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HomeMy WebLinkAboutSouthold Historical Museum - Candle Light Tour/ Tree Lighting TC Checklist for Parade/5KY/Bicyc1ex/Town Property/Road Closure Special Events Applications Name of Organization: 8mt[Iffid , I,StQrj r AW-0-ft Name of Event: 010hj�jt Lj? 3 Date(s) of Event: /l o� �! - ht �j9 *No SK and Bicycle events durinIZ the period of June 1 to November 1* r Event fee check(or request to be waived) 1� Road clean-up check (CANNOT BE WAIVED) Current Insurance certificate Application sent for approvals to the following Depts.: JPD Hwy Land Pres. TA Records Mngmnt/TC JApproval from Chief of Police Cost Analysis from Chief of Police Approval from Land Preservation Approval from Highway Dept. JTB Resolution for approval (once approval and cost analysis comes from Chief of PD) Town Board Reso. #: �60 00 y 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 TB Clean-up Reso. Voucher and copy of TB clean-up Reso. to Accounting Dept. Whole application file to Records Management (include copy of voucher& reso.) .�-Y pww7T DENIS NONCARROW Town Hall,53095 Main Road TOWN CLERK '- P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS , Fax(631)765-6145 MARRIAGE OFFICER ' '@�> �! Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER 'FREEDOM OF INFORMATION OFFICER 8`a ??ldtow=ygoa �1 OFFICE OF THE=TOWN CLERK TOWN OF SOUTAOLD Age f .., .. APPLICATION FOR ATERIKIT TO HOLD ``---._r_ OCr � _ SPECIAL E'V64 Please nr6,6 ALL::of fhe ini'ormati6 rect�'esfed bd6*..Incomnlete a0011csi#ioris,W1LL taOT'l;e reviewed. Date of Submission Name of Event y .. 1 Name of Organization: .1. 'f'�'11� ''."' �vl .. .. Is this a Not-Far-Profit Event? es o ii,,�� Contact's Name: .�I�DI �'�.l'V� 'p. l�''�.<.O ..... Mailing Address �.�Lal Contact's Phone Number: , Contact's:Email Address: Event Location and Site Diagram: . (Use additional paper if necessary) Event Date(s): :... ..r.1 I 2qM ..... _._....... (Include set u and shutdown times and dates) _ Nature of Event:.. .. (Please attach a detaile(Ydescription to this application) Time Period(Hours)of Event: From to Maximum Number of Expected Attendees: 1621). _��- C Specify any special requirements(i.e. road closure,polico presence): • T 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: 0-V biv.V,�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(ONI1� 15250 or more Clean-up deposit all other events CERT1F1CATE.:OFIN'S JRANCE REOWk0 Not less than$2,000,000 naming the Town-of Southold as an additional insured. ***NOTE: PLEASE SEE AT'x'ACI ED RE'V_ISED,:�AID:OP7CED...'PO.WN, POLICX*** Additional information and requirements may be required as deemed necessary by the Town Board,, 1 �, Print name of Authorized Person filling out igriature of Authorized Person 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 o�THO d 54325 Main Road PO Box 1 ;N" Southold,NY 11971 631.765.5500 a ogo �W info@southoldhistorical.org O� www.southoldhistorical.org "PROMOTING INTEREST IN AND EDUCATION ABOUT THE HISTORY OF SOUTHOLD" August 23, 2024 John Barnes President Caroline MacArthur Denis Noncarrow 1st Vice President Town Clerk Elizabeth Shanks Town of Southold 2nd Vice President PO Box 1179 Jay Cardwell Southold, NY 11971 Treasurer Paul Edelson Dear Denis, Assistant Treasurer Margaret Hollowell Secretary I am writing to request a waiver for the $250 special events fee for the Annual Candlelight Tour and Tree Lighting which is scheduled to be held on the Wiliam Carey Museum's Maple Lane Complex on November 29, 2024. This