HomeMy WebLinkAboutKennys Rd
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JUDITH T. TERRY
TOWN CLERK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
December 4, 1997
Elmore Associates Construction Corp.
2965 Horseblock Road
Medford, New York 11763
Dear Sirs:
Returned herewith is your License and/or Permit Bond and Maintenance
Bond with regard to your project to install water mains and appurtenances
on the north side of Kenny Road, Southold, in 1990. We just received
notification from Superintendent of Highways Jacobs that these bonds can
be released.
Very truly yours,
~~
Judith T. Terry
Southold Town Clerk
Enclosures
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ELMORE ASSOCIATES CONSTRUCTION CORP.
2965 Horse Block Road
Medford, New York 11763
Tel (516) 654-3130
Fax (516) 654-3150
RECEIVED
MAY 2 1 1990
x."thokl T~...- rl~.1.
May 15, 1990
Town of Southold
Town Clerk
Town Hall
P.O. Box 1179
Southold, NY 11971
Re: Road Opening Permit
Dear Mr. Jacobs,
Enclosed are the maintenance and performance bonds you requested.
If there are any additional problems or questions, regarding this
permit please get back to as soon as possible. Thank you.
Very truly yours,
~
w~
April Wagner
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Fidelity and Deposit Company
HOME OFFICE OF MARYLAND BALTIfttoRE. MD. 11203
Maintenance Bond No. 303l4674-M
KNOW ALL MEN BY THESE PRESENTS:
" .
That We t Flmn1"'o ACi'oci:itQ(', CSAstrYsti9Fl CSEf3-
2965 Horseblock Rd.. Medford, NY 11761 (hereinafter called the
Principal)as principal and the Fidelity And Deposit Company of .
Maryland, a Maryland Corporation with an office and place of
business for the State of New York at 90 John Street, New York,
N.Y. 10038
(hereinafter called the Surety)as Surety, are held and firmly bound
unto. the . Town of Southold. NY
(hereinafter called the Obligee in the sum of Four Hundred & no/lOO
($400.00 ) DOLLARS, lawful
money of the United States of America, for the payment whereof the
Principal and Surety bind themselves their successors and assigns,
jointly and severally, firmly by these presents.
--5 igned, sealed and dated this- - 15th day of May 19..2!2-
WHEREAS, the Principal heretofore ~~~~aia~~ ~EeR eeR~raet
ri-t:h the Obligee for Road Opening, Kenny Road and North Road, 'Greenpdrt Water Distri
WHEREAS, said Contract provides that the Principal shall
guarantee the above cited Road Ooenin~ Work
NOW, THEREFORE, the condition of this obligation is such, that
if the above Principal shall indemnify the Obligee against any loss by
reason of his failure to make good at his own expense any defects or
deficiencies in materials or workmanship which may appear in the work
under said contract within the period of Two (2) year (s) from
the date of accept~nce of the work, then this obligation shall be
.yoid; otherwise to remain in full force and effect.
FIDELITY AND DEPOSIT
_::Q,e)!"'Jj{'P
By:' L-fCfr I ~
COMPANY.:: ~~
Ro rt G. Tynan, Attorney-in-fact
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Power of Attorney -
STATE or ...,:_....Qe.w....ja:K..._........ }
CoUNTY or ..__.......Su.ffD.1.K................_.. ss:
On this __........._........:.L5~..1.~............._...................__day of........_..ffi~-....--...-.-....._-.19..'3 O. hefore me personally
":M... rln. ^ (\ n & ........n. I ....__.....__...._.._....____m.....
ppeared _..]...J..l]J.l_~...--~_..-.-.....-..------.....-..-----.-..---------. ........
~th who~.I"~; ;r.soD~lI~~quainted. who, being by me duly !w~om. did depose and say: .4). _..J. 1..
. ...., ... ^~! 1\. ~ thaI he is the......v...~......--m........
That he resldes at ..L....___. . ...._.~_.1J.l\.-_... .-- . -..... ..---
~ ~ ~_..~.__..._......._........._._.............
;~~h:o;;~.ration d~ribed-i;...~;;d..;hi~h. e~e~uted ;h;-for~~~ng 'i~;;;~m;~;'; ";b~~h~-bt~s the corpor~te seal of :t~ corr~tio~
that the seal thereto affixed is such corporate seal; that it is so affixed by order of the Board of Directors. an t at e Sign
his name thereto by like order.
