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HomeMy WebLinkAboutChurch of the Open Door JUDITH T. TERRY TOWN CLERK REGI~T~'~ OF V~TAL ~TA77ST~CS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFOP, MAT[ON OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1801 SPECIAL PERMIT In accordance with Chapter 27, Section 27.1.B of the Code of the Town of Southold, a permit is hereby granted to Lamb's Gate Pilgrim School of Southold to hold a fundraising Fair, on the school grounds (Church of the Open Door), Main Bayview Road, Southold, New York, on Saturday, September 25, 1993, from 10:00 A.M. to a,: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 (certificate on file). Dated: September 10, 1993. Southold Town Clerk cc: Police Chief Droskoski Lamb's Gate - Pilgrim School P.O. Box 1455 Main Bayview Road Southold, N.Y. 11971 Judith T. Terry Town Clerk Town Hall 53095 Main Road Southold , N.Y~. 11971 Judith T. Terry- Town C~erk, R Ct:IVED SEP 0 1993 So,!thol~ T~ ~, Cbrl~ Members of Lamb's Gate - Pilgrim School Of Southold would like to apply for a permit to hold a fair o~ September 25, 1993~ Saturday at and on Lamb's Gate - ~zlgrim School ground's. (Church of the Open Door ), P.o. Box 1455 Main Bayview Road ,Southold. School Board of Lamb's Gate- Pilgrim School and Fundraising committee are officers making such application. Fair is for raising funds for the Lamb's Gate - Pilgrim School.. Time being held on September ~,1993, Saturday from ~O a.m - 4 p.m, ( starting set up at 7 a.m to 9:30 a.m - cle~n up a to 6 p.m). Enclosed is Certificate of Insurance form. Thank You, The F~nd Raising Committee School Board of Lamb's Gate - Pilgrim School pldj/frc PRODUO£R THIS CERTIFICATE IS ISSUED 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. ROY H REEVE AGENCY INC COMPANIES AFFORDING COVERAGE HAIN ROAD MATTITUCK N Y 1 1952 COMPANYA COMMERCIAL UN INS CO COMPANY B CHURCH OF THE OPEN DOOR COMPANYD MAIN BAYVIEW ROAD __ SOUTHOLD NY 11971 COUPAN¥ 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 BEOUIREMENT TERM OR CONDITION OPANY CONTRACT OR OTHEB 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 GENERAL LIABILITY MJF445099 ], 11/01/92 11/01/93 BOD~LY~NJURY©CC $ X X PRODUCTSICOMPLETED OPER BI & PD COMBINED OCC sl , 000 , 000 X CONTRACTUAL BI & Pr) COMBINED AGG $ INDEPENDENT CONTRACTORS PERSONAL INJURY AGG $]- · 0 0 0 · 0 0 0 $ HIRED AUTOS ADDL INS TO~N OF SOU?HOLD FOR COUNTRY FAIR ON 9-25-93. $OUTHOLD NY 1197 I~ LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR ~'.~%-'~) ~1~ ,~ O.~40 ("\P'(~I' LIADILIT.~ ANY KIN~I~PO. ii~THE COMPANY ITS AGENTS OR REPRESENTATIVES PRODUCER THIS CERTIFICATE IS ISSUED 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. ROY H REEVE AGENCY INC COMPANIES AFFORDING COVERAGE MAIN ROAD MATTITUCK N Y 1 1952 ~COMP^N¥ LETTER A / COMMERCIAL UN INS CO COMPANY CHURCH OF THE OPEN DOOR COMP^NY MAIN BAYVIEW ROAD SOUTHOLD NY 11971 COUPAN~E THiS ~S TO CERTIFY T~AT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ~SSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD EXCLUSIONS AND CONDITIONS OF SUCH POLICIES ~ GENERAL LIABILITY MJF445099 ! 11/01/92 11/01/92 BO~,C~JN~UnYOCC S X PRODUCTS/COMPLETED OPE~ ~ BI & PD COMBINED UCC $1 ; 000 , INDEPENDENT CONTRACTORS ~ PERSONAL INJURY AGG $~ , 000 z 000 ADDL INS TOWN OF SOUTHOLD FOR COUNTRY FAIR ON 9-25-93. ~%~%%~%~ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF SOUTHOLD EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO ~AI ~ ~D ¢~ %~ MAIL __10DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE SOUTHOLD NY 1197 i ~ LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AN~ ~ND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES be AUT"ORIZEB , ~ ~ ~ .,.,.~