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Winterfest Road Closure
J 0,11 RESOLUTION 2025-55 �° ADOPTED DOC ID: 20988 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2025-55 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JANUARY 7,2025: RESOLVED that the Town Board of the Town of Southold hereby grants permission to the Southold Economic Development Committee to hold the Winter Fest on Saturday, February 8, 2025 from 9:00 am to 4:00 pm with a Rain Date of Sunday, February 9, 2025, on Town property located at 53670 Route 25 and 53720 Route 25, Southold,provided they follow all the conditions in the Town's Policy for Special Events on Town Properties,and subject to the Economic Committee working with Town and State departments as needed and the following additional conditions: 1. The Main Road (Route 25) closure for the event shall be limited to the hours of 10:00 AM and 3:00 PM; 2. The applicant shall notify local hospitals,senior and rehabilitation centers that access to Southold Pharmacy will be limited on the date of the event; and 3. This approval shall be considered for the 2025 event only, any future request will be reevaluated by the Board. All Town fees for this event are waived. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Anne H. Smith, Councilwoman SECONDER:Brian O. Mealy, Councilman AYES: Doroski, Mealy, Smith, Krupski Jr, Doherty, Evans c�,c1r� rnex� eV i sed �1y 5 _31 11 ao� Al At ml , 4 4 s .. , "ICA e' B F � y4 F_ A , v r • ', :gMEL 46 a . OrcfcJ e. 'k s u�1e re Cones roo-d e.`o5ure g'kc�v,s W Ioe (� pr ri's \_Q._"e �uungs Avenue �. ?j lj Y ee.r� �5 "��e C]�OU Y irk uT� ' 1�\ , .] PERM 224-f Excavation (10/23) Labor Law§ 224-f. Workers on excavations. 1. For the purposes of this section: a. "Covered excavation project"shall mean construction work for which a permit may be issued to a contractor or subcontractor of a utility company by the state, a county or a municipality to use, excavate, or open a street.A"covered excavation project"shall exclude construction work for which a permit may be issued to a service provided as defined by subdivision twenty-three of section one thousand twenty-b of the public authorities law. b. "Department of jurisdiction"shall mean the department of the state, board or officer in the state, or municipal corporation or commission or board appointed pursuant to law,whose duty it is to issue a permit to a utility company, or its contractors or subcontractors,for a covered excavation project. c. "Fiscal officer"shall mean the commissioner; except for covered excavation projects performed pursuant to a permit issued by a city with a population in excess of one million in which case the"fiscal officer" shall be the comptroller or other analogous officer of such city. d. "Utility company" shall have the same meaning as subdivision twenty-three of section two of the public service law. 2. Each contractor or subcontractor to a utility company shall be required to pay not less than the prevailing rate of wage in the same trade or occupation in the locality within the state where such covered excavation project is situated to each laborer, worker, or mechanic in the employ of the contractor or subcontractor to a utility company, performing work on the project in accordance with sections two hundred twenty and two hundred twenty-b of this article. No permit shall be issued for a covered excavation project until an agreement confirming the payment of wages as required by this section has been contractually mandated and filed with the department of jurisdiction, and all permits issued after the effective date of this section shall include therein a copy of this section. 3.The enforcement of any covered excavation project pursuant to this section shall be subject to the requirements of sections two hundred twenty,two hundred twenty-a,two hundred twenty-b,two hundred twenty-three and two hundred twenty-four- b of this article and section two hundred twenty-seven of this chapter and within the jurisdiction of the fiscal officer; provided, however, nothing contained in this section shall be deemed to construe any covered excavation project as otherwise being considered public work pursuant to this article. 4.The fiscal officer may issue rules and regulations governing the provisions of this section.Any violation of this section shall be grounds for determinations and orders pursuant to section two hundred twenty-b of this article. r- (:5-1 * 11) X( PERM 224-f Excavation (10/23) NN5-D Permit Applicant Certification Regarding Labor Law Section 224-f Instructions:This certification must be completed by all applicants for a NYSDOT highway work permit. For additional background,go to enforcement-guidance-update-2-roadway-excavation-quality-assurance-act.pdf(ny.gov), and see Labor Law§ 224-f(attached). Part 1: Is the entity applying for and performing all work under this permit a utility subject to the jurisdiction of the Public Service Commission? [M YES N NO. If YES—section 224-f does not apply, proceed to Part 6 of this form. If NO—proceed to Part 2. Part 2: Is the entity applying for or performing any work under this permit doing so under contract or subcontract with a utility subject to the jurisdiction of the Public Service Commission? 0 YES P NO. If YES—proceed to Part 3. If NO—section 224-f does not apply, proceed to Part 6 of this form. Part 3: Is the entity applying for or performing any work under this permit doing so under contract or subcontract with the Long Island Power Authority, a television or broadband provider? 0 YES ® NO. If YES—section 224-f does not apply. Proceed to Part 6 of this form and you are done. . If NO—proceed to Part 4. Part 4: Is the permit for a location and a project already underway under an existing utility contract signed or solicited before 9/15/23? M YES E] NO. If YES—section 224-f does not apply. Proceed to Part 6 of this form and you are done. If NO—proceed to Part 5. Part 5: Is the work to be performed under this permit under a general contract awarded before 9/15/23 with a subcontract awarded thereafter? n YES M NO. If YES—section 224-f does not apply. Proceed to Part 6 of this form and you are done. If NO— • Labor Law§224-f applies; • read the Labor Law§.224-f,attached, regarding your legal obligations to ensure the payment of at least the applicable prevailing wage; and • complete Part 6. Part 6: Certification. I certify that the information I have given on this form is true and complete,and that if Labor Law§224-f applies,that an agreement for the payment of prevailing wages has been contractually mandated for the permit work. WARNING: Intentionally making a false statement or providing false or misleading information in connection with this form is a criminal offense that may subject you to prosecution under law. NOTICE:Submitting this form to NYSDOT,saltisfies the filing requirement of Labor Law§ 224-f(2). Print name here: �.�Ir1c r\.i sv e✓ (if applying for corporation or her business entity, print your full name and business title) Sign Here rn Date: I I I Rudder, Lynda From: Rudder, Lynda Sent: Wednesday,January 29, 2025 12:35 PM To: jl pen ney@hamptonjitney.com'; 'grl@hamptonjitney.com'; 'buses@suffolkcountyny.gov'; 'david@sunrisecoach.com' Subject: NYSDOT Case# 112006 special event "Winterfest 2025" on Feb 8, 2025 Attachments: nysdot# 112006_20250129100850.pdf Importance: High Attached please find a copy of the Route 25/Main Road,Southold Road closure detour. The road closure will be on February 8, 2025 from 9:00 am to 4:00 pm, with a rain date of February 9, 2025 with the same times. If you have any questions please feel free to contact me. Deputy Town Clerk Deputy Registrar Principal Account Clerk Southold Town 53095 Main Road PO Box 1179 Southold,NY 11971 631/765-1800 ext.1210 631/765-6145 Fax i PERM 42(09/09) State of New York Department of Transportation Highway Work Permit Permit No.: 202410112006 Date Issued: 01/29/2025 p Project ID No.: Expiration Date: 02/28/2025 xr_cr.siaa *Permittee 1: *Permittee 2: TOWN OF SOUTHOLD STEVEN GRATTAN,CHIEF OF SOUTHOLD P D 54375 NYS25 P O BOX 1179 POBOX# 1179 SOUTHOLD,NY 11971 SOUTHOLD, NY 11971 Emergency Contact: STEVEN GRATTAN Emergency Number: 631-765-3115 Under the provisions of the Highway Law or Vehicle&Traffic Law,permission is hereby granted to the permittee to: TOWN OF SOUTHOLD TO CLOSE THE ROAD NY25 TO CONDUCT WINTERFEST 2025 ON SATURDAY FEBRUARY 8,2025 FROM 9:00 AM TO 4:00 PM,BETWEEN HORTONS LANE EASTWARD TO YOUNGS AVENUE BETWEEN MMS 25 0704 1611 AND 25 0704 1615 WITH APPROXIMATE PARTICIPANTS OF MORE THAN 2,000.APPLICANT IS RESPONSIBLE FORALL CLEAN UP RELATED ACTIVITIES,AND TO COMPLY WITH FIRE DEPARTMENT AND LOCAL JURISDICTION.ANY TEMPORARY SIGN INSTALLATION PROMOTING THE EVENT OR OTHER ADVERTISEMENT WITHIN THE STATE ROW WILL REQUIRE SEPARATE H W PERMIT.PLEASE FOLLOW THE POLICE CONTROL POINTS ATTACHED WITH THIS HIGHWAY WORK PERMIT. ALL TRAFFIC CONTROL SHALL BE IN ACCORDANCE WITH THE CURRENT EDITION OF THE NATIONAL MUTCD WITH NYS SUPPLEMENT.ALL TRAFFIC CONTROL AND DETOUR SHALL BE DONE ONLY WITH POLICE INVOLVEMENT.IF NECESSARY, RESCHEDULING EVENT DATE SHALL BE SUBJECT TO THE APPROVAL OF THE LOCAL PERMIT ENGINEER.CONTACT NYSDOT INFORM AT 631-904-3050 AND RESIDENCY 03 AT 631-727-1731 AT LEAST 3 DAYS PRIOR TO THE EVENT.PLEASE SEE ATTACHED A COPY OF LABOR LAW 224-F.IF SUCH SECTION APPLIES TO THE WORK TO BE PERFORMED UNDER THIS PERMIT,THE APPLICATION FOR AND ACCEPTANCE OF THIS PERMIT CONSTITUTE THE APPLICANT S/PERMITTEE'S AGREEMENT CONFIRMING THE PAYMENT OF WAGES AS REQUIRED BY SUCH SECTION HAS BEEN CONTRACTUALLY MANDATED.THIS PERMIT IS ONLY VALID WITH CURRENT INSURANCE COVERING NYS.TOWN OF SOUTHOLD WINTERFEST 2025 ON FEBRUARY 8,2025. THE PERMITTEE IS RESPONSIBLE FOR TEMPORARY TRAFFIC CONTROL IN ACCORDANCE WITH THE CURRENT NATIONAL MANUAL OF UNIFORM TRAFFIC CONTROL DEVICES AND THE NYS SUPPLEMENT.ANYONE WORKING WITHIN THE HIGHWAY RIGHT-OF-WAY SHALL WEAR HIGH-VISIBILITY APPAREL MEETING THE CURRENT ANSI 107 CLASS II OR CLASS III(AT NIGHT)STANDARDS AND A HARD HAT MEETING THE CURRENT ANSFISEA Z89.1 TYPE 1,CLASS C OR IF WORKING WITHIN CLOSE PROXIMITY TO ELECTRICAL POWER LINE, CLASS E OR G. ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. County Municipality State Hwy State Route Beg Ref End Ref SUFFOLK SOUTHOLD - 25 25 07041611 25 07041615 ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. as set forth and represented in the attached application at the particular location or areas, or over the routes as stated therein, if required; and pursuant to the conditions and regulations general or special,and methods of performing work,if any;all of which are set forth in the application and form of this permit. See additional conditions on PAGE 2. THIS PERMIT IS ISSUED BASED ON ALL LOCAL,STATE,AND FEDERAL REQUIREMENTS BEING SATISFIED. Dated at: Hauppauge Date Signed: 01/29/2025 Commissioner of Transportation By: M.T.Vijay Vijayendran IMPORTANT: THIS PERMIT,WITH APPLICATION AND DRAWING(OR COPIES THEREOF)ATTACHED,SHALL BE PLACED IN THE HANDS OF THE CONTRACTOR BEFORE ANY WORK BEGINS.THE HIGHWAY WORK PERMIT SHALL BE AVAILABLE AT THE SITE DURING CONSTRUCTION. BEFORE WORK IS STARTED AND UPON ITS COMPLETION,THE PERMITTEE ABSOLUTELY MUST NOTIFY: Christopher C Williams,PE,Resident Engineer 631-727-1731 "UPON COMPLETION OF WORK",SECOND TO LAST PAGE,MUST BE COMPLETED,SIGNED BY THE PERMITTEE,AND DELIVERED TO THE RESIDENT ENGINEER The issuing authority reserves the right to suspend or revoke this permit at its discretion without a hearing or the necessity of showing cause, either before or during the operations authorized. The Permittee will cause an approved copy of the application to be and remain attached hereto until all work under the permit is satisfactorily completed,in accordance with the terms of the attached application.All damaged or disturbed areas resulting from work performed pursuant to this permit will be repaired to the satisfaction of the Department of Transportation. * Upon completion of the work within the state highway right-of-way authorized by the work permit, the person, firm, corporation, municipality,or state department or agency,and his/her or its successors in interest,shall be responsible for the maintenance and repair of such work or portion of such work as set forth within the terms and conditions of the work permit. Permit Fee: $25.00 Insurance Fee: $0.00 Total Fees: $25.00 Amt Rec'd 1: $25.00 CheckNum: 157103 Check Date: 02-JAN-25 UOF: App 1: No App 2: No [Attachments and additional requirements to this Highway Work Permit include: Other-Attach Special Permit Applcation PERM PERM 41-ld-Method of Performing Work within the State Right of 1 33b Way Other-Attach 2 Labor Law Certification Sec 224-f END OF ATTACHMENTS PERM 42(09/09) State of New York Department of Transportation Highway Work Permit Permit No.: 202410112006 Date Issued: 01/29/2025 e�lr' Fx Project ID No.: "A � Expiration Date: 02/28/2025 Return this page to: Christopher C Williams, Permittee 1:TOWN OF SOUTHOLD PE,Resident Engineer 54375 NYS25 1900 Old Country Rd P O BOX#1179 Riverhead NY 11901 SOUTHOLD,NY 11971- UPON COMPLETION OF WORK AUTHORIZED,THIS PAGE OF THE PERMIT MUST BE COMPLETED,SIGNED BY THE PERMITTEE, AND DELIVERED TO THE RESIDENT ENGINEER. Work authorized by this permit has been completed.Refund of deposit or return/release of bond is requested. DATE PERMITTEE AUTHORIZED AGENT(if any) TO BE COMPLETED BY NYSDOT: Work authorized by this permit has been satisfactorily completed and is accepted. Inspection Report must be completed. �.......