BRUl3123-
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APRI. WAGNER CoUAty
NOrARV PUllUC. Slate of fWM York
No.l72e2l)l. SUIIoIc ~
Tenn ElcpNIll.oo119_
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Vice-PresideDr
By
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:::::'..__~_~~'.? '. _1..-__
,4881-" SecreW'y
STATE OF MARYLAND
CITY OF HAL TIMORE
/55:
,
On this 8th day of June . A.D. 19 87. before the subscriber. a Notary Public of the State of
Maryland. in and for the City of Baltimore. duly commissioned and qualified. came the above-named Vice-P....idenl and Aaaistanl
Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. to me penonalIy known to be the inclividuala and officers
described in and who executed the preceding instntmenl. and they each acknowledged the execution of the same. and being by
me duly sworn. aeverally and each for himaeU depoaeth and saith. thaI they are the aaiel officers of the Company aforeaaiel. and
thaI the aeal affixed 10 the preceding wtntmenl is the Corporate Seal of said Company. and that the said Corporate Seal and their
signaturea as auch officers were duly affIXed and aubocribed to the aaicI inatrumenl by the authority and direction of the said Corporation.
IN TESTIMONY WHEREOF. I have hereunto ael my hand and affIXed my Official Seal. at the City of Baltimore. the day and
STATE or ___Nelll...yark.......................___........... I
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CoUNTY or .N?~.~?.1,!____...__........._______.................. I .
On this _______.....__.......~--.[..~.~..........--...-...............--......day Of...._.f1:J...~..y......-_.-----.....-....-._193~. hefore me personally
appeared _..RQbe:;.t-..G-.~an.-._.................-----..-..........m.........----......-...---.......---..-.--..-..--.-.....
with whom I am personally acquainted. who. being by me duly sworn. did depose and say:
That he resid.. al ..Ga.l;QQn..City.,...NY.....--................-...................-.........--..........that he is the.....Att=eJl=.in::fac.t........_____
of the __......~!.~.:.:~~.~..::~:~...':::::._~~}.~_~~.:::?:~~~~~.'~:..~~.;.:.::~;~.~.~;l~.....____.___....._.....__.__.__..---.-...-.-..-.--.....-.-.---.-..--.-.............--.
the corporation described in and which executed tbe foregoing instrument; that be knows the corporate seal of said corporation;
that the seal thereto affixed is such corporate seal; that it is 90 affixed by order of the Board of Directors. and that he signed
his name thereto by like order.
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, CoUAty
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EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND
U Article VI. Section 2. The Chairman of the Board. or the President. or any Executive Vice-President, or any of the Senior Vice-
Presidents or Vice-Presidents spodaDy authorized so to do by the Board of Directors or by the Executive Committee, shaD have
power. by and with the concurrence of the Secretary or anyone of the A..iatant Secretaries, to appoint Resident Vice-Presidents,
Assistant Vice-Presidents and Attorneys-in-Fact as the business of the Company may require, or to authorize any person or persons
to execute on behaU of the Company any bonds, undertakings, recognizancee, stipulations, policies. contracts, agreements. deeds,
and releases and assignments of judgements, decrees, mortgages and instruments in the nature of mortgages.. . . and to aH"lX the
seal of the Company thereto."
Ll428b
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FIDELITY AND DEPOSIT CO!YIPANY
Of M41lIoANP
S''''.....ea. .. .,........, Coadi&iou
AS OF D~ ~1. l!/ll\J
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IS"",;, . . . . . . . . . . . . . . . . . . . . . . .. ; .. .. .\.. i . .. I . . . . . . . . . ., , , , . . ..1 ui.uz.'i..
~I"d,., . . . . . . , , . , , , , . . . . . . . . .. ........ ~; '..,... j... .. . , . . . . . . . . . . . . . .. . '" ~lIlIlI.OJ6
Heal 1-:.1....' . .. . .. .. . .. .. .. . .. . .. . .. . .............. .,..... .... . . . .. .. .. .. .... ~96!I.1I16
C...I, i.. lI....... alld OIlu..... ""d Sbull -r....m Ia".....'rt.....,........ ................. 11.__
l'r~lUjlllU. ill Cuur... ul Cull...uun (1- .U.IIII 90 .,. MlIU,. . ., . . . . , . . ., '" ., ......... ' zg.l6lI.861
Helll..."....... allU Olb.r AeooWlIli U.e01vabllt............,.. i... . . . . . '" . . . . . . . .... 2O.31f.901'
'/''''1'.\1 AIJ~lrrn::u A:i:it:'I~..........,:.... ....".;.;...;......... . .. ....". ....f 4lI2.235,533
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LlAillLIT1~, SUft1ll.U. ~ Q'fIiEH ~'UNUS
Ih::n.n,.... Jut l~lI~uru~d }JrclU~uu!~ . . . . . . . . . ....... ~. ...~,........ . . . . . . . . . . . . . . . . . . . . .... lzt9OK.W
He.eI'Ve I".. Clallll. allll CLouu E.\il""""". . . . . .. ..... 0"'" I'~, .. .. . . . . , . .. .. ...,...... Ul.lIlIO.lI1'
Ut:~":fIIC {uf TU.\.4::lt and Expt:~.,............ to ........".. r ,......................... g.~861
Alj~L:cJ1~,h..'uu~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...., . . . . . I . . . . . . . . . . . . . . . . . . I . 18,995.815
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'1'0"1'11. 1.1.\III1.nU:S.,. ................,........".......... .............1 alI6....n.
