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HomeMy WebLinkAboutOur Lady of Ostrabrama ChurchJUDITH T, TEP,~Y 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 PERelT 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 Ostrabrama R.C. Church Parish, Cutchogue, to hold a dance in the barn owned by Glovers Farm, Inc., Cox-~-ane, Cutchogue, on Saturday evening, September 13, 1997, 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: July 31, 1997. Southold Town Clerk on file. Certificate of nsurance ~ cc: Chief of Police Conway Building Department Daniel D. Kruy J&H Marsh & McLennan, Inc. 1166 Avenue of the Americas New York, NY 10036 Telephone: 212-345-3318 August 19, 1997 Mrs. Judith Terry Town Clerk 53095 Main Rd. Southhold, NY 11971 MARSH & MCLENNAN Certificate of Insurance Dear Judith: Here is a copy of the Certificate of Insurance that was requested to be sent to you. If you have any questions or concerns, please feel free to call me. Sincerely~ Daniel D. Kruy Risk Management Division cc: A. Schneider u-roh & McLonnan,, Tncorpo2rated 1166 Avonua of tho AIBO:E"ICaS Maw York,; NY 10036-2774 Ottr Lady of Ootrabrama Roman Catholic Church Diocooo of Rockv~lle Contr® $0 North Park Avonuo Rockville Centro, NY 11570 COMPANIES AFFORDING COVERAGE co~A~ A COt'~zNBI~L CASU~,,TY CO co~P,W, B co~P~ D THIS IS TO CERTIFY THAT POUCIES OF INSURANCE USTI;D HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NO~NITHSTANDING ANY REQUIRI~MENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESFECT TO WHICH THE CERTIFICAI~ MAY BE ISSL~D OR MAY PERTAJN, THE INSURANCE AFFORDED BY THE FOLICIES USTED HEREIN IS SUBJECT TO AIJ. THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POUClES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAJD CLAIMS. i 6433 68 16 9/01/97 9/01/98 ~:~,LW~U~OCC $ Im~3OUC'TS/CO~tErED O~R CX~m=~CTtJAL (SEE REVERSE AND/OR ATTACHED) CER~flCATEHOLD~ Town of Southold June Glover Sharon and Mark Burden CANCELLATION SHOULD ANY OF THE POLICIES LISTED HEREIN EE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO NLMI. 3 0 DAYS WRITTEN NOTICE TO THE C~RTIFICATE HOLDER NAMED HEREIN, BUT F,MLURE TO MArl. SUCH NOTICE SHALL IMPOSE NO ORLIGATION OR UABILIIY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES. OR THE ISSUER OF THIS CERTIFICATE. PAGE: I OF 2 -" DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL CERTIFICATE ~58989 INSURED : Our Lady of Ostrabrama HOLDER : Town of Southold Glover's Farm, Inc. June Glover Sharon and Mark Burden Coverage under the above captioned policy(ies) is exce~s ~f ~ f.~ms~'5 $250K self-insured retention. The Certificate Holders are hereby named as an Additio~a/ ~. PAGE: 2 OF 2 Fax £~om : 212 345 3695 08/19/97 13:10 P~: 2 PAGE: L O~ 2 ~" Fax from : 212 345 3695 AUI]-19-1997 14:16 14ARSH ~ McLE~AN 88/19/97 13:18 Pg: 3 212 545 5695 P.05,'05 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE 258989 (CONTINUI~D) INSURED HOLDER : Our Lady of Ostrabrama : Town of Southold Glover's Farm, Inc. June Glover Sharon and Mark Burden Coverage under the above captioned policy(les) is excess of the insured's $250K self-insured retention. The Certificate Holders are hereby named am an Additional Insured. Our Lad~ of Ostrabrama, R.C. Church Box 997- Depot Lane Cutcho~ue, L.I., New York 11935 (516) 734-6446 July 31, 1997 Mrs. Judith Terry Southold Town Clerk 53095 Main Road Southold, New York 11971 Dear Mrs. Terry: Our Lady of Ostrabrama Roman Catholic Parish has again been offered free of charge, the use of the barn owned by Glovers Farm, Inc. for a dance which will be held on Saturday evening, September 13, 1997. The total proceeds from the dance will be for the benefit of the parish. The barn is located on Cox Lane in Cutchogue. I am requesting a permit for the parish to conduct this dance in the barn on the above stated date. I have contacted the diocesan