HomeMy WebLinkAboutCR 48 & Youngs Ave & Peconic Ln t' i T it
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JAMES C.McMAHON Town Hall 530� �j 95 Maul Road
Director = �J.� P.O.Box 1179
cm Southold,New York 11971
Telephone(631)765-1283 5 •
Fax(631)765-9015
col � Sao ,
TOWN OF SOUTHOLD
DEPARTMENT OF PUBLIC WORKS
March 10, 2005
Commissioner Charles Bartha,PE
Suffolk County Department
of Public Works
335 Yaphank Avenue
Yaphank,NY,11980-9744
Dear Commissioner Bartha:
Please find the enclosed Agreement for the Installation of Traffic Control Devices
between the Town of Southold and the Suffolk County Department of Public Works at
two locations on CR 48.
If you need any additional information on the enclosed,please give me a call.
Sincerely,
ti
AimMcMahon
Town of Southold
•' ' Town of Southold with COS Am ment Location:'CR 48.Middle Road @ Youngs Avenue&
CR 48,Middle Road @ Peconic Lane,Peconic
Law Dept.No. As Revised 1/24/05
AGREEMENT FOR THE INSTALLATION OF
TRAFFIC CONTROL DEVICES
This AGREEMENT is between the.County of Suffolk("COUNTY"), a municipal corporation of
the State of New York, having its principal office at the County Center,Riverhead, New York 11901,
acting through its duly constituted Department of Public Works ("the DEPARTMENT") located at 335
Yaphank Avenue, Yaphank,New York 11980-9744, and the Town of SOUTHOLD ("TOWN"),.having
its principal office at 53095 Main Road, Southold,NY, 11971.
TERMS AND CONDITIONS: Shall be as set forth in "Exhibit A" and "Exhibit B" attached
hereto and made a part hereof.
IN WTI'NESS WHEREOF, the parties hereto have executed this Agreement as of the latest date
written below:
TOWN OF SOUTHOLD APPROVED:
1 By: By.
w
` 1 /0
-Martin f o r Date CHARLES J.BARTHA,P.E. Date
Dep. Supervisor Commissioner
APPROVED AS TO LEGALITY
NOT REVIEWED AS TO EXECUTION
'CHRISTINE MALAFI
Suffolk County Attorney COUNTY OF SUFFOLK
By. By.
MARISA G.MARLETTI,ESQ. Date PAUL SABATINO U Date
Assistant County Attorney Chief Deputy County Executive
Town of Southold with COS Agreement Location:'CR 48.Middle Road @ Youngs Avenue&
• CR 48,Middle Road @ Peconic Lane,Peconic
Law Dept.No. As Revised 1/24/05
EXMIT A
WHEREAS, the DEPARTMENT operates a program to improve traffic signals, markings, signs
and the like("Devices')in order to ensure the safe and continuous movement of traffic,and
WHEREAS,the DEPARTMENT has determined that certain Devices are necessary along CR 48,
Middle Road at Youngs Avenue and CR 48, Middle Road at Peconic Lane, Peconic for the
provement of traffic conditions at the said location within the TOWN, and the TOWN accepts said
determination,and
WHEREAS,pursuant to Section 136 of the New York State Highway Law, the Commissioner of
the Suffolk'County Department of Public Works ("Commissioner") is empowered to erect.Devices, as
authorized by the County Legislature,in order to improve traffic conditions,and
WHEREAS,the parties hereto desire to provide for the installation and maintenance of Devices at
the aforesaid location within the TOWN for the improvement of traffic conditions, in accordance with a
traffic signal plan on file with the DEPARTMENT:
NOW, THEREFORE, in consideration of the individual and mutual covenants, promises and
representations herein contained,the parties hereto agree as follows:
1. Definitions: The following terms whenever used in this Agreement shall have the following
meaning:
Devices: Traffic signals and associated appurtenances.
Traffic Signal Service Report: A report of any and all work performed on the Devices.
2. DesiOn: Installation: The COUNTY shall install, at the expense of the Permit Applicant or through
the COUNTY'S Capital or Operating Budget,Devices of the type,and at the location,set forth above.
3. Ownership:
A. Any and all Devices installed pursuant to this Agreement shall be the sole and exclusive property
of the TOWN.