L:4.1{Jt&..J 'stud... 1'6&i.J Uf'...................................,.... S 5.uuu,UUO ./
::iurplu~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . " to ~.". f~""'" .. 2Jl,lJ45.411
Surl,lu. ;.. n'~ard. I>olieybulu.........,......,.... .....;....;........,. ...,'..... ,..... 216.00.f1'l
'l"i".\L .~: tAU" 23S ...
. . . , .. . .. . .. . .. . .. . .. , .. .. .. . .......... '. .. .. . .. , . . . . . . . . . . , , .. . 'W4;\ ,......
-. -, ..... .
S.ellt;,ie. ,'arrieLl al $O.12u.412 w Ib~ ~bove ""~"'Ilt .1"<1.. r"'JuireLl by Iliw.
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Sc:cul'ilic~ ,'..&rricu u.II dtc boUi preMaibcd by ,he N..... 4".-J..t~n ullulIW"iuu.:t: CUfUP.I_:~!iv- 0.. 1M......
,,/ UeccUlI"'1 JI, 1'.IlI\J W....lel \i....'uuo... for .u boadIUllIlllCb oWII.d, lbe CWIII'IAllY" W4.l ,~il'" ....
w"ulJ Le ~'lll'J,5~,lkio uud .....1'1... lIII r.llurd. ~~I360,1SU. .
I, J'''''.I'U J. (;.\LL\\iU&::II. 'I'r....urcr ulUlC fwanr AIm Pt;l'O:il'l' CUMI'ANY U~' M.wy~. 4a 1NIIIi,
eenil)' 11...1 lhe lun'l:uwg >IalClu0111 ill a curreel Waibi&.,...... ~ Iiabililieb "I lb. ouid ~r, 81 ...
31., Jay ..I UeeemlN:r. 19U9. uCl:llrLliul: 1lI1be bIII&",,~, lo.uuwleLl~e a.1Il baIi.(. , "
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". SToITI: ot. ,\1.\11 YlAND I ..
'.~,Cl'l'l UF U.II-TIMoll&:: j~: '.
~:iul:o.... ij,..oI ami ...uru 10, belur. m., a NOlllty PIliIIII e( "" ~.. ull'durylulId. ill lb. Cily all"II;~ ~
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Fidelity and Deposit Company
HOME OFFICE OF MARYLAND BALTIMORE, MD. 21203
license and/or Permit Bond #30314674
KNOW ALL MEN BY THESE PRESENTS:
That we, ......~~?!:~..~.~?~~~.~~~...~.r.!~.~.~~.~~9E!..~ry:.L.?~~S...g~E~~pJ2~~..g.~_,.I...~.c!~Q~,...~L!,1763
as Principal, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, incorporated under the laws of the
State of Maryland. with principal office in Baltimore. Maryland. 'as Surety. are .held and firmly bound unto
...................__....................................................I~..9L~.?~.~.~9.~~J....~.............................__..............._.. as Obligee.
in penal sum of......Th9...ThQ!-!.~.@g..~...n9D9.Q.......c$.2.~QOO...QQ)...___..................................__..__........._........Dollars,
lawful money of the United States. for which payment, well and truly to be made. we bind ourselves, our heirs,
executors. administrators. successors and assigns, jointly and severally. firmly. by these presents.
WHEREAS, the above bounden Principal has obtained or is about to obtain from the said Obligee a
license or permit for._..Road.Qpening::Kenny...Bd~...and..North..Bd_........................................._...................-.-..
.................__...__................................................................___.; and the term of said license or permit is as indicated
opposite the block checked below:
[1g Beginning the.............1S.th.................day oL.May.................___......__...__....19.90... and
ending the..l:?1;h............................day oL.......MaY................____............19...9.L
-'
o Continuous. beginning the........................................day of................................................19.........
WHEREAS. the Principal is required by law to file with.__:!:2~...9.L~Q!_!.th9J..c;!LNX.............__..._.............
