf 5a.i .5t14C11L CAuAtq ` ax PQx•Cr�1S:.lot7o-i'Oq=•i—i,Z�y. 's.` 1tvFdp drciw.tt'- ,•-^•11{McJt)!t� • (•9fiti�. '• Preftll,Sf83 •af'e irr' Suiitfi9 '�ofse 'Rr. .s, lA 'ftjNfi. S7N �> b CUTCNEW-01 MEICHLER ACORO` CERTIFICATE OF LIABILITY INSURANCE DATE 5/2/2 D/YYYY) /2/2024 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 East End Insurance Agency PHONE FAX P.O.Box 1406 A/C,No,Ext:(631)765-3811 wC,No:(631)765-3846 Southold,NY 11971 E-MAIL INSURERS AFFORDING COVERAGE NAIC# INSURER A:MARKEL INSURANCE COMPANY INSURED INSURER B: Cutchogue New Suffolk Historical Council&Old House INSURER C: Society P.O.Box 714 INSURER D: Cutchogue,NY 11935 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPVTR LIMBS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F_V1 OCCUR X MKPOOOOSO1393000 5/1/2024 5/1/2025 DAMAGE TPREMISESO REN"ccTED"rencel $ 100,000 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 MOTHER: LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY JE0 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 HIRED NON OWN A 11000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident HIRED NON-OWNED PROPERTY AMAGE AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLALIAB M OCCUR EACH OCCURRENQE 11000,000 EXCESS LIAB CLAIMS-MADE MKX0000501393100 5/1/2024 5/1/2025 AGGREGATE $ DED I X I RETENTION$ 10,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ FFICER/MEMBER EXCLUDED? N/A (OMandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured for all events held by the named insured during the policy term per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Po Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Thi series is bein held in the style of our past - Memorial and Douglas Moore concerts on the Green. Bring a picnic & a chair, relax & enjoy. An Evening of Chamber Music �; = An"Ewen�ng�of Chambers Music . s} with the "° ." . , s wAthlthe. Sound Symphony Chamber Musicians SoundSymphony C°hamber°Musicians On the North Side of the Garage = W11 the North Sideof the Garage`` :_ Jul 25th 7 m-8:15 m (rain date July 26th ga 1. i Y p p ) August,22nd7pm $:1:5prn (rain'dateAug.23rd)`� •e - E, Full Orchestral Music! x `v with the Long Island Sound Symphony August 8th 7pm-8:15pm (rain date Aug. 9th) .— ,„ -.t,•y',lw 4.���`xe+ � •'"� �- - s, s -_ ,� •+���,�� `ls •,a I`�� r�Y_ .� - � a �!,' �" Yyv.Q'.• Ate;�, .7w:�,''•t}'t.�"� ^'>�:� %�; 'Y,•,'; ` � ^�9'+.r' . -� a�,� .fir:"`.. I-�ky�t�•n'F .. ��59� h. � ('�e�`�n''Y't.'j,b 4.� �'�`�� -.)4-✓�V��"1, ��}A'S.... �� �""Y'eD: �r��y����"'i s��•fy�J��;* Yi`y'�': G'^�.M„d �� }i.2L,s �$ "°�]i�i?`':P �. k DENIS NONCARROW Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 02 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS .` Fax(631)765-6145 MARRIAGE OFFICER Tele RECORDS MANAGEMENT OFFICER ®•` ��. .southi3v FREEDOM OF INFORMATION OFFICER RE 6-,' L gV DO OFFICE OF THE TOWN CLERK MAY 1 0 2024 TOWN OF SOUTHOLD Southold Town Clara APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVtNT Please provide ALL of the information requested below.Incomplete applications WILL NOT be reviewed. Date of Submission 2024 Name of Event �F (/ Name of Organization: ffP Is this a Not-For-Profit Event. Ye o Contact's Name: Mailing Address: 2. � Contact's Phone Number: 6 Jl 3 L I "I Contact's Email Address: Gr��• Event Location and Site Diagram: l W (Use additional paper if necessary ' L Event Date(s): 6 2 � 4 (Include set ej and shu down time p 3-nd dates) f� (� OWL Nature of Event: r Y w o'ku () -k lv (Please attach a detailed description to this plication)Q 1 L Time Period(Hours)of Event: From -7%V YV�to V 1� Maximum Number of Expected Attendees: a00 L an special requirements(i.e. road closure, police presence): (POW