B. Any Devices removed from the site(s) designated herein shall be delivered to either the
DEPARTMENT or the TOWN,as directed by the Commissioner.
4.Operation and Maintenance:
A. All costs incurred in the operation and maintenance of the Devices, including any and all charges
,for electricity, shall be borne by'the TOWN or, in the case of a Permit Signal, the Permit
Applicant, until such time as responsibility for the operation and maintenance of the Devices is
assumed by the TOWN.
B. At such time as responsibility for the.operation and maintenance of the Devices is assumed by the
TOWN, the TOWN shall operate and maintain the Devices in accordance with the current
Maintenance Specifications of the DEPARTMENT. A copy of said specifications is available
upon request at the DEPARTMENT.
Page 1
Town of Southold with COS Agreement Location:CR 48.Middle Road @ Youngs Avenue&
CR 48,Middle Road @ Peconic Lane,Peconic
Law Dept.No. As Revised 1/24/05
C. In the event that the TOWN has a set of Maintenance Specifications equivalent to that of the
DEPARTMENT, the TOWN may; subject to the review and approval of same by the.DE-
PARTMENT,use same in lieu of the DEPARTMENT'S Maintenance Specifications.
D. In connection with its maintenance of the Devices,the TOWN shall provide the COUNTY with a
Traffic'-Signal Service Report whenever and wherever a maintenance problem exists which
prevents the device from operating as designed
E. The TOWN shall keep all local police authorities aware of the party responsible for maintenance
of the Devices. The TOWN shall establish procedures that will allow maintenance.contractors
and/or TOWN employees to provide maintenance services for the Devices on a 24-hour basis.,
5. Modification of Devices: The TOWN shall not alter the signal operation or timing of the Devices
without the prior written approval of the DEPARTMENT. In the event of any alteration to the signal
operation or timing of the Devices,the TOWN shall furnish the DEPARTMENT with one(1)set of wiring
diagrams for ach alteration.
6. Representations.and Warranties:
A. The TOWN shall enact any ordinance, order, rule or regulation necessary for the installation and
maintenance of the Devices.
B. The TOWN shall comply, and shall require its officers, directors, partners, trustees and other
members of its governing body, as well as any personnel employed.to render services under this
Agreement, to comply, with all applicable rules, regulations'and requirements of law, including
Suffolk County local preference laws and other applicable Suffolk'County local laws, andreso-
lutions of the Suffolk County Legislature.
C. The TOWN shall maintain full and complete books and records of any and all Traffic Signal.
Service Reports. Such books and records shall be retained for a period of seven(7)years and shall
be available for inspection.by the DEPARTMENT, or its duly designated representative, upon.
written notice.during regular business hours. .
D. The COUNTY agrees to transfer any and all warranties and representations on all equipment and
materials installed by the COUNTY or its permittees to the TOWN.
7.Violation
A. In the event that the TOWN fails to maintain the Devices in accordance with the terms of this
Agreement, the COUNTY, in addition to any other remedies to which it may be entitled,:may
withhold funds for traffic improvements within the TOWN.
B. The COUNTY shall provide the TOWN with written notice of the TOWN'S failure to maintain
the Dev-mis. Such---not-tee--shall speeif -*,.Vart-w- -OW- --sha#---b
ple
reasonable period of time to.correct any said failure.
Page 2
` Town of Southold with COS Agreement Location:CR 48.Middle Road @ Youngs Avenue&
CR 48,Middle Road @ Peconic Lane,Peconic
Law Dept.No. As Revised 1/24/05
8. Insurance (See Exhibit B)
A. The TOWN shall procure, pay the entire premium for, and maintain throughout the term of this
Agreement, insurance in amounts and types specified by the COUNTY. The TOWN agrees to
require all of its subcontractors in connection with work performed for the TOWN related to this
Agreement, procure, pay the entire premium for and maintain throughout the term of this
Agreement, insurance.in amounts and types equal to that specified by the COUNTY for the
TOWN. Unless otherwise specified by the COUNTY and agreed to by the TOWN, in writing,
such insurance shall.be as follows:
i. COMMERCIAL GENERAL LIABILITY INSURANCE, including contractual
coverage, in an amount not less than TWO MILLION AND NO/100THS ($2,000,000.00)
DOLLARS per occurrence for bodily injury and TWO MILLION AND NO/100THS
($2,000,000.00)DOLLARS per occurrence for property damage.