.............. ....__...____..uu...nnnn_nnonn......n.._h..___ouuunnnnun.nnn_n___n_U.U..huuuunn.unn.._.nO_._.nUhuon___uonnn___..__o__h_.__n__.
a bond for the above indicated term and conditioned as hereinafter set forth.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH. That if the above
bounden Principal as such licensee or permittee shall indemnify said Obligee against all loss, costs, expenses
or damage to it caused by said Principal's non.compliance with or breach of any laws, statutes, ordinances,
rules or regulations pertaining to such license or permit issued to the Principal, which said breach or non.
compliance shall occur during the term of this bond, then this obligation shall be void. otherwise to remain in
full force and effect.
PROVIDED, that if this bond is for a fixed term. it may be continued by Certificate executed by the
Surety hereon; and
PROVIDED FURTHER, that regardless of the number of years this bond shall continue or be continued
in force and of the number of premiums that shall be payable or paid the Surety shall not be liable hereunder
for a larger amount, in the aggregate. than the amount of this bond. and
PROVIDED FURTHER, that if this is a continuous bond and the Surety shall so elect, this bond may
be cancelled by the Surety as to subsequent liability by giving thirty (30) days notice in writing to said Obligee.
Signed, sealed and dated the................l5..th..............................day oL.......Mall........................._.........._19..90..
Elmore Associates Construction Co .
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_///~ ~rt
By........../.__............................. . ........_.........
FIDELITY AND ~~'~::::..__
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Power of Attorney
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
MOME OFFlCE. IALT1MORE. MO
KNOW ALL MEN BY THESE PRESENTS: That the FlDEUTY AND DEPOSIT COMPA:"IY OF MARYLAND, a corporation of the
State of Maryland, by C. M. PECOT, JR., Vice-President. and C. W. ROBBINS ,
Assistant Secretary, in puralWlce of authority granted by Article VI, Section 2, of the By-Lawa of &aid Company, whicb are ..t
forth on the reve... side .he~f. and ~ h.!"eby cerli!i~ to be. ~"!l force ~d ~cl on lI.'e ~te ~, d,:,," h~! nominate,
STATE OF ..Gau...J:JcK...._m............. t
CoUNTY OF ......"su..ffi.Lt:.............._...... l 55:
On this _...L5:~.....~___ ..........................._ day of rn ou 19iA\. bef II
l-MJV"'- ............-...-.(..:.-.L.":...--:t---.---.-.....-.............- ~.!1_. ore me persona y
appeared .....Jh~..---. .... ~...\\o.e..............---...................___............_.___............
with whom I am per~nal1Y \!Uainted. who, being by me duly sworn, did depose and .;;;;~_.._..........---..---._._-_...-._................_- .
That he reSides at ._......;L\-=~~~j)(~..t....u.\.~---rlA~...................that he is the.___.....~ rJ}"...
of the J:.tlWtL..I.:wDo.\0L " -\I ..J.~...._....._.........__
the corporation described in and which exec~lJt.~~;~..h;.~~~..;h~..~~;;~~;e-;-.;;;i-;i.;jd..~~;;~;;ion;
t~at tbe seal theret~ affixed 18 such corporate seal; that it is so affixed by order of tbe Board of Directors. and that he s' ed
hiS name thereto by hke order. agn
BR(ll31.23-
APRL WAGtiR.......~..---...W~.._........-
NOTARY PUBlIC. SIa18 of New<<--. ~CIClNSIJI.lcooNcai;ounty
No. 4728201. &Jnok CouJIY Il.OClC IlCW)
Tenn ExpHIll /3O/19.Qr'\) NEWlQIK 11711
Maryland, in and for the City of Baltimore, duly commis.ioned and qualified, came the above-named Vice-Preoident and Assistant
Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers
described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being by
me duly .wom. severally and each for himseU depoeeth and .aith, that they are the said office... of the Company aforesaid. and
that the ..al affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their
signatureo as .uch officers were duly affIXed and aubacribed to the said instrument by the authority and direction of the said Corporation.