� Refund of Deposit is authorized Return of Bond is authorized Unable to meet schedule as specified in bid proposal Amount charged against Bond may be released. Retain bond for future permits Forfeit of Guarantee Deposit is authorized E) Other DATE RESIDENT ENGINEER 0 Mailing address of refund has been verified. If different,list new address: The Regional Office will forward this form to the Main Office with the appropriate box checked. Permit closed Bond returned/released Refund of Guarantee Deposit on this permit is authorized E) Forfeit Guarantee Deposit to NYSDOT �I.........Y Other DATE REGIONAL TRAFFIC ENGINEER INSPECTION REPORT For each Highway Work Permit issued,inspections will be performed.The following report must be completed for each site visit, indicating the date,inspector,and hours spent on inspection.if the total inspection time exceeds 1 hour,then a FIN 12 (PERMIT INSPECTION FOR DEPARTMENT SERVICES)is REQUIRED. INSPECTION REPORT LOG HOURS WORKED BY DATE HOURS Inspector Name Date Inspected Regular Overtime ................................................................................. Regular Overtime ................................................................................. Inspector Name Date Inspected Regular Overtime ................................................................................. Regular Overtime ................................................................................. Inspector Name Date Inspected Regular Overtime Regular Overtime Complete hours for each date inspected. Add regular hour numbers across rows,and then overtime hours across rows. Add hour columns down for total hours of permit inspection time. COMMENTS/OBSERVATIONS: I HEREBY CERTIFY THAT THE INFORMATION CONTAINED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. NAME TITLE Revision Date: 5/5/2016 ........................ zz- ............ ............... .......... State of New York Department of Transportation PERM 33b Application for the use of State Highway/NYSDOT Property for Special Events Parades, processions7 assemblages, walk-a-thons, festivals, civic or cultural events, etc. A PERM 33b is required when an event such as a parade, procession, assemblage, walk-a-thon, festival, civic or cultural event, etc. is planned to take place on state highway right-of-way, and the local Municipality chooses not to regulate the event. R16ECOUNIED JAN 03 206 PERMITS �")EPT OrrRmISV"OR,PJION Nee I of'9 PERM 33b (9r2013) INSTRUCTIONS FOR COMPLETING THE SPECIAL USE PERMIT (PERM 33b) • Identify the name, date, time, and type of event. • Identify all Cities, Villages, Towns, and Counties where the event will be held. Specify the location of the event by State Route numbers/highway names, street names, etc. by municipality, If the event includes facilities other than highways/streets, describe the location and names of the facilities (parks, trails, private property, etc.)that will be used. State the Permit Applicant's name and address. The event organizer is always the "Applicant". the applicant may be an individual, municipality, organization, or group. The Applicant assumes full responsibility for the event even if other organizations will be involved. The Permit will be issued to the Applicant, who will be responsible for complying with all ofthe terms of the Permit. Identify an Authorized Representative who will be the contact person. Provide information listed on Page 2 of the Application. Acknowledge permit terms and conditions; provide Applicant/Authorized Representative's signature and date. Submit non-refundable Application Fee of$25.00. (This fee is waived if the Applicant is a not-for-profit group.) Please make check payable to NYSDOT. Please submit the original completed permit application tothe address listed below a minimum of one month prior to the event date. Keep a copy for your records. on approval, a copy of the application and an Approval Form will be returned to you that will serve as the Special Use Permit. New York State Department of Transportation Regional Traffic Engineer NY' CST Region 111-RM 3.3b (99201 3)) 11a�e 2 of 9 PERM 33b NEW YORK STATE DEPARTMENT OF TRANSPORTATION (Application Form) APPLICATION FOR SPECIAL USE PERMIT (Pg 1 of 2) Speciall! 'Use Event: ame of Event 4- Nz%" 8 - CAOJS Lj 0 Dabel( T)2--�� Time(s) #of Participants 44� VP-byU0-%r11-1 tCt A %Ile Type of Special Use Event- (Check all that apply): Pairadie or l:'Iiriocession []Assemblage []Walk-a-thon Festiva! E]Other ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... ........................................................................................................ Location Municipaliti (specify highways.by route number and/or street namel (Cities,Towns,Villages, Counties) ................... ............................... ............. C.�......... .....................................................I............ ................................................................................ ..........................................[................ ................................................................. .0 r.+.2.........................................lxnt e a... a. . ....... .......... .... .......... N .......... ............ . ............................-.-........................................................................ ..........................................................................-.................................................................................... . ...................................................... ................................................................. .................................................................. .................................................................. ....................................................... .............................................................-.......................................................................................................................................................................................... ...................................................................— ......................................................................................................................................................................................................... ...................................................................... ................................................................................................-........................................................--................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. ........................................................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................................................... ......................................................................I.."." ..........I.................................................................................................................................................................................................................................................-1.............................................................................................................................................................................................................................................................................................................................................................. .................................................................................-.-................................................................................................................................................-1............................................................................................................................................................................................................................................................................................................................................................---......................... .................................................................................................................................................................................... ......................................................................................................................................................................................................................................................................... ....................................................................................................................................................... Applicant I formation: en v. Applicant(individual, organization, group) Authorized Representative (if differen from Applicant) '94 !i� !3.51 ? 0-21ine Mailing Address a Tel$phone Wutuber(including area code) sou+vlo � Hl I— City, State, Zip Code Cell Phone Number(including area code) rAq-....rLx1dfuc@-+c)ujw% o I do us r ftn. -wn..qoL ok - tA u's Erriail Address Emal Address (if different from Applicant) U!�Alw- spowNalLiQuon Website Address (if appropriate) 1 13 PERM 33b (9,,`2013) Page 3 of 9 PER- M 33b NEW YORK STATE DEPARTMENT OF TRANSPORTATION (Application Form) APPLICATION FOR SPECIAL USE PERMIT (Pg 2 of 2) The following in ormation must be submitted at the time of application: icial Map, Event Brochure, and Event Application The applicant shall provide an official map, event brochure and event application for (if applicable). Operation and Safety Plan The applicant shall provide an Operation and Safety Plan which includes the applicable items from the Checklist on pages 5 and 6; attach the completed checklist. $25 Application Fee (this fee is waived if the Applicant is a not-for-profit group) Please make check payable to NYSDOT. The following in ormation must be submitted no less than two weeks prior to the event date: insurance Certificates (must be in Applicant's name) The Applicant shall provide documentation of required insurance, including Workers' Compensation and Disability Insurance; see Item 7 of Responsibilities of Applicant for required insurance types and limits. Municipal Approvals The Applicant shall provide written proof from each municipality (County, City, Town, and Village) through which the event passes indicating that the Municipality has no objection to the event taking place. This written proof may take the for of a letter, resolution, email, or other. The applicant shall also provide the name of a contact person for each municipality. Acknowledgment. On behalf of the Applicant, I hereby request a Special Use Permit, and do acknowledge and agree to the Responsibilities of Applicant and obligations set forth in this permit and warrant compliance therewith. The attached documents are also made a part hereof and attached hereto: Application received by. -A WppAri ca�nV s �e NYSDOT Representative's Signature / y Date Date Received by NYSDOT PERM 33b (9/2013) Page 4 of 9 OPERATION AND SAFETY PLAN CHECKLIST leases y the following information or note as "Not Applicable." (The Event Map should show the entire course, but all other checklist elements only apply to the portions of the event occurring an State highways.) Event Map - show start and finish lines - show direcLon of event travel - show all intersections, railroad crossings and jurisdictional boundaries - show all facilities being used by the event (roads, parks, schools, parking lots, etc.) Description of Event and ocations. - identify event starting a ending t1mes and I - describe sequence of event activities, including setup and cleanup.,-,, describe any road Ma nels hou Ide rlsidewa Ik closings and times and method of closure (e.g., signs, cones, barricades) will violate the normal "rules of the road" and all describe all event activities where participants locations where traffic will be required to stop where no stop is normally required Locations requiring traffic control for event - list intersections where the existing type of traffic control (e.g., signal, stop, yield, no control)will be changed during the event and describe how normal traffic will be directed (e.g., police officer) - list locations where participants will turn left across lanes of traffic provide sketches of all locations requiring additional traffic control during event show types and locations of all traffic control devices (e.g., traffic signals, signs, cones, striping, barricades), both existing and proposed show types and locations of all event personnel (e.g., police officers, volunteers) show path of event participants Detours - provide map of detour, show detour sign/police locations and any existing signs to be covered - provide drawing of detour sign(s) showing text - provide sign dimensions, color, size of text, type of sign material, and posting method List of Railroad Grade Crossings - indicate whether grade crossing is active or inactive - list existing traffic control at all active grade crossings (e.g., crossbucks, lights, gates, YIELD sign, STOP sign) - list traffic control for event at all active grade crossings (e.g., police, RR flagger) - indicate whether railroad has been contacted El Pre-Event Public Notification - list locations for signs or show on a map ® provide drawing of signs showing text - provide sign dimensions, color, size of text, type of sign material, and posting method ® list locations or show on a map all Changeable Message Signs (CMS), provide pre-event text - specify what day signs and CMS will be placed and when they will be removed - describe any other type of notification (e.g., mailings, brochure, press release) being provided to the public Page 5 of 9 PER 33b (91`2013) t� OPERATION AND SAFETY PLAN CHECKLIST Banners - indicate if there will be any banners (roadside or overhead), type and locations Coordination - describe coordination with state/local police - describe coordination with statellocal highway agencies - describe coordination with municipalities describe coordination with other entities (e.g. railroads, park agencies, private property owners whose property will be used for the event) Event Day Communications - describe communications system used by event personnel, marshals, volunteers, police, and emergency personnel Emergency Services ® describe how emergency services will be provided during the event for event participants and spectators - describe how emergency vehicles will be able to uselcross the event course if necessary for non-event related circumstances Spectator control - indicate whether any speciali measures are being taken to control spectators (e.g., fencing, highway crossings) Pavement Markings - provide a sketch of each location where temporary pavement markings will be placed - describe material being used, and how and when it will be placed and removed Event Day Signing ®for highway users - list locations for signs or show on a map, note any existing signs to be covered - provide drawing of sign(s) showing text - provide sign dimensions, color, size of text, type of sign material, and posting method - list locations or show on a map all CMS, provide text Event Day Signing —for event participants - list locations for signs or show on a map - note types of signs being used (e.g., advance turn, mile markers, feed zones/water stations) - provide drawing of signs showing text - provide sign dimensions, color, size of text, type of sign material, and posting method Event Support Vehicles - describe the movements of any vehicles used in the event (e.g., parade floats, lead & trail, sweep, sag) - describe how each vehicle will convey its message (e.g., flashers, headlights, beacons, signs), as appropriate 11F'RM 131) (9 2013) Page 6 of`9 Responsibilities of Applicant 1. Limitations on Use. The ,,-,,,,pecific site identified in this permit, and only that porton identified, will be avaiilable for use by Applicant only for the purpose stated in this permit and only on the date(s) and for the duration designated in this permit. The authorization herein shall be only for the actual duration of the event. 