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Home My WebLink AboutOysterponds PTA Halloween Trick or Treating TC Checklist for Parade/5KY/Bicycle*/Town Property/Road C�1� Closure Special Events Applications Name of Organization: 0 ?TH --�-- Name of Event: iGrl'r illy A, (0 rl C- �Date�s)o�veent: *No SK and Bicycle events durinIZ the period of June 1 to November 1Y Event fee check (or request to be waived) V�— Road clean-up check (CANNOT BE WAIVED) IL D4- _Current Insurance certificate�e.•�-� ��` Application sent for approvals to the following Depts.: PD PQ Hwy °�- Land Pres. TA Records Mngmnt/TC Approval from Chief of Police Cost Analysis from Chief of Police Approval from Land Preservation Approval from Highway Dept. TB Resolution for approval (once approval and cost analysis comes from Chief of PD) Town Board Reso. #: qpa4—q07_ Approval letter to Organization's contact person w/copy of TB resolution After Event: v Confirmation from Chief of PD to release clean-up fee TB Resolution to refund clean-up fee TB Clean-up Reso. #: 20 Q Rq0 Voucher and copy of TB clean-up Reso. to Accounting Dept. Whole application file to Records Management (include copy of voucher& reso.) ~ t fi. RR ® Town Hall,53095 Main Road DENIS NONCARROW TOWN CLERK ®; :� '. P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p'° Fax(631)765-6145 MARRIAGE OFFICER -. �� • Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER 1 �+ wwwsoutholdtownnygov FREEDOM OF INFORMATION OFFICER - RECEIVED OFFICE OF THE TOWN CLERK F, TOWN OF SOUTHOLD ou i, APPLICATION FOR A PERMIT TO HOLD A Southold Town Clerk SPECIAL E'VINT PIease prdvide_ALL-df'the information requested be-WW:Incomplete applications:Wff.L NOT be reviewed. j �,�•, n is Date of Submission _ �V V O ;LYL-�- I v i l Name of Event - - •fir. O S �- i� Name of Organization: Is this a Not-For-Profit Event?Yes Contact's Name: kL v�ovn Mailing Address: - � Contact's Phone Number: c rf Contact's Email Address: W��✓� wn ` —- t, Event Location and Site Diagram: U V-AA* (Use additional paper if necessary) f Event Date(s): Say Del+ � �' _�- r►., (Include set up and shutdown and dates) n i Nature of Event: Ai� oo,� d 2 1 o Ys (Please attach a detailed description to this application) Time Period(Hours)of Event: From 5 to Maximum Number of Expected Attendees:- _ a Do f� i Specify any special requirements(i.e.road closure,police presence): V'pc,� C�pSL ✓ 4i - - j uS�2 S -�- crbSS_ n-li _ 'i jc,�U, V i air (CUA, sL I' 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 s Clean-up Fees(Can NOT be waived): $1,500.00 Clean-up for Bicycle and/or Running Special events(ONLY) _Dt�L, $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-. Print name of Authorized Person filling out Sign of Authorized Person fillip o t applicarion application *Upon the request by applicant,the Town Board may waive in whole or in part any of the application requirements. 2 HOLD HARMLESS AGREEMENT The applicant b-,t Skt r 0ayl AS 7-f*l A 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 On behalf of: (Name of Business Entity) Dates of event(s): k c� 2� 2- Sworn to before me this G Day of U C+-, , 20.2�. JENNIFER M MUDD NOTARY PUBLIC,STATE OF NEW YOW Registration No.01 MUS42M Quamed in Suffoik County , Commission Expires February 07#2Q � Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 10/10/24 Receipt#: 335472 Quantity Transactions Reference Subtotal 1 Clean-Up Deposit 10/26/2024 $250.00 Total Paid: $250.00 Notes: Payment Type Amount Paid By CK#8221 $250.00 950 VILLAGE LANE LLC Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Oysterponds, PTA C/O Miriam Foster PO Box 115 Orient, NY 11957 Clerk ID: JENNIFER Internal ID: 10/26/2024 