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HomeMy WebLinkAboutKim's Kindness 5K Vendor No. C1,eckk No To wn of Sou thold, of d New Yo rk - Pay ment t Vouc her -er Vendor Name Vendor Address EIIteied by : . Kim's Kindness 5K 620 Ridgemont Road Audtt Date Vendor Telephone Number 434-960-3405 Earlysville, VA 22936 Tdwxt Clerk Vendor Contact Alice Fletcher Invoice Invoice Invoice Net Purchase Order .......... Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 2025-319 4/29/2025 $1,500.00 $1,500.00 C/U 5K on 4/42/2025 .... .. Total: $1,500.00 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 note d,ed,and payment is approved. Signature . tie Deputy Town Clerk Signature Comp yName hold Town Clark Date 5/1/2025 Title e u T n Clerk Date . 5/1/2025 �s oaf f`Qy RESOLUTION 2025-319 ADOPTED DOC ID: 21246 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2025-319 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON APRIL 29, 2025: WHEREAS the following groups have supplied the Town of Southold with a refundable Clean- up Deposit fee, for their events and WHEREAS the Southold Town Police Chief, Steven Grattan, has informed the Town Clerk's office that this fee may be refunded, now therefore be it RESOLVED that Town Board of the Town of Southold hereby authorizes a refund be issued in the amount of the deposit made to the following: Name Date Received Amount of Deposit Kim?s Kindness 11/12/2024 $1,500.00 c/o Alice A. Fletcher 620 Ridgemont Road Earlysville, VA 22936 North Fork Little League, Inc. 3/19/2025 $250.00 PO Box 1855 Southold,NY 11971 Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Brian O. Mealy, Councilperson SECONDER:Greg Doroski, Councilperson AYES: Mealy, Smith, Doherty, Evans, Doroski, Krupski Jr TC Checklist for Parade/5KY/Bicyclex/Town Property/Road Closure Special Events Applications_ Name of Organization: -6 rn ,S ViAhts.5 614 Name of Event: goa5 Is K Date(s) of Event: q11,429- *No 5K and Bicycle events durinI4 the period of June 1 to November 1* Event-fee check(or request to be waived) Road clean-up check (CANNOT BE WAIVED) �1 Current Insurance certificate Application sent for approvalsto the following Depts.: l PD J Hwy Land Pres. '( TA Records Mngmnt/TC J Approval from Chief of Police Cost Analysis from Chief of Police Approval from Land Preservation Approval from Highway Dept. TB Resolution for approval (once approval and cost analysis comes from Chief of PD) Town Board Reso. #: "ot�a��� a� V Approval letter to Organization's contact person w/copy of TB resolution After Event: Confirmation from Chief of PD to release clean-up fee JTB Resolution to refund clean-up fee TB Clean-up Reso. #: �! Voucher and copy of TB clean-up Reso. to Accounting Dept. Whole application file to Records Management (include copy of voucher& reso.) S DENIS NONCARROW ,��.�' � �. � Tbwn Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 01 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER �` `�`�� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER southoldtownnygov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLE TOWN OF SOUTHOLD NOV 2 20a APPLICATION FOR A PERNIIT TO H Town Cle r3I SPECIAL EVENT Plcaseproyide:ALL of Elie:i�rfo �niation'ietiiesfea lieIoiv In'comnletc_atiiilications.WILL NOT-ti_c, reviewed. r Date of Submission, -- /13 t Z Name of Event Kiw ,s . -k,y a _tom, S1< Name of Organizations, K IN" I �hG�rl ts9 Is this a Not For-Profit Event? .es ; o. Contact's Name: r `P k1f G4ti*/ O VA- Mailing Address: 2�9 6 Contact's Phone Number: 3 a(00 3 40 5 Contact's Email Address Event Location and Site Diagram: on—e ,-Tok 1 y o (Use additional paper if necessary) Event Date(s): '►r' I = (Include set'u °and shutdown mes and dates) 11�,, Nature of Event:. C '. - " / Gt _ (Please attach a detailed de"scitp or to this application) Time Period(Hours)of Event: From. -0o.G-t�. .to Maximum Number of Expected Attendees:, a 00 Specify any special requirements(i.e.road closure,police presence): -V2�_Gl d-o- S a',L—wi - r . L If a Tent or other temporary structure will be used please contact the Southold Town Building Department at 631-765-1802 Mailing Address to Send Event Permit to: Event Fe with than 1000 expected attendees $250 for events wit less p $500 for events with 1000 or more expected attendees ;Clean- p:Fees-(Can_+TOT-beiwai�±ed): 51,500.00,.Clean=up for Bicycle and/or Running�Speciallevents.,(ONL $250 or more Clean-up deposit all other events SCE ITIp'1CCATE�OF W&10RAISCE�, nth i ��D;_Not.less tham,$2,OOq,000:naming the Town of_, Southold as an additional insured-j ***NOTE: PLEASE SEE ATTACHED REVISED,ADOPTED TOWN POLICY*** Additional information and requirements may be required as deemed necessary by the Town Board. Print name of Authorized Person filling out Signatu uffl rued 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 TEACHERS wi SO CIATION huYK To 90V. II � 9. ra i CAL � a• �5�-• r7,- o i e �y -sit '� 3, f.4et:atccke sui9 -kM'�w aw 18d VD indjOn 1p MarmuchMattituck Mittituck44 • gh4 S •+�l>'I�St 7.