insurance agency, and have secured an insurance certificate for the coverage of this affair naming Southold Town, Mr. June Glover, Sharon and Mark Burden on the certificate. The certificate will be mailed directly to you. With gratitude for your consideration of this request, I am Yours sincerely, Rev, Walter Rudnicki Administrator JUDITH T. TEi~RY TOWN CLEP. K 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 Ostrabrama Roman Catholic Parish, Cutchogue, to hold a dance in the barn owned by L.B. Glover, Jr., Cox Lane, Cutchogue, on Saturday, September 7, 1996, provided they file with the Town Clerk a One Million Dollar Certificate of Liability Insurance naming the Town of Southold and L.B. Glover, Jr. as an additional insured. Dated: July 30, 1996. Judith T. Southold Town Clerk Certificate of Insurance to be provided. cc: Chief Conway Building Dept. Our Lady of Ostrabrama, R.C. Church Box 997 - Depot Lane Cutchogue, L.I., New York 11935 (516) 734-6446 RECEIVED JUL I996 $oufhold Town Clerk July 28, 1996 Mrs. Judith Terry Southold Town Clerk 53095 Main Road Southold, New York 11971 Dear Mrs. Terry: Our Lady of Ostrabrama Roman Catholic Parish has again been offered free of charge, the use of the barn owned by Glovers Farm, Inc. for a dance which will be held on Saturday evening, September 7, 1996. The total proceeds from the dance will be for the benefit of the parish. The barn is located on Cox Lane in Cutchogue. I am requesting a permit for the parish to conduct this dance in the barn on the above stated date. I have contacted the diocesan insurance agency, and have secured an insurance certificate for the coverage of this affair naming Southold Town, Mr. June Glover, Sharon and Mark Burden on the certificate. The certificate will be mailed directly to you. With gratitude for your consideration of this request, I am Yours sincerely, /Rev. hsgr. oohn C. Nosser Pastor Ad)Olin. RTIFICATE OF INSUR CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Ge I I ag~er Ne~n )OES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE lgg Main St r eat POLICIES BELOW. wh i t · P I a i n s, NY 10 ~ 0 ~ C~ANIES AFF~D~Q COV~A~E United National Diocese of Rockvil le Centre &LEHERCO~ANY C Our Lady of Ostrabrama AIIR ~ ~ Depot Lane CO.ANY Cutchogue ~ T~,~m~- NY 1 1 g 3 5 [~LHIIIICA1~ MAY BE IS~UE~ORMAY P~RTAIN. THE INSURANC[ AFFOR~E~ BY THE POLICIES O[SCRIBED HEREINIS SUBJECT [0 ALL THE A X C~FRCIA[ GENERAL LIABILITY CP62929 9/01/95 9/01/96 IPRODUC]S C~P/OPAG6 .... MED EXPENSE (A~y one persm t CertJfiemte Holderm mre nmmed mm AddJtionm] Jnmured with referenem to the of p~emi~es for Annuml Omnce from ~eptember ?, Igg~ through ~eptember ]~, ~t vlr oum t mem C~R~C~E ~DER i:: i: ~AN~N :ii! :.:. ~i ~i:~ :: :: :::.i~ ~: ~ :::: ::::::: ::! ::!~ ~i::~ :: :::: ::::i :::: :::: :: :: ~ ~:.~:.~ ~:.~ ~ ~::~::~:: ::~ ~::~ ~::~ ~::~!~ ::~ ~ :. i~ :. ~ :. ~ ~: ENPlnATION DATE IHE~EOF. THE ISSUINO COMPANY WILL ENDEAVOR TO MAIL 30 DAYSW~ITTENNOTICETOTHECE~TIFICATEHOLDERNAMEDTOTHE Town of Southold June G I eve r *u~~a~ JUDITId 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 In accordance with Chapter 27, Section 27-1-B of the Code of the Town of Southold, a permit is hereby granted to Our Lady of Ostrabrama Roman Catholic Parish, Cutchogue, to hold a dance in the barn owned by L.B. Glover, Jr., Cox Lane, Cutchogue, on Saturday, September 9, 1995, provided they file with the Town Clerk a One Million Dollar Certificate of Liability insurance naming the Town of Southold and L.B. Glover, Jr. as an additional insured. Dated: July 31, 1995. Southold Town Clerk ( Insurance Certificate to be provided) cc: Police Chief Droskoski Building Department Our Lady of Ostrabrama, R.C. Church Box 99'/- Depot Lane Cutchogue, L.I., New York 11935 (516) 734-6446 RECFIVED JUl. $; I995 July 28, 1995 Mrs. Judith Terry Southold Town Clerk 53095 Main Road