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HomeMy WebLinkAboutOysterPonds Historical Society Fla `v d °g,1fF0(X�O� RESOLUTION 2025-374 Rf �d ADOPTED DOC ID: 21287 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2025-374 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MAY 13,2025: RESOLVED that the Town Board of the Town of Southold hereby grants permission to the Oysterponds Historical Society to use the following route for its Heritage Day Parade in Orient on Sunday,July 6th,2025, staging begins at 11:30 am with the parade to begin at 12 pm on Oysterponds Lane, from there to Main Road to Village Lane to the end of Village Lane, provided they follow all the conditions in the Town's Policy for Special Events on Town Properties. Failure to comply with the conditions will result in the forfeiture of the clean-up deposit and denial of future requests. In addition, the police will post"No Parking" signs the night before the event as requested. All Town fees for this event are waived with the exception of the clean-up deposit. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Anne H. Smith, Councilperson SECONDER:Brian O. Mealy, Councilperson AYES: Mealy, Smith, Doherty, Evans, Doroski, Krupski Jr TC Checklist for Parade/5KY/Bicycle*/Town Property/Road Closure Special Events`Applications aUl Name of Organization: Name of Event: H Y12Q,� Date( of Event:�8 *No SK and Bicycle events during the period of June I to November V Event fee check(or request to be waived) V Road clean-up check(CANNOT BE WAIVED) V Current Insurance certificate Application sent for approvals to the following Depts.: / PD �_Hwy Land Pres. J TA V Records Mngmnt/TC Approval from Chief of Police Cost Analysis from Chief of Police Approval from Land Preservation Approval from Highway Dept. TB Resolution for approval (once approval and cost analysis comes from Chief of PD) Town Board Reso. #: acoa Approval letter to Organization's contact person w/copy of TB resolution After Event: JConfirmation from Chief of PD to release clean-up fee TB Resolution to refund clean-up fee TB Clean-up Reso. JVoucher and copy of TB clean-up Reso. to Accounting Dept. Whole application file to Records Management (include copy of voucher & reso.) O�oS�FF04-co� . DENIS NONCARROW �� y Town Hall,53095 Main Road TOWN CLERK CZ �?O.Box 1179 COD Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER �',� RECORDS MANAGEMENT OFFICER ,( Telephone oldt 765-18o0 a Via: FREEDOM OF INFORMATION OFFICER www.southldtownnygov RECEIVED OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APR 2J APPLICATION FOR A PERMIT TO HOLD A Southold Town Clerk SPECIAL E'VINT Please provide ALL of the information reou'esfed below.Incomplete anplications'WILL NOT'be reviewed. Date of Submission MO -Cr,,V-\ 1 1 aoa5 Name of Event �—X Ct-co�� Name of Organization: S l C4. Is this a Not-For-Profit Event?Yes/No— Contact's Name: Mailing Address: 'b Rnn-C�10 y--Nm& N\-i Contact's Phone_Number: Contact's Email Address: oqic _ 6\—&1V • 0M Event Location and Site Diagram: � � � �' Vim► (Use additional paper if necessary) Event Date(s): (Include set up an shutdown times and dates) Nature of Event: Com MU h� - (Please attach a detailed description t his application) Time Period(Hours)of Event: From Q'•O OD(y)to ,.o0 O Maximum Number of Expected Attendees:_DV50 Specify any special requirements (i.e. road closure,police presence): M'. , Curd GS �C- > c-cxu& M 6k-\Stemcc& Lane An \J Aa°s \`?� S� No t�oc�k't Su3�s v►�lo�e � M If a Tent or other temporary structure will be used please contact the Southold Town Building Department at 631-765-1802 ` 1 Mailing Address to Send Event Permit to:b� �� Event Fees: X-$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, Melksso, .-e �j d Print name of Authorized Person filling out Signature of Authorized Pe ]ling out a plication application *Upon the request by applicant,the Town Board may waive in whole or in part any of the application requirements. 