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HomeMy WebLinkAboutMighty North Fork Triathlon I Vendor No. Check No. Town of Southold, New York - Payment Voucher Vendor Name Vendor Address Entered by CAST c/o Erica Steindl PO Box 1566 Audit Date Vendor Telephone Number Southold, NY 11971 Town`Clerk Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account'Number 2025-425 5/28/25 1,500.00 1,500.00 Clean-up Deposit T1.030 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 th ' stated,that the balance therein stated is actually performed and that the qua ' ' s thereof have been verified with the exceptions due and owing,andas at t es from which the Town is exempt are excluded. or discrep cies oted,and payment is approved. Signa a "e:Deputy Tow Cler Signat e Company Name Date o`� Title:Denuty Town Clerk Date 2— Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 02/04/25 Receipt#: 337437 Quantity Transactions Reference Subtotal 1 Clean-Up Deposit 5-25-2025 $1,500.00 1 Event Fee 5-25-25 $250.00 Total Paid: $1,750.00 Notes: Payment Type Amount Paid By CK#1022 $250.00 C A S T, CK#1023 $1,500.00 C A S T, Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: C A S T, 53930 Main Rd Po Box 1566 - Southold, NY-1-1971 Clerk ID: DIANAF __ Internal ID:5-25-25 ° , 1�4 outhold Towri Board - Letter Board Meeting of May._28;.2025 RESOLUTION 2025-425 Item # 5.34 ADOPTED DOC ID: 21343 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2025-425 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MAY 28,2025: 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 L I Antique Power Assoc. 4/7/2025 $250.00 c/o Susan Young 3637 Sound Ave Riverhead,NY 11901 Bicycle Shows U.S. 2/12/2025 $1,500.00 c/o Glen Goldstein 230 Smith Hughes Road Narrowsburg,NY 12764 CAST 2/4/2025 $1,500.00 c/o Erica Steindl 53930 Main Road PO Box 1566 Southold,NY 11971 GTG American Legion Post 803 3/18/2025 $250.00 c/o David DeFriest PO Box 591 .Southold,NY 11971 The Orient Fire Dept. 3/27/2025 $250.00 c/o Burke Liburt 23300 Main Road Orient,NY 11957 _..._ Generated May 28, 2025 _ Page 53 _ Southold Town Board- Letter Board Meeting of May.28, 2025.- iLt1-A I Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Brian O. Mealy, Councilperson SECONDER:Anne H. Smith, Councilperson AYES: Mealy, Smith, Doherty, Evans, Doroski, Krupski Jr Generated May 28, 2025 __ Page 54 TC Checklist for Parade/5KY/Bicyc1e"/Town Property/Road Closure Special Events Applications Name of Organization: CA5T Date(s) of Event: Name of Event: M 1 YI� (}{ Y101 l Y`�0� *No SK and Bicycle events durinIZ the period of June 1 to November 1X Event fee check(or request to be waived) J Road clean-up check (CANNOT BE WAIVED) JCurrent Insurance certificate Application sent for approvals;to the following Depts.: V PD ✓ Hwy Land Pres. V TA Records Mngmnt/TC Approval from Chief of Police Cost Analysis from Chief of Police Approval from Land Preservation Approval from Highway Dept. _TB Resolution for approval (once approval and cost analysis comes from Chief of PD) Town Board Reso. #: C� Approval letter to Organization's contact person w/copy of TB resolution After Event: Confirmation from Chief of PD to release clean-up fee ' TB Resolution to refund clean-up fee TB Clean-up Reso. #: Voucher and copy of TB clean-up Reso. to Accounting Dept. Whole application file to Records Management (include copy of voucher& reso.) t; O (0 RECEIVED - FEB 4 2D25 Southold Town Clerk 500m swim-7mi bike-35mi run Date: January 27, 2025 To: Honorable Albert Krupski, Town Supervisor Town of Southold Board Members Denis Noncarrow, Town Clerk From: Erica Steindl, Interim Executive Director, Center for Advocacy, Support and Transformation Vicki Ventura, Race Director, EventPower Re: CAST Mighty North Fork Triathlon CAST and EventPower are partnering to launch the 25t"Annual CAST Mighty North Fork Triathlon. Our/ collaborative goal is to: • Produce a safe and profitable event • Integrate community • Donate directly to the community In previous years the CAST Mighty North Fork Triathlon has raised money to help the residents of Southold. This year would mark the 25th Annual Triathlon. Enclosed please find the signed permit application for the 25th Annual CAST Mighty North Fork Triathlon for Sunday, May 25, 2025 at Cedar Beach in Southold, NY. The Triathlon begins at 6:50AM and is completed by 10:OOAM. The parking lot, beach and roads will be cleaned and the race site will be cleared by 11:OOAM. The race consists of a 500 meter swim, a 7 mile bike ride, and a 3.5 mile run. The course will be the same as it has been over the previous years. A map of the course is enclosed. Enclosed is a $250 check for the application fee, a $1500 check for the clean up deposit and a Certificate of Insurance for the Town of Southold. If you have any questions, please contact either Erica Steindl (631) 477-1717 or Vicki Ventura (516) 313-8329. Franke, Diana From: Grattan, Steven Sent: Wednesday, February 5, 2025 10:54 AM To: Franke, Diana Cc: Noncarrow, Denis; Rudder, Lynda Subject: RE: Special Event: Cast Mighty North Fork Triathlon Attachments: Mighty NF 2025.xls No objections to this event.Attached is my cost analysis. From: Franke, Diana<dianaf@town.southold.ny.us> Sent:Tuesday, February 4, 2025 2:58 PM To: Blasko, Regina <rblasko@town.southold.ny.us>; DeChance, Paul <pauld@southoldtownny.gov>; Goodwin, Dan <dang@southoldtownny.gov>; Grattan,Steven<sgrattan@southoldtownny.gov>;Johnson, Benjamin <benjaminj@southoldtownny.gov>; McCullough, Lillian <lillianm@southoldtownny.gov>; McGivney,Julie <juliem@southoldtownny.gov>; Noncarrow, Denis<denisn@southoldtownny.gov>; Norklun, Stacey, <Stacey.Norklun@town.southold.ny.us>; Orientale, Michael <michaelo@southoldtownny.gov>;Squicciarini,James <jacks@southoldtownny.gov>; Stype,John <johnst@southoldtownny.gov> Cc: Born, Sabrina <sabrina.born@town.southold.ny.us> Subject:Special Event: Cast Mighty North Fork Triathlon Good Afternoon, Please see attached the Application for a Special Event Permit from CAST received on 02/04/2025. Date of the Event: Sunday, May 25, 2025. Provide approval or disapproval and cost analysis. Thank you so much, liana Franke Account Clerk Southold Town Clerk's Office (631)765-1800 Ext 1228 1 Town of Southold Police Department Special Event Cost Analysis Event: Mighty North Fork Triathlon Date(s): May 25, 2025 Location: I Cedar Beach P�atraol Allocaton�fy nor Event .... Reg Hours OT Hrs Hrl Wage Total Comments iPolice Officers , Sgt Crosser 2 $89.74 $179.48 PPO Cardi 2 $27.64 $56.28 eI PafrQi Reg Hours OT Hrs Hrly Wage Total Comments CRU PO Chenche 2 $72.52 $145.04 PO Sanders 2 $72.52 $145.04 �Bicycle,Patrgl ;' $0.00 $0.00 $0.00 K UUnity $0.00 ghway 011 PO Onufrak $0.00 PO Flatley 2 $77.91 $155.82 Marine Units:::..' " �,-w;."'»,r�. �. T t _",� ,�,� ;jai;�.. , �see^ '''tom'"`,."" Traffic Con of -> <., f � Reg Hours" OT Hrs Hrly Wage Total Comments 3 Traffic Control Officers 6 $19.49 $116.94 ;EquiPmant Costsr . PD Vehicles #of vehicles Hours $/hr Total 4 8 $20.00 $160.00 Command Van Marine Patrol Boats 1 2 $90.00 $180.00 Total Department Cost for Event = $1,137.60 Prepared by Chief S. Grattan 2/5/2025 Pagel Franke, Diana From: Franke, Diana Sent: Tuesday, February 4, 2025 2:58 PM To: Blasko, Regina; DeChance, Paul; Goodwin, Dan; Grattan, Steven;Johnson, Benjamin; McCullough, Lillian; McGivney,Julie; Noncarrow, Denis; Norklun, Stacey; Orientale, Michael; Squicciarini,James; Stype,John Cc: Sabrina Born (sabrina.born@town.southold.ny.us) Subject: Special Event: Cast Mighty North Fork Triathlon Attachments: CAST MigFfy_North-Eor_k.pdf) Good Afternoon, Please see attached the Application for a Special Event Permit from CAST received on 02/04/2025. Date of the Event: Sunday, May 25,2025. Provide approval or disapproval and cost analysis. Thank you so much, �lltal�!ll�I7117I�P Account Clerk Southold Town Clerk's Office (631)765-1800 Ext 1228 1 DEIITIS NONCARROW �Z+o ®G.y Zbwn Hall,53095 Main Road TOWN CLERK o P.O.Box 1179 W Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p � .