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HomeMy WebLinkAboutSouthold Town Democratic Committee 2024-41 RESOLVED that the Town Board of the Town of Southold hereby grants permission to the Southold Town Democratic Committee, to hold Special Event 2024-41 at Meadowlark Macari Vineyards, 24385 Main Rd., Cutchogue,New York as applied for in Application MV4a for a Vote Raiser event on Sunday, September 15th, 2024 from 3PM to 5PM,Providing: 1. All parking of vehicles for this event must be as shown on the plan submitted with the special event application. 2. No parking can be on land where development rights have been sold to the Town. Provided they adhere to ALL conditions on the application, permit and to the Town of Southold Policy for Special Events. This permit is subject to revocation if the applicant fails to comply with any of the conditions of the approval or is unable to properly control traffic flow into and out of the event. Kc� x P--,*b Southold Town Clerk -- - - -- - TOWN OF SOUTHOLD — -- - Town-Code Chapter 205 "Public Entertainment and Special Events" SPECIAL EVENT PERMIT INSTRUCTIONS AND APPLICATION FORM Applications for a Special Event Permit are subject to an inter-departmental coordinated review by the Southold Town Board,Town Attorney,Town Assessors, Land Preservation, Building, Planning,Zoning Board of Appeals and Police Departments, and the Suffolk County Planning Commission.- Application fee: $150.00 per application — up to six (6) multiple events of the same type 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$250.00 by the Office of the Town Clerk, unless a waiver is obtained. Requesting an expedited review must be submitted in writing to the Town Clerk.The Town Clerk will forward all applications to the Special Events Committee for processing: The Committee will-obtain comments on all applications from relevant Town, County and/or State agencies and will forward completed applications to the Town Board with a recommendation as to whether to grant or deny the application. The'Town reserves the right to request additional information from an applicant to address issues related to the health, safety,and welfare of the community. D When is a Permit Required? All Special Events, per Southold Town Code Article I, Section 205-2(Definitions)must obtain a permit. Occasional events on private residential properties hosted by the owner thereof that are by invitation such as,family gatherings, weddings, graduations, parties or not-for-profit fundraisers do not require permits. Any use of residential property for profit, such as a venue for weddings or other events is prohibited. This application is deemed complete once all the following requirements are submitted to the Town Clerk: Please indicate submission of the following by checking off the boxes and signing below. ❑ A completed application form signed by the owner and the event manager.- Applications without property owner's signature/approval will be rejected. ❑ FEE: Is the application being submitted at least 60 days before the event [ ] Yes [ ]No ❑ If Yes, Fee of$ has been submitted ❑ If No, Fee of$ has been submitted Updated 8/7/201'8 i The app it cant/owner of the property where the special event is proposed to take-place must provide a cArtifioM,,f insurance not less than 2 million dollars naming the Town of Southold as an additional insured A Parking/Event Plan: consisting of a survey, site plan and/or aerial view of the subject property that t includes the locations of on-site parking, sanitary facilities, and tents-or other temporary structure(s). (See application form for details) - — - --a-Events-for three hundred (300) or more people require-submission-and-approval of a traffic control - -- plan acceptable to the Town of Southold AND a qualified traffic--controller must be provided at the ---event. (See application form for details) -- -- - ❑ Signature of Property Owner on the application authorizing Code Enforcement Personnel of the Town of Southold to enter the subject premises during the hours of the event to ensure compliance with any -and all special event permit conditions. My signature below affirms that I have submitted all the information required above in connection with my application. D ted I Signature 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_" _ . -❑ The applicant/owner of the property where the special evenf is proposed to take'place'must provide a ��; `} 41•tific f"L f insurance not less than 2 million dollars naming the Town of Southold as an additional insured .;. ❑ A Parking/Event Plan: consisting of a survey, site plan and/or aerial view of the subject property that iriclu8es the locations of on-site parking, sanitary facilities, and tents or other temporary structure(s). (See application form for details) Q-Events for three hundred (300) or more people require submission and approval of a traffic control plan acceptable to the Town of Southold AND a qualified traffic-controller must be provided at the event.