2 HOLD HARMLESS AGREEMENT The applicant�b� l , of this Special Permit shall defend, SSJ-0001-1 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 c,� S kWnr C�1It (Name of Business Entity) `-�o Dates of event(s): Sworn to b fore e this Day of �1 20 ZS 0M FRANK: X41e---,NOTARY PUSUC,STATE OF NEW YORK on No.05FR6288691 Qualified in Suffolk County My Commission Expires September 0%20 7—f Heritage ®ay=®ysterp®Inds Historical Society - Parade participants will line up on Oysterponds Lane at 11:30 am on. Sunday. - The parade will begin at 12 pm - leaving Oysterponds Lane,-turning right onto Rt..25 then quickly turning right onto Village Lane. The parade will continue the end of Village Lane. (by W Bay Avenue) - Vehicle will disperse to the left, off Village Lane. j i Following the parade, there will be a reading of the Declaration of Independence on the steps of the Old Point School House from approximately 12:30— 1:00 pm. If possible, we would like to have the traffic blocked on Village Lane between Orchard Street and Vincent Street during this time. We would like to have No Parking signs posted on Village Lane from the main road to the Yacht Club one or two days. before. i s'Ak�'� CL�IE'�arLEQd9E��L:GY[7U6 :Q• _ �r '•`dye . ` - mrient-Fire Ddod' ent 'beand ` y r � Q L ,t coun Stare ® Narrow Faver Marina $�" . oysterponds Dock Build m&Dredging:00L. w 3t rical Society Fly .r X a abor'ILauaelsceg�ing'� 14 API VL VAG. 4. adLt _ � ... � . del fa7 '. GI Paz"? s� 'G /R'�''• � f, ?S1a es,Burying Ground y 14 .r` •'�= a•"c +�• *v{` h-ems t a S' �IY �� �Q �G�Chg aG y. •�� � ��F 4/16125,2:44 PM Oysterponds Historical Society Mail-25-26 GL,UMB&WC-Town of Southold s� ' l Office Manager<office@ohsny.org> 25-26 GL,UMB & WC - Town of Southold 1 message Shelby Schmitt<sschmitt@nsainsure.com> Mon,Apr 14, 2025 at 12:38 PM To: Office Manager<office@ohsny.org> Melissa, You have a$1,000,000 umbrella -with both primary and umbrella the total limit is$2M. Please see the attached certificate as requested. Kindly,send all requests including certificates, ID cards, MVR requests and policy changes to CL@NSAinsure.com to ensure prompt processing. Best Regards, Shelby Schmitt Shelby Schmitt Commercial Lines Senior Account Associate One of the greatest compliments that clients and associates can give to me is a referral of friends, loved ones and co- workers. Thank you for your trust. NSA Insurance Solutions Service Neefus-Stype Agency, Inc. Phone: (631)722-3500 Ext 1134 www.nsainsure.com Review U:On https:Hmail.google.com/mail/u/0/?ik=bcad755bb7&view=pt&search=all&permthid=thread-f:1829396792096583170%7Cmsg-f:1829396792096583170... 1/4 4/1 6J25,2:44 PM Oysterponds Historical Society Mail-25-26 GL,UMB&WC-Town of Southold Please note that email will not be effective to bind or amend coverage or report a claim until such time as you receive confirmation that your ✓' request has been processed. Neefus-Stype Agency utilizes encryption technology when sending sensitive messages.If you receive an encrypted message from the Neefus-Stype Agency, you must ensure that any replied or forwarded messages are also encrypted. Any statements concerning accounting or legal matters are based solely on our experience as insurance agents and brokers and are not to be relied upon as accounting or legal advice for which you should consult your own professional advisors. This facsimile or email is intended only for the use of the addressee named herein and may contain LEGALLY PRIVILEGED AND CONFIDENTIAL INFORMATION from THE NEEFUS-STYPE AGENCY,INC. If you are not the intended recipient of this facsimile/email,you are hereby notified that any dissemination,distribution or copying of this facsimile is strictly prohibited.If you have received this facsimile/email in error,please immediately notify us by telephone and return the original facsimile/email to us at the above via the appropriate postal service. We will reimburse any costs you incur in notifying us returning this facsimile/email to us. From:Shelby Schmitt Sent: Monday,April 14, 2025 12:28 PM To: Office Manager<office@ohsny.org> Subject: RE: Certification Good afternoon! Working on this now. Kindly,send all requests including certificates, ID cards, MVR requests and policy changes to CL@NSAinsure.com to ensure prompt processing. Best Regards, Shelby Schmitt Shelby Schmitt Commercial Lines Senior Account Associate One of the greatest compliments that clients and associates can give to me is a referral of friends, loved ones and co- workers. Thank you for your trust. NSA Insurance Solutions Service Neefus-Stype Agency, Inc. Phone: (631)722-3500 Ext 1134 www.nsainsure.com https:Hmail.goog le.com/mail/u/0/?ik=bcad755bb7&view=pt&search=all&permthid=thread-f:l 829396792096583170%7Cmsg-f:1829396792096583170... 