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HomeMy WebLinkAboutEast End Hospice - Tree of Lights I,— TC Checklist for Parade/5K1/Bicycle*/Town Property/Road Closure Special Events Applications r Name of Organization: Eaat ffid Name of Event. Y'' Q �ate(s) of Event: *No 5K and Bicycle events during the period of June 1 to November 1Y / Event fee check(or request to be waived) J Road clean-up check(CANNOT BE WAIVED) Current Insurance certificate Application sent for approvals to the following Depts.: I PD Hwy Land Pres. y TA V✓ 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. #: ;1 -9 Q 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 0 TB Clean-up Reso. #: 2-0,i 1 ! _ Voucher and copy of TB clean-up Reso. to Accounting Dept. Whole application file to Records Management (include copy of voucher& reso.) D..v. .ter i t9f- .,�---�_ - ,. a ... - -•••.•��t��!�,,j+yL�; �.. DENIS,NONCARROW � .� . 'Ibwn Hall,53095'Main Road TOWN CLERK ,_� P.O.Box 1179 j Southold,New York'11971 GISTRAR,OF VITAL STATISTICS Q ® Fax(631)765-6145 'MARRIAGE OFFICER . : . ��� Telephone(631)765-1800 '3ORDS MANAGEMENT OFFICER wwwsoutho 'DOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUT-HOLD OCT 1 7 20�it APPLICATION FOR A PERIYIIT TO HOLD A00-t �0 � �0 � �70C . SPECIAL EV-NT 'lease nrovide•ALL of the-infothiation reauestied'below.Inc4mplefe an lications:WTI;NOT be -evieWed; )ate of Submission OGJobey- 161 " lame of.Event EA5 I -C N D H 05 PI CE -fib-:C OF L 1611TS .M4 M O P Ar,- 1 Cr lame of Organization: I "D- oS fICE Is this a Not-For-Profit Event?Yes/No \I-P ;ontast's Name: _ �U�G"'►IN '�E�/V j���1�( ... . . ... .... .... ... /Iailin Address: �d PDX each' NV i 1`1 ,ontact's Phone Number: ;ontact's Email Address: " )'w�� �- �� •� U ;vent Location and Site:Diagram: V LLAU- CTREN CUTCHOW6 c26800 M A 1 N 12 (Use=additional paper if necessary) ?vent Date(s): s 111 N P R y 1 pe ce 1-yj b e r a (Include:set up and shutdown times and,dates) dature of Event. ' ,ec6 n� of 'n(A rpvS d-�• pq+I e n-b W h0 )ern , (Please attach a detailed description to this application) 'ime:Period(Hours}of Event: From: ' p IY1, to 2aximurn Number of.Expected Attendees:. 35 pecify any special requirements(i.e: road closure, police presence): nG r e LAA re }ne()- 5 If a Tent or other temporary structure will be used please,contact the Southold Town Building DepEdment at 631-765-1802 P Mailing Address to Send"Event Permit to: A) Val e--)thcL rAPAY" lwo'61 1.9 131 Event Fees; .$250,for events with less than 1000 expected attendees $500 for events with 1000 or more expected attendees 7 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 DFINSURANCE Rffli��b:, Not less than,$1,000,000 naming the Town of Swtboldas 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;, AY1 .Print name o"uthorized'l?ers6h filling out Signature of Authorized' ers mg out application application *Upon the request by applicant, 1cant,the Town Board may waive in whole or in part,any of the application requirements. 2 HOLD HARMLESS AGREEMENT The applicant VV 14-1 )[0—vA0 Ian ottof 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,feeg, 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: n Signature: Name: AuthorizedAgent. M 0 P On behalf of.- ApS (Name.of Business Entity) Dates of event(s): )d Sworn to before me this Day of 0 6 20 DEBORAH L.DOYLE NOTARY PUBLIC, WW-!JU'Xr— Myc6mmWlwon E&xp Tres'81. I 5 Client#:3328 EASTEND46 ACORD. CERTIFICATE OF LIABILITY INSU 1016/202 NCE RATE/1612plY4 4 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. IYSUBROGATION IS WAIVED,subject to,the terms and conditions of the policy,certain policies may require an.endorsement.A statement on 'this certificate floes not•confer any"rights to the certificate holder In lieu of-such endorsement(s)., PRODUCER NAME: Commercial.Support Edgewood Partners Ins.Center PHO'NNEo 631 324=14.40 arc Nb:°631'390-9.790 A!C Ext:' 40 Marcus Drive ADDRESS: NECertificates@epicbrokers.com 3rd Floor INSURERS)AFFORDING COVERAGE NAIC# Melville,NY 11747' INSURERA:Nafl:Union Fire Ins:Co Pittsburgh PA 1.9445 INSURED INSURER B: East'End Hospice Inc INSURER C,: P:O:Box 1048 INSURERD: Westhampton Beach,NY 11978 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. TR TYPE OF INSURANCE IN DDLSUBR WVD POLICY NUMBER MMl TIDY EFF MP�OLIICCY EXP LIMITS A �( COMMERCIAL GENERAL Y VHNUHG001.1.02704 D41011202404/01/202 EACH �OCCURRENCE 51000000 CLAIMS-MADE � D A E OCCUR PRMISES Eao�urrence I $1 000 000 IVIED EXP(Any one person) S50 000 PERSONAL&ADV INJURY $1 