HomeMy WebLinkAboutOut East Farm FestELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765 1823
Telephone (516) 765-1800
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SPECIAL PERMIT
A Special Permit is hereby granted in accordance with Chapter 27,
Section 27.1 B of the Code of the Town of Southold, to the Kujawski
Farm, for an ~'OUT EAST FARM FEST to benefit the Interfaith
Volunteers for Charily in Action Dominican S~sters Family Health Service
held on the grounds of the KujawskJ Farm, Sound Avenue, MattJtuck,
New York, on Saturday, September 19, 1998 from 10:00 A.M. to q:00
P.M., provided they file with the Town Clerk a One Million Dollar
Certificate of Liability Insurance naming the Town of Southold as an
additional insured.
Dated: August 24, 1998
Ellza~oeth A. Neville c
Southold Town Clerk
(Certificate on file)
cc: Police Chief Conway
Superintendent of Highways Jacobs
ACORD CERTIFICA OF LIABILITY INSURANCE
PRODUCER THIS CERTIFICATE ~I~suED
WILLIS CORROON CORP. OF NEW YORK
7 HANOVER SQUARE
NEW YORK, NEW YORK 1000A
D~ {MM/ /YYI
o87 87 8
AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
COMPANY VIGILANT
A
INSURED
COMPANY
LOC. ~629 a
DOMINICAN SISTERS FAMILY HEALTH
COMPANY
SERVICE, INC. c
299 NORTH HIGHLAND AVENUE
OSSINING, NY 10562 COMPANY
D
COMPANIES AFFORDING COVERAGE
I NSUP~ANCE COMPANY
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE ~NSURED 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.
CO POLICY EFFECTIVE POLICY EXPIRA'~ON
LTR TYPE OF INSURANCE POUCY NUMBER DATE (MM/OD/YY) DATE {MM/DO/YYI LIMITS
GENERAL UAD~UTY 3519-22-79 09/01/97 09/01/99 GENERAL AGGREGATE $
X COMMERCIAL GENERAL UABILITY PRODUCTS-COMP/OP ADD $ I, 000, 000
CLAIMSMADE X OCCUR PERSONAL&ADVINJURY $1,
000,
000
1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1 , 0 0 0, 0 0 0
F]REDAMAGE(AnyoneRre) $ 10, 000
MED EXP (Any one person) $
AUTOMOBILE LIABIUTY
COMBINED SINGLE UMIT
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS IPer person)
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS IPer accident)
PROPERTY DAMAGE
GARAGE !JABIUTY AUTO ONLY - EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EXCESS LIABILITY EACH OCCURRENCE
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
OFFICERS ARE: :EXCL ELDrsEAS~ EAEMPLOYEE $
DESCRI~ONOFO~ON$/LO~nONSWEHICLES/SPECIALI~MS IN A~CORD~NCE Wi'i'~ 'I'HE 'I'EI~S .Z~D
CONDITIONS OF THE POLICY, TOWN OF SOUTHOLD IS INCLUDED AS AN
ADDITIONAL INSURED A.T.I.M.A. AS RESPECTS BAZAAR ON 9/19/98 AT THE
FARM OF JP KUJAWSKI & SONS, 175 SOUND AVE, MATTITUCK.
~HFICATEHOLDER
TOWN OF SOUTHOLD
P.O. BOX 1179
SOUTHOLD, NY 11971
CERT#: 3089
ACORD 25-S {1195)
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
AUTHORIZED REPRESENTATIVE /__~/..~ ~ , ~ .~ ...~
· ,ACORD CORPO~AIION l~j
Au§-23-O0 08:§6A P.O1
at the Kujawski Farm
Sound Avenue in Mattituck
to benefit the Interfaith Volunteers for Charity in Action
Dominican Sisters Family Health Service
Saturday, September 19th
10 A.M. - 4 P.M.
pony rides · face painting · make-a-scarecrow
bake sale · raffle · petting zoo
line dancing · vegetable & flower sales ° antique cars & trucks
white elephant sale · craft booths and exhibitions ° food
and much. much more
Admission $2 per person--S5 per family
For more information, please call 728-0937
Barbara Kuiawski