•.,`'A•cx�• cis 0 PiF.stiyti'tian 3 %Wo?�6int Rd 5�J cemetery Ikfflh rp no Old ROUTE: Begin at Mattituck High School; Head South on Maple Avenue Cross Route 25 to Reeve- Heading South; Left on New Suffolk Avenue- Proceed East; Right onto Maratooka road - Proceed South; Loop Left on Center and Bungalow back to Right on to Maratooka; Cross New Suffolk onto Maratooka LANE; Left on Route 25- Heading West; Right onto Wickham- Proceed North; Right onto Pike Street; Finish at school ACC ® CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY) `� 11/09/2024 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 poliey(ies)must have ADDITIONAL INSURED provisions or be endorsed. It 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 Dustin Powell NAME: Indaco Risk Advisors,Inc A N Ext: (434)971-1990 A C No: (434)971-5985 510 Locust Avenue E-MAIL ADDRESS: DEP@Indacodsk.com INSURER(S)AFFORDING COVERAGE NAIC# Charlottesville VA 22902 INSURERA: United States Liability Insurance Co 25895 INSURED INSURER B Kim's Kindness INSURER C: 620 Ridgemont Road INSURER D: INSURER E. Earlysville VA 22936 INSURERF: COVERAGES CERTIFICATE NUMBER: 24-25 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 EFF POLICY EXP LIMITS LTR NSD WVD POLICYNUMBER MM/DD MM/DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO CLAIMS-MADE ®OCCUR PREMISES EaEoccurrence $ 100,000 MED EXP(Any one person) $ 1,000 A SE 1134149 04/11/2025 04/14/2025 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JEC 7 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ 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/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE: Non Profit Event:Kim's Kindness 5K Date:4/12/25 General Liability additional insured subject to form CG2011 04/13.General Liability Primary/Non-Contributory subject to form CG 00 01 12 07. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Road P.O BOX 1179 AUTHORIZED REPRESENTATIVE aoL- da/ Southhold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ACC>R U® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYI) 11/09/2024t 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 poliey(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 Dustin Powell NAME: Indaco Risk Advisors,Inc acNN Ext. (434)971-1990 IX No): (434)971-5985 510 Locust Avenue E-MAIL DEP@Indacorisk.com ADDRESS- INSURER(S)AFFORDING COVERAGE NAIC# Charlottesville VA 22902 INSURERA: United States Liability Insurance Cc 25895 INSURED INSURER B. Kim's Kindness INSURERC: 620 Ridgemont Road INSURER D: INSURER E. Earlysville VA 22936 INSURER F: COVERAGES CERTIFICATE NUMBER: 24-25 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. LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MM/DD CY EFF MMIDD EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE FRI OCCUR -PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 1,000 A SE 1134149 04/11/2025 04/14/2025 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JJECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accdent P 1 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ 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/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE: Non Profit Event:Kim's Kindness 5K Date:4/12/25 General Liability additional insured subject to form CG2011 04/13.General Liability Primary/Non-Contributory subject to form CG 00 01 12 07. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Road AUTHORIZED REPRESENTATIVE P.O Box 1179 Southhold NY 11971 ©1988-2015 ACORD CORPORATION. All r(®lits'ieserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD �® CERTIFICATE OF LIABILITY INSURANCE FDATE A 11/09/'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 Dustin Powell NAME: Indaco Risk Advisors,Inc AHCNNo Ell: (434)971-1990 FAX No): (434)971-5985 510 Locust Avenue E-MAIL DEP@Indacorisk.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Charlottesville VA 22902 INSURERA: United States Liability Insurance Co 25895 INSURED INSURER B Kim's Kindness INSURER C: 620 Ridgemont Road INSURER D: INSURER E: EarlysVille VA 22936 INSURER F: COVERAGES CERTIFICATE NUMBER: 24-25 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MM/DDIYYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 1,000 A SE1134149 04/11/2025 04/14/2025 PERSONAL BADVINJURY $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT ❑LOC DUCTS-COMP/OPAGG $POLICY ❑PRO 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y f N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ 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/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RE: Non Profit Event:Kim's Kindness 5K Date:4/12/25 General Liability additional insured subject to form CG2011 04/13.General Liability Primary/Non-Contributory subject to form CG 00 01 12 07. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Road P.O BOX 1179 AUTHORIZED REPRESENTATIVE Southhold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: SE 1134149 COMMERCIAL GENERAL LIABILITY CG 20 11 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person(s)Or Organization(s) (Additional Insured): Effective Date: 04/11/2025 TOWN OF SOUTHOLD 53095 MAIN ROAD PO BOX 1179 SOUTHOLD, NY 11971 Designation of Premises(Part Leased To You): 15125 MAIN RD MATTITUCK, NY 11952 Additional Premium: $ Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II-Who is An Insured is amended to include 2. If coverage provided to the additional insured is as an additional insured the person(s)or organization(s) required by a contract or agreement, the insurance shown in the Schedule, but only with respect to liability afforded to such additional insured will not be broader arising out of the ownership, maintenance or use of that than that which you are required by the contract or part of the premises leased to you and shown in the agreement to provide for such additional insured. Schedule and subject to the following additional B. With respect to the insurance afforded to these exclusions: additional insureds, the following is added to This insurance does not apply to: Section III Limits Of Insurance: 1.Any'occurrence"which takes place after you cease If coverage provided to the additional insured is required to be a tenant in that premises. by a contract or agreement,the most we will pay on 2.Structural alterations, new construction or demolition behalf of the additional insured is the amout of operations performed by or on behalf of the person insurance: (s)or organization(s)shown in the Schedule. 1.Required by the contract or agreement; or However: 2.Available under the applicable Limits of Insurance 1.The insurance afforded to such additional insured only shown in the Declarations; applies to the extent permitted by law; and whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 11 0413 ©Insurance Services Office,Inc.,2012 Page 1 Of 1 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 11/12/24 Receipt#: 335952 r Quantity Transactions Reference Subtotal 1 Clean-Up Deposit 4.12.2025 $1,500.00 Total Paid: $1,500.00 Notes: Payment Type Amount Paid By CK#141 $1,500.00 Kims, Kindness Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Kims, Kindness 620 Ridgemont Road Enaylsville, VA 22936 Clerk ID: DENISN Internal ID:4.12.2025 Noncarrow, Denis To: Special Events PD Cc: Johnson, Benjamin;Sabrina Born (sabrina.born@town.southold.ny.us); Mudd,Jennifer; Noncarrow, Denis Subject: April 12, 2025 event Attachments: Kims Kindness_20241112150157.pdf Please let us know and thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov 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. i Noncarrow, Denis From: Grattan, Steven Sent: Tuesday, November 12, 2024 3:52 PM To: Noncarrow, Denis; Blasko, Regina; DeChance, Paul; Goodwin, Dan; Mudd,Jennifer; Norklun, Stacey; Orientale, Michael; Born, Sabrina Cc: Johnson, Benjamin; Born, Sabrina; Mudd,Jennifer Subject: RE:April 12, 2025 event/5k Attachments: Kims Kindness 25.xls I have no objections to this event. Attached is my cost analysis. Steve Chief Steven Grattan Southold Town Police Department 41405 Route 25 Peconic, NY 11958 (631) 765-2600 Main (631) 765-2715 Fax (631) 765-2784 Desk CONFIDENTIALITY NOTICE:This electronic mail transmission is intended only for the use of the individual or entity to which it is addressed and may contain confidential information belonging to the sender which is protected by privilege. If you are not the intended recipient,you are hereby notified that any disclosure,copying,distribution,or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this transmission in error, please notify the sender immediately by e-mail and delete the original message. 4 From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent:Tuesday, November 12, 2024 1:56 PM 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>; Born, Sabrina <sabrina.born @town.southold.ny.us>; Mudd, Jennifer<jennifer.mudd@town.southold.ny.us>; Noncarrow, Denis<denisn@southoldtownny.gov> Subject:April 12, 2025 event/5k Please let us know and thank you 1 Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov 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. z Town of Southold Police Department Special Event Cost Analysis Event: Kim's Kindness 5K Date(s): April 12, 2025 Location: Mattituck area ,P�atrol�Allocaton for Ey:,ent; Re Hours OT Hrs Hrl Wage Total Comments ?Pohce Officers ` + Sergeant 2 $88.00 $176.00 Police Officer 2 $72.00 $144.00 SpecialPatrol.h F Reg Hours OT Hrs Hrl Wage Total Comments CRU PO Chenche 2 $72.52 $145.04 PO Sanders 2 $72.52 $145.04 Bicyc el Patrol . $0.00 $0.00 $0.00 K' 9'Unit�°• $0.00 HighWI MPatrolM � I PO Onufrak 2 $77.20 $154.40 PO Flatley 2 $77.91 $155.82 Marine£Units ,; ff Traffic Co "trol Reg Hours OT Hrs Hrly Wage Total Comments Equipment Costs PD