2/4 4/16/25,2:44 PM Oysterponds Historical Society Mail-25-26 GL,UMB&WC-Town of Southold Pe Ilmv Us On ... - ®© ® yelp', Please note that email will not be effective to bind or amend coverage or report a claim until such time as you receive confirmation that your request has been processed. Neefus-Stype Agency utilizes encryption technology when sending sensitive messages.If you receive an encrypted message from the Neefus-Stype Agency, you must ensure that any replied or forwarded messages are also encrypted. Any statements concerning accounting or legal matters are based solely on our experience as insurance agents and brokers and are not to be relied upon as accounting or legal advice for which you should consult your own professional advisors. This facsimile or email is intended only for the use of the addressee named herein and may contain LEGALLY PRIVILEGED AND CONFIDENTIAL INFORMATION from THE NEEFUSSTYPE AGENCY,INC. If you are not the intended recipient of this facsimile/email,you are hereby notified that any dissemination,distribution or copying of this facsimile is strictly prohibited.If you have received this facsimile/email in error,please immediately notify us by telephone and return the original facsimile/email to us at the above via the appropriate postal service. We will reimburse any costs you incur in notifying us returning this facsimile/email to us. From: Office Manager<office@ohsny.org> Sent: Monday,April 14, 2025 10:21 AM To:Shelby Schmitt<sschmitt@nsainsure.com> Subject: Certification Good morning Shelby, We are applying for a permit from the town of Southold and they need it to be 2,000,000. 1 have one for 1,000,000, could you please send me over a new certification of Liability? Thank you. Best, Melissa Melissa Groeneveld Office Manager Oysterponds Historical Society 631-323-2480 .® 25-26 GL,UMB $WC -,Town of Southold.pdf 28K https:Hmail.goog le.co m/mai I/u/0/?i k=bcad755 bb7&view=pt&search=a I I&permth id=th read-f:1829396792096583170%7Cmsg-f:1829396792096583170... 3/4 Franke, Diana From: Johnson, Benjamin Sent: Thursday,April 17, 2025 2:36 PM To: Franke, Diana Cc: Schroeder, Gwynn Subject: RE: Special Event: Oysterpond Historical Society(Heritage Day Parade) Hi Diana, The per occurrence cannot be met with an umbrella policy. If you would like to have the applicant, contact our office please do. From: Franke, Diana <dianaf@town.southold.ny.us> Sent:Thursday,April 17, 2025 11:04 AM 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>; Mudd,Jennifer<jennifer.mudd@town.southold.ny.us> Subject:Special Event: Oysterpond Historical Society(Heritage Day Parade) Importance: High Good Morning, Please see attached the Application for a Special Event Permit from Oysterpond Historical Society received on 04/02/2025. Provide approval or disapproval and cost analysis. Please note that the application includes a revised Certificate of Liability Insurance. Thank you so much, Account Clerk Southold Town Clerk's Office (631)765-1800 Ext 1228 1 ' Franke, Diana From: Johnson, Benjamin Sent: Thursday,April 17, 2025 4:18 PM To: Franke, Diana Subject: RE: Special Event: Oysterpond Historical Society (Heritage Day Parade) You too. When they insist, please just have them call our office.Thank you for the help. Sorry this is so tedious. From: Franke, Diana<dianaf@town.southold.ny.us> Sent:Thursday,April 17, 2025 4:17 PM To:Johnson, Benjamin <benjaminj@southoldtownny.gov> Subject: RE: Special Event: Oysterpond Historical Society(Heritage Day Parade) I told her. But she insisted,to us to take it. I will let her know. Thank you and have a good night liana