� Fax(631)765-6145 MARRIAGE OFFICER y� !' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER www southoldtownnygov OFFICE OF THE TOWN CIDERS TOWN OF SOUTHOLD APPLICATION FOR A PERMIT TO HOLD A SPECIAL E'VtNT ' Please pr•dyide ALL of the information fto,mist6d Wow.ZncoM pli to app➢icationsviILL NOT be reviewed. Date of Submission_ I� I O►1 A7"-� Name of Event Name of Organization: Is this a Not-For-Profit Event?Yes/No Contact's Name: L1 6 c1c�� Mailing Address: � ��`� \V\(��(\ l . --Lou ���O�D.�,1� 6\�• `\c1-:)A Contact's Phone Number: Contact's Email Address: "\���� c '�, St1� QjI�L,�I� C�c 0 Event Location and Site Diagram: 6��, %; �O.C)r\ —�Z\ 21& �cre� oho.CQ�o 5 (Use additional paper if necessary) Event Date(s): y,0 C8 °\—r�)9 Nv-\, & 34�• (Include set up and stlutdown ti and dates) Nature of Event: (Please attach a detailed description lo this application) 30 �Uc��c St ace o� Time Period(Hours)of Event: From � Os� to S1�t Q� „ Maximum Number of Expected Attendees:. nJ � Specify any special requirements(i.e.road closure,police presence): y�,�\L.,— If a'Pent 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: �')r �`� Qa �V ,`JCaro 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): V/ $1,500.00 Clean-up for Bicycle and/or Running Special events(ONLY) $250 or more Clean-up deposit all other events :CERT1fI♦ICATE OF MIMANCE RE,OUMV: Not less than$2,000,000 naming the !'own of Southold as an additional insured. z ***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 Signature of Authorized Person filling t application application *Upon the request by applicant,the Town Board may waive in whole or in part any of the application requirements. 2 (t) O T �MR) @140 500m swim-7mi bike-3.5mi run January 27, 2025 Dear Town Supervisor, Members of the Town Board and Town Clerk, This letter is to explain the mission of the CAST Mighty North Fork Triathlon to be held on May 25, 2025. This will be the 25t'Annual CAST Mighty North Fork Triathlon. Our mission is-to fight poor health through a culture of care on Long Island. Focusing on goal setting, health, fitness; and wellbeing we want to promote and grow the competitive sport of triathlon through the safe and fair conduct of races. We are looking to educate the community about physical and mental health and generate funds for local community outreach. The race consists of a 500 meter swim, a 7 mile bike, and a 3.5 mile run. The triathlon would start at 6:50 AM and be complete by 10:00 AM. The site, including the parking lot, beach and roads will be cleaned up by 11:00 AM. EventPower is proud to produce triathlons across Long Island. We currently produce 10 adult events and 3 youth events per season. We encourage participation from every ability and are open to anyone interested in athletics. For more information, please visit us at EventPowerLI.com. Sincerely, Victoria Ventura Race Director CAST Mighty North Fork TRIATHLON INCIDENT ACTION PLAN The purpose of this Incident Action Plan(IAP)is to identify and mitigate any potential risks associated with the planning, implementation and successful completion of the above referenced event. The parties that are planning and coordinating this event are committed to ensuring that all participants, sponsors, community members and emergency personnel are able to partake in the event in a safe and organized manner.The procedural information contained herein will be strictly adhered to. Title of Event: The 25'Annual CAST Mighty North Fork Triathlon Date of Event: May 25,2025- Start Time:6:50 AM(RAIN or SHINE) Event