(See application form for details) ❑ Signature of Property Owner on the application authorizing Code Enforcement Personnel of the Town of Southold to enter the subject premises during the hours of the event to ensure compliance with any and all special event permit conditions. My signature below affirms that I have submitted all the information required above in connection with my.application. l D ted I Signature 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: S n��01 �M UI2MOC�1� �Irh►i oe, _ Date of Submission a- Name of Event p`MW►J n� ___jam- -- -- — — __ SCTM Ws 1000-Section 4 n C1 . 6 p Block- . V ., a C - Lot(s) . O O 1 _ Dates of Each Event: If Multiple Dates are requested, applicant must give all information for all dates. Nature of Event: g� (Please attach a detailed description of EACH event to this application) Time Period(Hours)of Event: -From M to 5 (P ry) - Town Services requested: ( )Yes IX)No If yes, Describe Police Dept. Highway Dept. Describe Services Maximum Number of Persons Attending At One Time: a 6C) Number of cars expected 1 y Is a Tent or other temporary structure being used? [ ] Yes �A No If yes provide size(s) Will food be served?Llrlql Yes [ ]No If yes provide number and name(s)of food vendor(s) Suffolk County permit#(s) l�0 Will other vendors be on the premises during the event? [ ]Yes [-/No If yes how many? Describe Type of vendor(s) Property Owner(name/address): o4jW1o,/L Contact Person and Contact Tel.# �0. h i - ZOUZ ij e-mail address K0."MLA&&A Event Location: Street-Hamlet Address: c a y S �A y\ SCTM# Will any services be requested [ ]Yes No. If Yes describe Police Highway Other: - -Mailing-Address to Send Event Permit to: c � Tkim'Dcil Ace— - Updated 8/7/2018 r 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 example Google Earth) of the subject property. INDICATE ON THE PLAN ALL of the following information: A parking/event plan showing: (1) The size of the property and its location in relation to-abutting streets or highways. (2) The size and location of any existing building(s)or structure(s)that will be in operation during the course of the event and any proposed building, structure, or signs to be erected temporarily for the event. (3) The location of the stage or tents, if any. (4) The designated areas of use for spectators, exhibitors, vendors,employees and organizers. (5) Location of all entries and exits. (6) The location of all fire extinguishers and other fire safety equipment. (7) The location of all temporary utilities to be installed for the event, if any. (8) The layout of any parking area for automobiles and other vehicles and the means of ingress and egress for such parking areas. The parking spaces must allow for 300 sq.ft. per car. (9) A traffic control plan for vehicles entering and leaving the site for the proposed event. (10) Plan for the use of live outdoor music, loudspeakers and other sounds which will be used, - if any, and the type and location of speakers and other audio equipment. (11) A description of emergency access and facilities related to the event. (12) Provisions to dispose of any garbage,trash, rubbish or other refuse., (13) Location and description of any additional lighting to be utilized in conjunction with the event. (14) Location of sanitary facilities on site. Traffic Control Plan Events for three hundred(300)or more people also require submission and approval of a traffic control plan, acceptable to the Town of Southold,AND a qualified traffic controller must be provided. Please attached a written description and/or notate on the parking event plan the following: 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 ":µ' - Furthermore, I hereby authorize Cole Enforcement Personnel of the Town of Southold to enter the property(luring the hours of the permitted special event to make any and all inspections necessary in connection with this Special Event. Con K-t in tica,__)��, Pnnt name of Owner Jana re of Owner - --•Prin name o Authorized erson/R res ntative Signat re o on d (son/Representative - - - PERMISSION IS HEREBY GRANTED,SUBJECT-TO-T-HE 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 - -Vl/ay. -_ - 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, in rg ess/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 pen-nit 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 _ _.__.._�.,...�,-.-{-.;_ram--.,--- -- ---from the building(s) on the property_, to a public_ way or_re_m_ ote 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 n6iso.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: .Updafed 8/7/2018 _ Event Description A celebration of our southold community and the American right to vote. Neighbors, friends and families will gather and lister-to music by the Mudflats, speeches by Democratic candidates for office and-a tribute to retiring-Assemblymember-Fred Thiele. Light food.will_be served. Cash wine bar. - HOLD HARMLESS AGREEMENT - The applicant yr of this Special Permit shall defend, indemnify and-hold harmless the Town of4thold, its officers, employ_ees_-,_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: thorized Agent _ -On behalf of.. i41r`ooa p binlh MaCXt� �GhnW�� (Name of Business Entity) -Dates of event(s): Sworn to before me this (9 Day of 4= 20 a y. LAUREN M.STANDISH NOTARY PUBLIC,STATE OF NEW YORK Recis,rat d i NO.01ST6164008 Count 0J31itiad in Suffolk County � _ - r - -=',r Expires April 9,20 - - - -' --' ---- ._---_- y--•-=-,l � -_{-.