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Home My WebLink AboutJefferson Temple JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE 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 AMENDED 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 Jefferson Temple Church of God in Christ, Middle Road, Cutchogue, to hold a Youth Crusade from August 31 through September 5, 1992, from 7:00 P.M. to 10:00 P.M. nightly, at the church grounds; 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 11, 1992. // Judith T. Terry ~/ Seuthold Town Clerk cc: Police Chief Droskoski Building Department CHURCH OF GOD IN CHRIST BOX 438, MZDDLB ROAD; ~UTC'HOQ~B, )IL'W YORK ~Xg3S PAB~TOR JOH~3BIIBR~OH (SZ6) 734-5498 (7X8) 740-3866 JUN i I 1992 ,to h. ctve ott ,4~z~J.,~,~ 20 - 29. SZn. ce ,~Jza/c ,time we h. ctve ch. arLR. ed ;~h.e dcaee of...O.e C,zu.,~o. de we w. LLZ n.ow be ,~porv.~o,z,~og ;~e C~.u~ad¢ on. /luoa, u~xc 31 - Sep£embe.,_ 5. £ E~i' I F I C A T E ...... : .............. ---::=:- .... : ............................................... .............. ROI, OCER .............. T ...... .... BAVLIS & GEISL INC I NO RIGHTS UPON THE CERTIFICATE HOL~ER.~ ' THIS CERTIFICATE BOES NOT AMEND,, 2161HILBURN AVENUE BALDWIN, N.Y. I COMPANIES AFFORDING COVERAGE ZIP CODE 11510 I COMPANY LETTER A PRUDENTIAL LMI ........................................ [ COMPANY LETTER B INSURED JEFFERSON TEMPLE CHURCH I COMPANY LETTER C JUN OF ~nn IN cHRLT P.O. BOX 438 t COMPANY LETTER D CUTGHOGOE N ¥ I ZIP CODE 11935 I COMPANY LETTER E EXTEND OR ALTER THE COVERAGE AFFORBEB BY THE POLICIES BELOW. THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEB ABOVE FOR THE POLICY PERIOD INDICATEB, NOTWITHSTANDING ANY REOUIREMENT, 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 F'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY POLICY TYPE OF INSURANCE POLICY NUMBER EFF. DATE E,F.~' BATE ~!~ ....~ ................. LIMITS ....... : ........ :::? ........................ : ............. ..... Al (X) COMMERCIAL GENERAL LIABILITY I RENEWAL OF 08/06/92 08/06/93 I PRODUCTS-COMP/OP AGG. $ 1~000,000 I ( ) CLAIMS MADE (X) OCCUR. I RI7241&O0 I PERSONAL & ADV. INJURY $ 1~000,000 I ( ) OWNER'S & CONTRACTOR'S PROT. , ; EACH OCCURRENCE $ 1~000~000 I ( ) I I FIRE DAMAGE (ANY ONE FIRE) $INCL I ( ) I I MED. EXPENSE (ANY ONE PERS) $ 5~000 IAUTOMOBILE LIABILITY I ( ANY AUTO I COMBINED SINGLE LIMIT $ I ( ALL OWNED AUTOS I ( SCHEDULED AUTOS I BODILY INJURY (PER PERSON) I ( HIRED AUTOS I ( NON-OWNED AUTOS I BODILY INJURY (PER ACC) I ( GARAGE LIABILITY I ( t PROPERTY DAMAGE tEXCESS LIABILITY I I I ( ) UMBRELLA FORM I I EACH OCCURRENCE $ t ( ) OTHER THAN UMBRELLA FORM I IAGGREGATE I I( ) STATUTORY LIMITS WORKER'S COMPENSATION I IEACH ACCIDENT $ AND t IDISEASE-POLICY LIMIT EMPLOYER'S LIABILITY I IDISEASE-EACH EMPLOYEE $ IOTHER l I I I t t I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS YOUTH CRUSADE TO BE HELD AUGUST ~1, 1772 THROUGH SEPTEMBER 5~ 1~2. THE TOWN OF SOUfHOLD IS NANED AS ADDITIONAL INSURED WITH RESPECTS TO THIS. TOWN OF SOUTHOLD I SHOULD ANY OF THE ABOVE DESCRIBED POLI~IES BE CANCELLED BEFORE THE MAIN ROAD I EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL SOUTHOLD N 7 I !5 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, I BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY ZIP CODE 11771 I OF ANY KIND UPON THE COMPARE ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTAIlVE JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE 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 Jefferson Temple Church of God in Christ, Middle Road, Cutchogue, to hold a Youth Crusade from August 24 through 29, 1992, from 7:00 P.M. to 10:00 P.M. nightly, at the church grounds; 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 8, 1992. Southold Town Clerk cc: Police Chief Droskoski Building Department JEFFERSON TEMPLE CHURCH OF GOD IN CHRIST P.O. BOX 438v MIDDLE ROADv CUTCHOGUEv NEW YORK 11935 PASTOR JOHN JEFFERSON ASST. REV. EUGENE JEFFEREON (516) 734-5498 (718) 740-3866 ~une 5, 1992 Town Of $outhoid I~uin Road $outhoid, NY 11971 Dear /~r4. Nev~i: #ere i~ the LnformoZLon tha~ ~ou requested in reference to the Youth Crusade Dc~.e: /~u~z~dt 24 - 29, 1992 Time: 7:00 P.fl'l. - Approx. 10:00 P./~. (ni.g/vtbj) T~ Youth Crusade w~ii be held on ~he church ground~ of ~e~f~rson T~pie Church Of ~od Yn C~ri~t, iocat~d on Rou~e kS, £utchogue. Please gind a~cached the ia~arance certi~ca~e and a diagram of where ~he tent wJ~li be Zocated on the proper~ig. ~rs Nevei £f you have any ~u~s~ion conc~g ~ aa~ter, piea-~e do not h~i~ate to con~act us. Than~ y. ou. ~s~stant Pastor