Description: Sprint Distance Triathlon:Swim:500 meters,Cycle:7 miles,Run 3.5 miles Location: 1) Swim:Cedar Beach, rectangle swim 2) Cycle-Exit Cedar Beach Rd heading North, Right turn onto Paradise Point Rd, Left turn onto N Bayview, Right turn at intersection of Bayview&Jacobs Lane continuing on Bayview Rd, Left turn at intersection of Bayview and Anchor Lane continue on Bayview, Left turn onto Pine Neck Rd, Left turn onto Main Bayview Rd,continue back to Cedar Beach 3) Run- Exit Cedar Beach Rd heading North, Right turn onto Paradise Point Rd, Left turn onto N Bayview, left turn at Jacobs Lane, Left Turn onto Main Bayview Rd,continue back to Cedar Beach. Command Post Location: Town of Southold Police Chief Steve Grattan:- SGrattan@town.southold.ny.us 631-765-2600 Coordinator/Chairperson- Name: • Vicki Ventura Phone Number: 516-313-8329 Email Address: vicki@eventpowerli.com Course Director- Name: Vicki Edwards Phone: 631-831-4333 Email Address: info@eventpowerli.com Staff Coordinator- Name: Tara Hohlman Phone: 516-840-7259 Email Address: tara@eventpowerli.com Medical Emergencies Procedure All medical emergencies will be reported to the Command Post by use of Radios, cell phones or by verbal means. The Event Coordinator will call directly to the Command Post and report the incident/problem.The EMT(s)will report to the Command Post,as appropriate,when entering the event and notify the Command Post when leaving the event.The event coordinator will make sure an area is open to allow EMS personnel,vehicles and equipment access to the event grounds wherever emergency assistance is needed.The nearest hospital for receiving patients is East Long Island Hospital Police Emergencies Procedure For all police emergencies, Notification to the command post. Police enforcement will be provided by the Town of Southold Police with be station at position listed in the attached Course control document. Lost Child Procedure Police will be notified. In the event of a lost child, he/she should be taken to the Command Post. The child, if able, will be asked to provide parent/guardian information. Lost child announcements will be made from Stage, informing the crowd of the situation. The child will remain under the supervision of the Command Post who will ensure the child is comfortable and safe until his/her parent/guardian arrives. Police should be present to check identification of adult claiming to be the parent/guardian before release. Communication Plan: We will be using cell phones and a police radio if supplied Important Phone Numbers: Event Coordinator: Vicki Ventura 516-313-8329 vicki@eventpowerli.com Ambulance&Emergency Services: Southold Ambulance 631-765-3385 CAST MightyNorth, Fork Triathlon Awards �M • D - Nutrition/ p B 1 ke I n Water Bike Out Results 10x10 Tent DBike Support A Race K Equipment Port-O-Johns Run Out Finish Line Enter/Exit i sr'r • swim r L .� C ASS T wu�.l a..m ldm® G® NORTS FORH 500m swim-7mf bike-35m9 nm Swim Course—500 meters The Swim will start in the water at the first buoy1 � F "� Keep all buoys on your left, except the final turn buoy should be on your right as you head to the swim exit folk County �I \ *You must walk over the timingmat, through the swim 4rk�� chute, before entering the water. Sta rt Bike Course—7 miles �iy Start at Cedar Beach Turn right,onto Paradise Point Road 4 7Z L p f 'pfp VI _ Left onto N. Bayview Road Right to stay on N. Bayview Road f g Left to stay on N. Bayview Road Left onto Pine Neck Road pt.l 8.' o` ♦ xij Left onto Main Bayview Road § skit , I , u yt Left onto Cedar Beach Road �.�rS A ! � �S•� • Vjf 1' � .w A: rr� #.«.+i.AFf"'�'•'�...r.