IN TESTIMONY WHEREOF. I have hereunto set my hand and affIXed my Official Seal. at the City of Baltimore. the day and
year fIrst above written. ~'fi::.. ~ :::' "
STATE OF ....New...YOl:k.................................... I 55'
N""""U .-........... i . ,r.' all
CoUNTI or .._..~_or..-.lM..__.........-.............-. 19-\ J before me person y
On tbis .................\~~.~~......::.........:~.::::::::::::.:~:.~.~::..~::.~:~:..V:.=:.~~~:::~~::.~:~~~:::.:~~.::.:::.:::.::.:.:.....=.=....._.._..........................
appesred ..E.9.!?g,1;J..............lYP...-.....;d......i, be'ng by me duly sworn. d.d depose and say.
with whom I am oersonally acqualnt . 'II O. 1 . h ^ t- t-.......,~.u::lv.~.in-=.f.act......_-
. Garden I:;:!:.!;Y..L.~..........................._........................................ that he IS t e..................-T
That he reSides at ..............--........- ...._._._____.___....._
Fl S ~ ~. ~ ';' 2,-, ',. ~ =,- : .~: ~ ;.;.:~:~~:::~.;:~...~_~._:;~_,.j_~.l:_.~:.~:'..........._.._..:-._.._.~..h~..k~~~~..;h~.-~~;;;~;~-;;. of said corpor~tion;
of the --.._..._............_......-:~d.-:.._..--.d.-~hich executed the foregoing instrument. tha d f the Board of Directors. and that he stgned
the corporation lescn m an h te seal. that it is so affixed by or er 0
that tbe seal thereto affixed is sue corpora . ~il ,~-..
his name thereto by like order. /. ' /~ >/
_._..._..n..n..n.n..n........_::::.....:..~~_:.._..._.~~ ~ -. ~bii.:"'-""'-'-"
. oUJry County
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EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND
"Article VI, Section 2. The Chairman of the Board, or the President, or any Executive Vice-President, or any of the Senior Vice-
Presidents or Vice-Presidents specially authorixed ao to do by the Board of Directors or by the Executive Committee, shall have
. power, 'by and with the concurrence of the Secretory or anyone of the Aasiatant Secretaries, to appoint Resident Yice-Pr~idents,
Assistant Vice-Presidents and Attomeya-in~Fact as the business of the Company may require, or to authorize any pe'non or p;ersons
to execute on behall of the Company any bonds, undertakingo, recopixances, stipulationa, policies, contracts, agreements, deeds,
and releases and assignments of judgements, decrees, mortgages and mstnunenta in the Dature of mortgages,. . . and to affix the
seal of the Company thereto."
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FlDELIJ'Y AND DEPOSIT COlVIPANY
Of M4IllloANP
Stateweat .. 1'1-....,,' Coaditi....
AS Of D~ 11. 19l1~
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lJuud.", . , . . .. . . . . . . . . . . . . . . .. ... ~.. ""~.' i"""'" . .
'sIUI'L..:a . " , . .. . .. . .. . . . . .. . .. . ........~ ..'1".'..... . . . . . .
l{caJ E:.l.lh' ,.,............................ ..... ..,.., f...........
<:::.J. .;11 tJ.~ul::.. ~ud OIJlce:>> Wl~ SJlW"t 'rum Iay-'q"-"..~. r............
1 r~UllIlI'" III Cuur... ul CullOClwn U..... .IIUUl 90 .,~ JIIIj, ... , . . . . . . . . . _ . .
UC:JII;:illr~&.uI~I' auu Olhu ACCOW1lM lteCc:lv&bJe......,'.', I! ' . . ; . . . . . . . . . . ...
'ruT.\!. AU:\UTTl::U ASSa:;TS............... .........,.....;............
~
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. . . . . . ...f 212.111.""
. .. .. ... auDollllll,1l11i
. - . .. .. .,.. .' S.9Qg.t16
t. 'llIO,GlW
- - .. .. . .. . 2t,16t,86'l
. - - . .. . .. .. 20.51..901-
. . . . . . . . . . . . . ., 482.235,533
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LJAIULJT1~, SUftll.U. ~ OTliEH r'UNDS
Ih::n'I'VC J". l~u~u..u-=cJ i>>rcm~u.u,l~ ................ ~"..~"........ . . . . . . . , . . . . . . . . . .. ...1 l25.,,465
He.ene f.... <.101111. aud Chulll u(JClI:lc._........ .....,;.".._,.....,. _.... ...... _...... Ul,llllll,t'Z6
Hc.:acr....c l\ll' 'l'U.l.C:, Mnd Exp.:OIic:.. . . . . . . .. . . . ...." ..... p" ~.... . . . . . . . . . . . . . . . . . . . . '" g.~161
rwl~l;"cUalh"uu.:a ..,..............................,.....", ~ ' . , . . . . . . . . .. ............ 18,993.815
'rlfl'-\I. l.uUII.I'I'U::S,.. .................................. ............1 *,II8.J~
t:~pll.,I.sl.,~.h.. J'..i.J U..........................,.,;".....~~...I S,ouo,UOU ./
SUfjJlu:. ,....................... .....~...."t...t..... 2Jl,lH5.-l!1
SW"plu~ ;l.'l fl'~arU:i IlolicybuldClll. . . . . . . . . . . . . . . , .. ... ~ , ... ; .. . . . . . . . , . . . . . . . . . . . . 216.0&5.'17
'I', ,.,'.'L .: : S AU" OG.r S3u
~ . . . . . . . . . . . . . . . . . . . . . . .. . . .. .........,......... . . . . . . . . . ... . . . . . . . . ... T .....J4oW) ..