educational event is Mary Korpi free and open to the public and has been a Southold tradition for many years. Janet Larsen Rosemary McKinley Barbara Poliwoda We would be extremely grateful if the Town would consider waiving the fee. Joel Reitman Thank you for any assistance you can give us in this matter. Larry Rubin Marie Scalia Mickey St John Sincerely, Trustees Deanna Witte-Walker J&�M�L Executive Director Deanna Witte-Walker Amy E. Folk Manager of Collections Executive Director Marie Thompson Office Administrator Susan Ewing Office Assistant Kristen Matejka Marketing Liaison Ed Forte Bookkeeper �0 T 110 54325 Main Road PO Box 1 Southold,NY 11971 1111 631.765.5500 �1 ogo W info@southoldhistorical.org O www.southoldhistorical.org "PROMOTING INTEREST IN AND EDUCATION ABOUT THE HISTORY OF SOUTHOLD" John Barnes August 23, 2024 President Caroline MacArthur 1st Vice President Denis Noncarrow Elizabeth Shanks Town Clerk 2nd Vice President Town of Southold Jay Cardwell Treasurer p0 Box 1179 Paul Edelson Southold, NY 11971 Assistant Treasurer Margaret Hollowell Dear Denis, Secretary We have provided the Town with a copy of our General Liability Insurance William Carey with the Town of Southold listed as an additional insured. Mary Korpi Janet Larsen We are a small Not-for-Profit agency, and it would be a financial hardship to Rosemary McKinley Barbara Poliwoda carry the required amount. We presently carry$1,000,000.00 coverage. We are Joel Reitman requesting a waiver for the $2,000,000.00 requirement. Larry Rubin Marie Scalia Mickey St John To the extent permitted by law, we shall indemnify and hold harmless the Trustees County of Suffolk,their consultant (if any), employees, agents and other persons Deanna Witte-Walker from and against all claims, costs,judgments, liens, encumbrances and expenses, Executive Director including attorneys'fees, arising out of the acts or omissions or negligence of Amy E. Folk this organization, its officers, agents, servants or employees in connection with Manager of Collections the services provided under this agreement. Marie Thompson Office Administrator Thank you for any assistance you can give us in this matter. Susan Ewing Office Assistant Sincerely, n Kristen Matejka Marketing Liaison Ed Forte Bookkeeper Deanna Witte-Walker Executive Director AC RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) F04/05/2024 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 CERTIFICATEREPRESENTATIVE OR PRODUCER,AND THE 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 o not confer riahts to thecertificate holder in lieuf such endg sement(s). PRODUCER ° E: TACT NAME: EVENTS&ATTRACTIONS rMuNr FAX K&K INSURANCE GROUP, INC. A/C No Ext: 800-553-8368 A/C No: 260-459-5624 P.O.BOX 2338 , FORT WAYNE,IN 46801 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: MARKEL AMERICAN INSURANCE COMPANY INSURED INSURER B: MARKEL INSURANCE COMPANY 38970 SOUTHOLD HISTORICAL SOCIETY, INC. INSURERC: 54325 MAIN ROAD PO BOX 1 SOUTHOLD,NY 11971 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: C164230 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 POLICY EXP LIMITS LTR INSD WVD MM/DD MM/DD/YYYY B X COMMERCIAL GENERAL LIABILITY X MKP0000501340000 3/5/2024 3/5/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR 12:01 AM 12:01 AM DAMAGE ToPREMISES Ea Occurrence $300,000 X NONOWNED/HIRED AUTO MED EXP(Any one person) EXCLUDED PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 M'OTHER: LAGGREGATELIMITAPPLIESPER: PRODUCTS—COMP/OPAGG $5,000,000 POLICY ElPROJECT