ii. AUTOMOBILE LIABILITY INSURANCE,(if any vehicles are used by the TOWN in
the performance of this Agreement including owned,non-owned, and hired cars)in an amount
not less than Five Hundred Thousand Dollars ($500,000)per person, per accident, for bodily
injury and not less than One Hundred Thousand Dollars ($100,000) for property damage per
occurrence.
iii. WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY INSURANCE,in
compliance with all applicable New York State laws and regulations and DISABILITY
BENEFITS INSURANCE,if required by law.The TOWN shall furnish to the COUNTY,prior
to its execution of,the Agreement, the documentation required by'the State of New York
Workers' Compensation�Board of coverage or exemption from coverage pursuant to §§57 and
220 of-the Workers'. Compensation Law. In accordance with General Municipal Law•§ 108,
this Agreement shall be void and of no effect unless the TOWN shall provide and maintain
coverage during the term of this Agreement for the benefit of such employees as are required to.
be covered by the provisions of the Workers' Compensation Law.
iv. PROFESSIONAL LIABILITY INSURANCE (ERRORS AND OMISSIONS),'that
covers any damage arising out of the TOWN'S performance of professional .services
caused by an error, omission, or negligent acts, in an amount.not less than Two Million
Dollars($2,000,000)on either a per occurrence or claims made coverage basis.
V. In• the event the TOWN maintains a COMPREHENSIVE GENERAL
LIABILITY INSURANCE policy form in lieu of Commercial General Liability, said
policy must include all of the above requirements- plus premises/operations,
independent contractors, contractual, and broad form property damage.
B. All policies providing such coverage shall be issued by insurance companies with an
A.M. best rating of A- or better. All insurance shall be obtained from companies licensed to
o .us ess. n W.SW_of eW. .Or. .
Page 3
Town of Southold with COS Agreement Location:CR 48.Middle Road Q Youngs Avenue&
CR 48,Middle Road Q Peconic Lane,Peconic
Law Dept.No. As Revised 1/24/05
C. The'County of Suffolk must be named Additional Insured and the TOWN shall
finish to the COUNTY a declaration page for each such policy of insurance, and
upon-request, a true and certified original copy of each such policy, evidencing
compliance with the aforesaid insurance requirements. In the case of commercial
general liability insurance, the County of Suffolk shall be named as an additional
insured and the TOWN shall furnish a Declaration page and endorsement page
evidencing the County's status as an additional insured on said policy. Where work
under this Agreement is sub-contracted, the TOWN must require the subcontractor to
provide that the COUNTY be named as an additional insured on all required policies,
as well. as require; the subcontractor to provide the COUNTY with all required
evidence of insurance.
D. All such Declaration Pages, certificates and other evidence of insurance shall provide for
the County of Suffolk to be notified in writing thirty(30) days prior to any cancellation,
non-renewal or,material change in said policies. Required limits of insurance are not to be
modified by deductibles that the COUNTY deems excessive without the COUNTVS written
permission. All such Declaration Pages, certificates, policies and other evidence of
insurance and.notices shall be mailed to the DEPARTMENT and to the Suffolk County
Risk Management and Benefit Division [700 Veterans Memorial Highway, 2nd Floor,
Hauppauge, New York 11788, or such other address of which the COUNTY shall have
given the TOWN written notice].
E. If the TOWN,as a municipal corporation,has a self insurance program under which it acts as
a self insurer for.any of such for any such required coverage, it may provide self-funded
coverage, declarations and certificates or other evidence of such self-insurance in lieu of
insurance issued by insurance companies.
F. In the event the TOWN fails to provide the Declaration Pages or certificates of insurance or to
maintain any insurance required by this Agreement, the COUNTY may, but shall not be
required to, obtain such policies and deduct the cost thereof from payments due the TOWN
under this Agreement or any other Agreement between the COUNTY and the TOWN.
G. The COUNTY will not authorize work to begin under this Agreement until all the required
insurance has .been obtained and said insurance has been approved and filed by the
COUNTY.Approval of the insurance by the County shall not relieve or decrease the liability
of the TOWN. The TOWN shall assume all responsibility for the insurance requirements of
any applicable sub-consultants.