000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $3,000,000 X JET LOC PRODUCTS-COMP/OP AGG 53',000,000 POLICY❑ S OTHER: A AUTOMOBILE LIABILITY VHNUHAOOT103604 4/01/2024 04/0:1/202 E°a "deentED SINGLEUMI7 $1,000,000 ANY AUTO BODILY INJURY(Per personj S OWNED SCHEDULED BODILY INJURY(Per"accideAq, $ AUTOS ONLY X AUTOS, HIRED NON0WNED PROPERTY DAMAGE $ X AUTOS ONLY X" AUTOS'ONLY, Peneocident ' $ A UMBRELLA LIAR X OCCUR VHNUHX001103704 4/01/2024 04/01/202 "EACH.OCCURRENCE S5 000 000 X EXCESS LIAB CLAIMS-MADE AGGREGATE S5 000 000: DED I X1 RETENTION SO S WORKERS COMPENSATION" PER. .. =OTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT S OFFICER/MEMBER-EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ It yes,describe under E.L.DISEASE-POLICY LIMIT S 'DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 11I1',Additional Remarks Schedule,may 6e attached It more space Is required) RE:Tree lighting memorial service on,Sunday,December Sth,2025 The-certificate holder is'included As additional insured for general liability coverage as required by 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 PO BOX 1179 ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All;rights reserved. ACORD 25(2016103) 1. of 1 The ACORD name:and logo"are registered marks'of ACORD #86972815/M6448940 SMB01 Noncarrow, Denis From: Debbie Doyle <ddoyle@eeh.org> Sent: Thursday, October 17, 2024 10:20 AM To: Noncarrow, Denis Subject: Special Event Application - East End Hospice Attachments: doc08856720241017101647.pdf Good Morning Denis: Attached is an application for East End Hospice's Tree of Lights Memorial reading to be held on December 8"at the Village Green in Cutchogue. We've held this event for 20+years. There is no food or drink,just a speaker and the reading of patient's names. I will get the required security deposit to you within the next two weeks. Thank You, Debbie EAST Debbie Doyle �I Development Associate East End Hospice PO Box 1048 •: Westhampton Beach,NY 11978 a' .;—W-;- P: 631.288.7080 F 631.288.4943 631.220.1864 o � tt •�'pa v'7F•f Try_',wy -� += x 1*0 o eeh.or ,h Click to learn more about East End Hospice :.. _..." ..._ " .a.__ :_.,_ ,.•. To make a referral call 631-288-8400. This email message and any attachments are confidential and may be protected by the applicable privileges.The information is intended to be conveyed only to the designated recipient(s)of the message.If you are not an intended recipient,please notify the sender immediately and delete the message from your email system. Unauthorized use,dissemination,distribution,or reproduction of this message by other than the intended recipient is strictly prohibited and may be unlawful.Thank you. ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. i Noncarrow, Denis From: Debbie Doyle <ddoyle@eeh.org> Sent: Thursday, October 17, 2024 10:20 AM To: Noncarrow, Denis Subject: Special Event Application - East End Hospice Attachments: doc08856720241017101647.pdf Good Morning Denis: Attached is an application for East End Hospice's Tree of Lights Memorial reading to be held on December 8'at the Village Green in Cutchogue. We've held this event for 20+years. There is no food or drink,just a speaker and the reading of patient's names. I will get the required security deposit to you within the next two weeks. Thank You, Debbie EAST EN LJ Debbie Doyle HOSPICEDevelopment Associate East End Hospice PO Box 1048 Westhampton Beach,NY 11978 [F. P: 631.288.7080 ` �- F 631.288.4943 C 631.220.1864 eeh org Click to learn more about East End Hospice e.. :_._.. _.... . : :,. ..__. To make a referral call 631-288-8400. This email message and any attachments are confidential and may be protected by the applicable privileges.The information is intended to be conveyed only to the designated recipient(s)of the message.If you are not an intended recipient,please notify the sender immediately and delete the message from your email system. Unauthorized use,dissemination,distribution,or reproduction of this message by other than the intended recipient is strictly prohibited and may be unlawful.Thank you. ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. i • __ _ Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 10/28/24 Receipt#: 335731 Quantity Transactions Reference Subtotal 1 Clean-Up Deposit 12.8 $250.00 Total Paid: $250.00 Notes: Payment Type Amount Paid By , CK#8693 $250.00 East End Hospice Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: East End Hospice P.o.b. 1048 r' Westhampton, NY 11978 Clerk ID: DENISN Internal ID: 12.8 n . • r Noncarrow, Denis To: Special Events PD Cc: Noncarrow, Denis Subject: East End Hospice event 12/8/2024 Attachments: Hospice_20241 0281 1 5143.pdf Please let us know. 