Vehicles #of vehicles Hours $/hr Total 6 2 $20.00 $240.00 Command Van Marine Patrol Boats Total Department Cost for Event = $1,160.30 Prepared by Chief S. Grattan 11/12/2024 Pagel �SUfFRL RESOLUTION 2024-982 S ADOPTED DOC ID: 20796 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-982 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NOVEMBER 19,2024: RESOLVED that the Town Board of the Town of Southold hereby grants permission to Kim's Kindness 5K to use the following route for its 2025 5K in Mattituck, on Saturday,April 12th, 2025, from Sam to 1 lam: beginning on the South side of Route 25 on Reeve Avenue,Reeve Ave even with the north side of the Church, head south; left on to New Suffolk Avenue- proceed east; right onto Marratooka Road—proceed south; Loop left on Center and Bungalow back to right on Marratooka; Cross New Suffolk onto Marratooka Lane; left on Route 25- heading west; Right on Wickham Avenue, proceed north, right onto Pike Street, finish at the school; provided they follow all the conditions in the Town's Policy for Special Events on Town Properties. The fees have been waived for this event with the exception of the clean-up deposit. This approval is for one event only as it will be reviewed by the Town Board. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Greg Doroski, Councilman SECONDER:Jill Doherty, Councilwoman AYES: Doroski, Mealy, Smith, Krupski Jr, Doherty, Evans o�os�FFoc,��o _ DENIS NONCARROW =� G.j� Town Hall,53095 Main Road TOWN CLERK p - P.O.Box 1179 y Z Southold,New York 11971 REGISTRAR,OF VITAL STATISTICS S � .F Fax(631)765-6145 MARRIAGE OFFICER �' RECORDS MANAGEMENT OFFICER ��,( .��� Telephone oldt nny.gov FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Kim's Kindness Alice Fletcher November 20,2024 620 Ridgemont Road Earlysville VA 22936 Dear Alice, The Southold Town Board at its regular meeting held November 19th, 2024 granted permission to Kim's Kindness to hold their 5K on April 12t'2025 as applied for. A certified copy of the resolution is enclosed. An insurance policy naming the Town of Southold as additionally insured has been filed with this office. Please contact Captain Grattan at the Southold Town Police Department as soon as possible to set up traffic control. . If you have any further questions,please do not hesitate to contact the Town Clerk's office at(631)765- 1800. Best of luck with your event. gnc/e , oncarrow Town Clerk Enc. 1 DENIS NONCARROW �� .�, Town Hall,53095 Main Road TOWN CLERK ® P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER �' RECORDS MANAGEMENT OFFICER ®,� ��® Telephone oldt nny.gov FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD June 5, 2024 Alice A. Fletcher 620 Ridgemont Road Earlysville,VA 22936 Re: Special Event Dear Ms. Fletcher, This office is in receipt of your Special Event Application. I'm returning it to you because the fee is incorrect. For Not-For-Profit events, you may ask the Town Board to waive the Event Fee, however, you must pay the clean-up deposit, which is $1500.00 for Running (5K) and/or bicycle events. I'm returning check no. 295 in the amount of$250.00 to you. Please submit the application within six (6) months of the event date and include a Certificate of Insurance (see page 2 of the application). If you have any questions, please call the office at 631-765-1800. Very truly yours, Sabrina M. Born Deputy Town Clerk �oytue5 f s DENIS NONCARROW Town Hall,53095 Main Road TOWN CLERK ' P.O.Box 1179 U2 A Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ' Fax(631)765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER �� ` Telephone 76 FREEDOM OF INFORMATION OFFICER ' www southoldtoldtownny.g000v OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION FOR A PERMIT TO BOLD A SPECIAL EV9NT Please provide ALL of the information requested below.Incomplete annlications WILL NOT be reviewed. Date of Submission r) /13/zcf Name of Event K ice'' s k eyia wl ss . S 1< Name of Organization: .tw o Ksyid n e-sS Is this a Not-For-Profit Event? es o Contact's Name: Mailing Address: fo �.� d. �.vYLcr•'L� -� ( S V ytA V Vj 2 -q 36 Contact's Phone Number: 4, 3 LOS Contact's Email Address: Event Location and.Site Diagram: T-D L'Je 0—,.) w✓1�%ca, �Yd (Use additional paper if necessary) Event Date(s): kwl`1 12 - (Include set upfand /shutdown times and dates) Nature of Event: S- � C l.t,Yi / V�4 (Please attach a detailed description to this application) Time Period (Hours)of Event: From -W ao— to l l .U0 Lt vm Maximum Number of Expected Attendees: a 00 Specify any special requirements (i.e. road closure, police presence): rip 6 et 05 e- ��,�n e �- 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 Peimit to: Event Fe h $250 for events with less'than expected attendees 000 a 1 $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. Print name of Authorized Person filling out Signatu uthorized 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