2. Conditions of Use. NYSDOT makes no affirmation that the state-owned site to be used for the event has been designed, constructed, or maintained for the purpose of the conduct of the event. The Applicant assumes full responsibility for planning and conducting a safe and orderly event that does not expose participants or the public to any unreasonable hazards and that involves a minimal disruption of the normal uses of the state highway system. It shall be the sole obligation of the Applicant to determine whether the site is suitable forte purpose of safely conducting the event. The Appkcant assumes all responsibility for assuring that the use of the highway/property conforms to applicable requirements of'aw, including, but not limited to those set forth herein. 3. Operation and Safety Plan. The Applicant assumes all responsibility for the set-up, conduct and break-down of the event. The Appiicant assumes all responsibility for the control of the event site, and warrants that the site has been inspected, and that any perceived defects in the state highway(s) have been or shall be reported to NYSDOT and that adequate provision has been or shall be taken to mitigate and/or separate event participants from these perceived hazards. The Operation and Safely Plan must detail how the Applicant intends to (1)promote safety and (2) minimize the disruption of traffic. To the extent of any closure on the state highway or the disruption of the movement of traffic proceeding along (e.g. lane and shoulder closures), entering, or crossing a state highway for a period more than ten minutes, the Applicant shall provide and maintain a si�ned detour or police officers to direct traffic. The Applicant shall consult with and coordinate the event with state an for local police to determine such action as may be necessary to protect the public safety, security, or convenience, and incorporate all recommendations into the Operation and Safety Plan. Notwithstanding any other provision of law tothe contrary, no person or entity shall have the right to bring an action against the state or municipality or any person employed by the state or municipality who was acting within the scope oft eir authority for damages resulting from or in connection with the event(s). The Applicant shall ensure that all participants shall obey any lawful order or direction (1) of any police officer that deviates from the Operation and Safety Plan before, during or after the event(s), (2) of any police officer, flag person or other person duly empowered to regulate traffic during an emergency, or (3)given by a federal, state, county or city official or any person acting as part of the civil defense forces. 4. Rail Grade Crossings. The Applicant is responsible for ensuring the safety of event participants at all railroad grade crossings. The Operation and Safety Plan shall address rail crossing operations. For grade crossings where a train may cross during the event, the applicant must propose a safety plan. 5. Assumption of Risk. Use of the permitted site shall be in accord with the general authority of the State (where applicable) and applicable New York State Vehicle & Traffic Law sections so that although the participants are exempted from compliance with the usual traffic laws as detailed in the Operation and Safety Plan, they must exercise reasonable care. PERM 33b (9/2013) 11,9-c 7 o[9 0 Responsibilities of Applicant 6. Insurance Requirements. The Applicant shall provide NYSDOT with proof of insurance prior to the installation of any temporary traffic control devices or the commencement of the event, i.e. a certificate of insurance is required to maintain and provide proof that it has, in full force and effect, the following insurance coverages: (a) Workers' Compensation and Disability Insurance. As required by State Finance Law §142, the Applicant shall maintain in force workers' compensation insurance for all employees. The Applicant shall also maintain disability insurance as required by the Disability Benefits Law of the State of New York. (b) Commercial General Liability Insurance. The Applicant shall maintain an occurrence form commercial general liability policy or policies insuring against liability arising from premises (including loss of use thereof), personal injury or death, advertising injury, liability insured under an insured contract (including the tort liability of another assumed in a business contract) occurring on or in any way related to the premises or occasioned by reason of the operations of the Applicant. Such coverage shall be written on an ISO occurrence for CG 00 01 12 07 (or a form that provides equivalent coverage) in an amount of not less than ONE MILLION DOLLARS ($1,000,000.00) per occurrence and not less than TWO MILLION DOLLARS ($2,000,000.00) aggregate. This insurance must be endorsed to provide coverage to"The to of New York/New York State Department of Transportation, any municipality in which the event is conducted, and any governmental entity whose facilities are affected by the event, or any oft eir employees or agents working for or on the event," using ISO form CG 20 10 07 04 or a form that provides equivalent coverage. (c) Automobile Insurance (applicable where automobiles or other vehicles will be used in relation to the event)® The Applicant shall maintain a commercial or other automobile policy or policies insuring against liability for bodily injury, death, or damage to property and other mandatory coverages, relating to the use, operation, loading or unloading of any of applicant®s automobiles (including owned, hired and non-owned vehicles) on and around the site/event. Coverage shall be in an amount of not less than ONE MILLION DOLLARS ($1,000,000-00) each accident. (d) Umbrella or Excess Liability Insurance, The Applicant shall maintain an occurrence form umbrella liability policy or policies insuring against liability arising from premises (including loss of use thereof), operations, personal injury and advertising injury, and liability insured under an insured contract (including the tort liability of another assumed in a business contract) occurring on or in any way related to the premises or occasioned by reason of the operations of the Applicant as described above. Such coverage shall be written on an ISO occurrence form CU 00 01 12 07 or a form that provides equivalent coverage. In the event that umbrella coverage is unavailable, equivalent excess coverage may be substituted. The minimum required limits for the umbreila/excess coverage shall be sufficient to provide a total of not less than FIVE MILLION DOLLARS ($5,000,000,00) per occurrence/aggregate. 7. Indemnification: In addition to the protection afforded the State by the insurance provision herein, NYSDOT shall not be liable for any damage or injury to the Applicant, employees, event organizers and volunteers, or participants, or any other person, or to any property, occurring on the site covered by this permit or any part thereof associated in any way with Applicant's use of the site. To the fullest extent permitted by law, the Applicant agrees to defend, indemnify and hold harmless the State of New York, NYSDOT, and their agents from and against all claims, damages, losses and expenses, including but PER 33b (9,'2013) Page 8 Of 9 Responsibilities of Applicant not to attorneys' fees, arising out of any claim for personal injuries, property damage or wrongful death associated in any way with the Applicant's or participants' use of the permitted site(s,) or in any way related to the event, no matter how caused. 8. Termination of the Permit. NY DOT shall have the right, in its sole discretion, at any time to terminate this permit, or any portion thereof, should it be necessary due to operations or other reasonable need of NYSDOT, by giving written notice of termination of the permit. Any termination by NYSDOT shall in no way constitute or be deemed a breach of this Permit and no liability shall be incurred by or arise against NYSDOT, its agents and employees for loss of profits or any other damages. 9. Applicant's Use of the Highway/Property. The Applicant shall exercise due care in its use ofthe site and shall upon the expiration, termination, or cancellation of the issued permit, surrender the site in as good a condition as on the effective date of this permit, ordinary wear and tear excepted. The Applicant shall designate a representative to conduct both a pre-event and post-event field review of the event course with the NYSDOT Resident Engineer(s) to determine at damage may or may not have resulted from the event. The Resident Engineer is given the authority to determine if any of the post-event damage is required to be repaired. 10. Agency's Representative. The Commissioner of the NYS Department of Transportation, or his/her designee, shall be, and hereby is authorized to act for and on behalf of NYSDOT. 11® Promotional Materials. Any promotional materials shall be consistent with the provisions of this permit. NYSDOT shall in no way be represented to be a sponsor or organizer ofthe event. The Applicant represents that it has permission to reproduce any such materials, and will defend and indemnify NYSDOT for any damages NYSDOT may incur for the infringement of any third-party proprietary rights because of the use of such materials. 12. Reporting Requirements. The Permittee agrees to notify the Agency's representative about any hazardous or unsafe conditions and about any accidents that occur during the event immediately upon the discovery of such condition or accident. 13. Site are and Restoration (if necessary and conducted by NYSDOT). An Undertaking, a bond or a certified check in an amount designated by the Department of Transportation may be required before a permit is issued, to guarantee restoration ofthe site to its original condition. If the Department is obliged to restore the site to its original condition, the costs to the Department will be deducted from the amount of the Permittee's guarantee deposit at the conclusion of the work. The Permittee agrees to be responsible for any costs in excess of the Bond/guarantee deposit on file and will be billed directly therefore. If there is no Undertaking, bond or certified check, a statement of such costs and expenses will be submitted to the Per mittee within 30 days after completion of the event. The Permittee shall make payment ofthis amount, if any, within 60 days after completion of the event. 14. Costs Incurred by Issuance ofthis Permit. All costs beyond the limits of liability insurance, surety deposits, etc. are the responsibility of the Applicant. The State shall be held free of any costs incurred by the issuance of this permit, direct or indirect. 