LOC BODILY INJURY TO PARTICIPANTS PROFESSIONAL LIABILITY AUTOMOBILE LIABILITY COMBINED LIMITSINGLE Ea accident ANY AUTO BODILY INJURY(Per person) OWNED SCHEDULED AUTOS BODILY INJURY Per accident AUTOS ONLY ( ) HIRED NON-OWNED PROPERTY uA9AnE__ AUTOS ONLY AUTOS ONLY Per accident A UMBRELLA LIAB X OCCUR X MKX0000501340100 3/5/2024 3/5/2025 EACH OCCURRENCE $1,000,000 X EXCESS LIAB CLAIMS-MADE 12:01 AM 12:01 AM AGGREGATE $1,000,000 11 DED RETENTION WORKERS PEN N AND EMPLOYERS'LIABILITY N/A STATUTE OTHER ANY EXECUTIVE FFICE ARTNER/ Y/N E.L.EACH ACCIDENT F�(ECUTNE OFFICER/MEMBER EXCLUDED?(Mandatory In NH) If yes,describe under El E.L.DISEASE—EA EMPLOYEE DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT PARTICIPANT ACCIDENT AD&D Primary Medical Excess Medical Weekly Indemnity DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER IS ADDED AS ADDITIONAL INSURED,BUT ONLY FOR LIABILITY CAUSED IN WHOLE,OR IN PART,BY THE ACTS OR OMISSIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MAIN STREET EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH SOUTHOLD,NY 11971 THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD tV Q VCR •0 . . v`i SURVEY OF PROPERTY �j a t SO UTHOLD O�YA5 � TO WAT OF SOUTHOLD SUFFOLK COUNTY N. Y. 1000-62-02-5.12 25) o SCALE: 1`40' - Vy ° TE R UTE oN+°y,°,�„'°� FEB. 17, 2016 (L.Urr Yogi( 764 30 0.1 ROAD MRIN �.no7 Al At�m 70g5° J t300 �StpRICA L wdjO 4 0 75 a ., yy us11�'SoulNolsppc 4g.� .gp.EPAROE -N C0.- 0p-602p PO 4' q -t 0. yo•r° �- rnN ss 5.0 73'0 117'17 0 W n`` w ll N/°Kest" u To �_�w r✓.9a '�° W Oro 75 p0 r1' �7� �\ ___ 4`—@a•_-j sT6b�.28�W �o YY 58720'40"W N/O�pS p�i OHON P�ONtY USE BAST GAR,M OIAST 0_PIPE PARCEL AREAS ■-NONUACWT A' = 30.201 sq.1k 0-NT/UTT POLE B-1" = 8,035 sq.ft. B-2" = 17,428 sq.fk "C" = 13,739 sq.fk AN AETERAPON OR AODIRON TO 71OS SURVEY IS A WO ARON D = 43,14 s .fk N.Y.S.L!G NO.49618 OF EPr AS PER SW7209O THE New YW 57ATE E2 ALL NEAR. q P£CONIC SURVEYORS P.G HEREON A R PER SECRON HIS A UB AND ON 2 ALL MOF OCARMIS "E" = 14,114 Sq.fk SAM M ARE vctm s THIS E AND c0°rM UIOF U SUR IF (631)765-5020 FAX(631)765-1797 WO NAP OR RE A PEAR THE DIPRESSED sEAe T1Q sraWrar TOTAL AREA=126,740 SQ. FT. P.O.eox 909 IMOSE ACNAIURE APPEARS HEREON. 1250 OR 2.910 ACRES SGUoulHOLTRAVELER S1o.N.Y. n971s71 15-206 Noncarrow, Denis To: Special Events PD Cc: Schlachter, Amy(amys@southoldtownny.gov);Johnson, Benjamin Subject: Southold Historical Event. 11/29/2024 Attachments: Cande light tour_20240828110816.pdf Please see event attached and comment. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisn@southoldtownny.gov 631-765-1800 CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. 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: 08/28/24 Receipt#: 334556 Quantity Transactions Reference Subtotal 1 Clean-Up Deposit 11.29.2024 $250.00 Total Paid: $250.00 Notes: I Payment Type Amount Paid By CK#7184 $250.00 Southold Historical Society Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 1 Y Name: Southold Historical Society Pob 1 Southold, NY 11971 Clerk ID: DENISN Internal ID: 11.29.2024 Noncarrow, Denis To: info@southoldhistorical.org Cc: Sabrina Born (sabrina.born@town.southold.ny.us); Mudd,Jennifer;Johnson, Benjamin Subject: Candlelight tour event Hi Deanna We need some additional items as listed here. The hold harmless they included refers to the County of Suffolk,not the Town of Southold. The certificate of insurance should read that the certificate holder is added as an additional insured. Please inform the applicant that the qualifying statement regarding liability should be removed and have their representative sign the Southold Town Hold Harmless form. Any questions give us a call. Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownnv.gov denisn @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 Noncarrow, Denis From: Grattan, Steven Sent: Thursday,August 29, 2024 8:31 AM To: Noncarrow, Denis Subject: RE: Southold Historical Event. 11/29/2024 No objections to this event. From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent:Wednesday,August 28, 202411:04 AM To: Blasko, Regina <rblasko@town.southold.ny.us>; DeChance, Paul<pauld@southoldtownny.gov>; Goodwin, Dan <dang@southoldtownny.gov>;Grattan,Steven<sgrattan@southoldtownny.gov>; Mudd,Jennifer <jennifer.mudd@town.southold.ny.us>; Noncarrow, Denis<denisn@southoldtownny.gov>; Norklun,Stacey <Stacey.Norklun@town.southold.ny.us>; Orientale, Michael<michaelo@southoldtownny.gov>; Born, Sabrina <sabrina.born@town.southold.ny.us> Cc:Schlachter,Amy<amys@southoldtownny.gov>;Johnson, Benjamin<benjaminj@southoldtownny.gov> Subject:Southold Historical Event. 11/29/2024 Please see event attached and comment. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisn@southoldtownny.gov 631-765-1800 CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. 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. Noncarrow, Denis From: d.walker@southoldhistorical.org Sent: Thursday,August 29, 2024 8:46 AM To: Noncarrow, Denis; info@southoldhistorical.org Cc: Born, Sabrina; Mudd,Jennifer;Johnson, Benjamin Subject: RE: Candlelight tour event Attachments: TOWN OF SOUTHOLD.pdf Here you go.Sorry about that—I must have placed the wrong one in the pile. Many thanks, Deanna Deanna Witte-Walker Executive Director Southold Historical Museum 631.765.5500 ext 3 www.southoldhistorical.ors Follow us on Facebook Instaeram Pinterest YouTube Named Dan's Best of the Best: -North Fork Museum,Southold Historical Museum -North Fork Family Attraction, Nautical Museum at Horton Point Lighthouse -North Fork Thrift Shop,Treasure Exchange From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent:Wednesday,August 28, 2024 12:04 PM To: 'info@southoldhistorical.org'<info@southoldhistorical.org> Cc: Born,Sabrina<sabrina.born@town.southold.ny.us>; Mudd,Jennifer<jennifer.mudd@town.southold.ny.us>; Johnson, Benjamin<benjaminj@southoldtownny.gov> Subject:Candlelight tour event Hi Deanna We need some additional items as listed here. The hold harmless they included refers to the County of Suffolk, not the Town of Southold. The certificate of insurance should read that the certificate holder is added as an additional insured. Please inform the applicant that the qualifying statement regarding liability should be removed and have their representative sign the Southold Town Hold Harmless form. Any questions give us a call. Denis Noncarrow Southold Town Clerk. Town of Southold, New York 1 www.southoldtownny.aov denisn@southoldtownnv.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. 2 A� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYY`() 04/05/2024 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 s o confer ri s hecertificate holder in lieu of such end se e s PRODUCER NAME:N EVENTS&ATTRACTIONS NAME: K&K INSURANCE GROUP,INC. NC No Eli).. 