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HomeMy WebLinkAbout1995JUDITH T. TERRY
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town HaH, 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
In accordance with Chapter 27, Section 27-1-B of the code of the Town
of Southold, a permit is hereby granted to the Cutchogue Lions Club to
hold their annual Antique Auto Show on the East Cutchogue School
grounds, Main Road, Cutchogue, N.Y., on Sunday, July 9, 1995, from 8:30
A.M. to 4:30 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: June 1, 1995.
Southold Town Clerk
Certificate on file.
cc:
Supt. of Highways Jacobs
Police Chief Droskoski
Building Department (tents)
May 31, 1995
Ms. Judith Terry
Southold Town Clerk
Main Road
P. O. Box 1179
Southold, N. Y. 11971
RECEIVED
MAY 3 11995
Seulbold To, Clerb
Re:
Cutchogue Lions Club
Antique Auto Show
July 9, 1995
Dear Judy:
On behalf of the Cutchogue Lions Club, I wish to apply for a
permit for the Lion's Antique Auto Show on July 9, 1995. The sho,
will be held on the grounds of the East Cutchogue School, Main
Road, Cutchogue, N. Y. The school grounds will be open to the
public around 8:30 a.m.. The Show will start at 12:00 p.m. and it
end around 4:30 p.m. The Club's current president is David
Robinson, and the Vice President is John Kujawski.
I have enclosed a diagram of the field layout. We ill have three
tents on the property -- two very small tents for sun protection
by the gates, and one tent for the Food Committee.
I am also enclosing herewith a copy of the Certificate of In-
surance listing the Town of Southold as Certificate Holder and
Additional Insured.
If you have any questions, please give me a call.
Sincerely,
East End Insurance Services
Main Street, P. O. Box 1406
Southold, N. Y. 11971
MAy~-30-1995 13:47 T.J. ADAMS ASSOC. TO 15167653846 P.02
UUTC~0GU~, NY 11935
,,,,,c~ ~vros Owned Atttomo~lle$
Not Covered
IN~UR~D, RUT ONLy ~DITtONAL
CITTCHOuUE LION9 CLUB AND NOT OUT OF ~ SOL~ N~CLiO~CE O~ SAZD ~DITON~ IN~I~ED.
~ RESPECTS I.~LI~ ~I~IN~ ~R~ O~ THE U~ OF T~TR ~R~Zg~ ~y , ~
I'O~N OF ~OUTHOLD
5309~ ~AIN ROAD
g.o. EOX 1179
9OI1T'~OLO, gy 11971
TOTAL P.02
PRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
I
CONFERS NO RIGH'r8 UPON ~-IE CERTIFICATE HOLDER. THIS CERTIfiCATE
TJ. Adams & Assoc. Inc. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POUCIES BELOW.
2021 Spring Road
Oak Brook, IL 60521 COMPANIES AFFORDING COVERAGE
(708)572-1550 COMPANY
(708)$74-3278 FAX L~TTEa A Royal Insurance Company of America
CUTCHOGUE LIONS CLUB ~-~ C
I~SURED
P.O. BOX 715
CUTCHOGUE, NY 11935 ~=m~ D
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER~OD
INDICATED, NOTINITHSTANDING ANY REC~JIREMENT, 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,
GENERAL UABJUTY GENERAL AGGREGATE $ 2,000,000
X COMMERCLaL GENERAL LIABILITY PRODUCTE-COMP~JP AGG. $ 2,000,000
A I CLaiMS ~[~ OCCUR. ~ 600094 09/01/94 09/01/95 PERSONAL & ADV. INJURY $ 1,000,000
OWNER'S & CONTRACTOR~ pRO] EACH OCCURRENCE $ 1,000,000
FIRE OAMAGE (Afly oeo fke)$ 1,000,000
MED. EXPENSE (Any o~e pe~ S 1,000
AUTOMOBILE UABIUTY COMBINED m.C~E s Included
A~V ^u~o UM~T In Above
A SCHEDUt~D ~UTOS PIW 600094 09/01/94 09/01/95
X HIRED numa Owned Automobiles sorely INJURY S
X ~O~OWN~O^UmS NotCovered
Not Covered ~c~TE &
~..~ L~..~.~.>.,~.~.~.~.~..~.~..~.i~ o~ :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
~ Not Covered ~ACH ~CC~OENT
~LO~S' uAatur,, DmE~SE_~C~ EM~.O~ $
ESCRIPTION OF OI~RATIONSa. OCATIONSN EHICL ES~S pEClAL ITEaS
PROVISIONS OF THE POLICY AP?LY TO THE ~NTIQUE AUTO SHO~ SPONSORED BY THE CUTCHOGUE LIONS
CLUB JULY 9, 1995 AND [NCLUDES THE [~TEREST OF THE TO~ OF SOUTHOLD AS AN ADDITIONAL
I~SURED, BUT ONLY AS RESPECTS LIABILITY ARTSTNG OUT OF TEE USE 0P THETR ?REMTSES BY TEE
CUTCHOGUE LIONS CLUB A~D ~OT OUT DE THE SOLE NEGLIGENCE OY SAXD ADDTTO~AL [~SURED.
~~ .................. :...
TO!~q OF SOUTHOLD
53095 I~IN ROAD
P.O. BOX 1179
SOUTHOLD, NY 11971