Southold, New York Southold Town Cler~ 11971 Dear Mrs. Terry: Our Lady of Ostrabrama Roman Catholic Parish has again been offered free of charge, the use of the barn owned by Glovers Farm, Inc. for a dance which will be held on Saturday evening, September 9, 1995. The total proceeds from the dance will be for the benefit of the parish. The barn is located on Cox Lane in Cutchogue. I am requesting a permit for the parish to conduct this dance in the barn on the above stated date. I have contacted the diocesan insurance agency, and have secured an insurance certificate for the coverage of this affair naming Southold Town, Mr. June Glover, Sharon and Mark Burden on the certificate. The certificate will be mailed directly to you. With gratitude for your consideration of this request, I am Yours sincerely, Rev. Msgr. John C. Nosser Pastor 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) 765-1801 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 Our Lady of Ostrabrama Roman Catholic Parish, Cutchogue, to hold a dance in the barn owned by Glovers Farm, Inc., Cox Lane, Cutchogue, on Saturday evening, September 10, 1994, 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: July 28, 1994. Judith T. T6rr? . Southold To~m Clerk ( Insurance Certificate to be provided) cc: Police Chief Droskoski Building Department '~eeu~i: ::: ........................... ~Ri~ <;~ki~icAfE"i~"iggOEO AS A MA~ER OF iNFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Gallagher Ne~an DOES NOT AMEND. EXTENDOR ALTER THE COVERAGE AFFORDED DYTHE 199 Main Street POLICIES BELOW. Wh i t e P I a i n s, NY 10601 CO~ANIES AFF~D~G COVERAGE 914-997-9200LEHERCO~ANY A Underwriters at Lloyd's -~RED LEUER B National Union Diocese of Rockville Centre &LEIIERCO~ANY C Our Lady of Ostrabrama Illinois Union Cutchogue NY 1 1 g 3 5 ~AC c~.&nv OENE~L AO6REOAT~ A X C~ERCIAL 0tHERA[ tlABmHIV ISL5932/ICO7635 9/01/94 9/01/95 PROOUCIS-C~P/OPAOO B lCLASMS MAOE ~ OCCUR CP62791 9/01/94 9/01/95 P(RS0NAL & Am mJUm C 0W~aER S & CON~flACTOR'S ~ROT ECBG1B 17 1259 9/01/94 9/01/95 EACH 0CCURRENCE t 1,000,000 [ACH *ccm[m D~Sefl~TmN OF OPER ATIONSILOeAT~NIlV~ mLEIIlPEQIAL Certificate Holders are named ~s Additional Insured with reference to the use of premises far Annual Dance September 10. . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOaE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVO~ TO ~ow~ of So~ho Id LE~T.BUT ~*ILU~E TOM*,L ~UO. ~OTIO~ S~AL~ "~OSE "O O~LI~*TIO~O~ Olover's Farm. Inc. LIABILIIYOFANY~INDUPONTHECOMPANY.ITSAGENTSORREPRESENTATIVES Sh.ron and Mark Burden :.~ ~,~ ' ~ /(~ -- 007921023 ACO RD ~ ( 71 ~ l )~ ~ :/ :: [ ~:[ ~ ?,::::::: [[~::,?:~ ~:[~ ~:~ ::? :: :,~ :,~:: :,~ :[ :, ?:: ::~:::: ::::::::::::::::::::::::::::::::::::::::::: ::?: :::/::: :/::: :: :?::: ::?: ::: :,:::::: :'::::[ ~:,~::::[?: :::: :::::/: :?::: :,:/:?: :: :,:::/::: Our Lady of Ostrabrama, R.C. Church Box 997- Depot Lane Cutchogue, L.I., New York 11935 (516) 734-6446 RECEIVED Mrs. Judith Terry Southold Town Clerk 53095 Main Road Southold, New York J U L 2 8 1994 Southold Town Cl~r~ 11971 August 1, 1994 Dear Mrs. Terry: Our Lady of Ostrabrama Roman Catholic Parish has again been offered free of charge, the use of the barn owned by Glovers Farm, Inc. for a dance which will be held on Saturday evening, September 10, 1994. The total proceeds from the dance will be for the benefit of the parish. The barn is located on Cox Lane in Cutchogue. I am requesting a permit for the parish to conduct this dance in the barn on the above stated date. I have contacted the diocesan insurance agency, and have secured an insurance certificate for the coverage of this affair naming Southold Town, Mr. June Glover, Sharon and Mark Burden on the certificate. The certificate will be mailed directly to you. With gratitude for your consideration of this request, I am Yours sincerely, g John