C>Aaxr e Account Clerk Southold Town Clerk's Office (631)765-1800 Ext 1228 From:Johnson, Benjamin<beniamini southoldtownny.gov> Sent:Thursday,April 17, 2025 2:36 PM To: Franke, Diana <dianaf town.southold.ny.us> Cc:Schroeder, Gwynn <gwynns southoldtownny.gov> Subject: RE: Special Event: Oysterpond Historical Society(Heritage Day Parade) Hi Diana, The per occurrence cannot be met with an umbrella policy. If you would like to have the applicant, contact our office please do. From: Franke, Diana <dianaf@town.southold.ny.us> Sent:Thursday,April 17, 2025 11:04 AM . To: Blasko, Regina <rblasko town.southold.nv us>; DeChance, Paul <pauld southoldtownny.goy>; Goodwin, Dan <dang@southoldtownnv.gov_>; Grattan,Steven<sBrattan southoldtownny.gov_>;Johnson, Benjamin <beniamini southoldtownny.govv>; McCullough, Lillian <lillianm southoldtownny.gov>; McGivney,Julie <iuliem@southoldtownny.gov>; Noncarrow, Denis<denisn southoldtownny.gov_>; Norklun, Stacey <Stacey.Norklun@town.southold.nv.us>; Orientale, Michael<michaelo southoldtownny.govv>; Squicciarini,James <iacks southoldtownnv.gov_>; Stype,John <iohnst southoldtownny.govv> Cc: Born, Sabrina<sabrina.born town.southold.ny.us>; Mudd,Jennifer<iennifer.mudd town.southold.nv.us> Subject:Special Event: Oysterpond Historical Society (Heritage Day Parade) Importance: High Franke, Diana From: Grattan, Steven Sent: Thursday,April 17, 2025 2:46 PM To: Franke, Diana Cc: Noncarrow, Denis Subject: RE: Special Event: Oysterpond Historical Society (Heritage Day Parade) Attachments: Orient Heritage Day Parade 2025.xls No objections. We will post signs the afternoon before the event. Attached is my cost analysis. From: Franke, Diana <dianaf@town.southold.ny.us> Sent:Thursday,April 17, 2025 11:04 AM 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.southo Id.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>; Mudd,Jennifer<jennifer.mudd@town.southold.ny.us> Subject:Special Event: Oysterpond Historical Society (Heritage Day Parade) Importance: High Good Morning, Please see attached the Application for a Special Event Permit from Oysterpond Historical Society received on 04/02/2025. Provide approval or disapproval and cost analysis. Please note that the application includes a revised Certificate of Liability Insurance. Thank you so much, liana p-d�rmtke Account Clerk Southold Town Clerk's Office (631)765-1800 Ext 1228 t Town of Southold Police Department Special Event Cost Analysis Event: Orient Heritage Day Parade Date(s): July 6, 2025 Location: Village Lane Pa#ro ' 1.. cafan ar Even' = -$ .- Reg Hours OT Hrs Hrly Wage Total Comments Sergeant $0.00 Police Officer $0.00 �.- m Reg Hours OT Hrs Hrly Wage Total Comments PO Chenche .5 $0.00 PO Sanders $0.00 Bicycle $0.00 , $0.00 $0.00 'K 9 tJn� F $0.00 �f4ighuay atra PO Onufrak $0.00 PO Flatley 2 $79.82 $159.64 ffi o of_ ._ w. Reg Hours OT Hrs Hrly Wage r Total Comments TCO 2 $19.49 $38.98 Post No Parking Sign TCO 2 $19.49 $38.98 Post No Parking Sign TCO 2 $19.49 $38.98 Parade Traffic Control TCO 2 $19.49 $38.98 Parade Traffic Control TCO 2 $19.49 $38.98 Parade Traffic Control TCO 2 $19.49 $38.98 Parade Traffic Control Equi` ,mmen Cos ss_ PD Vehicles #of vehicles Hours $/hr Total 5 2 $20.00 $200.00 Command Van Marine Patrol Boats Total Department Cost for Event= $593.52 Prepared by Chief S. Grattan 4/18/2025 Pagel Born, Sabrina From: Office Manager <office@ohsny.org> Sent: Wednesday, April 23, 2025 11:36 AM To: Born, Sabrina Subject: Heritage Day Liability Insurance Attachments: Town of Southold - OHS Liability-4-23-25.pdf Good morning Sabrina, Attached is a copy of our liability insurance for Heritage Day. I have been told by our insurance company that this states that we have a combined total of$2,000,000 per occurrence. I hope this works for you. Best, Melissa Melissa Groeneveld Office Manager Oysterponds Historical Society 631-323-2480 ATTENTION:This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. i Born, Sabrina From: Born, Sabrina Sent: Wednesday,April 23, 2025 11:51 AM To: Johnson, Benjamin Cc: Noncarrow, Denis; Franke, Diana Subject: FW: Heritage Day Liability Insurance