--- --_ - - ---___ ---•-_—Ica=--_.._:_,- --- - I ® DATE(MMIDD/YYYY) ACC)RO CERTIFICATE LIABILITY INSURANCE 09/06/2024 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). CONTACT PRODUCER NAME: Diane Vertucci Newbridge Coverage Corp. A$NECo. 516 781-9000 ac No: 516 781-9172 1666 Newbridge Road E-MAIL Bellmore, NY 11710 ADDRESS: dvertuccl newbrid ecovera e.com INSURERS AFFORDING COVERAGE NAIC if Phone No. 516 781-9000 Fax No. 516 781-9172 INSURERA: AGL-American Guarantee and Liability Insurance Company 26247 INSURED INSURERB: ZAI-Zurich American Insurance Company 16535 Suffolk County Democratic Committee 1461 Lakeland Avenue Ste 3 INSURERC: Bohemia, NY 11716 INSURER D: INSURER E: Phone No. 631 439-0400 Fax No. INSURERF: COVERAGES CERTIFICATE NUMBER:1129435 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 SUER POLICY NUMBER POLICY EFF IYYYY FOLIC EXP LIMITS LTR I D WVD ZAI X COMMERCIAL GENERAL LIABILITY FLM9494426-00 09/15/2024 09/16/2024 EACH OCCURRENCE $ 1,000.000 CLAIMS-MADE �OCCUR X PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREG ATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 X POLICY PRO ❑LOC PRODUCTS-COMP/OP AGG $ 1,000,000 JECT OTHER: COMBI AUTOMOBILE LIABILITY Eaa_Cd.nISINGLELIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED L SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ GL UMBRELLA LIAB X OCCUR SXS7902438-00 09/15/2024 09/16/2024 EACH OCCURRENCE $ 1,000,00 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION STATUTE ERH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N 1 A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E (Mandatory in NH) .L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S ZAI Inland Marine FLM9494426-00 09/15/2024 09/16/2024 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Coverage Location: United States&Canada Event: Community Vote Raiser Macari Vineyards and Winery Ltd.dba Meadowlark North Fork and Town of Southold,53095 Route 25. PO Box 1179 Southold,NY 11971 are named as additional insured 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 Macari Vineyards and Winery Ltd. dba Meadowlark SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 24385 Main Rd ACCORDANCE WITH THE POLICY PROVISIONS. Cutchogue, NY 11935 United States Of America AUTHORIZED REPRESENTATIVE Phone No. 1 Fax No. ©1988-2015 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 09/06/2024 INSURED Suffolk County Democratic Committee The following is attached to and made part of certificate number 1129435. Policy Details Coverage Limit Deductible Inland Marine Company: Zurich American Insurance Company Policy Number: FLM9494426-00 *Period: 09/15/2024-09/16/2024:1 Day(s) Equipment,props,sets,wardrobe(rented) Excluded Equipment,Props,Sets,Wardrobe(owned) Excluded Rented Furs,Jewelry,Art&Antiques Coverage Excluded Extra Expense Excluded Third Party Property Damage 10,000 1,500 Hired/Non-Owned Physical Damage-Aggregate Excluded Hired/Non-Owned Physical Damage-Per Vehicle Excluded Rental Cost Reimbursement Excluded Waiver of Subrogation Excluded Coverage Extension Endorsement Coverage Extension Endorsement Excluded Terrorism Included General Liability Company: Zurich American Insurance Company Policy Number: FLM9494426-00 *Period: 09/15/2024-09/16/2024:1 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 carts& Included waivers) City/Other Special Certificates Excluded Waiver of Subrogation Excluded Host Liquor Excluded Liquor Liability-Aggregate Excluded Liquor Liability-Each Common Cause Limit Excluded Abuse&Molestation-Aggregate Excluded Abuse&Molestation-Each Claim Excluded Participant Legal Liability-Aggregate Limit Excluded Participant Legal Liability-Occurrence Limit-Bodily Injury Excluded Participant Legal Liability-Occurrence Limit-Property Damage Excluded Cross Suits Exclusion See Exclusion Terrorism Included *All coverages expire at 12:01 a.m.Standard Time. APM-CERT-DETAILS 1009 Certificate Number 1129435 Scheduled Events Certificate Number: 1129435 Event Type Venue Dates Attendees Community Vote Raiser Macari Vineyards and Winery Ltd,dba 09/15/2024-09/16/2024 at 12:01 am 10 Participants Political Rallies Meadowlark No 250 Spectators 24385 Main Rd Cutchogue,NY 11935 ABANEV-SCHD(05/06) Page 1 of 1 DATE(MM/DDN1) SCHEDULE OF FORMS 09/06/2024 Insured: Suffolk County Democratic Committee This Schedule of Forms is attached to and made part of certificate number 1129435,as of 09/06/2024 at 11:31 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 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 UABI100ACW 0117 Schedule Of Productions