\+#f�� po' 8 e, �ce. � �. Run Course 3.5 miles Water Start at Cedar Beach A stop l BUYview Rd 6a—•l_ ? Turn right onto Paradise Point Road `s Left onto N. Bayview Road '� o AWakdBreakfst . Bed and Breakfast (1 4. �"'T'''°pr.: ° Great S ''FEAR r Hog Neck� . ��f r '+•' " Left onto Jacobs Lane d. - there will be a Water Stop here Soft IKE ntyk �y Y a ` vr' -. -'a Envvonmentol ;j�rf rr` Left onto Main Bayview Road I j' `O North Fork Sgn - -merges with bike course AR, } Left onto Cedar Beach Roada_cWea;F �` ACORU® DATE(MM/DONYM CERTIFICATE OF LIABILITY INSURANCE 1/27/2025 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 certifcate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Vaaler Insurance,A Marsh&McLennan Agency LLC Company P"�"N Ext:701-775-3131 Nc No:701-775 4020 2701 S Columbia Rd E-MAIL Grand Forks ND 58201 ADDRESS: USATRequests@MarshMMA.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Accredited Surety and Casualty Company Inc 26379 INSURED USATRIA-01 INSURER B:United States Fire Insurance Company 21113 USA Triathlon of Colorado INSURER C:Allianz Global Risks US Insurance Company 35300 As Per The Named Insured Extension Schedule 5825 Delmonico Drive INSURER D: Colorado Springs CO 80919 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER:1454333657 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 ADDLSUBRTYPE OF INSURANCE INSD WVD POLICY NUMBER MM DPOLDY EFF MMI DY EXP LTR LIMITS A X COMMERCIAL GENERAL LIABILITY 1-RSL-CO-17-01538664-00 1/1/2025 1/1/2026 EACH OCCURRENCE $2,000.000 CLAIMS-MADE OCCUR PREM SES(E.oocccu RTED nce) $2,000,000 X Participant LL MED EXP(Any one person) $5,000 X Desig.Event Cap PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $4,000,000 RX POLICY❑jEa LOC PRODUCTS-COMP/OPAGG '$2,000,000 OTHER: Event I Desig.Event Cap $20,000,000 A AUTOMOBILE LIABILITY 1-RSL-CO-1 7-01538664-00 1/1/2025 1/1/2026 COMBIN ED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Hired&Non-Owned $2,000,000 A UMBRELLA LIAB X OCCUR 1-RSL-CO-1 7-01538665-00 1/1/2025 1/1/2026 EACH OCCURRENCE $3,000,000 KX EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED RETENTION$ $ WORKERS COMPENSATIONER OTH AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Participant Accident US1929940 1/1/2025 1/1/2026 AccldentMedical 25,000 C Excess Liability 24ABHX0236 1/1/2025 1/1/2026 Occ/Agg 2,000,000 A Liquor Liability 1-RSL-CO-17-01538664-00 1/1/2025 1/1/2026 Occ1A99 2M/4M DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) USA Triathlon of Colorado;USA Triathlon(USAT);USA Triathlon(Ironman);USA Triathlon Foundation USAT Race Directors,Event Owners,Regions,Clubs,Official Sponsors,Committee Members,Race Officials,Volunteers,Lifeguards and Race Participants, Severally as Their Interests may appear in the business of USAT,Functioning on behalf of the named insured or performing in a"sanctioned or Approved Event" The Certificate Holder is included as Additional Insured under General Liability and a Waiver of Subrogation under General Liability applies in favor of the Certificate Holder for work performed by the named insured for the referenced job and/or contract or agreement as required by written contract.The General Liability insurance evidenced by this certificate shall be primary and non-contributory to any other insurance of the certificate holder. Mighty North Fork Triathlon 1 2025-05-25 1 2025-05-25 Southold,NY 11971 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Southold Town Hall,53095 Main Road AUTHORIZED REPRESENTATIVE Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD HOLD HARMLESS AGREEMENT The applicant�IC-Lz< cV" ����n` 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 off bl -� (Name of Business Entity) Dates of event(s): Mci ac�ar-�) Sworn to before me this `Z-g Day of 3(, u w:1 , 20 2 ALDCANDER S.ROTHENBERG NOTARY PUBLIC.STATE OF NEW YORK NO.01 R00019973 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES 17 JANUARY 20 Town of Southold Police Department Special Event Cost Analysis Event: Mighty North Fork Triathlon Date(s): May 25, 2025 Location: Cedar Beach { ' .fAllocafion,for�fven`f � �;� Reg Hours OT Hrs Hrly Wage Total Comments P.,olice Officers r Sgt Crosser 2 $89.74 $179.48 PPO Card! 2 $27.64 $55.28 Special Patrols Reg Hours OT Hrs Hrly Wage Total Comments PO Chenche 2 $72.52 $145.04 PO Sanders 2 $72.52 $145.04 Bicy_cIe Patrol" $0.00 $0.00 $0.00 $0.00 !Highway Patrol PO Onufrak $0.00 PO Flatley 2 $77.91 $155.82 Marine Units .