15. Legal. The privilege granted by the permit does not authorize any infringement of federal, state or local laws or regulations, is limited to the extent of the authority of NYSDOT and is transferable and assignable only with the written consent of the Commissioner of Transportation. The Commissioner reserves the right to modify fees and to revoke or annul the permit at any time, at hisiher discretion without a hearing or the necessity of showing cause. PERM 33b (9)2013) Page 9 of 9 15 PERM 224-f Excavation (10/23) I V Per A licarat Certification Re ardin Labor Law Section 2:24-f Instructions:This certification must be completed by all applicants for a NYSDOT highway work permit. For additional background,go to enforcement uidance-u date-2-roadwa -excavation- ualit -assurance-act. df n . ov', and see Labor Law § 224-f(attached). Part 1: Is the entity applying for and performing all work under this permit a utility subject to the jurisdiction of the Public Service Commission? [] YES Eff NO. If YES—section 224-f does not apply, proceed to Part 6 of this form. If NO—proceed to Part 2. Part 2: Is the entity applying for or performing any work under this permit doing so under contract or subcontract with a utility subject to the jurisdiction of the Public Service Commission? C]YES I NO. If YES—proceed to Part 3. If NO—section 224-f does not apply, proceed to Part 6 of this form. Part 3: Is the entity applying for or performing any work under this permit doing so under contract or subcontract with the Long Island Power Authority, a television or broadband provider? ® YES [:] NO. If YES—section 224-f does not apply. Proceed to Part 6 of this form and you are done. If NO—proceed to Part 4. Part 4: Is the permit for a location and a project already underway under an existing utility contract signed or solicited before 9/15/23? []YES rl NO. If YES—section 224-f does not apply. Proceed to Part 6 of this form and you are done. If NO—proceed to Part 5. Part S: Is the work to be performed under this permit under a general contract awarded before 9/15/23 with a subcontract awarded thereafter? [] YES rl NO. If YES—section 224-f does not apply. Proceed to Part 6 of this form and you are done. IfNO— • Labor Law§ 224-f applies; • read the Labor Law§ 224-f,attached, regarding your legal obligations to ensure the payment of at least the applicable prevailing wage; and • complete Part 6. Part 6: Certification. I certify that the information I have given on this form is true and complete, and that if Labor Law § 224-f applies,that an agreement for the payment of prevailing wages has been contractually mandated for the permit work. WARNING: Intentionally making a false statement or providing false or misleading information in connection with this form is a criminal offense that may subject you to prosecution under law. NOTICE:Submitting this form to NYSDOT satisfies the filing requirement of Labor Law§ 224-f(2). Print name here:L C (if applying for a corporation or 9kher business entity, print your full name and business title) Sign Here ry-\ Date:, Sri rr' r/ , %� I �IUmuuvi u� i IN po t� 0 N U P /\may f rp °j ✓ �T J J� � s,th i rr f.a r j r r •S •'r ,,,, I '' � I r� ra. ;r 3 (° N ATTACHMENT #1 courdeis Fa Southold m. Southold ar- re G®t b "Quality aht Brands CubeSmart Self Steerage _Fond Storage das Long Island n cwth®'d da 7 1 E�A tuuchGO 3 `loueW q9 y 0 V4 91>. ependent Group _ Home Living-Sl e _Churcl 0 in 1 . Town Hall Parking PE iT, 4. i all ar i sit i rary viti log eve in care) NYSE 1 T N 5. CAST 6. First Presbyterian 7. 7 l t " t o�� from intersection of Horton to Youngs Avenue IDEN I CC i f ° Town Hall, 53005 Main Road TOWN CnLER P.O. Box 1179 Southold,New York 11971 RE GIS'1"ii,}5.R C.1!°VyJAI,Sr. TIS"SIC i � Fax(631)76 -6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS NINNACtEME;NT OFFICER www,southoldtownnyegov FREEDOM OF INFORMATION OFFICER RECEIVED OFFICE TOWN OF SOUTHOLD APPLICATION FOR A PERMITTO HOLD A Southold Town Clerk SPECIAL E V19NT Picaase provide ALL of the information requested below, Incornplete applications WILL NOT be reviewed. Date of Submission ��- Name of Event Name of Organization; 'ti��� _ � , � � �° PA ti f t Is this a Not-For-Profit VCDt?yes ca --- Contact's Name: L�1, NP 1-1 A t Mailing,address: _ C� � �'€` Contact's Phone Number: Contact's Email Address: ~J Event Location and ,Site Dia razra4 � jJse additional paper if necessary) Event Date(s): C - �� Include se u and shutd n ti es and dates , rr to �' -h4i - �xr � � Po.�v Mature of Event: C tj v (Pleaase attach a detailed description o this applications Time Period (Hours) of vent: From ►,�'._._ _____-- __ ....to rV Maximum Number of Expected Attendees: ` 0 VqY3� �f,q,.t)F T WNSP(RTAFKA1 Specify any special rcciuirements (i.e. road closure, police presence): L --r -.t & ,Wl,,l POmeg a 61-'r, m Ira Tent or other Lernporary structure will be used please Contact the Southold Town Building Depailment at 63 1-765-1802 Mailing Address toSend Event Permit to: f0_0_tX-S. 0 .......... ............ Event Fees: $250 for events with less than 1000 expected attendees ............. $500 for events with 1000 or more expected attendees Clean-up Fees (Can NOT be waived): S1,500.00 Clean-up for Bicycle and/or Running Special events(ONLY) $250 or more Clean-up deposit all other events TIE�ICATE OF INSURANCE REQELR_-B_D. Not less than$2,000,000 naming the Town of Southold as an additional insured. ***NO-FE: PLEASE SEE ATTACHED REVISED ADOPTED TOWN POLICY' Additional infon-natiOD and requirements may be required as deemed necessary by the Town Board. Print name of Authorize d Person filling out Signature*outhor zed Person filling out application application *Upon the request by applicant,the Town Board may waive in whole or in part any of the application requiremerim Subject: Southold WinterFest Exhibit Confirmation Dear Third Annual Southold WinterFest Exibitor: We are very pleased to confirm your booth space for this exciting community event. Please note the following: 1. The event takes place on Saturday, February 8, 2025 between 10:00 AM and 3:00 PM on Main Rd. in the Village of Southold. 2. Kindly take a few minutes to carefully review the attached list of exhibits and locations. It shows where you will be located and other details. Unless otherwise indicated, please be prepared for setup at your assigned space by 9:00 AM on Saturday, February 81h. 3. To allow space for each exhibitor, please keep your exhibit area no larger than a 10' X1 0' space. 4. Be certain to bring your own table, chairs, signs, extension cords, and power strips. For those requiring it, electric power is available at the Village Green (gazebo area)and at the municipal parking lot on Main Rd,across from the library. 5. Members of the WinterFest Committee will be available to assist throughout the day and an information table will be staffed in the municipal parking lot on Main Road across from the library. You can spot us, as we will be wearing black"WINTERFEST"caps. 6. If the weather is inclement, check the event Face book page at"S out hoil dWinterFesr for updates. 7. If you have any questions, kindly reach out to us no later than Friday, January 31st. The best way to reach us is via email at ,,orn. The Committee has done its best to promote the event via media outreach,social media, radio advertising, and email campaigns.A good crowd is expected.We look forward to your participation! Thank you very much, Third Annual Southold WinterFest Committee Jennifer Del Vaglio Lucine Kirchhoff Jack Malley Susan McHugh Brian Q. Smith ti RElOEIVED JA N 10 3 2 0�5 Pr FOAM$ 114YS IDIFPT FT WNmA-ORTXWION Town all„ 53095 Route 25 SUPERVISOR ALBERT J. y P.O. Box 1179 Southold, New York 11971-0959 Fax(631) 765-1823 ; Telephone(631) 765-1889 An TOWN OF SOUTHOLD December 27, 202 r. Olumuyiwa Fajolu NYSDOT 250 Veterans Memorial Highway Room 6A7, Traffic Safety & Mobility Hauppauge, NY 1178 Dear Mr. Fajo1 The Town of Southold is in support of the road closure application for the Winterfest to e held on February , 2025 witha rain date of February9, 2025. Sincerely, Albert J. Krupski, Jr. Southold Town Supervisor RECEIVED 'S DE-F7O F TRAAj po rXr,(',)N FDATE IMMIDOrmy YY) CERTIFICATE LIABILITY I 1212612024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.TH14� IS CERTIFICATE DOES NOT AFFIRMATIVELY CAR NEGATIVELY AMEND,EXTEND OR ALTER THECOVERAGE 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, IN1P()FtlANT; If the certificate 1lolder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions DI 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 endorsernent(s). CONTACT Barbara Dammers PRODUCER NAME: Roy H Reeve Agency,Inc. PHONE (631)298-4700 AiC.AX Fda: (631)298.3E50 aaC No Eat PO Box 54 E-MAIL : bdammers@royreeve.com royreeve.com 13400 Fain Road rNSURERlSI AFF!nsuranceReciprocal NAIC d Ctlattituck NY 11952 INSURERA: New York Municipal i INSURED INSURER B Town Cat Southold INSURER C 170[$daX'1179 INSURER D: INSURER E: Southold NY 11971 IMsuRER F COVE GE CERTIFICATE NUMBER: CL24122622334 REVISION NUMBER- THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LkSTED BELOU4 HAVE BEEN ISSUED TO THE 115URED hlAFAED ABOVE POR TFiE POLICY PERIOD INDICATED, NOT THSTANDING ANY REQUIREMENT,TERM OR CC}ND1TlON OF ANY CONT CT OR OTHER DOCU[vlErdT TH 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.LIMCTS SHO FRAY HAVE BEEN REDUCED BY PAID CLAIFpS. IN P r Y P I Y 34 PREre&IS'ES E uaasmeeSLIMITS LT TYPE OF INSURANCE S5 15,,000J0_0,0 _00 FENCE AGERCIAL C 50,007 CLAIMS-MADE ✓ OCCUR ,000 Deductible EEO EXP(A a-Person) A Y MPK-THOLD-0000001-24 01101/2025 01101/2026 PERSONAL&ADV INJU S 1,000,000 GENERAL AGGREGATE S 9,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: 1,000,000 PRODUCTS�COMPIOPAGG IE POLICY JECT LOC S OTHER: COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY Ea,ar�derat 6 BODILY INJURY(Per PerwnI $ ANYAUTO A OWNED SCHEDULED MC;A-THOLD-0000001-24 01101/2025 01/0112026 BODILY INJURY{Peraccident) , AUTOSONLY AUTOS PROPERTY DAMAGE HIRED WON-OWNED Per dent 5 AUTOS ONLY AUTO�SONLY E UMBRELLA UAB EACH OCCURRENCE S 10,000,000 CUR A EXCESSUAB MEC-THOLD•0000001-24 0110112025 01f0V2026 AGGREGATE y 20,000,000 CLA:MS� DE DED RETENTION S 10,000 S PER caul• WORKERS S COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY Y g N. ANY PROPRIETORIPARTNER!EXECUTIVE E.L.EACH ACCIDENT OFFICE EMBER E)XLUI N d A E.L.DISEASE-EA EMPLOYEE (Mandatory In NH) - If yes,describe under E.L.DISEAASE.-POLICY LIMIT 5 DF-SCRIPTIONOFOPERATICINS ° DESCRIPTOR OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached V mate apace is requi ) The NYSDCIT,any municipality in which the event Is conducted,and any governmental entity whOSe facilities are affected by the event,or any of their employees or agents working for or on the event, are listed as additional insureds with respect to general liability as per the terms and conditions of form #MPL-216(09106)-General Uabi'kty New York Municigaj Spec l Add4ionaf fissured Endorsement,cr form#CG2013(11185)-Additional Insured Slate or Political Subdivision-permits relating to premises, as required by written contract or agreement. kMntedest 218125,Rain date 219125 RECEIVED CERTIFICATE HOLDER CANCELLATION r �t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN D BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL iT NXS DOT,Traffic Engineering&Safety ACCORDANCE WITH THE POLICY PROVISIONS. "ISPORTAIIILIIii 250 Veterans Highway AUTHORIZED REPRESENTATIVE Rm BA-7 Hauppauge NY 11788 t11,.,d„_ \ CP 1988m2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Operation and Safety Checklist Detalots Rl,E--G[-::El"VED JA!ql () 3 210i25 PERMU"F8 NYS IDEFT OF TRANSP()RTA'p�)M OPERATION AND SAFETY PLAN CHECKLIST Speciat Acconii-nodabons 0 Uzrta'in per nflssioii'i for 3 parkin ig spaces foir I:�Ihariinacy users iii„n Featheii" WJ 0 Contact tocat ii ne6cal offices advisingfl iiieii„T,) atxwt u oad CV Ui"e 0 1: pennitted, p� ace a sigrt 'urthe p mii'inacy advising of 1he C[OSUre date aii"id t�iii ne 0 f!1oUcevyJL[ ass�st zflrnaii'inmcy defiv&y vain enteriii,ig aii- lea0ng closed m' ,!Id * 0111 �er �as rieeded Event Map ® show start and finish lines -show direction of event travel -show all intersections, railroad crossings and jurisdictional.boundaries - show all facilities being used by the event(roads, parks, schools, parking tots, etc.) See attac�ied inap of event Wcation fii�oni [ I011011 tO YOLMgS (atlac�hiil')erltl) Description of Event -identify event starting and ending times and locations ®describe sequence of event activities, including setup and cleanup -describe any roe d/lane/shouLder/sidewalk closings and times and method of closure (e.g., signs, cones, barricades) -describe all event activities where participants will violate the normal."ruies oft e road" and all locations where traffic will be required to stop where no stop is normally required See attached IL.0S Aplpticatponfor a Per,�nit toi lold a Special aind Wii,Mtei,�IV est II hi ItO III, Cornfkrirmt�on (Altaclunent 12 ar�d 3) REIGIEIIIVVED J A l�Iq o 3 210 PERIJAM NYS DEPTOF TRANSPOF�,TATJON Locations requiring traffic controt for event - list intersections where the existing type of traff is control(e.g., signal, stop, yield, no control)wi It be cha nged duri in the event and describe how normal traff is will be directed (e.g., police off icer) - List Locations where participants will turn left across lanes of traffic - provide sketches of all Locations requiring additional traff is control during event -show types and locations of all traff is control devices (e.g.,traff is signals, signs, cones, striping, barricades), both existing and proposed -show types and locations of all event personnel(e.g., police off icers,volunteers) -show path of event participants See Altacl'iimei''A 1 Detours - provide map of detour, show detour sign/police locations and any existing signs to be covered provide drawing of detour sign(s) showingtext provide sign dimensions, color, size of text,type of sign material, and posting method See Nitachmem 'I List of Raltroad Grade Crossings -indicate whether grade crossing is active or inactive - list existing traffic control at a LL active grade crossings(e.g., crossbucks, Lights, gates, YIELD sign, STOP sign) - list traff is control for event at all active grade crossings(e.g., police, RR flagger), - indicate whether railroad has been contacted 11�JA Pre-Event Public Notification - list locations for signs or show on a map - provide drawing of signs showing text - provide sign dimensions, color, size of text,type of sign material, and posting method ,, list locations ors on a map all Changeabte Message Signs (CMS), provide pre-event text specify what day signs and CMS wilt be placed and when they will be removed describe any other type of notification (e.g., mailings, brochure, press reLease) being provided to the publicPERM 33b (9/2013) Page 6 of 9 CMS ProOded by SPD, tocated be�:or,e Hortoi Notifications to be provded Lo S92 and Ham. lonfitney and t1edicat Yffices re: Phan'nacy Banners ®indicate if thereill be any banners(roadside r overhead),type and locations NA Coordination ®describe coordination with state/local police llegW ii. ii,ii"ieetings pu uo U) and u�� ,irk'i cveu��'[ -describe coordination with state/local highway agencies describe coordination with municipalities ® describe coordination i r entities(e.g. railroads, park agencies, private property owners whose propertyill be usedfor theevent) Event Day Communications ®describe communications system s y event personnel, marshals,volunteers, police, and emergency rs n l Ceth Aar cornrr°nruni atio r arrioiig the Cofnmittee r'r°iemb rs and SPD Emergency Services -describe how emergency services will be provided during the event for event participants and spectators - describe how emergency vehicles wilt be able to use/ciross the event course if necessary for non-event related circumstances Sou diold un liu ity eduate aii'eau SF�IID at site of Winne lest'® Spectator Controt - indicate whether any special measures are being taken to control spectators(e.g., fencing, highway crossings) N/'A' Pavement Markings ®provide a sketch of each Location where temporary pavement markings wilt be placed -describe materiaL in used, and how and when it will be placed and removed N'A Event Day Signing—for highway users - list locations for signs or show on a map, note any existing signs to be covered - provide drawing of sign(s) showing text - provide sign dimensions, color, size of text,type of sign material, and posting method - list locations or show on a map all CMS, provide text Pai king signs Event Day Signing—for event participants list locations for signs or show on a map note types of signs in used (e.g., advance turn, it markers,feed zones/water stations) ® provide drawing of signs showing text - provide sign dimensions, color, size of text,type of sign material, and posting method NA Event Support Vehicles - describe the movements of any vehicles used in the event(e.g., parade floats, Lead &trait, sweep, sag) ® describe how each vehicle will convey its message(e.g.,flashers, headlights, beacons, signs), as appropriate. Sl�'D Coii,nii,i,iar�d Van If the following section of NYS Labor Law applies to the work to be performed under this permit, the application for and acceptance of this permit constitute the applicant's/permittee's agreement confirming the payment of wages as required by such section has been contractually mandated. New York Labor Law § 224-f. Workers on excavations. [Effective September 15, 2023] 1. For the purposes of this section: a. "Covered excavation project" shall mean construction work for which a permit may be issued to a contractor or subcontractor of a utility company by the state, a county or a municipality to use, excavate, or open a street. A"covered excavation project" shall exclude construction work for which a permit may be issued to a service provided as defined by subdivision twenty-three of section one thousand twenty-b of the public authorities law. b. "Department of jurisdiction" shall mean the department of the state, board or officer in the state, or municipal corporation or commission or board appointed pursuant to law, whose duty it is to issue a permit to a utility company, or its contractors or subcontractors, for a covered excavation project. c. "Fiscal officer" shall mean the commissioner; except for covered excavation projects performed pursuant to a permit issued by a city with a population in excess of one million in which case the "fiscal officer" shall be the comptroller or other analogous officer of such city. d. "Utility company" shall have the same meaning as subdivision twenty-three of section two of the public service law. 2. Each contractor or subcontractor to a utility company shall be required to pay not less than the prevailing rate of wage in the same trade or occupation in the locality within the state where such covered excavation project is situated to each laborer, worker, or mechanic in the employ of the contractor or subcontractor to a utility company,performing work on the project in accordance with sections two hundred twenty and two hundred twenty-b of this article. No permit shall be issued for a covered excavation project until an agreement confirming the payment of wages as required by this section has been contractually mandated and filed with the department of jurisdiction, and all permits issued after the effective date of this section shall include therein a copy of this section. 3. The enforcement of any covered excavation project pursuant to this section shall be subject to the requirements of sections two hundred twenty, two hundred twenty-a, two hundred twenty-b, two hundred twenty-three and two hundred twenty-four-b of this article and section two hundred twenty-seven of this chapter and within the jurisdiction of the fiscal officer; provided, however, nothing contained in this section shall be deemed to construe any covered excavation project as otherwise being considered public work pursuant to this article. 4. The fiscal officer may issue rules and regulations governing the provisions of this section. Any violation of this section shall be grounds for determinations and orders pursuant to section two hundred twenty-b of this article. BEFORE WORKING WITHIN THE NYSDOT RIGHT-OF-WAY YOU MUST CALL YOUR PERMIT INSPECTOR Mr. Joshua Ecker AT: (631) 727-1731 Address: Residency 03 -- Suffolk East 1900 County Road 58 Riverhead, NY 11901 DENIS NONCARROW �� „ � .. �,� � Town Hall,53095 Main Roams �- P.O.Box 1179 TOWN CLERK \y� '` `• Southold New York 11971 REGISTRAR OF VITAL STATISTICS ® Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ®� �� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER RECEIVED OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD DEC • APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVtNT Southold Town Clerk Please provide ALL of the information requested below. Incomplete applications WILL NOT be reviewed. Date of Submission NameofEvent ��,�, ��.� ® c,u ,,.► ��+.tT2,��s�' Name of Organization: :Sp-0`CVy0L-D V -c�►vvatl 7�V �v�MZ��' �rAM ftF' C�..��� Is this a Not-For-Profit Event? Yes 0 Contact's Name: Mailing Address: b�� 6c-rx Jrt� V rl5T ►-A JX-2 1 v t Contact's Phone Number: �®� Contact's Email Address: C--O,n^ Event Location and Site Diagram: SO-Y N 4�k nl L etC MAt nL KTm�&.� (Use additional paper if necessary) Event Date(s): rg-e rz j A RU le I2al 4 (Include se up and shutd n ti es and dates rr-op-(% -Te 5-0-rkOt,`g Y1—::kR- XdvMk, JNR-t)CdN�SvPPd$� Nature of Event: C-bLA i. (zjv6 t N 5-r-.S S aS A,, C k ,a.e—Ct MS Ajn, a, 't (Please attach a detailed description f6this application) Time Period (Hours) of Event: From )0 A JN to 3 Prh Maximum Number of Expected Attendees: 'D,06eg Specify any special requirements (i.e. road closure, police presence): gAA,,a 2oAA f R0-06. 1�t�fL'Cc�(vS ` e. V0 V NGS' n USG lc-tvw tUL& AP-k 1N6s- 4 F X AL4 SMALL PA2kl ���wIJ,- Sv� P62;6J Pb'rT)e;-, r ` S 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: 10 a aX ©cz, J S� r/d�dZ1 s ti�N N 9 Lq g Event Fees: $250 for events with less than 1000 expected attendees $500 for events with 1000 or more expected attendees Clean-up Fees (Can NOT be waived): $1,500.00 Clean-up for Bicycle and/or Running Special events (ONLY) $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. �101t N �A iL.fc Print name of Authorized Person filling out Signatur4oauthor zed 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 J "1' C.•r �. .>��!� ,d eov 1 —Town Hall Parkin g. 00 2—Annex Vehicle _ •- �?r'. `\-dam, _ � ' ti._mil:' � ,-... I - toceY!_.�r_7 A! r CY'}r.v ' w ~ y Parking. .F � ` Yt ex� r• - s 3 ` ®R.�T �p^� �.ti•,h „ gip 4n 3 —Gazebo Activities. 4 - Small Parkin ` :` :�,•. 5 _ opposite Library activities SPD block off evening t g - .�.,,�` - �'xJ"' _ "six' _ :i t 7 -Tk'",. ��•,,»,,. - _ before). :• a" : > 4s;: - a 5 - CAST =- �• ' p 6 — First Presbyterian �yJ Church. $'. — a 7 Close 25 from Horton .i- a� - to Youngs. M p data 92023 200 h TOWN OF SOUTHOLD Policy for Special Events on Town Properties and Roads In addition to the criteria set forth in Chapter 205 of the Southold Town Code with respect to the review of events that are proposed to utilize or be held on any land owned, leased or controlled by the Town of Southold and, in particular, special events on Town roads, and with the exception of community organized parades, the issuance of a Special Event Permit by the Town Board will be subject to the following guidelines: 1. All events must be sponsored by a not-for-profit organization or recognized charity and the applicant must verify that all proceeds generated by the event are wholly for the benefit of said organization or recognized charity. 2. Events that require the closing of a road shall not be held on a holiday or at the same time or location of previously approved community or special events absent authorization from the Chief or Captain of the Police Department. 3. All motorcycle events shall be limited to 600 participants. 4. Applicants may only receive approval for one event in each calendar year. 5. The prior issuance of an approval does not bind the Town Board to approve the same or a similar event in the future. 6. Failure to comply with any condition of approval may result in revocation of approval and/or denial of future applications. In addition to the above, all Bicycle and/or Running Special Events shall be subject to the following guidelines: 1. There shall be no bicycle and/or running special events conducted within the Town of Southold during the period of June 1 to November 1. 2. Organizers and participants of bicycle and/or running special events shall fully adhere to the "rules of the road" including every applicable provision of the New York State Vehicle and Traffic Law, including but not limited to VTL §§1231-1234. 3. Organizers of bicycle and/or running special events shall post a deposit of one thousand five hundred dollars ($1,500.00) to ensure that the roads are returned to pre-event condition. 4. Where the expected number of persons or the duration of the bicycle and/or running special event may impact the health, safety and welfare of the public, as a condition to granting the permit, the Town Board, upon the recommendation of the Chief of Police, may require the applicant to reimburse the Town for the costs of increased police protection, public safety oversight, and public works facilitation, including any additional equipment as may be deemed necessary by the Chief of Police to adequately and safely control and protect the persons attending the event, the event area and traffic in and 3 around the event area. Such costs shall include all necessary staffing and shall be provided to the applicant prior to the issuance of the permit. 5. All bicycle events and/or running special events shall be limited to 600 participants. All special event approvals shall be subject to compliance with the following conditions: 1. They file with the Town Clerk a Two Million Dollar Certificate of Insurance naming the Town of Southold as an additional insured; a$250 or$500 filing fee (depending on size of event); a remuneration fee determined by the Chief or Captain of the Police Department for traffic control; $250.00 or more deposit for clean-up (deposit to be returned after event upon recommendation of the Southold Town Police Chief; Southold Town Police Department); 2.' Make every effort to control noise; 3. Comply with Chapter 205 of the Southold Town Code to notify neighbors in advance of event; 4. Coordinate traffic control upon notification of the adoption of a Town Board resolution with Police Captain; 5. No permanent markings be placed on Town, County or State roads or property for the event; 6. Any road markings or signs for the event be removed within twenty-four(24) hours of the completion of the event; and 7. Any parade participants shall not throw candy or other objects at or in the direction of spectators along the parade route but such items may be handed directly to spectators. The Town Board reserves the right to waive or modify any or all of the above guidelines and conditions as it may deem appropriate under the circumstances presented and to deny any application for a special event that is determined to not be in the best interest of the residents of the Town of Southold. 4 HOLD HARMLESS AGREEMENT The applicant 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): Sworn to before me this Day of , 20 i a Noncarrow, Denis To: Special Events PD Cc: Johnson, Benjamin; Schlachter,Amy(amys@southoldtownny.gov) Subject: Winterfest 20205 w road closer Attachments: wi nterfest_20241205122033.pdf Please see attached and let us know.This is a town committee. 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. r 1 HOLD HARMLESS AGREEMENT The applicant 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): Sworn to before me this Day of 20 Noncarrow, Denis To: Special Events PD Cc: Johnson, Benjamin; Schlachter,Amy (amys@southoldtownny.gov) Subject: Winterfest 20205 w road closer Attachments: winterfest_20241205122033.pdf Please see attached and let us know.This is a town committee. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www southoldtownny.aov denisn(@southoldtownny.aov 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. 6 6 i Noncarrow, Denis From: Grattan, Steven Sent: Thursday, December 5, 2024 3:47 PM To: Noncarrow, Denis; Blasko, Regina; DeChance, Paul; Goodwin, Dan; Mudd,Jennifer; Norklun, Stacey; Orientale, Michael; Born, Sabrina Cc:. Johnson, Benjamin; Schlachter,Amy Subject: RE:Winterfest 20205 w road closer Attachments: Winterfest 2025.xls I have no objections to this event.We will provide officers to close Route 25 at Hortons Ln and Youngs Ave from 1000- 1500 hrs. My cost analysis is attached. 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. 06LIICE From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent:Thursday, December 5, 202411:14 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:Johnson, Benjamin<benjaminj@southoldtownny.gov>;Schlachter,Amy<amys@southoldtownny.gov> Subject:Winterfest 20205 w road closer Please see attached and let us know.This is a town committee. 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. 