C. Nosser Pastor TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1801 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 Our Lady of Ostrabrama R.C. Parish, Cutchogue, to hold a dance in the barn owned by Glovers Farm, Inc., Cox Lane, Cutchogue, on Saturday evening, September 11, 1993, 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: August 12, 1993 / ' Judith T. Terry ~/ Southold Town Clerk (Certificate to be supplied) cc: Police Chief Droskoski Building Department A(=411tlk PRODUCER Gallagher Newman 199 Main Street White Plains, N.Y. ITHIS CERTIFICATE IS issUED AS A MATTER 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. 10 6 01 COMPANY LETTER A COMPANIES AFFORDING COVERAGE Underwriters at Lloyd's INSURED COMPANY LETTER B Diocese of Rockville Centre COMPANYLETTER C and COMPANY Our Lady of~Ostrabrama LETTER D Cut chogue, NY 11935 COMPANY LETTER E 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 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. POLICY EFFECTIVE POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) CO .TR GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR. OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $ PRODUCTS-COMP/DP AGG. $ ISL 5642 09/01/93 09/01/94 PERSONAL & ADV. INJURY $ EACH OCCURRENCE $ ICC 7352 ~,uuu,uuu FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accidenl) GARAGE LIABILITY PROPERTY DAMAGE EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMERELLA FORM STATUTORY LIMITS WORKER'S COMPENSATION EACH ACCIDENT $ AND DISEASE--POLICY LIMIT $ EMPLOYERS' LIABILITY DiSEASE--EACH EMPLOYEE $ OTHER CERTIFICATE HO~ER Town of Southold Glover's Farm, Inc. June Glover Sharon and Mark Burden DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS For: Use of premises for annual Dance from 9/9/93 to 9/12/93 at various times. Additional Insureds: Town of Southold, Glover's Farm, Inc. June Glover, Sharon and Mark Burden CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ~C~ EXPIRATION DATE THEREOF, THE ISS01NG COMPANY WILL ENDEAVOR TO MAIL 30 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 REPRESENTATIVES, AUTHORIZED REPRESENTATIVE Our Lady of Ostrabrama, R.C. Church August 10, 1993 Mrs. Judith Terry Southold Town Clerk 53095 Main Road Southold, New York 11971 Dear Mrs. Terry: Our Lady of Ostrabrama Roman Catholic Parish has again been offered free of charge, the use of the barn owned by Glovers Farm, Inc. for a dance which will be held on Saturday evening, September 11, 1993. The total proceeds from the dance will be for the benefit of the parish. The barn is located on Cox Lane in Cutchogue. I am requesting a permit for the parish to conduct this dance in the barn on the above stated date. I have contacted the diocesan insurance agency, and have secured an insurance certificate for the coverage of this affair naming Southold Town, Mr. June Glover, Sharon and Mark Burden on the certificate. The certificate will be mailed directly to you. With gratitude for your consideration of this request, I am /~ours truly, (M~gr.)John C. Nosser, Pastor 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 Our Lady of Ostrabrama, R.C. Parish to hold a dance in the barn owned by Leander Glover, Jr., Cox Lane, Cutchogue, on Saturday evening, September 12, 1992, 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: August 21, 1992. Southold Town Clerk cc: Police Chief Droskoski Building Department PROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND Arthur J. gallagher & Company EXTENDOflALTERTHECOVERAGEAFFORDEDBYTHEPOLICIESBELOW. The Gallagher Centre Companies Affording Coverage Two Pierce Place Itasca, Illinois 60143-3141 Company Underwriters of Lloyd's of London Letter A& Other British Companies Company ~NSURED Roman ~atholic Diocese oi Letter B Centennial Insurance Company Rockville Centre Company 50 North Park Avenue Letter C United