HomeMy WebLinkAbout1994JUDITH T. TERRY
TOWN CLERK
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 Orient Congregational Church to hold
a Church Fair on the church grounds, Main Road, Orient, on Saturday, July
23, 1994, from 9:00 a.m. to I:00 p.m., provided they filed with the Town
Clerk a One Million Dollar Certificate of Liability Insurance naming the Town
of Southold as an additional insured.
Dated: July 20, 1994.
Judith T. Terry
Southold Town Clerk
(Insurance Certificate
on file)
cc: Police Chief Droskoski
Southold Town Clerk
Town Hall
Main Road
Southold, N.Y. 11971
RECEIVED
JUL 2 0 lgg4
Southold Town Ct~rJ(
Orient Congregational Church
P 0 Box 804
Orient, N.Y. 11957
Dear Mrs. Terry:
We respectfully request the issuance of a permit for our
planned Church Fair, to be held on the grounds of the church/
parsonage, Main Road, Orient, on Saturday, July 23, 1994,
from 9:00 a.m. to 1:00 p.m. (rain date Saturday, July 30).
The funds raised by the Fair are used for charitable
purposes and the scope is relatively small, with tables set
up for the sale of baked goods, toys, jewelry, books, white
elephant and yard sale items, etc.
We enclose herewith a faxed copy of nur certificate of
insurance,listing the Town of Southold as an additional insured.
The insurance company indicated to me that they would be
forwarding a copy to you directly. I hope that, in the interest
of time, the fax will suffice for now.
Thank you for your consideration in this matter.
Sincerely, ~
Colin Van Tuyl, Treasurer
: MNIItlI. CERTIFIC--A -( N- LiR I E
PRODUCER
Marsh & McLennan, Inc.
1620 L Street NW
Suite 600
Washington, DC 20036
INSURED
Orient Congregational (Q0211)
Main Road, P.O. Box 126
Orient, NY 11957
COVERAGES
DATE (MM/DD/YY)
7/19/94
THIS CERTIFICATE IS ISSUED AS A MAI'FER 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.
COMPANIES AFFORDING COVERAGE
COMPANY
A Continental Insurance Company
COMPANY
s
COMPANY
C
COMPANY
D
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 REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH~S
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 TYPE OF INSURANCE
LTR
GENERAL LIABILITY
A X COMMERCIALGENERALUABILITY
CLAIMS MADE X OCCUR
OWNER'S & CONT PROT
POUCY EFFECTIVE POLICY EXPIRATION
POLICY NUMBER DATE (MM/DD/YY) DATE (M~DD/YY)
Renewal of
CBP6145429 1/01/94 1/01/95
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEDAUTOS
H~RED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
ANV AUTO 3BL-
EXCESS LIABILITY
LIMITS
GENERALAGGREGATE $ 2, 000, 000
PRODUCTS COMP/DP AGG $ 2,000,000
PERSONAL&ADVINJURY $ 1~, 000; 000
EACHOCCURRENCE $ 1, 000; 000
FIRE DAUAGE(Anyonefire) $ 100 ~ 000
MED EXP (Any one person) $ 15 ,. 000
COMBINED SINGLE LIMIT $
BODILYINJURY
(Perperson) $
BODILYINJURY
(Per accident)
PROPERTY DAMAGE
AUTO ONLY- EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT
UMBRELLA FORM
OTHERTHAN UMBRELLA FORM
AGGREGATE
OFFICERS ARE: EXCL DISEASE - EACH EMPLOYEE
OTHER
WORKERS COMPENSATION AND STATUTORY LIMITS
EMPLOYERS' LIABILITY EACH ACCIDENT
THE PROPRIETOR/ INCL D~SEASE POLICY LIMIT
PARTNERS/EXECUTiVE
DESCRIPTION OF OPE RATIONS/LOCATIONS/VEHICLE~SR ECIA L ITEMS
Re: Town of Southold, N.Y. is an additional
to be held 7/23/94 (rain date: 7/30/94)
CERTIFICATE HOLDER
Southold Town Clerk
Town Hall
Main Road
Southold, N.Y. 11971
ACORD 25-S (3/93)
insured as respects church fair
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,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPREEENTATIVES.
AuTHORizED R~ .~E~ir:NTATivE
~ ACOR~,'~OR~ORATION 1~3