= Traffic°Control Reg Hours OT Hrs THrly Wage Total Comments 3 Traffic Control Officers 6 $19.49 $116.94 Equipment Costs `. _ PD Vehicles #of vehicles Hours $/hr Total 4 8 $20.00 $160.00 Command Van Marine Patrol Boats 1 2 $90.00 $180.00 Total Department Cost for Event= $1,137.60 Prepared by Chief S. Grattan 2/21/2025 Pagel Noncarrow, Denis From: Grattan, Steven Sent: Wednesday, February 5, 2025 10:54 AM To: Franke, Diana Cc: Noncarrow, Denis; Rudder, Lynda Subject: RE: Special Event: Cast Mighty North Fork Triathlon Attachments: Mighty NF 2025.xls No objections to this event.Attached is my cost analysis. From: Franke, Diana<dianaf@town.southold.ny.us> Sent:Tuesday, February 4, 2025 2:58 PM To: Blasko, Regina<rblasko@town.southold.ny.us>; DeChance, Paul<pauld@southoldtownny.gov>; Goodwin, Dan <dang@southoldtownny.gov>; Grattan,Steven<sgrattan@southoldtownny.gov>;Johnson, Benjamin <benjaminj@southoldtownny.gov>; McCullough, Lillian <lillianm@southoldtownny.gov>; McGivney,Julie <juliem@southoldtownny.gov>; Noncarrow, Denis<denisn@southoldtownny.gov>; Norklun,Stacey <Stacey.Norklun@town.southold.ny.us>;Orientale, Michael<michaelo@southoldtownny.gov>; Squicciarini,James <jacks@southoldtownny.gov>;Stype,John <johnst@southoldtownny.gov> Cc: Born, Sabrina<sabrina.born@town.southold.ny.us> Subject:Special Event: Cast Mighty North Fork Triathlon Good Afternoon, Please see attached the Application for a Special Event Permit from CAST received on 02/04/2025. Date of the Event: Sunday, May 25, 2025. Provide approval or disapproval and cost analysis. Thank you so much, Account Clerk Southold Town Clerk's Office (631)765-1800 Ext 1228 RESOLUTION 2025-195 ADOPTED > DOC ID: 21117 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2025-195 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MARCH 4, 2025: RESOLVED that the Town Board of the Town of Southold hereby 14rants permission for CAST to hold the "25th Annual CAST Mighty North Fork Triathlon", at Cedar Beach Park, Southold,New York, on Sunday, May 25, 2025, 4:30AM to 12:OOPM (set-up Saturday, May 24th from 9AM to 3PM) using the following roads: Cedar Beach Road, Paradise Point Road, Bayview Road North,Anchor Lane, Pine Neck Road, Jacobs Lane and Main Bayview Road provided they file with the Town Clerk a Two Million Dollar Certificate of Insurance naming the Town of Southold as an additional insured; $250.00 filing fee; $1,500.00 clean-up deposit (deposit to be returned after event upon recommendation of Chief Grattan, Southold Town Police Department) and provided they comply with the Town of Southold's Policy for Special events on Town Properties and Roads. Failure to comply with all provisions and conditions will result in the revocation of the permit. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Anne H. Smith,-Councilperson SECONDER:Brian O. Mealy, Councilperson AYES: Mealy, Smith, Doherty, Evans, Doroski ABSENT: Albert J Krupski Jr DENIS NONCARROW o�0 Gyp Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 y = Southold,New York 11971 REGISTRAR.OF VITAL STATISTICS 5 Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ��.� `t►a www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD CAST, March 5, 2025 Erica Steindl Post Office 1566 Southold,New York 11971 Dear Erica, The Southold Town Board at its regular meeting held March 4th, 2025 granted permission to CAST to have their Mighty North Fork Triathlon on Sunday,May, 251h, 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. AN cereoncarrow Town Clerk Enc.