~ .........
S.c..ri,ie, ...rried 01 $0,120,412 ill IhO! ~hovO! ""~ lit .,..,1 ... r.'1..ired by l.iw.
--
~CCU..iLlC:> \'..rrlcJ un the b"",ili IJ'cQCtWcd by Uu. Na&Io8II ~~".'cn uJ lu.W'~uu.:.: Cuuuu;";":^"':r. 0. &lie...
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nu..IJ Le ~-Ill'J,5JO.llIJCl alld .....1'111II ... r.lllltWt poIiIlJ"'" ~,360,150.
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ccnif) aI..., ,he fUl'c~uill~ .lal.Ill.1l1 .. a cucreel edtiIti&......14IlllI ~ liabililic. ut lhc lII&id CotafuJ.II'"
3bl J..y ..e December, 1'.111'.1, a.':lIlll"" 10 lit. -III w~, luuwkJ,e ami bali.C. . . .
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Sub"',,b.'d .....1 '\Y0I'1l 10. bet"r. m., a N"llIry '1IItI/I ef. _ _.. uf IIIlaryl.II.1, i.. II.. Cily oIlhl.,llIlltI. IIIlt
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.
JUDITH T. TERRY
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
TELEPHONE
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 3, 1987
Elmore Associates Inc.
2965 Horseblock Road
Medford, New York 11763
Gentlemen:
On April 2, 1986 you were issued a Permit for Highway Excavation
and Repairwith respect to water main installation at Long Pond Estates,
Southold. At that time you submitted a Surety Bond in the form of a
$300.00 certified check, which is returnable upon completion of the job,
inspection and authorization of the Superintendent of Highways.
If you have completed the work, kindly notify Superintendent of
Highways Raymond L. Jacobs, Peconic Lane, Peconic, N.Y. 11958, and
request a final inspection. If everything is in order this office will
authorize the refund of your Surety Bond.
Very truly yours.
~~
Judith T. Ter~
Southold Town Clerk
cc: Supt. of Hwys. Jacobs
110 (
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'.
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,
Permit No. / /
File No. /1
.
.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(516) 765-3140
!lr
c?6 - ~t1.CJC1
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town
of Southold for the issuance of an Excavation Permit pursuant to Chapter 83 of the
Code of the Town of Southold, Suffolk County, New York, and other applicable' laws,
ordinances or regulations for the excavation herein described. The applicant agrees
to comply with all applicable laws, ordinances, codes and regulations, and to permit
authorized inspectors to m'ake, necessary inspections of the job site.
Print or Type
1)
Elmore Associates Const. 2965 Horseb1ock Road, Medford, ~~
Name of Applicant
Address
2)
Name of Owner of Premises Address
North side of Kenny Road beginning at North Road and going west for approx. 1700'.
3) Installation of water mains and appurtenances
Work Description and Location (Street Number, Hamlet. Cross Street)
(a) Is construction located within 75 feet of tidal wetlands? *Yes No
*If yes, other Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
~-r)M !kilL
Signature plicant
4/26/90
Date
5) a) Attach plot plan showing location of proposed excavation and relationship to
adjoining premises or public streets or areas, and giving a detailed descrip-
tion of layout of excavation.
b) Attach all other necessary permits and licenses for this project.
c) Work covered by this application may not commence before issuance of a
Highway Excavation Permit by the Town Clerk.
6)
7)
Tax Map: Section
Block
, Lot
Starting Date:
May 5, 1990
Completion Date unknown
8) Work Schedule:
Phase
Excavation............... ..........................
Facility Installation..... ........ ....................
'Backfill & Compaction..............................
Pavement Replacement..............................
Completion Date
9} Under which authority is the application made: Greenport Water District
10)
Estimated Cost of Proposed Work: $
44,000.00
11) Remarks:
.~~
-~
D-39
Page 1 of 3
.
.
12)
Insurance Coverage:
a)
b)
c)
Insurance Company:
Policy #
State whether P9licy of certification
ment: No I copy enclosed
(Attach copy)
Transcontinental Insurance
104957311
on file with the Highway Depart-
d) Coverage required extended to the Town:
Bodily injury and property damage: $300,000/$500,000 Bodily Injury,
and $50,000 property damage.