National Insurance Company Rockville Centre, NY 11570 Company and Letter D Our Lady of Ostrabrama R.C.C. Company Cutchoque t NY Letter E COVERAGES THIS IS TO CERTIFY THAT 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 WH CH THIS CERT F CATE 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 ItAVE BEEN REOUCED BY PA D CEA MS. ' General Liability A) I5L5269/ G~ta'Aggce~ate S A ]~ommercial General Liability ICO6944 9-1-92 9-1-93 PrO4~'~'~-oml~OP Agg S i~ii ii O Claims Made [~Occurrence I~'s~l & *",. ,-iu,y S .... :':~ B) 287012536 9-1-92 9-1-93 B [] O~vners' & Contractors' Protective Eac~ O~cu,,e.ce $ i , 0 0 0 , 0 0 0 Automobile Liability Comblned Single Limit S [] All Owned.Autos RECEI V~D [] Scheduled Autos [] Hired Autos ~ Nonowned Autos SEP 1992 [] Garage Liability Excess Liability E.* ^,~-., $ [] Umbrella Form And E~^c~., J S Employers' Liability oi~a~. ~i~ umi, $ Other Town of Southold, Glovers Farms, Inc., Glover & Sharon & , Mark Burben are hereby named as Additional Insured limited to and arising solely out of the negligent use of premises by agents, servants or employees of the above named Description of Operations/LocationsNehicles/SPecial Items: insured With reference to the use of premises for Annual Dance from September 10, 1992 .......................... ~: 'F~-~:o'~ ~:*'":o.*'. .......... ~',~<'~':o:~ ...... ~:: iiii SHOULD ANY OF THE ABOVE DESCRIBED PO£ICIE~ BE CANcELEo BEFORE THE ii Town of Southold, !::~:: EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENOEAVOR TO MAIL DAYS ii:. Glovers Farm Inc. ~i~ WR TTEN NOT CE TO THE CERT F CATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO June Glover & ~ THECOMPANYt ITSAGENTSORREPRESENTATIVES. :: Sharon & Mark Burden i!:: AuthoriZe August 19, 1992 Mrs. Judith Terry Southold Town Clerk 53095 Main Road Southold, New York 11971 Dear Mrs. Terry: Our Lady of Ostrabrama Roman Catholic Parish has again been offered free of charge, the use of the barn owned by Glovers Farm, Inc. for a dance which will be held on Saturday evening, September 12, 1992. The total proceeds from the dance will be for the benefit of the parish. The barn is located on Cox Lane in Cutchogue. I am requesting a permit for the parish to conduct this dance in the barn on the above stated date. I have contacted the diocesan insurance agency, and have secured an insurance certificate for the coverage of this affair naming Southold Town, Mr. June Glover, Sharon and Mark Burden on the certificate. The certificate will be mailed directly to you. With gratitude for your consideration of this request, I am (Rev.) Yours truly, Richard P. Kopinski, Pastor JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER OFFICE OF YHE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold. New York 1197I 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 Our Lady of Ostrabrama, R.C. Parish to hold a dance in the barn owned by Leander Glover, Jr., Cox Lane, Cutchogue, on Saturday evening, September 14, 1991, provided they secure and file with the Town Clerk a Certificate of Liability Insurance for at least One Million Dollars naming the Town of Southold as an additional insured. Dated: September 5, 1991. Judith ~T. Terry Southold TowTne~Yer k cc: Police Chief Droskoski Building Department ARTHUR d. GALLAGHER & CO. 21600 Oxnard Street, Woodland Hills, CA 91367 SEP 1 2 199t - LOS ANGELES · (818) 340-3642 .~ 'r,,,... ~ CERTIFICATE OF INSURANCE · rTown of Southold, Glovers Farm, Inc., June Glover & Sharon & Mark Burden L ~ ~nd i~d~ of imu~l Roman Catholic Diocese of Rockville Centre NY 50 North Park Ave. Rockville Centre, NY 11570 -AND- Our Lady of Ostrabrama R.C.C Cutchogue, NY COMPANY London Package Centennial Travelers/International/ ~ome/Hartford/Athena KIND OF INSURANCE Excess Liability Insurance LIMITS OF LIABILITY $1,000,000 applicable REFERENCE With reference to the use of at various times. ADDITIONAL INSURED POLICY NO. ISL4954/ICO6576 287-02-15-99 AJG100134-91 E.