2 Town of Southold Police Department Special Event Cost Analysis Event: Southold Town Winterfest 2025 Date(s): February 8, 2025 1 Location: Southold Village area 7," Reg Hours OT Hrs HrIy Wage Total Comments Sergeant Crosser 6 $89.74 $538.44 Police Officer Conlon 6 $78.61 $471.66 Reg Hours OT Hrs HrlyWage Total Comments PO Chenche $0.00 PO Sanders --��$00-00�00 � Bic 0 0� $0.00 $0.00 $0.00 $0.00 Highway;Patrol 'Po onufrak 6 $77.20 $463.2.0 PO Flatley $0.00 Mar"!"' Units - Traffic Control !L Hours µµ OT Hrs Hrly Wage Total Comments ...... quipment 7,7 7 S!S� PD Vehicles of vehicles' Hour $/hr Total 3 6 $20.00 $360.00 Command Van 1 6 $20.00 $120.00 Marine Patrol Boats ,Total Department Cost for Event = $1,953.30 Prepared by Chief S. Grattan 12/6/2024 Pagel RESOLUTION 2025-55 ° ADOPTED" DOC ID: 20988 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2025-55 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JANUARY 7, 2025: RESOLVED that the Town Board of the Town of Southold hereby grants permission to the Southold Economic Development Committee to hold the Winter Fest on Saturday, February 8, 2025 from 9:00 am to 4:00 pm with a Rain Date of Sunday, February 9, 2025, on Town property located at 53670 Route 25 and 53720 Route 25, Southold, provided they follow all the conditions in the Town's Policy for Special Events on Town Properties, and subject to the Economic Committee working with Town and State departments as needed and the following additional conditions: 1. The Main Road(Route 25) closure for the event shall be limited to the hours of 10:00 AM and 3:00 PM; 2. The applicant shall notify local hospitals, senior and rehabilitation centers that access to Southold Pharmacy will be limited on the date of the event; and 3. This approval shall be considered for the 2025 event only, any future request will be reevaluated by the Board. All Town fees for this event are waived. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Anne H. Smith, Councilwoman SECONDER:Brian O. Mealy, Councilman AYES: Doroski, Mealy, Smith, Krupski Jr, Doherty, Evans State of New York Department of Transportation EE 318 447 358 US PERM 33b Application for the use of State Highway/NYSDOT Property for Special Events Parades, processions, assemblages, walk-a-thons, festivals, civic or cultural events, etc. A PERM 33b is required when an event such as a parade, procession, assemblage, walk-a-thon, festival, civic or cultural event, etc. is planned to take place on state highway right-of-way, and the local Municipality chooses not to regulate the event. Page 1 of 9 PERM 33b (9/2013) INSTRUCTIONS FOR COMPLETING THE SPECIAL USE PERMIT (PERM 33b) • Identify the name, date, time, and type of event. • Identify all Cities, Villages, Towns, and Counties where the event will be held. • Specify the location of the event by State Route numbers/highway names, street names, etc. by municipality, If the event includes facilities other than highways/streets, describe the location and names of the facilities (parks,trails, private property, etc.)that will be used. • State the Permit Applicant's name and address. The event organizer is always the "Applicant'; the applicant may be an individual, municipality, organization, or group. The Applicant assumes full responsibility for the event even if other organizations will be involved. The Permit will be issued to the Applicant, who will be responsible for complying with all of the terms of the Permit. • Identify an Authorized Representative who will be the contact person. • Provide information listed on Page 2 of the Application_ • Acknowledge permit terms and conditions; provide Applicant/Authorized Representative's signature and date. • Submit non-refundable Application Fee of$25.00. (This fee is waived if the Applicant is a not-for-profit group.) Please make check payable to NYSDOT. • Please submit the original completed permit application to the address listed below a minimum of one month prior to the event date. Keetpa phat will serve records.the Spec Special Use Permit.proval, a y of the application and o an Approval Form will be returned you New York State Department of Transportation Regional Traffic Engineer NYSDOT Region Page 2 of 9 PERM 33b (9/2013) i PERM 33b NEW YORK STATE DEPARTMENT OF TRANSPORTATION (Application Form) APPLICATION FOR SPECIAL USE PERMIT (Pg 1 of 2) Special Use Event: �ame of Event 0 -jr- Date( ) Time(s) #of Participants C.;r q - �1p Type of Special Use Event: (Check all that apply): Parade or Procession ❑Assemblage ❑Walk-a-thon Festival ❑ Other yes T Location Municipalities (specify highways bV route number and/or street name) (Cities Towns Villages Counties) e- 5 Q- o oVIS e e o ` urn .s e Applicant Information: Applica—own—S S uk-�nn nt(individual, organization, group) Authorized Representative (if differen from Applicant) . oo3l) n 6 5- Mailing Address Tel phone Wimber(including area code) sad+�Iak� -1 i City, State, Zip Code Cell Phone Number(including area code) c,w S al .ny.�s a.. own.sou�lnol . ,��.us E ail Address Em I Address (if different from Applicant) WWtA-) S0 6A:kouOnlnq . 4y-1 Website Address (if appropriate) i Page 3 of 9 PERM 33b (9/2013) k f i i t i 3 PERM 33b NEW YORK STATE DEPARTMENT OF TRANSPORTATION (Application Form) APPLICATION FOR SPECIAL USE PERMIT (Pg 2 of 2) The following information must be submitted at the time of application: Official Map, Event Brochure, and Event Application The applicant shall provide an official map, event brochure and event application form (if applicable). E?r' Operation and Safety Plan The applicant shall provide an Operation and Safety Plan which includes the applicable items from the Checklist on pages 5 and 6; attach the completed checklist. ❑ $25 Application Fee (this fee is waived if the Applicant is a not-for-profit group) Please make check payable to NYSDOT. The following information must be submitted no less than two weeks prior to the event date: [� Insurance Certificates (must be in Applicant's name) The Applicant shall provide documentation of required insurance, including Workers' Compensation and Disability Insurance; see Item 7 of Responsibilities of Applicant for required insurance types and limits. Municipal Approvals The Applicant shall provide written proof from each municipality (County, City, Town, and Village) through which the event passes indicating that the Municipality has no objection to the event taking place. This written proof may take the form of a letter, resolution, email, or other. The applicant shall also provide the name of a contact person for each municipality. Acknowledgment. On behalf of the Applicant, I hereby request a Special Use Permit, and do acknowledge and agree to the Responsibilities of Applicant and obligations set forth in this permit and warrant compliance therewith. The attached documents are also made a part hereof and attached hereto: Application received by: Applicant's epresentative's Signature NYSDOT Representative's Signature / Date Date Received by NYSDOT PERM 33b (9/2013) Page 4 of 9 OPERATION AND SAFETY PLAN CHECKLIST Please supply the following information or note as "Not Applicable." (The Event Map should show the entire course, but all other checklist elements only apply to the portions of the event occurring on State highways.) ❑ Event Map - show start and finish lines - show direction of event travel - show all intersections, railroad crossings and jurisdictional boundaries - show all facilities being used by the event (roads, parks, schools, parking lots, etc.) ❑ Description of Event = identify event starting and ending times and locations - describe sequence of event activities, including setup and cleanup✓ - describe any road/lane/shoulder/sidewalk closings and times and method of closure (e.g., signs, cones, barricades)�✓ - describe all event activities where participants will violate the normal "rules of the road" and all locations where traffic will be required to stop where no stop is normally required ❑ Locations requiring traffic control for event - list intersections where the existing type of traffic control (e.g., signal, stop, yield, no control)will be changed during the event and describe how normal traffic will be directed (e.g., police officer) - list locations where participants will turn left across lanes of traffic - provide sketches of all locations requiring additional traffic control during event - show types and locations of all traffic control devices (e.g., traffic signals, signs, cones, striping, barricades), both existing and proposed - show types and locations of all event personnel (e.g., police officers, volunteers) - show path of event participants []�Detours - provide map of detour, show detour sign/police locations and any existing signs to be covered - provide drawing of detour sign(s) showing text - provide sign dimensions, color, size of text, type of sign material, and posting method ❑ List of Railroad Grade Crossings - indicate whether grade crossing is active or inactive - list existing traffic control at all active grade crossings (e.g., crossbucks, lights, gates, YIELD sign, STOP sign) - list traffic control for event at all active grade crossings (e.g., police, RR flagger) - indicate whether railroad has been contacted ❑ Pre-Event Public Notification - list locations for signs or show on a map - provide drawing of signs showing text - provide sign dimensions, color, size of text, type of sign material, and posting method - list locations or show on a map all Changeable Message Signs (CMS), provide pre-event text - specify what day signs and CMS will be placed and when they will be removed - describe any other type of notification (e.g., mailings, brochure, press release) being provided to the public PERM 33b (9/2013) Page 5 of 9 OPERATION AND SAFETY PLAN CHECKLIST ❑ Banners - indicate if there will be any banners (roadside or overhead), type and locations ❑ Coordination - describe coordination with state/local police - describe coordination with state/local highway agencies - describe coordination with municipalities - describe coordination with other entities (e.g. railroads, park agencies, private property owners whose property will be used for the event) ❑ Event Day Communications used by event personnel, marshals, volunteers, police, and - describe communications system emergency personnel ❑ Emergency Services - describe how emergency services will be provided during the event for event participants an spectators - describe how emergency vehicles will be able to use/cross the event course if necessary for non-event related circumstances ❑ Spectator Control - indicate whether any special measures are being taken to control spectators (e.g.,fencing, highway crossings) ❑ Pavement Markings avement markings will be placed - provide a sketch of each location where temporary p - describe material being used, and how and when it will be placed and removed ❑ Event Day Signing —for highway users - list locations for signs or show on a map, note any existing signs to be covered - provide drawing of sign(s) showing text - provide sign dimensions, color, size of text, type of sign material, and posting method - list locations or show on a map all CMS, provide text ❑ Event Day Signing—for event participants - list locations for signs or show on a map nce turn, mile markers, feed zones/water stations) - note types of signs being used (e.g., adva - provide drawing of signs showing text - provide sign dimensions, color, size of text, type of sign material, and posting method ❑ Event Support Vehicles - describe the movements of any vehicles used in the event (e.g., parade floats, lead &trail, sweep, sag) - describe how each vehicle will convey its message (e.g., flashers, headlights, beacons, signs), as appropriate Page 6 of 9 PERM 33b (9/2013) I S' Responsibilities of Applicant 1. Limitations on Use. The specific site identified in this permit, and only that portion identified, will be available for use by Applicant only for the purpose stated in this permit and only on the date(s) and for the duration designated in this permit. The authorization herein shall be only for the actual duration of the event. 2. Conditions of Use. NYSDOT makes no affirmation that the state-owned site to be used for the event has been designed, constructed, or maintained for the purpose of the conduct of the event.The Applicant assumes full responsibility for planning and conducting a safe and orderly event that does not expose participants or the public to any unreasonable hazards and that involves a minimal disruption of the normal uses of the state highway system. It shall be the sole obligation of the Applicant to determine whether the site is suitable for the purpose of safely conducting the event. The Applicant assumes all responsibility for assuring that the use of the highway/property conforms to applicable requirements of law, including, but not limited to those set forth herein. 3. Operation and Safety Plan. The Applicant assumes all responsibility for the set-up, conduct and break-down of the event. The Applicant assumes all responsibility for the control of the event site, and warrants that the site has been inspected, and that any perceived defects in the state highway(s) have been or shall be reported to NYSDOT and that adequate provision has been or shall be taken to mitigate and/or separate event participants from these perceived hazards. The Operation and Safety Plan must detail how the Applicant intends to (1)promote safety and (2) minimize the disruption of traffic. To the extent of any closure on the state highway or the disruption of the movement of traffic proceeding along (e.g. lane and shoulder closures), entering, or crossing a state highway for a period more than ten minutes, the Applicant shall provide and maintain a si ned detour or police officers to direct traffic. The Applicant shall consult with and coordinate the event with state and/or local police to determine such action as may be necessary to protect the public safety, security, or convenience, and incorporate all recommendations into the Operation and Safety Plan. Notwithstanding any other provision of law to the contrary, no person or entity shall have the right to bring an action against the state or municipality or any person employed by the state or municipality who was acting within the scope of their authority for damages resulting from or in connection with the event(s). The Applicant shall ensure that all participants shall obey any lawful order or direction (1) of any police officer that deviates from the Operation and Safety Plan before, during or after the event(s), (2) of any police officer, flag person or other person duly empowered to regulate traffic during an emergency, or(3) given by a federal, state, county or city official or any person acting as part of the civil defense forces. 