13)
Security:
a) Surety
total amount
:JoOld 020011
~;
of $
..-
~or Ce,-tified Ct:ccl,
r;:--::'.#::!:::! ". ~~~
b) Maintenance Bond provided:
#IJ !!!! 2 years or
3 yea rs
14)
Fees for applications and permits:
Basic
Application Fee........ $25. 00
@ $20.00 = $
A 1. /Service Connections excavations
~
A2. /Additional Excavations same service @ $10.00 = $
~
B. Excavations 18" in depth or less:
0-100 i.f. = $10.00
I. f. @ $0. 10 - $
C.
Additional
Excavations 18" in depth to 5'
0-100 I,. f. = $30.00
~I.f. @ $0.30 = $
Additional
D. Excavations 5' in depth and over:
0-100 i.f. = $50.00
I.f. @ $0.50 ~ $
in depth:
t/- t, .5,
c> b
Additional
E.
Utility Repair Excavations @$10.00 = $
No.
Repairs same service @ $5.00 = $
Additional
F. Notice to public utilities proof must be provided and attached to
this application prior to issuance of permit.
* * *
Authorization is hereby granted to the
issue a Highway Excavation Permit to:
in accordance with this application.
Town Clerk of the Town of Southold to
~//12/JR.e ,/) c:,<::;Ot!I'A--teS ('f//?/lJS+,
SUPERINTENDENT OF HIGHWAYS
TOWN 0 SOUTHOLD, NEW YORK
,6-- / -<1- '70
Date
Received by the Town Clerk
'-7,~~~l/ / <9 tJ
. Date
Permit Issued
~~~&7
ate
.ol.A.l.. Permit No.
//
Note:
Permit expires one (1) year from Date of Issuance.
No work to start without 48 hour notice to the Superintendent
Permit must be available for inspection.
of Highways.
",-,
D-39
Page 2 of 3
"
.
.
.
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S
RECORD
Inspection Date
Findings (use code)
Applicant Notified
1st
2nd
3rd
lith
(To Permit Clerk)
REMARKS
CODE
I B - Improper barricades
IL - Improper lights
ST - Sunken trench or excavation
UTM - Unable to measure (due to backfilling)
BUC - Building under Construction
WIP - Work in progress
DB - Improper backfill (too high) (not sufficient)
HFS - Inspector holding for final settlement of excavation
RFR - Ready to repair
...r....A'>_
>~
D-39
Page 3 of 3
'... ,....
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Highway Department
Town of Southold
Peconic Lane
Peconic, N.Y. 11958
RAYMONDL.JACOBS Tel. 765-3140
Superintendent -734-5211
DATE: Lllal\QO
TO:
CASE NUMBER: 1 \{o~ 15G
This is to notify you that New York Telephone Company
and Long Island Lighting Company have been notified in
respect to the application for an Excavation Permit in
the Town of Southold.
~rzFV; tw[
Signature of the applicant
."''--
>~
;~H~J!\~R~E~NS~~WAy~;EN~~O~
(212) 312-7276
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ELMORE ASSOCIATES INC
2965 HORSEBLOCK RD
MEDFORD NY 11763
POLICY NUMBER
472 196-5
DATE
4/17/90
CERTIFICATE NUMBER
788-849
PERIOb>COVEREO>ElVTHI$CERTI1'i ATE
.........J2106189..TO..1210$190... .
CERTIFICATE HOLDER
POLICYHOLDER
ELMORE ASSOCIATES INC
2965 HORSEBLOCK RD
MEDFORD NY 11763
GREENPORT WATER DISTRICT
236 THIRD ST
PO BOX 2095
GREENPOR T NY 11944
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE
INSURANCE FUND UNDER POLICY NO. 472 196-5 UNTIL 12/06/90, COVERING THE ENTIRE
OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK-
ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK,
EXCEPT AS INDICATED BELOW.
IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 12/06/90 IN SUCH MANNER AS
TO AFFECT
THIS CERTIFICATE,
5 DAYS WRITTEN NOTICE OF SUCH CANCELLATION
WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE.
NOTICE BY REGULP~ MAIL SO
ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE
FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE.
THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION.
THE STATE INSURANCE FUND
ht. ~p~
DIRECTOR. INSURANCE FUND UNDERWRITING
587
.. _.~
- .
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.
':jSer- ~:~:-,. 1,~iO 22: 22
P.02
A4~.~ItI., CERTIFICATE QF 1~$URANce
,,' .. . ..... ,
!SSl,JE' rlb.Tr (~k' f:> .,",
4 ~b/9u
i'A0f}..JCER
Designed Coverage Corp.