9. Indemnification: To the greatest extent.permitted by law, the TOWN agrees that it shall protect,
indemnify and hold harmless the County and its officers, officials,employees,agents and invitees from and
against all liabilities, fines, penalties, actions, damages, claims, demands, judgments, losses, costs,
expenses, suits or actions-and costs, including reasonable attorneys' fees, and shall defend the County in
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such'suit arising out of the-acts or omissions-or negligence of the TOWN, its agents, employees or
subcontractors in connection with the services described or referred to in this Agreement.
J
'Page 4
Town of Southold with COS Agreement Location:CR 48.Middle Road @ Youngs Avenue&
CR 48,Middle Road @ Peconic Lane,Peconic
Law Dept.No. As Revised 1/24/05
10. Licenses: The TOWN covenants, warrants and represents that it has, and shall have throughout the
term of this Agreement, and that,to the extent applicable, its employees, agents and subcontractors have,
and shall have throughout the term of this Agreement,the required education,knowledge, experience and
character necessary to qualify them individually for the particular duties they are to perform with respect to
this Agreement(the"Services"), and that the TOWN has, and shall have,and,to the extent applicable,its
employees, agents and subcontractors have, and shall have throughout the term of this Agreement, all
required authorization(s), registration(s), license(s) or permit(s) [hereinafter collectively referred to as a
"License"] required by State, COUNTY or local authorities for the Services. The TOWN shall forward to
the DEPARTMENT a copy of its License or, if applicable, a complete list of its employees, agents and
subcontractors providing Services, including names, area of License, License numbers and copies of
L•icense(s). The TOWN shall furnish the DEPARTMENT with copies of any updates, additions or
deletions to such list as the same may occur, together with copies of any new or renewal License(s)., The
.TOWN shall immediately notify the DEPARTMENT, in.writing, of any disciplinary proceedings against
the holder of any License. In the event•that the TOWN or such other holder of a License is no longer
licensed for any one or more of the Services,theTOWN shall immediately so notify the DEPARTMENT.
11. Offset of Arrears or Default: The TOWN warrants that it is not,and shall not be during the term of
this Agreement, in arrears to the COUNTY for taxes or upon debt or contract and that it is not, and shall
not be during the term of this Agreement, in default as surety, contractor or otherwise on any obligation to
the COUNTY. The COUNTY may withhold the amount of any such arrearage or default from amounts
payable to the TOWN under this Agreement.
12. Termination: In the event that the COUNTY assumes responsibility for the maintenance of the
Devices,this Agreement shall automatically be deemed terminated.
13. Merger: Modification: This Agreement represents the entire agreement of the parties. All previous
understandings of the parties concerning the terms hereof are merged into this Agreement.No modification
of this Agreement shall be valid unless written and executed by both parties.
14. Local Law No. 32-1980: TOWN warrants and represents that TOWN has not offered or given any
gratuity to any official, employee or agent of Suffolk County,New York State or any political party with
the purpose or intent of securing an agreement or securing favorable treatment with respect to the awarding
or amending of an agreement, or the making of any determinations with respect to the performance of an
agreement, and that TOWN has read and is familiar with the provisions of Suffolk County Local Law
Number 32- 1980(Chapter 386 of the Suffolk County Code).
15.Living Wage Law: This Agreement is subject to the Living Wage Law of the County of Suffolk. The
law requires that, unless specific exemptions apply, or a waiver is granted, all employers(as defined)under
service contracts and recipients of county financial assistance (as defined) shall provide payment of a
minimum wage to employees as set forth in the Living Wage Law. Such rate shall be adjusted annually
pursuant to the terms.of the Suffolk County Living Wage Law of the County of Suffolk.Under the provisions
of the Living Wage Law, the COUNTY shall have the authority, under appropriate circumstances, to
terminate this Agreement and to seek other remedies as set forth therein,for violations of this law.
16. Child Sexual Abuse Reporting Policy: The TOWN agrees td-comply with Chapter 577,Article IV of
the Suffolk County Code, entitled, "Child Sexual Abuse Reporting Policy', as now in effect or amended
hereafter or of any other Suffolk County Local Law that may become applicable during the term of this
Agreement with regard to child sexual abuse reporting policy.