Mudd, Jennifer From: Mudd,Jennifer Sent: Thursday, October 10, 2024 4:10 PM To: Blasko, Regina; Born, Sabrina; Goodwin, Dan; Grattan, Steven; McCullough, Lillian; Mudd,Jennifer; Norklun, Stacey; Orientale, Michael; Stype,John; DeChance, Paul; Johnson, Benjamin; McGivney,Julie; Schlachter,Amy; Squicciarini,James Cc: Noncarrow, Denis Subject: Emailing: Orient Village HalloweenTrick-Or-Treating.pdf Attachments: Orient Village HalloweenTrick-Or-Treating.pdf Importance: High Good Afternoon, Please see attached Special Event Application. Insurance certificate to follow. Thank you, Jen Jennifer M. Mudd Sub-Registrar and Deputy Town Clerk Account Clerk Southold Town Clerk's Office 53095 Route 25 P.O. Box 1179 Southold, NY 11971 Phone: 631-765-1800 ext. 1274 Fax: 631-765-6145 Your message is ready to be sent with the following file or link attachments: Orient Village HalloweenTrick-Or-Treating.pdf Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. i ASSOCIATION INSURANCE MANAGEMENT INC MEMBER CERTIFICATE OF INSURANCE 10/11/2024 Thank you for purchasing your insurance from AIM.This is your Member Certificate and should be kept with your permanent records. Named Insured Member(mailing address): Named Insured&Mailing Address Producer Name 05-532 Oysterponds PTA Education Support Purchasing Group AIM Association Sarah Anglum or Current Officer Insurance c/o AIM Management, Inc. 23405 Main Rd P.O. Box 742946 P.O. Box 742946 Orient,NY 11957 Dallas,TX 75374-2946 Dallas,TX 75374-2946 Named Insured Member(physical address): 23405 Main Rd Insured#: NY1177118 Orient,NY 11957 Coverage Policy# Effective Dates Deductible Limits of Insurance General Liability GL2024AIM10465 $2,000,000 Concert Specialty Insurance Company 07/07/24-07/01/25 $0 Per Occurrence 07/07/24-07/01/25 Damage to Rented $500,000 Premises 07/07/24-07/01/25 Extended Medical $5,000 RECEIVED 07/07/24-07/01/25 $1,000,000 Hired&Non-owned Auto(HNOA) 07/07/24-07/01/25 Personal& $2,000,000 3 Advertising Injury 07/07/24-07/01/25 Abuse& $1,000,000 Southold Town Clerk Molestation General Aggregate $2,000,000 $2,000,000 Products- Comp/Ops Fidelity Bond(Crime) CR2024AIM08178 07/07/24-07/01/25 $250 Per Occurrence/ $50,000 Concert Specialty Insurance Company Aggregate Directors and Officers D02024AIM09167 07/07/24-07/01/25 $0 Per Occurrence/ $1,000,000 Concert Specialty Insurance Company Aggregate Retroactive Date:07/07/2024 Print Date:10/11/2024 Certificate Holder: This member certificate, together with the common policy conditions, Town of Southold coverage part(s), coverage form(s), and endorsements, if any complete the 53095 Main Road above numbered policy. Copies of the Master Policies are available upon Southold, NY 11971 request. AUTHORIZED REPRESENTATIVE Mudd, Jennifer From: Noncarrow, Denis Sent: Friday, October 11, 2024 7:20 AM To: Blasko, Regina; DeChance, Paul; Goodwin, Dan; Grattan, Steven; Mudd,Jennifer; Noncarrow, Denis; Norklun, Stacey; Orientale, Michael; Born, Sabrina Cc: Schlachter, Amy;Johnson, Benjamin Subject: FW: Orient Village Halloween - COI Attachments: Oysterponds PTA- COI Town of Southold.pdf Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownn.y.pov 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. From:Sarah Anglum [mailto:sarahanglum@gmail.com] Sent:Thursday, October 10, 2024 8:28 PM To: Noncarrow, Denis<denisn@southoldtownny.gov> Cc:orientvillagehalloween@gmail.com Subject: Orient Village Halloween -COI Good evening Mr. Noncarrow, Attached is the Oysterponds PTA COI as requested. Please confirm receipt and advise if anything else is needed. Many thanks for your help making this event safer for the kids! Best, Sarah Anglum ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. 