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 Noncarrow, Denis From: Grattan, Steven Sent: Tuesday, October 29, 2024 2:07 PM To: Noncarrow, Denis Cc: Born, Sabrina Subject: RE: East End Hospice event 12/8/2024 Hi Denis, No objections From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent: Monday,October 28, 202411:57 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.southo Id.ny.us>; Orientale, Michael<michaelo@southoldtownny.gov>; Born, Sabrina <sabrina.born @town.southold.ny.us> Cc: Noncarrow, Denis<denisn@southoldtownny.gov> Subject: East End Hospice event 12/8/2024 Please let us know. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisn@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 RESOLUTION 2024-960 G,aa b�fa� ADOPTED DOC ID: 20761 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-960 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NOVEMBER 6,2024: RESOLVED that the Town Board of the Town of Southold hereby grants permission to East End Hospice to hold its East End Hospice Tree of Lights Memorial on the Cutchogue Village Green on Sunday, December 8th, 2024 from 1:00 PM to 3:30 PM,provided they adhere to the Town of Southold Policy for Special Events on Town Properties and Roads. All Town fees for this event, with the exception of the Clean-up Deposit, are waived. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Greg Doroski, Councilman SECONDER:Jill Doherty, Councilwoman AYES: Doroski, Mealy, Smith, Krupski Jr, Doherty, Evans DENIS NONCARROW Town Hall, 53095 Main Road TOWN CLERK ® P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 5 ® Fax(631)765-6145 MARRIAGE OFFICER '� �° RECORDS MANAGEMENT OFFICER °�®� ��® Telephone oldt nny.gov FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD November 7, 2024 Attn: Morgan Rewinski East End Hospice PO Box 1048 Westhampton Beach,NY 11978 Dear Morgan Rewinski, The Southold Town Board, at its regular meeting held on November 6`h, 2024 has granted permission to the.East End Hospice to hold its Tree of Lights Memorial Reading on Sunday, December 81h, 2024, from 1 PM to 3:30 PM. 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 be sure to contact Chief Grattan at the Police Department, 631-765-2600, as soon as possible,to coordinate traffic control. Very truly yours, Sabrina M. Born Deputy Town Clerk Encl. Vendor No. ClieCk a ...................................................................... .. ................................................................. ........................... .......................................... Town of Southold New York - Payment Voucher Vendor Name Vendor Address EIlt6r6db)! ................. ................................. ................................................................... .............. .................................................... ..................................................................... ............._................. ... East End Hospice PO Box 1048iiditDate ............. ...... ......................................... Vendor Telephone Number ...... ..:.............. ......:::::::::.:::::::::::::::: 631-288-7080 Westham oton Beach, NY 11978 Tovv#i'Cleck Vendor Contact,. Morgan-Rewinski V Invoice Invoice Invoice Net Purchase Order Number Date ,Total Discount Amount Claimed Number Description of Goods or Services Geueia I edgrEundandAccdunt:Niimlier:>=' ..... ..... ...................... $250.00 $250.00 C/U-Tree of Lights Memorial 2 024-1048 12/17 202412/8/2024 0: 0` .............. ...... ................ 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. Si Title Deputy Town Clerk Signature Compannyy Name"'outhold Town ClerkDate 12/18/2024 Title e u T wn Clerk Date 12/18/2024 'ssrr'ecxzy °s RESOLUTION 2024-1048 ADOPTED DOC ID: 20910 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-1048 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON DECEMBER 17, 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 East End Hospice October 17, 2024 $250.00 c/o Morgan Rewinski PO Box 1048 Westhampton Beach,NY 11978 Cutchogue Fire Dept. May 31, 2024 $1,500.00 c/o Thomas Shalvey 260 New Suffolk Road Cutchogue,NY 11935 Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Anne H. Smith, Councilwoman SECONDER:Jill Doherty, Councilwoman AYES: Doroski, Mealy, Smith, Krupski Jr, Doherty, Evans