HomeMy WebLinkAboutEast End Horsemens Assoc .KUDITH T. TERRY
TOWN CLERK
REGISTRAR OF VITAL STATI$TICS
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
TELEPHONE
(516) 765-1801
SPECIAL PERMIT
In accordance with Chapter 27, Section 27.1.B. of the Code of the
Town of Southold, a permit is hereby granted to the East End Livestock
and Horsemens Association to hold a Livestock Fair and Exhibit at Hidden
Lake Farm, County Road 48, Southold, New York, from 10 A.M. to 3
P.M. on Sunday, June 12, 1988, provided they secure and file with the
Town Clerk a Certificate of Insurance naming the Town of Southold as
an additional insured.
Dated: May 27, 1988.
Judith T. Terry (~ -
Southold Town Clerk
cc: Chief ~inters
RECEIVED
~A¥ ~ 6 '1988
~ ~..~.,~" "/a --u rance ~ u --rop COMMERCIAL GENERALDECLARATIONS UABILRR'Y COVERAGE PART
POi cy NO.: 7LAO. 5,7-6~4035 T
Named'l~sumd and' Mailing Address (N~., Stmt,,~,,~ o~Ci~,Co..~,, ~t~ ~ip Co<~' ~ Hain ~$CreeC ~,~ ~
EasC End Ho~,.en!s Assoclat;~on, Inc, .-...,,~ , .,.: ~ ~.. P.O.: .Box 406 ~.
Southold, N.Y. 11971
' at 12:01 A.M. Standard Time at your mailing
N RETUR, FO"THE PAYMENT OF THE P"~M'U.M. AND ~UBJECT. TO ALI- T,E TERMS
YOU TO PROV DE T, HE NSURANCE ~AS STATED~ N THIS POL CY.. ' '
LIMITS OF INSURANCE
General Aggregate iLimit'(Other Than Products--completed Operations) ~ ,~,,,~, ,
Products--Completed Operations Aggregate;Limit
Personal and Advertising Ipju~y;L, imit ,? .~,~
Each Occu.[ren, ce Limit
Fire Damage Limit'~'' '"
Medical Expense Limit.
RETROACTIVE DATE (CG 00 02 only)
OF THIS POLICY, WE AGREE WiTH
900,000
300,000
Nil
$ 300,000
$ ~
Any One Fire
Any One Person
$ Nil
Coverage A of this insurance does not apply to "bodily inju[y" or "property.dpmage" which occurs before the Retroactive Date,
ere: ~
if any, shown h ............ ; ~' u:..
DESCRIPTION OF BUSINESS AND LOCATION OF PREMISES
Form of Business::.~ . .... ,
[] Individual m. [3Joint Venture [] Partnership,: ' [~ Organization (Other than Partnership or Joint Venture)
Business Descriptionha.,, ...... ii ,,...~. .... ,..,:,.,~.
' ClUb ' '~- .: ; .,i,,: .... l. ~. . ,::~.,:/ , :., ,
Location of All Premises You Own.~Rent or Occupy: '. Peconic, N.Y.
PREMIUM~r~ ,, .,
· .,., ~ Rate
~ ~,, Classification _ . Code No. Premium Basis Pr/Co All Other
Clubi~C~,~e.S¢~v~e~e Or $oclal. 41663
Lea~ed ExceBC ¥o~ oEEzee
purpose- ~ prod~:&~ Com@leCed,,.. ~,; ; .,~..~
FORMS AND EN~R~EMEN~ "~ ' ~ · ......
~rms and gnd°~men~ aPPlyin~ t~' ~hi~C~berag~'~A and made paA ~f thi~ ~licy.at time o~ issueh COO001(11-85)
CG0037( ':i~-85)C~ 130( 1~86)C~ 175( 1-86)CG004 I (5-86) ~L00~ 1 ~ I J~85)~G~ 163( I 1~85)
CGO221('j'~:86)CG2138(II-85)CO2140,CG2135,CG2145,CG2,139,~2002
· En~ optiona f ~n n ~mmon ~li~ ~clarations. ~ -'J Authoriz~ Repre~ntative
t~rms an~ En~o~men~ applicable to this C~rage ~A omi~ed if'sh~n el~h~li~.
~af DiCaR~O~ ~D ~E COMIOS ~U~ DiCtIOnS, IF
MU 620qi7/~) iOnia ~8, FJRM!, ~0 mDO~mm~ IF ~ ISSUED m FORM A ~ maEo~ COM~E mE ~E NUMBERED ~U~.
Advance Premium
Pr/Co All Other
,0,5 :~' "~ T~l'.'~]i'71! $ Zncl. $ ]'42.
TotalAdvance Premium $ ]4.2.o0
PRODUCER
DSFNYLI$ & ~ AGENCY OF SUFFOLK,
D/B/A EAST nD TU~ SEI~VZCES
P.O. BOX 1406, MArS FFu~
SOI~fliOLD, NY 11971
INSURED
F.o. BOX 386
PECTIC, NY 11958
ISSUE DATE (MM/DD/YY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE ODES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY
LE3-rER A ~ ]~J'zl, J~ ~A]~C~
COMPANY
LE~-FER
COMPANY ~;
LETTER
COMPANY B
LETTER
COMPANY
LETTER E
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POMCY 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 I$ SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES.
POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS
TYPE OF iNSURANCE POLICY NUMBER DATE (MMIDD/YY) DATE (MM/ODPCY)
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
OWNERS & CONTRACTORS PROTECTIVE
AUTOMOBILE LIABILITY
ANY AUTO
-- ALL OWNEO AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON OWNED AUTOS
GARAGE LIABILITY
EXCESS LIABILITY
OTHER THAN UMBRELLA FORM
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
7I, A0-57-64~0331
10/03/87
10/03/88
GERERAL AGGREGATE
PRODUCTS-OOMP/OPS AGGREGATE
~ERSONAL & ADVERTISING LNJURY
EACH OCCURRENCE $300,
FIRE DAMAGE (ANY ONE FIRE)
MEDICAL EXPENSE (ANY ONE PERSON)
STATUTORY
EACH AGGREGATE
OCCURRENCE
$
(EACH ACCIDENT)
(OLSEADE POLICY UM]T)
(DISEASE-EACH EMPLOYEE
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/RESTRiCTIONS/SPECIAL ~TEMS
FOR AHNUAL FATe, AT HIDDKH LAKK R.T. DING SCl~0OL 6/12/88
TOWN OF $OUTHOLD - ADDITIONAL INSURED
TO~ OF 5Ou'fuOLD
NAT. ti ST~g~T
SOUTIIOLD, NY 11971
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX.
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 1~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, I~ A(j~NTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~.. ~
File:
Special Permits - East End Horsemens Assoc.t-~'~'~
East End Horsemens Assoc.