UABI101ACW 0117 Definition Of Employee UAB100ACW 0117 Minimum Earned Premium Endorsement IL0185 0808 New York Changes-Calculation Of Premium IL0003 0908 Calculation of Premium IL1201 1185 Policy Changes-Locations 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 UABM109ACW 0117 Third Party Property Damage Coverage Form UABM103ACW 0117 Loss Payable Endorsement UABM128ACW 0117 Excluded Property Endorsement UABM114ACW 0117 Unscheduled Production,Presentation Or Event Exclusion 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 CG2028 1219 Additional Insured-Lessor of leased equipment 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 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 UABL106ACW 0117 Unscheduled Production,Presentation Or Event Exclusion UABL103ANY 0517 Stunt,Pyrotechnic And Animal Exposure Exclusion-New York UABL148ACW 1019 Liquor Liability Exclusion UABL144ACW 1019 Event Conditional Exclusion CG2132 0509 Communicable Disease Exclusion 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 APA-CERT-FORM LIST 0914 Certificate Number:1129435 Page 1 of 2 DATE(MM/DDNY) SCHEDULE OF FORMS 09/06/2024 Insured: Suffolk County Democratic Committee This Schedule of Forms is attached to and made part of certificate number 1129435,as of 09/06/2024 at 11:31 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 CGO104 1204 New York Changes-Premium Audit IL0268 0114 New York Changes-Cancellation and Nonrenewal CG2621 1091 New York Changes-Transfer of Duties When a Limit of Insurance is Used Up UABL105ANY 0117 Commercial General Liability Changes-New York U-GU p767-BCW _ 0115 w 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 IL1201 1185 Policy Changes-Locations U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism U-SXS-117-BCW 0514 Professional Liability Limitation Endorsement U-EXS-115-CCW 0411 Communicable Disease Exclusion UEXS319CCW 0514 Liquor Law Liability And Alcohol Consumption Health Hazards Exclusion UEXS101 BCW 0411 Abuse Or Molestation Exclusion UEXS107ACW 0499 Athletic Participants 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 09/06/2024 at 11:31 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:1129435 Page 2 of 2 Date(MM/DDIYYYY) Certificate Verification 09/06/2024 Insured: Suffolk County Democratic Committee 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 OLOOOF74H7 o . 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:1129435 Page 1 of 1 PIO- �p;46 -- Ir NI DO R) 95 Irv, i • �" �• S' I if dp if o � l p r MACARI VW YARD&WINERY LTD 2=5 MAIN ROAD CUTC M UIE,N.Y-' j tolltexllv 42 sPo,n G; too_ i { �.■..�s_ .was- � �� ; � _ mum ISS tv, to i k. k rjj I,t 4j6s r+ -- sloop i { r lavom 40010 430im to I � Lor SPOT r i i f ' r i 1 I i ®� 4mmft-mw� snob Ewa M�4w"4=0 0�Wmi fs iiJ s Cobs AOO C ' wmtm tMOAM Gvmw eums agam owwo 4aum- - cw-q�' ema F X'ra 7am .s.:ii..L� ht- q tu Lu leo 40 `tea f; lip: ! Vt � try -N4,IN 1 4, i 3AT'e9 lTr=STORE 2A.386 MAN ROAD � t . . is Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 09/06/24 Receipt#: 334766 Quantity Transactions Reference Subtotal 1 Event Fee MV 4 a $150.00 1 Late Fee MV 4 a LATE $250.00 Total Paid: $400.00 Notes: Payment Type Amount Paid By CK#637 $400.00 Macari, Vineyards Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Macari, Vineyards 150 Bergen Ave Po Box 2 Mattituck, NY 11952 Clerk ID: SABRINA Internal ID:MV 4 a LATE Noncarrow, Denis To: Schroeder, Gwynn Cc: Sabrina Born (sabrina.born@town.southold.ny.us); Mudd,Jennifer; Norklun, Stacey; Franke, Diana;Johnson, Benjamin Subject: MV4a Attachments: Meadowlark_20240906152652.pdf Please see attached special event for 9/15/2024 Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisnCa@southoldtownny.goov 631-765-1800 CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. It is solely for the use of the intended recipient(s). Unauthorized interception, review, use or disclosure is prohibited and may violate applicable laws including the Electronic Communications Privacy Act. If you are not the intended recipient, please contact the sender and destroy all copies of the communication. 1 Noncarrow, Denis From: Noncarrow, Denis Sent: Monday, September 9, 2024 4:31 PM To: Schroeder, Gwynn Cc: Noncarrow, Denis; Rudder, Lynda Subject: Re: Special Event MV$a Thank you On Sep 9, 2024 4:09 PM, "Schroeder, Gwynn" <gwynns@southoldtownny.gov>wrote: Denis, Per our earlier discussion,this to confirm that an approval resolution for tomorrow's agenda as been prepared for the special event at Macari Vineyard on September 15—MV$a. Thank you and have a good evening! Best, Gwynn Schroeder Government Liaison Officer Office of the Supervisor Town of Southold gwynns@southoldtownny.gov 631-765-5806 1 Noncarrow, Denis From: Noncarrow, Denis To: kathcasey@gmail.com Subject: Special Event Attachments: 20617.rtf Hi Kathryn, Here is your Special event resolution as applied for. Thank you have a good week. Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownnv.goov 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. 1