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HomeMy WebLinkAboutOur Lady of Mercy ,,4._, ~3'95 P. 02/05 3'IJL !4 19~, 11:~6 MARSH & McLENNAN 212 ~ ~ Marsh & MaLe~nal~t IllcoL~oorate~ 1166 AveA1/e of the ~erlcas New Yo~k, ~ 10036-2774 ~r Lady 9f Merc~ Reg. School ~ B Diocese of R~chville 50 Nor2h Park Avenue ~ C 2cc~ville Cen~re~ ~ 11~70 THIS IS ~ ~T ~ ~ I~ ~ ~ ~ ~ I~ED ~ ~ I~ ~ ~N ~ ~ ~ ~ I~l~O. ~ ~ i 6433 68 16 9/01/96 9/01/97 ~~ ~$ 2750000 ~.~ (5~E R~SE ~/OR C~R~TE HO~ ~CE~ON ~UL-i4-1997 !1:57 f'IARSH &, ~tcLENNAN 2!2 345 369~ P.03,/03 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE #42837 INSURED : Our Lady of Mercy Reg. School HOLDER : Town of Southold (CONTINUED) Coverage under the above captioned policy(ies) is excess of the insured's $250K self-insured retention. The Certificate Holder is named as an Additional Insured with reepect to use of premise~ for Country Line Dancing Night on 7/19/96. PAGE: 2 OF 2 JUL-!4-199?.l~':5S MARSH Marsh & McLennaa, Incorpor, ued 1166 Avenue Of tile Now York. NY' Telephone 212 945 6000 Via ,Federal Expre~s July 9, 1997 MARSH & MCLENNAN Ms. Missy P. einhardt Our Lady of Mercy PO Box 474 Mattotuch, NY 11952 Certificate of Insurance Town of Southold Fax Note 7671 Dear Ms. Reinhardt: Enclosed please find an original certificate of insurance prepared for the captioned certificate holder which evidences General Liability coverage. I trus~ the enclosed is in order. Should them be any questions or comments please do not hesitate to contact us. I can be reached at (212) 345-6563. ~ e~a~'?n~ent Division-Ca~ -.ai, cc: L Wallace-Diocese D. Kried-CNA A. Schneider-M&M JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 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 A Special Permit is hereby granted, in accordance with Chapter 27, Section 27-1-B of the Code of the Town of Southold, to Our Lady of Mercy, Cutchogue, N.Y., to hold a Country Line Dance at Pindar Vineyards, Main Road, Peconic, N.Y., on Saturday, July 19, 1997, from 7:00 p.m. to 11:00 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. Dated: June 27, 1997. Southold Town Clerk Certificate of Insurance pending cc: Chief of Police Conway Building Dept. (tent) OUR LADY OF MERCY MAIN RD, - P,O, BOX g70 CUTCHOGUE, NEW YORK 11935 516 734.-5166 RECEIVED JUN 2 $1997 Southold ?own Clerk Ms. Judith Terry Southold Town Clerk Southold Town Hall 53095 Main Road Southold, NY 11971 May 13, 1997 Dear Ms. Terry, This is to request a Special Permit for Our Lady of Mercy Country Line Dance to be held at Pindar, Main Road, Peconic, on Saturday, July 19, 1997 from 7:00 PM to 11:00 PM. A Certificate of Insurance accompanies this request. Your assistance in this matter would be appreciated. Maryellen Reinhardt, ~ President, Corps of Alumni and Parents tOOl3 qTq ~HOIJS, ZlNDS RECEIVED JUL I 8 1996 Soutbold Town ~ 17:56 MARSH & McLEN~N 212 345 5696 H~ XOC~r ~ Z0036'2774 D~O~OBI o~ Roc~llle Co~t~e ,, S0 ~rth ~ark Avenue ~ C D ~~' ~ . '~" ' ~g~~~~~ ~ ~m ,~ 6433 68 16 9/01/96 ~/01/g7 ~t~ ~ ,, -~ ., J~N-23-1997 17:56 MARSH & McLENNAN 212 545 5696 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE #42837 (CONTINUED) INSURED : Our Lady of Mercy Reg. School