P.O. 3o~ 670
Hauppauge, NY 11788
THIS CERTIFICATE IS ISSUED AS A 1,;ATlER OF INFORMAT!UN ONLY MJO CO!-Jr::ERS
NO RIGHTS UPON THE CERTIFICATE' HOLDER THIS CERTIFICATE OOE:S ~JOT AME~JD
EXTEND O~ A~ TEl=! Tj-iE COVEi='lAGE AFFO~DED BY THE POLICIES BElOW
COMPANIES AFFORDING COVERAGE
~~~~y A Transportation lnsurance Co.
CODE
SUe-COD!
INSiJAfD
COMPANY B Continental Casualty Co.
LETTER
Elmore Associates, Inc.
2965 Horse Block Road
Medford, NY 11763
COMPANY' C
LETTER
COMPANY 0
LET'l"el!l
COMrANY E
lenEFI
COVERAG"S
THIS IS TO CERTIFY THAT THE ~OLICleS OF INSURANce LISTeD BeLOW HAve BeeN IssueD TO THE INSUReD NAMeD ABOvE FOR TH" .oue'! ."Ale'
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RFSPEGT TO >'VH!CH THt'i
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TME INSU~ANCE AFFORDED BY TME POLICIES DeSCRIBED HEREIN IS SUBJECT TO All TI".E- TF~rPJ
E'XCLUSIONS AND CONDITIONS OF SUCH ~OLICleS. LIMITS SHOWN MAY HAVE BeeN REDuceD BY ~AID CLAIMS
POLICY EFFECTIVE POLIC~ EKPIAATION
DATE (MM/DOIYY) DA.TE (MMIODIYY)
CO
"R
TYPE OF INSURANCE
POLICY NUMBEPI
ALL LIMITS !..~ _TH_QIJ~ANl?~
GENEAAl LIABILITY
X COMMel'lCIAl GENERAL UAE!ILITv
A CLAIMS ~ADE X OCCUR
OWNERS & CONTRACTOR'S PROTo
104957311
9/1/89
9/1/90
GENERAL AGGREGATE :j, 'i., (il)I>.,
PflOD\JCTS.COMP,(JP$ A('1(;REUATF $ 1 . ()fIr) ~
PERSONAL & ADVERTISING IN~URY $ 1 ,oon .
EACH OCCURRENCE $ ,O(!O
l=IRIO DAMAGE. (Any 0.'" ';,-.,., f:..j"
MEDICAL EXPENSE (.'l,n. one ;;8Ia,)l1i
A
SCHEDULED AUT!:\5
004957312
9/1/89
9/1/90
COMBINED
SINGLE $
LIMI'r
BODilY
INJIJFh'
(F'filrptlfGonl
1,000.
"'UTOMOBIL~ lIA&ILITV
X A~jy ....UTO
Al L OWNED AUTO:~
X H:RE:D AUTOS
X NON.OWNED AUTOS
OAfV"Gt. U.a.BIUTY
BODILY
INJUR'Y $
iF'oer aCGloenq
PROPERTY
I..lAMAGl;:
B X
804957313
9/1/89
9/1/90
EACb
OCCURRENCf
,
5,000,
A3.'J'jl...."
EXCf:99 L.IAbILliV
5,000,
OTHER. THAN UMBRELLA FOAM
STATl.;T'JR{
WORKER'S COMPENSATION
AND
!MPLOYI!RS' U41!ULlTY
.
$
.
eLl!..'"'..'"
'-~F I, -
.']',
(~'1 ,r:i\'.~ "~'.., '-'.:r'i.OY[~
OTH!:~
DESCRIPTION OF OPERATIONS/LO(:ATION~VEHICLE9/RE$TAICTIONS/8PECIAL.ITEMG
CERTIFICATE HOLDER
CANCELLAtiON
Greenport Water District
236 Third Avenue
Greenport, NY 11944
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLFD BEF(')Rt: lH~
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL..lil...- DAYS WRITTeN NOTICE TO THE ceRTIFICATE HNDE" N~MeO TO THE'
LEFT BUT FAILURE TcP~~I!:lWfiIU:IlMWQfi;CD.RROMilQM OBliGATION OR
LIABILITY OF ANY KIND U~ON THE COMPANY, ITS At3ENTS OR RE'PREscrHATIVES.
JUT AUTHORIZED REPRESENTATIVE
CORPORATION 1988
ACORD 25-$ 3/88
C.~.c.~.:r-i !~- 1~
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