Attachments: Town of Southold - OHS Liability-4-23-25.pdf Importance: High Hi Ben, Please see the attached Certificate of Liability Insurance for the Oysterpond Historical Society's Heritage Day Parade and let this office know in writing if this is acceptable for their event. If not, please reach out to the applicant directly. Thank you, Sabrina M. Born Sub-Registrar& Deputy Town Clerk Senior Account Clerk Southold Town Clerk's Office 53095 Route 25 P.O. Box 1179 Southold,NY 11971 Ph: 631-765-1800 ext. 1226 Faz: 631-765-6145 From: Office Manager<office@ohsny.org> Sent:Wednesday, April 23, 2025 11:36 AM To: Born, Sabrina <sabrina.born @town.southo Id.ny.us> Subject: Heritage Day Liability Insurance Good morning Sabrina, Attached is a copy of our liability insurance for Heritage Day. I have been told by our insurance company that this states that we have a combined total of$2,000,000 per occurrence. I hope this works for you. Best, Melissa i Melissa Groeneveld Office Manager Oysterponds Historical Society 631-323-2480 ATTENTION:This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. n 2 DENIS NONCARROW c� Gy� Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 y 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O Fax(631)765-6145 MARRIAGE OFFICER 'y Q� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ��•� `1►a www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Oysterponds Historical Society May, 14, 2025 Sarah Olmstead P.O.Box 70 Orient,New York 11957 Dear Sarah, The Southold Town Board at its regular meeting held May 13th, 2025 granted permission to The Oysterponds Historical Society to hold its Heritage Day Parade on Sunday, July 61'2025 as per resolution. 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(6.31)765- 1800. Best of luck with your event. Si A l Sinc ar row Town Clerk Enc. •'s DENIS NONCARROW Town Hall,53095 Main Road P.O. TOWN CLERK �pF sou'r Box 1179 o O� Southold,New York 11971 Fax (631) 765-6145 Telephone (631) REGISTRAR OF VITAL 765-1800 STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT wwwsoutholdtownny.gov o OFFICER FREEDOM OF o INFORMATION OFFICER ` to IM,�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2025-536 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JULY 8, 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 the Town Board of the Town of Southold hereby authorizes a refund to be issued in the amount of the deposit made to the following: Name Date Received Amount of Deposit Mattituck Lions Club 1/30/2025 $500.00 PO Box 595 Mattituck,NY 11952 Cutchogue-New Suffolk Library 1/17/2025 $250.00 PO Box 935 Cutchogue,NY 11935 New Suffolk Civil Association 5/12/2025 $250.00 PO Box 642 New Suffolk,NY 11956 Southold Village Merchants 3/25/2025 $250.00 c/o Joan Tyrer PO Box 1356 Southold,NY 11971 North Fork Country Club 4/16/2025 $250.00 PO Box 725 Cutchogue,NY 11935 Oysterponds Historical Society 462025 $250.00 PO Box 70 Orient,NY 11957 Denis Nonearrow Southold Town Clerk RESULT: Adopted MOVER: Councilwoman Doherty SECONDER: Councilman Doroski AYES: Supervisor Krupski, Jr., Councilwoman Doherty, Councilwoman Smith, Councilman Doroski, Councilman Mealy NAYES: None Vendor No. Check No. Town of Southold, New York - Payment Voucher Vendor Name Vendor Address Entered by Oysterponds Historical Society PO Box 70 Orient, NY 11957 Audit Date Vendor Telephone Number 631-323-2480 ext. 2 Town Clerk Sarah Olmstead Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 2025-536 7/8/25 250.00 250.00 c/u deposit return A.1410.4.600.100 Total 250.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved. Sign r Title:De u _Town Signature Company Name Date 7/10/2025 Title:Deputy Town Clerk Date 7/10/2025 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 04/17/25 Receipt#: 339018 Quantity Transactions Reference Subtotal 1 Clean-Up Deposit 07-06-25 $250.00 Total Paid: $250.00 Notes: Payment Type Amount Paid By CK#882116768 $250.00 Oysterponds, Historical Society Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Oysterponds, Historical Society P O Box 70 1555 Village La Orient, NY 11957 Clerk ID: DIANAF Internal ID: 07-06-25