Page 5
End of Text
l'
t
Suffolk County Living Wage Requirements Exhibit
As Last Revised by the Suffolk County Department of Labor on 9/26/02
Suffolk County Living Wage Requirements Exhibit
As Last Revised by the Suffolk County Department of Labor on 9/26/02
Pursuant to Section 6 of Chapter 347 of the Suffolk County Local Law No. 12-2001, "A Local Law to
Implement Living Wage Policy for the County of Suffolk" (the "Living Wage Law'j, all RFP's,
County contracts and financial assistance agreements subject to the law shall contain the following
two paragraphs or substantially equivalent language:
This Agreement is subject to the Living Wage Law-of the County of Suffolk. The law requires
that,unless specific exemptions apply,or a waiver is granted, all employers (as defined)under
service contracts and recipients of county financial assistance, (as defined) shall provide
payment of a minimum wage of employees (as defined) of$9.00 per hour with health benefits
of at least $1.25 per or otherwise $10.25 per hours. Such rate shall be adjusted annually
pursuant to the terms of the Suffolk County Living Wage Law,of the County of Suffolk.
Under the provisions of the Living Wage Law,the County shall have the authority,under the
appropriate circumstances, to terminate this Agreement and to seek other remedies as set
forth therein,for violations of this law.
Suffolk County Local Law No. 2002, "A Local Law to Implement Living Wage Policy for the
County of Suffolk"provided for certain amendments to the Living Wage Law.
Forms for Completion and/or Signature(as applicable)
• Suffolk County Department of Labor—Living Wage Unit
Notice of Application for County Assistance(Contract)
Form LW-1 (consists of 1 page)
• Suffolk County Department of Labor-Living Wage Unit
Certification of Compliance
Form LW-2(consists of 1 page)
• Suffolk County Department of Labor—Living Wage Unit
Certificate of the Non-Applicability of the Living Wage Law
Form LW-3(consists of 2 pages)
• Suffolk County Department of Labor—Living Wage Unit
Request for General Living Wage Exemption
Form LW-4(consists of 1 page)
• Suffolk County Department of Labor—Living Wage Unit
Request for-spec Mc Living.. age Exemption.:
Form LW-5(consists of 2 pages)
1 of 2 pages
Y '
Suffolk County Living Wage Requirements Exhibit
As Last Revised by the Suffolk County Department of Labor on 9/26/02
• Suffolk County Department of Labor—Living Wage Unit
Declaration of Compliance—Subject to Audit
Form LW 33(consists of 1 page)
Note: Pursuant to Section 7 of Local Law No. 2002,"A Local Law to Implement Living
Wage Policy for County of Suffolk", all employers subject to the provisions of the Living
Wage Law shall submit a completed and sworn (under+penalty of perjury) Certification
of Compliance Subject to Audit form,signed by an authorized representative,as part of an
executed contract with the County of Suffolk. The complete Declaration of Compliance
form shall be made a part of any executed contract or project agreement and made
available to the public upon request.
• To certify Living Wage compliance: Return Form LW 1,Form LW 222 and Form LW 33.
Or
• To certify non-applicability of Living Wage law: Return Form LW 3.
Or
• To request and document a general living wage exemption: Return Form LW-,LW-2 and Form
LW-4
Or
• To request and document a specific living wage exemption: Return Form LW 1,LW-2 and Form
LW 5.
• In the event that there is a change in circumstances,it is the Contractor's responsibility of submit
to the County additional Living Wage forms which either replace or supplement prior submissions
of Living Wage forms.
Living Wage Law Information Fact Sheet, text of the Local Law, Frequently Asked Questions,
Forms, and Rules and Regulations can be found on the Suffolk County web site at
www.co.suffolk.nv.us .
Click De artment Directory
Labor
Living Wage Law Info
• Suffolk County Department of Labor Living Wage Unit Tel.(631)853-3808
End of Text for Suffolk County Living Wage Requirements Exhibit
As Last Revised by the Suffolk County Department of Labor on 9/26/02
2 of 2 pages
SUFFOLK COUNTY DEPARTMENT OF LABOR - LAVING ALAGE UNIT
CERTIFICATION OF THE NON-APPLICABILITY OF THE LIMG WAGE LAW
Living Wage Law,Suffolk County Code,Chapter'347(2001)
To Be Completed By Applicant(Employer).