If a Tent or other temporary structure will be used please contact the Southold Town Building Department at 631-765-1802 MailingAddress to Send Event Permit to: ��i��U Event Fees: $250 for events with less than 1000 expected attendees i $500 for events with 1000 or more expected attendees Clean-up Fees(Can NOT be waived): $1,500.00 Clean-up for Bicycle and/or Running Special events(ONLY) �$250 or more Clean-up deposit all other events _CERTIFICATE OF INSURANCE REQUIRE ID: Not less than$2,000,000 naming the Town of Southold as an additional insured. ***NOTE: PLEASE SEE ATTACHED REVISED, ADOPTED TOWN POLICY*** Additional information and requirements may be required as deemed necessary by the Town Board. MW,Mk' Print name of Authorized Person filling out Aigeeo?�Aoriike!PrMn filling out application application *Upon the request by applicant,the Town Board may waive in whole or in part any of the application requirements. 2 1' th dnrs std.� • 'tom . . �• `bb •• v`` To Lad* Swr opF 4t , a R a {Cu f f lfOFiu� �QE$LtE2AZY)f 11d SX.o -A. 5� •oy:z n If a 4 �O Q F ,j�1A L jcoll,ge o a 4 N. �c Ul J m N ;1f � garageCr s C g ��hbb 4 ]a g•9T W/ 5 I so' Carriage House SO- - r - 44 47.s9 MAP OF LAND,. .19-A9'?a ` MADE . Ororz ►..Horton r. , INDEPENDENT CQNG 2.E GATI.Q.N AL CHU12CH &` SOCK��' ' . E -CUAT �'G�I.06uF `,CUTGH6GUG.,N.y' ;. r. X1REA_.BA'ST. OF CA56�6 •LANE': 1.4.41 AG{Z 5CALEf 50'=i" �. m rrionumtnt - � - i.• �i :;' h � ;� `• •,� ,�,u oll� COt1Ht y. -rag Parcels . drdwty t-'Abi ots .2, 49GGt.,,° premises .a>�e ier 8uitdirtc� VAN'done `C'l}�fLi S t�(;�• _ -k' CUTCNEW-01 M ICHLER ACORO` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `-►'' 5/2/2024 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 East End Insurance Agency PHO NE ,FAX P.O.Box 1406 A/c,No,E.t:(631 765-3811 A/c,N,:(631)765-3846 Southold,NY 11971 EDDRLES . INSURERS AFFORDING COVERAGE NAIC# INSURER A:MARKEL INSURANCE COMPANY INSURED INSURERS: Cutchogue New Suffolk Historical Council&Old House INSURER C: Society P.O.Box 714 INSURER D: Cutchogue,NY 11935 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPnIY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR X MKP0000501393000 5/1/2024 5/1/2025 DAMAGETORENTED $ 100,000 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JEC LOC PRODUCTS-COMP/OPAGG $ 2'000,000 OTHER: HIRED NON OWN A 11000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED ' AUTOS ONLY AUTOS BODILY INJURY Per accident HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLALIAB X OCCUR EACH OCCURRENCE 1,000,000 EXCESS LIAB CLAIMS-MADE MKX0000501393100 5/1/2024 5/1/2025 AGGREGATE $ DED X RETENTION$ 10,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/NA LITE OFFICER/MEMBER EXCLUDED?ECUTIVE ❑ 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 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate holder is included as additional insured for all events held by the named insured during the policy term per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Po Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD dORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Thi series is bein held in the style of our past - Memorial and Douglas Moore concerts on the Green. Bring a picnic & a chair, relax & enjoy. �r—^,. �-,:_:- .s:,.j--� t rah":�Tiz ,.�„�," An Evening of Chamber Music g _ An Evening of°Chamber Mus,�c with the with the . Sound Symphony Chamber Musicians S'oundl Symlphon►y Chamber:Music ans On the North Side of the Garage Un the North Side of the Garage July 25th 7pm-8:15pm (rain date July 26th) August,;,2�2nd17pm70.1�5p �.,a(aain�dateAug.23ad) .:_. E Full Orchestral Musk! with thex 'u Long Island Sound Symphony August 8th 7,pm-8:15pm (rain date Aug. 9th) V 4�Ys� " "." "'.q�+ErNz�•.. _ ,J``?.i ems'%~k � �= �� ��'�..,.