4. Rail Grade Crossings. The Applicant is responsible for ensuring the safety of event participants at all railroad grade crossings. The Operation and Safety Plan shall address rail crossing operations. For grade crossings where a train may cross during the event, the applicant must propose a safety plan. 5. Assumption of Risk. Use of the permitted site shall be in accord with the general authority of the State (where applicable) and applicable New York State Vehicle &Traffic Law sections so that although the participants are exempted from compliance with the usual traffic laws as detailed in the Operation and Safety Plan, they must exercise reasonable care. PERM 33b (9/2013) Page 7 of 9 Responsibilities of Applicant 6. Insurance Requirements. The Applicant shall provide NYSDOT with proof of insurance prior to the installation of any temporary traffic control devices or the commencement of the event, i.e. a certificate of insurance is required to maintain and provide proof that it has, in full force and effect, the following insurance coverages: (a) Workers' Compensation and Disability Insurance. As required by State Finance Law §142, the Applicant shall maintain in force workers' compensation insurance for all employees. The Applicant shall also maintain disability insurance as required by the Disability Benefits Law of the State of New York. (b) Commercial General Liability Insurance. The Applicant shall maintain an occurrence form commercial general liability policy or policies insuring against liability arising from premises (including loss of use thereof), personal injury or death, advertising injury, liability insured under an insured contract (including the tort liability of another assumed in a business contract) occurring on or in any way related to the premises or occasioned by reason of the operations of the Applicant. Such coverage shall be written on an ISO occurrence form CG 00 01 12 07 (or a form that provides equivalent coverage) in an amount of not less than ONE MILLION DOLLARS ($1,000,000.00) per occurrence and not less than TWO MILLION DOLLARS ($2,000,000.00) aggregate. This insurance must be endorsed to provide coverage to"The State of New York/New York State Department of Transportation, any municipality in which the event is conducted, and any governmental entity whose facilities are affected by the event, or any of their employees or agents working for or on the event," using ISO form CG 20 10 07 04 or a form that provides equivalent coverage. (c)Automobile Insurance (applicable where automobiles or other vehicles will be used in relation to the event). The Applicant shall maintain a commercial or other automobile policy or policies insuring against liability for bodily injury, death, or damage to property and other mandatory coverages, relating to the use, operation, loading or unloading of any of Applicant's automobiles (including owned, hired and non-owned vehicles) on and around the site/event. Coverage shall be in an amount of not less than ONE MILLION DOLLARS ($1,000,000.00) each accident. (d) Umbrella or Excess Liability.Insurance. The Applicant shall maintain an occurrence form umbrella liability policy or policies insuring against liability arising from premises (including loss of use thereof), operations, personal injury and advertising injury, and liability insured under an insured contract (including the tort liability of another assumed in a business contract) occurring on or in any way related to the premises or occasioned by reason of the operations of the Applicant as described above. Such coverage shall be written on an ISO occurrence form CU 00 01 12 07 or a form that provides equivalent coverage. In the event that umbrella coverage is unavailable, equivalent excess coverage may be substituted. The minimum required limits for the umbrella/excess coverage shall be sufficient to provide a total of not less than FIVE MILLION DOLLARS ($5,000,000.00) per occurrence/aggregate. 7. Indemnification: In addition to the protection afforded the State by the insurance provision herein, NYSDOT shall not be liable for any damage or injury to the Applicant, employees, event organizers and volunteers, or participants, or any other person, or to any property, occurring on the site covered by this permit or any part thereof associated in any way with Applicant's use of the site.To the fullest extent permitted by law, the Applicant agrees to defend, indemnify and hold harmless the State of New York, NYSDOT, and their agents from and against all claims, damages, losses and expenses, including but PERM 33b (9/2013) Page 8 of 9 Responsibilities of Applicant not limited to attorneys'fees, arising out of any claim for personal injuries, property damage or wrongful death associated in any way with the Applicant's or participants' use of the permitted site(s,) or in any way related to the event, no matter how.caused. 8. Termination of the Permit. NYSDOT shall have the right, in its sole discretion, at any time to terminate this permit, or any portion thereof, should it be necessary due to operations or other reasonable need of NYSDOT, by giving written notice of termination of the permit. Any termination by NYSDOT shall in no way constitute or be deemed a breach of this Permit and no liability shall be incurred by or arise against NYSDOT, its agents and employees for loss of profits or any other damages. 9. Applicant's Use of the Highway/Property. The Applicant shall exercise due care in its use of the site and shall upon the expiration, termination, or cancellation of the issued permit, surrender the site in as good a condition as on the effective date of this permit, ordinary wear and tear excepted. The Applicant shall designate a representative to conduct both a pre-event and post-event field review of the event course with the NYSDOT Resident Engineer(s) to determine what damage may or may not have resulted from the event.The Resident Engineer is given the authority to determine if any of the post-event damage is required to be repaired. 10. Agency's Representative. The Commissioner of the NYS Department of Transportation, or his/her designee, shall be, and,hereby is authorized to act for and on behalf of NYSDOT. 11. Promotional Materials. Any promotional materials shall be consistent with the provisions of this permit. NYSDOT shall in no way be represented to be a sponsor or organizer of the event.The Applicant represents that it has permission to reproduce any such materials, and will defend and indemnify NYSDOT for any damages NYSDOT may incur for the infringement of any third-party proprietary rights because of the use of such materials. 12. Reporting Requirements. The Permittee agrees to notify the Agency's representative about any hazardous or unsafe conditions and about any accidents that occur during the event immediately upon the discovery of such condition or accident. 13. Site Care and Restoration (if necessary and conducted by NYSDOT). An Undertaking, a bond or a certified check in an amount designated by the Department of Transportation may be required before a permit is issued, to guarantee restoration of the site to its original condition. If the Department is obliged to restore the site to its original condition, the costs to the Department will be deducted from the amount of the Permittee's guarantee deposit at the conclusion of the work.The Permittee agrees to be responsible for any costs in excess of the Bond/guarantee deposit on file and will be billed directly therefore. If there is no Undertaking, bond or certified check, a statement of such costs and expenses will be submitted to the Permittee within 30 days after completion of the event.The Permittee shall make payment of this amount, if any, within 60 days after completion of the event. 14. Costs Incurred by Issuance of this Permit. All costs beyond the"limits of liability insurance, surety deposits, etc. are the responsibility of the Applicant. The State shall be held free of any costs incurred by the issuance of this permit, direct or indirect. 15. Legal. The privilege granted by the permit does not authorize any infringement of federal, state or local laws or regulations, is limited to the extent of the authority of NYSDOT and is transferable and assignable only with the written consent of the Commissioner of Transportation. The Commissioner reserves the right to modify fees and to revoke or annul the permit at any time, at his/her discretion without a hearing or the necessity of showing cause. Page 9 of 9 PERM 3 3 b (9/2013) 4 ATTACHMENT 41 6 a�.p.. l;•y,. ;.:� `�� . .�, .� �•. Founders Tavern 04 ti { Southold Hard.�are`Cor ualii OE <�y CubeSmart:Self Storage" IA P' :Find Stora e. in Long.lsiande •o . �,�`f •,,_. ..� .or' .°;ram„--emu:.:.. e0 -X touchGOQQ. �...�c;. 5:.. ARU ..�': ./` .'y�:, t,-"! +j ,. �Q; 'ram'•- .... 4:�'i s�.:♦��'•'^I e`"en"dentlrGroU� St Patrick's Rc Church xrsi'?s�:J:Y:rla`n`� A"' . 1. Town Hall Parking 2. Annex Vehicle Parking 3. Gazebo Activities 4. Small Parking opposite Library activities (SPD block off evening before) 5. CAST 6. First Presbyterian Church 7. Ro:adclosieo�f StateR25,=— from intersection of Hortons Lane to Youngs Avenue Town Hall,53095 Main Road DENIS CAI3I�OW � -''`- ,L t' �� 1179 NON r;, , P.O.Box OWN CLERr ~ ' _s Southold,Newyork 11971 Fax(631)765-6145 REGISTRAR OF VITAL STATISTICS �� E`x �'� ' Telephone(631)765-1800 MARRIAGE OFFICER c �v.southoldto�vnny.gov RECORDS MANAGEMENT ww ON OFFICER � L FREEDOM OF INFORMATION Ri ECE-WED OFFICE OF THE TOWN CLEItIK TOWN OF SOUTHOLD DEC 4W APPLICATION FOR A PERMIT TO HOLD A Southold Town Clerk SPECIAL EVtNT Please provide ALL of the information requested below.Incomplete applications WILL NOT be reviewed. Date of Submission Name of Event Name of Organization: Is this a Not-For-Profit Event?Yes o Contact's Name: (Z. Mailing Address: l7� max ��S' `5T r ►u Contact's Phone Number: �- t�J! ti L , C_ . n� Contact's Email Address: _A c ► � -1 Event Location and Site Diagram: r e`er ►-`A n� ' �°�t �`t�� (Use additional paper if necessary) Event Date(s): 1?� (Include se up and shut- n ti es and dates) ,/ �� �av�,� ���� ��,�a S+�Pt?d : Nature of Event: t"-A-ac t3L-"e'„''-s s eS Fv., C K"�c� = A.& t'.t 't (Please attach a detailed description o this application) Time Period (Hours) of Event: From l o A rA to 3 Prn Maximum Number of Expected Attendees: 2.d Specify any special requirements (i.e. road closure, police presence): G.os� R-�`+� r�-a� 1"2a�.► s x Aov Sw.nLL ' F'R2�i9v ��4����:✓a `�a \1�':-,�C:�' ry SSG •�Za W N Y�I;P.c. f��n-k�/A'tt(�� � PQP: Bq �(Fu `itT� t5' RRrL.I :5vu<-wJot�t� �UtV 1� 'r 3 be used please contact the Southold Town Building Department if a Tent or other temporary structure will at 631-765-]802 Mailing Address to Send Event Permit to: C Cix des r1iSi sn :� t 9L .3d Event Fees: _$250 for events with less than 1000 expected attendees _$500 for events with 1000 or more expected attendees Clean-up p Fees (Can NOT be waived): _$1,500.00 Clean-up for Bicycle and/or Runnin g Special events (ONLY) $250 or more Clean-up deposit all other even CERTIFICATE OF INSURANCE RE UIRED: 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. qSi "%reof Person filling out application Print name of Authorize Person filling out application `Upon the request by applicant,the Town Board may waive in whole or in part any of the application requirements. 2 I 1 c %,A 'CI Subject: Southold WinterFest Exhibit Confirmation Dear Third Annual Southold WinterFest Exibitor: We are very pleased to confirm your booth space for this exciting community event. Please note the following: 1. The event takes place on Saturday, February 8, 2025 between 10:00 AM and 3:00 PM on Main Rd. in the Village of Southold. 2. Kindly take a few minutes to carefully review the attached list of exhibits and locations. It shows where you will be located and other details. Unless otherwise indicated, please be prepared for setup at your assigned space by 9:00 AM on Saturday, February 8th 3. To allow space for each exhibitor, please keep your exhibit area no larger than a 10' X10' space. 4. Be certain to bring your own table, chairs,signs, extension cords, and power strips. For those requiring it, electric power is available at the Village Green (gazebo area)and at the municipal parking lot on Main Rd.across from the library. 5. Members of the WinterFest Committee will be available to assist throughout the day and an information table will be staffed in the municipal parking lot on Main Road across from the library.You can spot us, as we will be wearing black"WINTERFEST" caps. 6. If the weather is inclement, check the event Facebook page at"SoutholdWinterFest'for updates. 