1) EMPLOYER NAME: Tom o f 'sA,,,t hni d
Southol d. Town Hal 1
2) ADDRESS: 53095 Main Road
Southol d,. NY. 11971
3) CONTACT: Joshua Y. Horton, supervisor 4)TELEPHON, #: 765-1889
S) PROJECT NAME: (IF DIFFERENT FROM#1).
6 ORIGIN OF ASSISTANCE SOUGHT: (e.g.,State or County assistance program and
contracting Department). Co unty _
-7) AMOUNT OF CONTRACT. 0 8)TERM OF CONTRACT: /NSA
9) BRIEFDESCIIONO PROJECT OR SERVICE: Traffic-c ^Signal Agreement for:
10) PROJECTED EMPLOYMENT NEEDS: (attach a statement of projected needs by job
classification,under the prospective assistance,including calculation of estimated net increase-
or decrease in jobs as a result of assistance).
Reason Living Wage Law is not applicable: No None y Involve-d
I hereby attest that the provisions of Suffolk County Local Law No. 12-2001, the Suffolk
County.Living Wage Law, are not applicable to this agency, organization, employer, contract
or assistance applied for. I declare under penalty of perjury under the Laws of the State of
New York that the undersigned is authorized to provide this certification, and that the above
y
Signature Date
Martin Sidor, Deputy Supervisor for
Print Name & Title Vendor#
LW-3
�4gOFFO�,�c
JAMES C. McMAHON �O ��j Town Hall,53095 Main Road
Director o �� P.O.Box 1179
y Southold,New York 11971
Telephone(631)765-1283 0 •
Fax (631)765-9015 1i
viol � Sao
TOWN OF SOUTHOLD
DEPARTMENT OF PUBLIC WORKS
FAX TRANSMISSION COVER SHEET
To: Madeline Jubenville, SC DPW,Permits & Traffic Div.
From: Jim McMahon, Town of Southold
FAX Number: 852-4079
Re: Certificate of Insurance
Date: March 24, 2005
Please find the following copy of the Certificate of Insurance for the installation of traffic
signals at CR 48 and Young's Ave and CR 48 and Peconic Lane, as per your request of
3/14/05.
If you have any questions on the above,please give me a call.
We are sending you 6 pages including this cover sheet. If you have any problems receiving
this document,please contact our office at(631) 765-1283
Mar 24 2005 12: 20PM Roy H Reeve Rgency 6312983850 P. 1
Facsimile
Roy H Reeve Agency, Inc.
PO Box 54
Mattituck NY 11952
Phone (01)298-4700 Fax 631-298-3850
rbra@royreeve.com
March 24, 2005
Insured: Town Of Southold
Company: American Alternative Insurance Co.
Policy#: 01 A2-RL-0000022-00
Policy Period: JAN 105 To: JAN 106
Total Number of Pages: 4
Town Of Southold c/o Southold Town Hall
Phone: 631 765--4333
Fax: 631-765=9015
Jim'McMahon
Re: Certificate of Insurance-County of Suffolk
Please see certificate following. Please let me know if there need to be any changes.
Thank you.
Sincerely,
Barbara J. Damniers
Commercial Lines CSR ext. 14
bjd
Page 1
Mar 24 2005 12: 20PM Roy H Reeve Rgenc:y 6312983850 p. 2
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(M oos�PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ROY H REEVE AGENCY,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
PO BOX 54 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
MATTITUCK NY 11952 ALTER THE COVERAGE AFFORDED BY THE POUCIES Ia3EL01N.
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA: American Alternative Insurance Co.
TOWN OF SOUTHOLD INSURER B. American Altemative Insurance Company
CIO SOUTHOLD TOWN HALL
P.O.BOXOX 1179 INSURER c: Aierican Altemative Insurance Co.