HOLDER : Town Southold Coverage under the above ~aptioned policy(ies) is excess o~ ~he insured's $2~0K self-insured retantlon. T~e Certificate Holder is named as an Addition&l Insured with respect to use of pre. lees fur Country Line Dancing Night on 7/27/96. TOTAL P. 03  DATE (MMJDD,'YY) 6/25/97 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE COVERAGE ASSOCIATES INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2941 SUNRISE HIGHWAY, P.O, BOX 8 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ISLIP TERRACE, NY 11752 COMPANIES AFFORDING COVERAGE PHONE #516-277-5700 & FAX #516-277-5941 COMPANY AMERICAN ZURICH INS. CO. A INSURED PINDAR VINEYARDS COMPANY P. O. BOX 332 B PECONIC, NY 11959 COMPANY C COMPANY I D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NO'P/VITH STAN DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO I POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE i POLICY NUMBER DATE ( M MIDD/YY) DATE (MMIDD/YY) LIMITS OE~xE~ ERAL LIABILITY CPO2049221 : 1/1/97 I 1/1/98 [GENERAL F~_O_D_U_ ~_T S - AG Gr~_E_G_A~TE C O M_P_/_O P__A_G~$ ~$ 2,000,000,000,000 A COMMERCU~L GENERAL L~mUTY I 1 i IC~,MS MADE ~ OCCUR PERSONAL & ADV INJURY s 1~000,000 __ OWNER'S & CONTP~ACTOR'S PROT i EACH OCCURRENCE I $ 1 ~000~000 I FIRE DAMAGE (Anyonefire)I $ 1,000,000 MED EXP (Any one person) $ 51000 , AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO __ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS ~ BODILY INJURY -- NON_OWNED AUTOS ! (Per accident) $  UMBRELLA FORM i ,~ ~ _R~G,~_T_E. ........... I OFFICERS ARE; EXCL i j EL DISF~SE - EA EMPLOYEE I $ OTHER,] i ' CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED WITH RESPECTS TO EVENT BEING HELD ON 7119197. TOWN OF SOUTHOLD EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL i'~rmit ~ - WP displayed not longer than thfrty (30) dayg before thin event, and removed wfthin 3. Applicant LndemnLfLo~ ~nd hold~ hnrmle~ th~ To~n of Sou~hold f[om LinbJI. i~y naming kho Town of Soubhold ng an addiEional lngured in tile amoun~ On~ H~llion ($1,000,000.00) Dolla~o ~n h~by filed by Appltcan~, and Cortiflcabe mugt remain in full force and effect during ~ht.~ entire event. 4. Tent proposals mu~t recelve prior wrJtt~m approval from the Soukhold Town ~uildLng Inmpector amd must me~t all fifo amd gafoty codeg- above. Each additio~a], day wLll requlro m ~ew perm[t, fee, a~d related documents for review 30 days (or moro) pr[or to the event. 7. No on-oit~ fnod prepnratiot) or cooking at thin ~{te [s permitted, although bui]dingg are u~ed during Iht, tempi, led wfth. vfolatfons fn connection with thin event will terminate thf~ porm] t. JUDITH T. TERRY ToWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF THE TOWN CI,ERK TOWN OF SOUTHOLD SPECIAL PERMIT A permit is hereby granted, in accordance with Section 27-1-B of the Code of the Town of Southold, to Our Lady of Mercy, Cutchogue, N.Y., to hold a Country Line Dance at Pindar Vineyards, Main Road, Peconic, N.Y., on Saturday, July 27, 1996, from 7:00 P.M. to 11:00 P.M., provided they file with the Town Clerk a One Million Dollar Certificate of Insurance, naming the Town of Southold as an additional insured. Dated: May 31, 1996. Judith T. Terry~ Southold Town Clerk (Certificate of Insurance on file) cc: ~;~laief .,~.f-=P~"-e Lieutenant Conway Building Dept. (tent) RI~IVED JUl. 1 8 I996 Soulhold Town SENT §Y:GALLA~HER NEWMAN ' ?