7. If you have any questions, kindly reach out to us no later than Friday, January 31st.The best way to reach us is via email at southoldwinterfest(Qgmail.com. The Committee has done its best to promote the event via media outreach,social media, radio advertising, and email campaigns.A good crowd is expected.We look forward to your participation! Thank you very much, Third Annual Southold WinterFest Committee Jennifer Del Vaglio Lucine Kirchhoff Jack Malley Susan McHugh Brian Q. Smith Q 03-y'% K S 4 a SOUr�O ALBERT J.KRUPSKI,JR. aQ lQ Town Hall, 53095 Route 25 SUPERVISOR � � P.O.Box 1179 Southold,New York 11971-0959 G Q Fax(631) 765-1823 Telephone (631) 765-1889 UNTY,� OFFICE OF THE SUPERVISOR TOWN OF SOUTHOLD December 27,2024 Mr. Olumuyiwa Fajolu NYSDOT 250 Veterans Memorial Highway Room 6A7,Traffic Safety &Mobility Hauppauge,NY 11788 Dear Mr. Fajolu: The Town of Southold is in support of the road closure application for the Winterfest to be held on February 8, 2025 with a rain date of February 9, 2025. Sincerely, Albert J. Krupski, Jr. Southold Town Supervisor 1 ® DATE(MMIDDIYYYY) A��o CERTIFICATE OF LIABILITY INSURANCE 12/26/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Barbara Darnrners NAME: Roy H Reeve Agency,Inc. gIONn o Ext: (631)298-4700 Fnic,No): (631)298-3850 PO Box 54 E-MAIL bdammers@royreeve.com ADDRESS: 13400 Main Road INSURER(S)AFFORDING COVERAGE NAIC q Mattituck NY 11952 INSURERA: New York Municipal Insurance Reciprocal INSURED INSURER B: Town of Southold INSURER C: PO Box 1179 INSURER D: INSURER E: Southold NY 11971 INSURER F COVERAGES CERTIFICATE NUMBER: CL24122622334 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 POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DDlYYYY (MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 N/ A A 50,000 CLAIMS-MADE /. a occurren OCCUR PREMISES Ece $ X $25,000 Deductible MED EXP(Any one person) $ 5,000 A Y MPK-THOLD-0000001-24 01/01/2025 01/01/2026 PERSONALBADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3.000,000 X POLICY PROJECT F ]LOC PRODUCTS-COMPIOPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED MCA-THOLD-0000001-24 01/01/2025 01/01/2026 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000.000 A EXCESSLIIAB CLAMS-MADE MEC-THOLD-0000001-24 01/01/2025 01/01/2026 AGGREGATE $ 20.000,000 X DED RETENTION$ 10.000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT s OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The NYSDOT,any municipality in which the event is conducted,and any governmental entity whose facilities are affected by the event,or any of their employees or agents working for or on the event, are listed as additional insureds with respect to general liability as per the terms and conditions of form #MPL-216(03/06)-General Liability New York Municipal Special Additional Insured Endorsement,or form#CG2013(11/85)-Additional Insured-State or Political Subdivision-permits relating to premises, as required by written contract or agreement. Winterfest 218/25,Rain date 219/25 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NYS DOT,Traffic Engineering&Safety ACCORDANCE WITH THE POLICY PROVISIONS. 250 Veterans Highway AUTHORIZED REPRESENTATIVE Rm 6A-7 Hauppauge NY 11788 � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(20.6/03) The ACORD name and logo are registered marks of ACORD Operation and Safety Checklist Details OPERATION AND SAFETY PLAN CHECKLIST Special Accommodations ® Obtain permission for 3 parking spaces for Pharmacy users in Feather Hill ® Contact local medical offices advising them about road closure ® If permitted, place a sign in the pharmacy advising of the closure date and time © Police will assist pharmacy delivery van entering and leaving closed road © Other as needed Event Map -show start and finish lines - show direction of event travel -show all intersections, railroad crossings and jurisdictional boundaries -show all facilities being used by the event(roads, parks, schools, parking lots, etc.) See attached map of event location from Horton to Youngs(attachment 1) Description of Event -identify event starting and ending times and locations -describe sequence of event activities, including setup and cleanup - describe any road/lane/shoulder/sidewalk closings and times and method of closure (e.g., signs, cones, barricades) -describe all event activities where participants will violate the normal"rules of the road" and all locations where traffic will be required to stop where no stop is normally required See attached TOS Application for a Permit to Hold a Special Event and WinterFest Exhibitor Confirmation (Attachment 2 and 3) Locations requiring traffic control for event -list intersections where the existing type of traffic control(e.g., signal, stop,yield, no control)will be changed during the event and describe how normal traffic will be directed (e.g., police officer) -list locations where participants will turn left across lanes of traffic - provide sketches of all locations requiring additional traffic control during event -show types and locations of all traffic control devices (e.g.,traffic signals, signs, cones, striping, barricades), both existing and proposed - show types and locations of all event personnel(e.g., police officers,volunteers) -show path of event participants See Attachment 1 Detours " -provide map of detour, show detour sign/police locations and any existing signs to.be covered - provide drawing of detour sign(s) showing text -provide sign dimensions, color, size of text,type of sign material, and posting method See Attachment 1 i i List of Railroad Grade Crossings -indicate whether grade crossing is active or inactive -list existing traffic control at all active grade crossings (e.g., crossbucks, lights, gates, YIELD sign,STOP sign) - list traffic control for event at all active grade crossings(e.g., police, RR flagger) -indicate whether railroad has been contacted NA Pre-Event Public Notification -list locations for signs or show on a map - provide drawing of signs showing text -provide sign dimensions, color, size of text,type of sign material, and posting method *list locations or show on a map all Changeable Message Signs (CMS), provide pre-event text -specify what day signs and CMS will be placed and when they will be removed -describe any other type of notification (e.g., mailings, brochure, press release) being provided to the publicPERM 33b (9/2013) Page 6 of 9 CMS Provided by SPD, located before Horton Notifications to be provded to S92 and Hampton Jitney and Medical Offices re: Pharmacy 9 d� d x d Banners -indicate if there will be any banners(roadside or overhead),type and locations NA Coordination -describe coordination with state/local police Regular meetings prior to and during event -describe coordination with state/local highway agencies -describe coordination with municipalities -describe coordination with other entities(e.g. railroads, park agencies, private property owners whose property will be used for the event) Event Day Communications -describe communications system used by event personnel, marshals,volunteers, police, and emergency personnel Cellular communication among the Committee members and SPD 1 b Y Emergency Services -describe how emergency services will be provided during the event for event participants and spectators -describe how emergency vehicles will be able to use/cross the event course if necessary for non-event related circumstances Southold FD in immediate area, SPD at site of Winterfest. Spectator Control -indicate whether any special measures are being taken to control spectators(e.g., fencing, highway crossings) NA Pavement Markings -provide a sketch of each location where temporary pavement markings will be placed -describe material being used, and how and when it will be placed and removed NA Event Day Signing—for highway users -list locations for signs or show on a map, note any existing signs to be covered - provide drawing of sign(s) showing text - provide sign dimensions, color, size of text,type of sign material, and posting method - list locations or show on a map all CMS, provide text Parking signs Event Day Signing—for event participants -list locations for signs or show on a map - note types of signs being used (e.g., advance turn, mile markers,feed zones/water stations) -provide drawing of signs showing text -provide sign dimensions, color, size of text,type of sign material, and posting method NA Event Support Vehicles -describe the movements of anyvehicles used in the event(e.g., parade floats, lead &trail, sweep, sag) -describe how each vehicle will convey its message (e.g.,flashers, headlights, beacons, signs), as appropriate. SPD Command Van i s Vendor No. Check No. Town of Southold, New York - Payment Voucher 14286 Entered by Vendor Address Vendor Name NYSDOT 250 Veterans Memorial Highway Rm 6A7 Traffic Safety & Mobility Audit Date Vendor Telephone Number Hauppauge, NY 11788 Town Clerk 6311952-6022 Vendor Contact Olumuyiwa Falolu Invoice Invoice Invoice Net Purchase Order General Ledger Fund and Account Number Number Date Total Discount Amount Claimed Number Description of Goods or Services Application Fee for A.1010.4.600.780 122624 12/26/24 25.0.0 25.00 Road Closure Winterfest 2025 Total I 25.00 Department Certification Payee CertbehalflOn I hereby certify that the materials above specified have been received by me The undersigned(Claimant)(Acting on behalf of the above named claimant) in good condition without substitution,the services properly does hereby certify that the foregoing claim is true and correct,that no part has erformed and that the quantities thereof have been verified with the exceptions been paid,except as therein stated,-that the balance therein stated is actually p or discrepancies noted,and payment is approved. due and owing,and that taxes from which the Town is exempt are excluded. Signature Denutv Town Cler Title k Signature Company Name Date Title Town Attorney Date DOT Special Use Permit Application Contacts Where do I send my completed Special Use Permit Application? All PERM 33a Special Use Permit Applications for the conduct of multi-county races,speed contests, exhibitions of speed or similar special events on public highways must be sent to the Main Office. All other.Special Use Permit Applications must be sent to-the Region in which the event will occur. If an event is located in more than one Region,the Special Use Permit Application can be sent td•any one of the affected regions. REGION COUNTIES CONTACT PERSON MAILING ADDRESS PHONE 1 Albany, Essex, Steven Palleschi Region 1 (518)485-0210 Greene,Rensselaer, Traffic&Safety—Suite 1 S50 Saratoga, 50 Wolf Road Schenectady, Albany,NY 12232 . r Warren,Washin ton 2 Fulton,Hamilton, Kelly Vandenberg State Office Building. (315)793-2564 Herkimer,Madison, 207 Genesee Street Montgomery,Oneida Utica, NY 13501 3 Cayuga,Cortland, Jeremy Lawton State Office Building (315)428-4380 Onondaga, Oswego, 333 East Washington Street Seneca,Tompkins Syracuse,NY 13202 4 Genesee, Livingston, Lyle Lake State Office Building (585)272-3770 Monroe,Ontario, 1530 Jefferson Road Orleans,Wayne, Rochester,NY 14623 Wyoming 5 Cattaraugus, John Billittier State Office Building (716)847-3271 Chautauqua, Erie, 100 Seneca Street Niagara Buffalo,NY 14203 6 Allegany,Chemung, Andrew Puleo State Office Building (607)324-8517 Schuyler,Steuben, 107 Broadway Yates Hornell, NY 14843 7 Clinton, Franklin, Thomas Compo State Office Building (315)785-7981 Jefferson,Lewis, 9t' Floor-Permits St. Lawrence 317 Washington Street Watertown, NY 13601 8 Columbia,Dutchess, John lapoce State Office Building (845)437-3383 Orange,Putnam, 4 Burnett Blvd. Rockland,Ulster, Poughkeepsie, NY 12603 Westchester 9 Broome,Chenango, Cathy Niedernter State Office Building (607)721-8082 Delaware,Otsego, 44 Hawley Street Schoharie,Sullivan, Binghamton,NY 13901 Tio a 10 Nassau,Suffolk Olumuyiwa Fajolu NYSDOT (631)952-6022 250 Veterans Memorial Highway Room 6A7,Traffic Safety&Mobility Hauppauge, NY 11788 Main multi-county race «fnan Khwaja NYS Dept.of Transportation (518)457-9146 Office permit applications& Traffic Operations Bureau General: general questions 50 Wolf Road—POD 53 (518)457-0271 Albany, NY 12232 Revised(812021) r Vendor No. Check No. Town of Southold, New York - Payment Voucher 14286 Vendor Name Vendor Address Entered by NYSDOT 250 Veterans Memorial Highway Rm 6A7 Traffic Safety & Mobility Audit Date Vendor Telephone Number Hauppauge, NY 11788 6311952-6022 Town Clerk Vendor Contact Olumuyiwa Falolu Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 122624 12/26/24 25.00 25.00 Application Fee for A.1010.4.600.780 Road Closure Winterfest 2025 Total 25.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved. Signature Title—Ds: puty Town Clerk Signature Company Name Date Title•Town Attorney Date s • DOT Special Use Permit Application Contacts Where do I send my completed Special Use Permit Application? ` All PERM 33a Special Use Permit Applications for the conduct of multi-county races,speed contests,exhibitions of speed or similar special events on public highways must be sent to the Main Office. All other Special Use Permit Applications must be sent to-the Region in which the event will occur. If an event is located in more than one Region,the Special Use Permit Application can be sent td'any one of the affected regions. REGION COUNTIES CONTACT PERSON MAILING ADDRESS PHONE 1 Albany, Essex, Steven Palleschi Region 1 (518)485-0210 Greene,Rensselaer, Traffic&Safety—Suite 1 S50 Saratoga, 50 Wolf Road Schenectady, Albany, NY 12232 Warren,Washington i 2 Fulton,Hamilton, Kelly Vandenberg State Office Building (315)793-2564 Herkimer, Madison, 207 Genesee Street Montgomery, Oneida Utica, NY 13501 3 Cayuga,Cortland, Jeremy Lawton State Office Building (315)428-4380 Onondaga, Oswego, 333 East Washington Street Seneca,Tompkins Syracuse, NY 13202 4 Genesee, Livingston, Lyle Lake State Office Building (585)272-3770 Monroe,Ontario, 1530 Jefferson Road Orleans,Wayne, Rochester,NY 14623 Wyoming 5 Cattaraugus, John Billittier State Office Building (716)847-3271 Chautauqua, Erie, 100 Seneca Street Niagara Buffalo, NY 14203 6 Allegany, Chemung, Andrew Puleo State Office Building (607)324-8517 Schuyler,Steuben, 107 Broadway Yates Hornell, NY 14843 7 Clinton, Franklin, Thomas Compo State Office Building (315)185-7981 Jefferson, Lewis, 9t' Floor-Permits St.Lawrence 317 Washington Street Watertown, NY 13601 8 Columbia, Dutchess, John lapoce State Office Building (845)437-3383 Orange, Putnam, 4 Burnett Blvd. Rockland, Ulster, Poughkeepsie, NY 12603 Westchester 9 Broome,Chenango, Cathy Nlederriter State Office Building (607)721-8082 Delaware, Otsego, 44 Hawley Street - Schoharie, Sullivan, Binghamton,NY 13901 Tio a 10 Nassau,Suffolk Olumuyiwa Fajolu NYSDOT (631)952-6022 250 Veterans Memorial Highway Room 6A7,Traffic Safety&Mobility Hauppauge, NY 11788 Main multi-county race :,fnan Khwaja NYS Dept.of Transportation (518)457-9146 Office permit applications& Traffic Operations Bureau General: general questions 50 Wolf Road—POD 53 (518)457-0271 Albany, NY 12232 Revised(812021)