1 Mudd, Jennifer From: Grattan, Steven Sent: Friday, October 11, 2024 10:53 AM To: Mudd,Jennifer Subject: RE: Emailing: Orient Village HalloweenTrick-Or-Treating.pdf Hi Jennifer, No objections to this event. Steve Chief Steven Grattan Southold Town Police Department 41405 Route 25 Peconic, NY 11958 (631) 765-2600 Main (631)765-2715 Fax (631)765-2784 Desk CONFIDENTIALITY NOTICE:This electronic mail transmission is intended only for the use of the individual or entity to which it is addressed and may contain confidential information belonging to the sender which is protected by privilege. If you are not the intended recipient,you are hereby notified that any disclosure, copying, distribution,or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this transmission in error, please notify the sender immediately by e-mail and delete the original message. -----Original Message----- From: Mudd,Jennifer<jennifer.mudd@town.southold.ny.us> Sent:Thursday, October 10, 2024 4:10 PM To: Blasko, Regina <rblasko@town.southold.ny.us>; Born,Sabrina <sabrina.born @town.southo Id.ny.us>; Goodwin, Dan <dang@southoldtownny.gov>; Grattan,Steven <sgrattan@southoldtownny.gov>; McCullough, Lillian <lillianm@southoldtownny.gov>; Mudd,Jennifer<jennifer.mudd@town.southold.ny.us>; Norklun,Stacey <Stacey.Norklun@town.southold.ny.us>; Orientale, Michael<michaelo@southoldtownny.gov>;Stype,John <johnst@southoldtownny.gov>; DeChance, Paul <pauld@southoldtownny.gov>;Johnson, Benjamin <benjaminj@southoldtownny.gov>; McGivney,Julie<juliem@southoldtownny.gov>; Schlachter,Amy <amys@southoldtownny.gov>; Squicciarini,James<jacks@southoldtownny.gov> Cc: Noncarrow, Denis<denisn@southoldtownny.gov> Subject: Emailing: Orient Village HalloweenTrick-Or-Treating.pdf Importance: High Good Afternoon, Please see attached Special Event Application. Insurance certificate to follow. Thank you, 1 Jen Jennifer M. Mudd Sub-Registrar and Deputy Town Clerk Account Clerk Southold Town Clerk's Office 53095 Route 25 P.O. Box 1179 Southold, NY 11971 Phone: 631-765-1800 ext. 1274 Fax: 631-765-6145 Your message is ready to be sent with the following file or link attachments: Orient Village HalloweenTrick-Or-Treating.pdf Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 2 Noncarrow, Denis From: Noncarrow, Denis To: orientvillagehalloween@gmail.com Subject: Special Event Resolution Attachments: 20719.txt Good Morning, Please see attached Resolution for your event. Any questions please give us a call. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southold townn y.qov denisn @southoldtownn y.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 ; uouthold Town Board - Letter .... ...Board Meeting.,of October 22, 2024 _. RESOLUTION 2024-907 Item# 5.8 ADOPTED DOC ID: 20719 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-907 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 22,2024: RESOLVED that the Town Board of the Town of Southold hereby grants permission to the Oysterponds PTA to use Village Lane in Orient on Saturday, October 26, 2024 from 5:00 PM- 7:00 PM for Trick-or-Treating,provided they adhere to the Town of Southold Policy for Special Events on Town Properties and Roads, and coordinate traffic control upon notification of the adoption of this resolution with Chief Steven Grattan to the Southold Town Police Department. All Town fees for this event, with the exception of the Clean-up Deposit, are waived. �L ��L.