- B-g6 ; 3:1gPM ; 32- 510 ?05 1823;# Arthur ,~. Gallagher & Co. 3allaghet Newman Division 2 Gannett Drive Wh,te Pla/ns, NY 10604-3408 (9~4) ~7-~oa~ FAX (~4) ~9~-~0~0 To: Fa~x Cover Sheet This is page I of .g page(s). From: JO ROSANL Comments: Please deliver tki~ ~AXaS soon as possibi& ~ank youl JUL- 8-96 M0N 12:06 P, O2 ^,,om~ CERTIFICATE OF ' INSUR~:,?, ~' Gt~l Jgher Non.nan White Ptling. NV 10604 Diocese of Rockville Centre & Our Lady of Mercy Reg School Box 970 Cutchogue, NY 11935 ~IERTIPJ(::A~'~ i~ i~U~D &~'~' MATfl~ ~I~" ~ORMATION ONLY AND COMPANIES AFFORDING COVERAGE ~er tifie~te Holdo~ i~ named a~ Add~t;o~l Insured w~th respect to u~o of prem;~es for Country Line O~ncl~g N~ght HOLDER SENT BY:GALLAGHER NEWMAN ' ?- 8-96 ; 3:19PM ; 515 ?65 1823;~ 2 THI~ Ig TO OERT~y THAT THE POLICIES O~ INSURA~E LIST Clrtlflcltl Holder II named ii Addltlonl~ niurid with [IiplCt tO ~ll of )remlle8 for Country Line Olneln8 Night ~n JUDITH T. TERRY Dear Ms. Wittmeier: OFFICE OF THE ]'OWN CLERK TOWN OF SOUTHOtA) May 30, 1996 I regret that I must return this Certificate of Insurance. must name the Town of Southold as an additional insured. Once I am in receipt of the corrected certificate, I will Permit for the Country Line Dance on July 27th. Fown Hall, 53095 Main Road P.O. Box 1179 Southold, New York 1197[ [:AX (516) 76~.1823 The certificate issue a Special CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, E'~(TEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE LEITER A United National In~ Co Gallagher Newman 2 Gannett Drive White Plains, NY 10604 Att: Jo Rosania 914-696-3700 Diocese of Rockville Centre & Our Lady of Mercy Reg. School Box 970 Cutchogue, NY 11935 COMPANY LETTER a LEIIER D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIL:A ~ ED, NOT WITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR ©fliER 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 E×CLUSIUNS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWNMAY HAVE BEEN REDUCED BY PAiD CLAIMS GENERAL LIAEILIT Y WORKER'S OOMPENSAT ION AND EMPLOYERS' LIABILITY CP62929 g/01/95 9/01/96 I STAIUIOflY LIMITS EACH ACCIOENI DISEASE-EACH EMPLOYEE 1,000,000 OESORIPTION OF OPERRTIONSTLOORTIONSTVEHIOLE~TSPEOIAL ITEIdS Re: Use of premises for Country Line Dancing Night Pindar Vineyard 3gg-35 Main Road Peconic, NV 11958 r, , ,L~' ,L,,,'2 EDESLr~BEL PQLUIESBECANCELLEDBEFORETHE 007921000 ~)&CORD CO RPORATIQN 19g0 OUR LADY OF MERCY MAIN RD. - P.O. BOX 970 CUTCHOGUE, NEW YORK 11935 516 734-5166 May 28, 1996 R[CF~VED Ms. Judith Terry Southold Town Clerk Southold Town Hall 53095 Main Road Southold, NY 11971 3 [, 1996 $ot,'thofd Town Cler~ This is to request a Special Permit for Our Lady of Mercy Country Line Dance to be held at Pindar, Main Road, Peconic, on Saturday, July 27, 1996, frc~ 7:00 PM to 11:00 PM. A Certificate of Insurance accc~panies this request. Your assistance in this matter would be appreciated. Sincerely, OUR LaDY OF MERCY Patricia Wittmeler Secretary THONS, RND$