SOUTHOLD NY 11971 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE USTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCYPERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONbITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
]NOR AWL TYPE OF INSURANCE POLICY NUMBER POLICY EPFECTNE PDut:Y EXPRA7IDN LIMITS
LTR tNBR DATE M1UD
GENERAL LIABILITY 01-A2-RL-0000022-00 01/011105 01101/08 EACH OCCURRENCE $ 1.000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TC RENTED
PREMISES •p,Llge. s 300,000
CLAIMS MADE OCCUR MED.EXP(Arty one person) S 5,000
C PERSONAL SADVINJURY S 1,000,00D
X CONTRACTUAL GENERAL AGGREGATE S 3,000,000
GEN-L AGGREGATE umrr APPLIES PER: PRODUCTS-COMPIOPAGG. S 2,000,dO0
POLCY D PRO-
JECT LOC
AUTOMOBLELIABILFTY 01-A2-RL-0000022-00 01101/05 01101/06 COMBINED SINGLE LIMIT
X 'ANYAUTD (Ee accident) . d 1,000,000
ALL OWNEDAUTOS' BODILY INJURY
C SCHEDULED AUTOS (Parpereon) $
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Peracddw..) S
PROPERTY DAMAGE g
Peraaldent
GAMGE UABA= AUTO ONLY-EAACCIDENT $
ANY AUTO OTHER THAN EAACC S
AUTO ONLY: AGG S
EXCESS r UMBRELLA LIABIUTY 5OA2UB000057701 01101/OS 01101foe EACH OCCURRENCE $ 10,000,000
X OCCUR CLAIMS MADE AGGREGATE s
B $
DEDUCTIBLE $
X RETENTION S 10,000 $
WORKERS COMPENSATION AND MIC STATiI OTli�l
EMPLOYERS'UABLITY TORY LIMITS
NOYPROPIOETCRMARTNERfaXECUTIVE E.L.EACH ACCIDENT $
OFMCBifMW91.R E.XCLUB T . E.L.DISEASE-EA EMPLOYEE Is
uin,d�wib�ucder
SPECIAL PROVISWNe below E.L.DISEASE-POLICY LIMB S
OTHER:
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
SEE SUPPLEMENTAL CERTIFICATE INFORMATION
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 9EFORE THE
E)PIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE
COUNTY OF SUFFOLK TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY FOND UPON THE INSURER,
DEPARTMENT OF PUBLIC WORKS ITS AGENTS OR REPRESENTATNES.
335 YAPHANK AVENUE
YAPHANK,NY 11980-9744 AUTHORIZED REPRESENTATIVE
Attention:' Tfi
ACORD 26(200008) Certificate 5612 0 ACORD CORPORATION 1988
Mar 24 2005 12: 20PM Roy H Reeve Rgency 6312983850 p. 3
SUPPLEMENT TO CERTIFICAtE OF-LIABILITY INS #5612 MAAR22406
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS
COUNTY OF SUFFOLK WILL BE ADDED AS ADDITIONAL INSURED AS THEIR INTERESTS MAY APPEAR WITH REGARD TO ONGOING '
MAINTENANCE&OPERATION OF TRAFFIC LIGHTS AT CR 46 MIDDLE ROAD AT YOUNGS AVENUE,PECbNIC,NY 11958&CR 48 MIDDLE
ROAD AT PECON)c LANE,PECONIC,NY 11968
SUFFOLK COUNTY INSTALLING TRAFFIC SIGNALS AT ABOVE LOCATIONS,TURNS OWNERSHIP&MAINTENANCE TO TOWN AFTER
INSTALLATION IS COMPLETE.
CertZ;ts 5612
Mar 24 2005 12: 20PM Rod H Reeve Agency 6312983850 p. 4
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IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does riot constitute a contract between
the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does It
affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon.
ACORD-25-S(2001108) Certificate#5612
U3/14/0005 11:53 YAX 631 8514078 SCDPW PERMITS/TRAFFIC 10001/002
COUNTY OF SUFFOLK
STEVE LEVY
SUFFOLK COUNTY IBC anwE
DEPARIAMNT OF PMLXC WoR
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CHIEF DEPUTY cOMmISSmmR. CHA$tLES 3.$ARTHA,P.E. LESLIE A.MITC
COMIv1IS$IONER FIEXDEPUTY COMMISSIONER
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SUFFOLX COUNTY IS AN EQUAL OPPORTUNITy./AFFIRMATIVE AC`n0N EMFLOyER
535 YAPHANK AVENUE r
XAPHA.NK N.V,11990 ■ (631)S52-4081, 852.41oo
FAX(631)8524079
Resolved that the Town Board of the Town of Southold hereby authorizes the installation
of street lights on Pole No. 86L and Pole No. 85L, on Route 48 and the southwest corner
of Young's Avenue, Southold
Town Board Meeting: November 9, 2004
If you have any questions on the above,please call Jim McMahon at 765-1283