-I I Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Greg Doroski, Councilman SECONDER:Brian O. Mealy, Councilman AYES: Doroski, Mealy, Smith, Krupski Jr, Doherty, Evans Generated October 23, 2024 Page 23 ft RESOLUTION 2024-940 r � ADOPTED DOC ID: 20762 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-940 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NOVEMBER 6,2024: 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 PTA October 17, 2024 $250.00 c/o Kimberly Kraehling 1530 Boisseau Ave. Southold,NY 11971 Oysterponds PTA October 10, 2024 $250.00 c/o Miriam Foster PO Box 115 Orient,NY 11957 Southold School Athletic Assoc. Sept. 20, 2024 $1500.00 c/o Nicole Helf PO Box 470 Southold,NY 11971 Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Greg Doroski, Councilman SECONDER:Brian O. Mealy, Councilman AYES: Doroski, Mealy, Smith, Krupski Jr, Doherty, Evans Vendor No. C1ieCkTo . ..... Town of Southold, New York - Payment Voucher - Vendor Name ._..... .. ...- Vendor Address EhteIEdby`.: ................ ... ` ............ O ster onds PTA ::::.::;::: .:::: ::::::.::: ::::::::::.:. Y P PO Box 115 ::..: �::.:....:.::.:.::•:::::::,:•::::::::::.::_>•::::::::::::: Vendor Telephone Number Orient, NY 11957 631-905-1979 Vendor Contact owiiCleik ',` ; ................ ............... ::::-:::• _............. Miriam Foster Invoice Invoice Invoice Net Purchase Order ..................................................... Number Date Total Discount Amount Claimed Number Description of Goods or Services ::;E:;Generat I ed er Fund'and Actoimt liTuuiher E g.. 2024-940 11/6/2024 $250.00 _ $250.00 Halloween Trick-0r-Treating :::::::::::::::::::::.::::.:.::.:.::.:.:::::::::::i:::::: ::::: ::: (10/26/2024) Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above gamed claimant) I hereby certify that the materials above specified have been received by me does n ify a eby cert that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly o 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. Signatur Title Deputy Town Clerk Signature Comp yName Date 11/7/2024 Title `De u wn Clerk Date 111712024 AFC S S 0 .,.III iP"'4.II 10 N1 I I"q S U 11IR A 114 C f. 1 III 1A L III IF�IVY„t r III II"q c� MEMBER CERTIFICATE OF INSURANCE 10/11/2024 Thank you for purchasing your insurance from AIM.This is your Member Certificate and should be kept with your permanent records. Named Insured Member(mailing address): Named Insured&Mailing Address Producer Name 05-532 Oysterponds PTA Education Support Purchasing Group AIM Association Insurance Sarah Anglum or Current Officer c/o AIM Management, Inc. 23405 Main Rd P.O. Box 742946 P.O. Box 742946 Orient,NY 11957 Dallas,TX 75374-2946 Dallas,TX 75374-2946 Named Insured Member(physical address): 23405 Main Rd Insured#: NY1177118 Orient,NY 11957 Coverage Policy# Effective Dates Deductible Limits of Insurance General Liability GL2024AIM10465 07/07/24-07/01/25 $0 Per Occurrence $2,000,000 Concert Specialty Insurance Company 07/07/24-07/01/25 Damage to Rented $500,000 Premises 07/07/24-07/01/25 Extended Medical $5,000 07/07/24-07/01/25 Hired & Non-owned $1,000,000 Auto(HNOA) 07/07/24-07/01/25 Personal & $2,000,000 Advertising Injury 07/07/24-07/01/25 Abuse& $1,000,000 Molestation General Aggregate $2,000,000 Products- $2,000,000 Comp/Ops Fidelity Bond (Crime) CR2024AIM08178 07/07/24-07/01/25 $250 Per Occurrence/ $50,000 Concert Specialty Insurance Company Aggregate Directors and Officers D02024AIM09167 07/07/24-07/01/25 $0 Per Occurrence/ $1,000,000 Concert Specialty Insurance Company Aggregate Retroactive Date:07/07/2024 Print Date:10/11/2024 Certificate Holder: This member certificate, together with the common policy conditions, coverage part(s), coverage form(s), and endorsements, Town of Southold if any complete the above numbered policy. Copies of the Master 53095 Main Road Policies are available upon request. Southold, NY 11971 AUTHORIZED REPRESENTATIVE " Print Date:10/11/2024