�;"�"� ,�.:'.:� - _ .s6- J'��6- � -a.:n- � � :7Z'I�.'is .^�",_•:-�k, ..��'�^.�.,,.,��'� x '� < <r _ s..�q`• L •f- I I Iffi-TRUME0 II "IMEWINU Town of Southold Police Department Special Event Cost Analysis Event: Cutchogue New Suffolk Library Summer Concert Series Date(s): July 25,August 8,August 22, September 14, 2024 Location: Village Green, Cutchogue Patrol Allocation`for Event Reg Hours OT Hrs Hrly Wage Total Comments Police Officers - S ecial Patrol Reg Hours OT Hrs Total Comments `CRU W,MMC Oel Patrol. 'K-9 Unit Highway Patrol Marine Units "Traffic Contrl o Reg Hours OT Hrs Hrly Wage Total Comments TC Officer#1 2 $19.11 $38.22 TC Officer#2 2 $19.11 $38.22 TC Officer TC Officer TC Officer Equipment Costs PD Vehicles 1#of vehicles $/hr Total 2 $10.00 $40.00 $40.00 Command Van Marine Patrol Boats Total Department Cost for Each Event = $116.44 /PER EVENT Prepared by Chief M. Flatley 5/14/2024 Page 1 Franke, Diana From: Franke, Diana Sent: Friday, May 10, 2024 3:52 PM To: Blasko, Regina; DeChance, Paul; Flatley, Martin; Goodwin, Dan; Grattan, Steven; McCullough, Lillian; Norklun, Stacey; Orientale, Michael; Spiro, Melissa; Stype, John Cc: Noncarrow, Denis; Sabrina Born (sabrina.born@town.southold.ny.us) Subject: Special Event: Cutchogue New Suffolk Historical Council Attachments: CNSHC-7-25.pdf; CNSHC-8-8.pdf, CNSHC-8-22.pdf, CNSHC-9-14.pdf, CNSHC-Rec.pdf Good Morning, Please see attached the Applications for a Special Event Permits from Cutchgue New Suffolk Ffistorical Cou c eceived on 05/10/2024. Provide approval or disapproval and cost analysis. Thank you so much, CqFrmke Account Clerk Southold Town Clerk's Office (631)765-1800 Ext 1228 1 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/10/24 Receipt#: 327284 Quantity Transactions Reference Subtola 1 Clean-Up Deposit 07/25 $250.00 1 Clean-Up Deposit 08/24 $250.00 1 Clean-Up Deposit 08/22 $250.00 1 Clean-Up Deposit 09/14 $250.00 eoC '-P AI)) Total Paid: $1,000.00 Notes: Payment Type Amount Paid By CK#1704 $250.00 Cutchogue, - New Suffolk Historical Coun CK#1705 $250.00 Cutchogue, - New Suffolk Historical Coun CK#1706 $250.00 Cutchogue, - New Suffolk Historical Coun CK#1707 $250.00 Cutchogue, - New Suffolk Historical Coun Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Cutchogue, - New Suffolk Historical Council P O Box 714 Cutchogue, NY 11935 Clerk ID: DIANAF Internal ID:09/14 Franke, Diana From: McCullough, Lillian Sent: Thursday, May 16, 2024 8:59 AM To: Franke, Diana Subject: RE: Special Event: Cutchogue New Suffolk Historical Council Hi Diana, No comments from me, as these events are not taking place on preserved land. Cheers, Lilly From: Franke, Diana <dianaf@town.southold.ny.us> Sent: Friday, May 10, 2024 3:52 PM To: Blasko, Regina <rblasko@town.southold.ny.us>; DeChance, Paul <pauld@southoldtownny.gov>; Flatley, Martin <mflatley@town.southold.ny.us>; Goodwin, Dan <dang@southoldtownny.gov>; Grattan, Steven <sgrattan@southoldtownny.gov>; McCullough, Lillian<lillianm@southoldtownny.gov>; Norklun,Stacey <Stacey.Norklun@town.southold.ny.us>; Crientale, Michael<michaelo@southoldtownny.gov>; Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Stype,John <johnst@southoldtownny.gov> Cc: Noncarrow, Denis<denisn@southoldtownny.gov>; Born, Sabrina <sabrina.born @town.southo Id.ny.us> Subject:Special Event: Cutchogue New Suffolk Historical Council Good Morning, Please see attached the Applications for a Special Event Permits from Cutchgue New Suffolk Historical Council received on 05/10/2024. Provide approval or disapproval and cost analysis. Thank you so much, °alQW&r"yfe Account Clerk Soutliold Town Clerk's Office (631)765-1800 Ext 1228 1