800-553-8368 FAX No: 260-459-5624 P.O.BOX 2338 . A FORT WAYNE,IN 46801 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: MARKELAMERICAN INSURANCE COMPANY INSURED INSURER B: MARKEL INSURANCE COMPANY 38970 SOUTHOLD HISTORICAL SOCIETY,INC. INSURER C: 54325 MAIN ROAD PO PDX 1 INSURERD: SOUTHOLD,NY 11971 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: C164230 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 EXP LIMITS LTR INSD WVD MMIDD MM/DD/YYYY B X COMMERCIAL GENERAL LIABILITY X MKP0000501340000 3/5/2024 3/5/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE�OCCUR 12:01 AM 12:01 AM DAM A E To RENTED $300,000 PREMISES Ea Occurrence X NONOWNED/HIRED AUTO MED EXP(Any one person) EXCLUDED PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMP/OP AGG $5,000,000 POLICY ❑PROJECT LOC BODILY INJURY TO PARTICIPANTS OTHER: PROFESSIONAL LIABILITY AUTOMOBILE LIABILITY COMBINED S NGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) OWNED SCHEDULED AUTOS BODILY INJURY Per accident AUTOS ONLY ( ) HIRED NON-OWNED PROPER'—"DAMAGE AUTOS ONLY AUTOS ONLY Per accident A UMBRELLA LIAB X OCCUR X MKX0000501340100 3/5/2024 3/5/2025 EACH OCCURRENCE $1,000,000 X EXCESS LIAB CLAIMS-MADE 12:01 AM 12:01 AM AGGREGATE $1,000,000 DED RETENTION WORKERS COMPE SA ON NIA PER OTHER AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETORIPARTNERI YIN E.L.EACH ACCIDENT EXECUTIVE OFFICER/MEMBER EXCLUDED?(Mandatory in NH) If yes,descr be under E.L.DISEASE—EA EMPLOYEE DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT PARTICIPANT ACCIDENT AD&D Primary Medical Excess Medical Weekly Indemnity DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER IS ADDED AS ADDITIONAL INSURED,BUT ONLY FOR LIABILITY CAUSED IN WHOLE,OR IN PART,BY THE ACTS OR OMISSIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MAIN STREET EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH SOUTHOLD,NY 11971 THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Noncarrow, Denis From: Noncarrow, Denis Sent: Tuesday, September 3, 2024 12:38 PM To: info@southoldhistorical.org Cc: Mudd,Jennifer, Born, Sabrina;Johnson, Benjamin; Norklun, Stacey Subject: Emailing: hold harmless Attachments: hold harmless.pdf HI Deanna I may have missed it but can you send me this hold harmless signed. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisn@southoldtownny.gov 631-765-1800 CONFIDENTIALITY NOTICE:This communication with its contents may contain confidential and/or legally privileged information. 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. Your message is ready to be sent with the following file or link attachments: hold harmless 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. � 1 IESS AGREEIvIE _ :HOD.,HARIvI_ r To of d�h�1d�lfiarmless:ttie:T e< ecial:Peiiiiiti.sKal'l ct'eeil indemnify;anw - 'u a l ca it of lu PP.. .�° z "s`ntati'�es from=A id a`"ainst an. ,srid all- _."'ages, Soutloli;ifs>offieeisem to ees-.andiepre a Y' p__ .Y•. _>.�- ..�.: .,,gam,:. -7j' ny .n "di clu'e •:in -- e s''f'tt`in g o'a 0 of l' ii 'tel't - 'es�R� nclu`dn':'but_Yn Y-liatili_ 'uci� �`eits��losses;.aiid'expens - - ,. t- .. am Or "e fr's"'cl%an -whi ana"e to r =a. ersozis anaPa p, Y -dam es;arisin���froniri'uries ordeat`li•�of _ .g.-� -_P.µ•. -. - _ _ = n` aie�~�t � ,. m ` cu t>,- fdn /_ o r`r wit ti e <igen:r . - $: ti-, -is`- - I f th _ lo` s: , - - :ern for is a nd - ervan -. - �s .Y a� `nts P. i. '-:iiiiier=tlus==A` �ement` cl�tlat�of._ -g.. ��.:.: . : - _ �.orriiss ans _ gre.�., _ �._ �1?I?.� _ - = _ - _.. _ ' - r - �y •S _ _ `.tlll =�� d`v u al`ex cutin=� �=� -:tfie .�e�<resetative,ca aci - �rA 'eement:=`i5-Hein' _execute��ui:a=r ,.�•-`- ,s�t - - `v`.i mil.. r e tlo z u�sybeezi�`a`a`one h's�>acti Presenfs=that:tlu "•eeinerit liereti�.�:ze` �._ _ v • ated -• ..'.. ._.. fin" � .,. _ _ .. - ' , h- u _,-L S~� - v , , �r- _. - _ a _a _ •h „M s e. n _ jw - < _or xia 4^tt$;^ ;fief - =Sworo.to. - a.' - - 4 . tiT Y.t �k. H , •vr£i'i n ..m �a � �x "i �f�M. •b c. _ y r - r d c' a— _ .-,--'-^.....ra .��,.:y.. -c-..«,:..�,.....Y ..ti•ct„ J. - -. -ate_'���-, �S- _ - _ Q�Og�FFO(��0 DENIS NONCARROW o~� G.f� Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 y Z 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 `1► www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Deanna Witte-Walker September 11,2024 Southold Historical Museum P.O.Box 1 Southold,NY 11971 Dear Deanna, The Southold Town Board at its regular meeting held September loth,2024 granted permission to The Southold Historical Museum to hold their Candlelight Tour on November 29th,2024 as applied for. A certified copy of the resolution is 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 of ck ith yo r event. crel , D is N ro Town Clerk Enc. RESOLUTION 2024-800 �..G,. ADOPTED DOC ID: 20611 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-800 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON SEPTEMBER 10,2024: RESOLVED that the Town Board of the Town of Southold hereby grants permission to the Southold Historical Society, 54325 Main Road, Southold,New York to holds its Candle light tour, Friday,November 29th, 2024, from 3:OOPM to 6:00 PM. Applicant must coordinate traffic control with Chief Grattan upon notification of the adoption of this resolution. Clean up deposit will be returned after approval from the Chief. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Brian O. Mealy, Councilman SECONDER:Anne H. Smith, Councilwoman AYES: Doroski, Mealy, Smith, Krupski Jr,Doherty, Evans ARESOLUTION 2024-1024 ADOPTED DOC ID: 20869 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-1024 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON DECEMBER 3, 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 Mattituck-Cutchogue Teachers Assoc. October 17, 2024 $1,500.00 c/o Dawn Rowe 2100 Aldrich Lane Laurel,NY 11948 Southold Historical Museum August 28, 2024 $250.00 PO Box 1 Southold,NY 11971 Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Brian O. Mealy, Councilman SECONDER:Anne H. Smith, Councilwoman AYES: Doroski, Mealy, Smith, Krupski Jr, Doherty, Evans ..................:. Vendor No. CheckINo.° :<>:>> ....................................................................... ....................................................................... Southold, N Tow 1 New Yor k - Payment Voucher n _ ...- _. Vendor Name Vendor Address Entered by . .................................................... Southold Historical Museum PO Box 1 Atidtt:Date::::;:::;;::.:;::,;......; ;; >_::>:: ................:.......................................:. ...... ...................................................................... Vendor Telephone Number Southold NY 11971 ': ci ' > > 631-765 5500Town.. ...zk.......................................:....... Vendor Contact Deanna itte I-Wa W" ker Invoice Invoice Invoice Net Purchase Order Date Total Discount Amount Claim Number Description of Goods or Services GeneiaF I eil`er Eiriil and 7lceoun[Numbe=; Number P &..............................._... 25 20241024 12/3/2024 $250.00 $ 0.00 Candle Light Tour& Tree Lighting(11/29/2024) ` �3. .....................:.:.:.::.... =TOTAL: 250 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. SignatureJGwu�. Title_Deputy Town Clerk Signature Compannnyy'N'a'me�d7 Date 12/4/2024 Title Date 12/4/2024