~XPIRATION 9/1/92 9/1/92 9/1/92 including General Liability for any One Occurrence and Annual Aggregate wherever Excess for Existing Underlying Insurance. premises for Annual Dance from 9/12-15/91 Town of Southold, Golvers Farm, Ic., June Glover and Mark and Sharon Burden are hereby named as Additional Insured limited to and arising solely out of the negligent use of premises by agents, servants or employees of the above named insured. Cancellation: Should Iny of the above cles~ibed policies be cancelled before the exl)iration date thereof, the Issuing company will endeavor to mail,_],.~_ days written notice to the above named mnificata holder, but failure to mail such ~ notice thall impose no obligation or liability of Iny kind upon the company. DATE 9/4/91 ARTHUR J. GALLAGHER & CO. kma BY Our Lady of Ostrabrama, R.C. Church Box 997 - Depot Lane Cutchogue, El., New York 11935 (516) 734-6446 5 lggl August 30, 1991 Mrs. Judith Terry Southold Town Clerk 53095 Main Road Southold, New York 11971 Dear Mrs. Terry: Our Lady of Ostrabrama Roman Catholic Parish has again been offered free of charge, the use of the barn owned by Glovers Farm, Inc. for a dance which will be held on Saturday evening, September 14, 1991. The total proceeds from the dance will be for the benefit of the parish. The barn is located on Cox Lane in Cutchogue. I am requesting a permit for the parish to conduct this dance in the barn on the above stated date. I have contacted the diocesan insurance agency, and have secured an insurance certificate for the coverage of this affair naming Southold Town, Mr. June Glover, Sharon and Mark Burden on the certificate. The certificate has been mailed directly to you. With gratitude for your consideration of this request, I am Yours truly, (Rev.) Richard P. Koplnskl, Pastor JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS 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-I-B of the Code of the Town of Southold, a permit is hereby granted to Our Lady of Ostrabrama, R.C. Parish to hold a dance in the barn owned by Leander Glover, Jr., Cox Lane, Cutchogue, on Saturday evening, September 15, 1990, provided they secure and file with the Town Clerk a Certificate of Liability Insurance for at least One Million Dollars naming the Town of Southold as an additional insured. Dated: August 24, 1990. Judith T. Terry (/ Southold Town Clerk cc: Building Department Police Chief Winters ~e ARTHUR d. GALLAGHER & CO. - LOS ANGELES 21600 Oxnard Street, Woodland Hills, CA 91367 (818) 340-3642 CERTIFICATE OF INSU I/ CE rTown of Southhold Glovers Farm, Inc. June Glover Sharon & Mrak Burden g Nlme.ndldd~nofimumd Roman Catholic Diocese of Rockville Centre, NY 50 North Park Ave. Rockville Centre, NY 11570 -AND- Our Lady of Ostrabrama R.C Cutchogue, NY Ce ,COMPANY National Casualty Co. Underwriters at Lloyds and other British Companies Centennial Insurance KIND OF INSURANCE Excess Liability Insurance LIMITS OF LIABILITY $1,000,000 applicable REFERENCE POLICY NO. XL000742 ILS4647/ICO6213 287-02-15-84 including General Liability E~XPIRATION 9/1/91 9/1/91 9/1/91 R[CF. IV~D for any One Occurrence and Annual Aggregate wherever Excess for Existing Underlying Insurance. With reference to the use of premises for Annual Dance from September 13, 1990 through September 16, 1990 at various times. ADDITIONAL INSURED Town of Southold, Glovers Farm, Inc., June Glover and Sharon & Mark Burden are hereby named as Additional isnured limited to and arising solely out of the negligent use of prises by agents, servants or employees of the above named insured. Canc~btion: Should imf of ~e id)ow clflc~ibKI policies be an,ll~l before Ih. explretiofl dim thereof. ~e Ilsuing comi)~y will endflvor to mail 10 days written notice to Ihe Ibove nixed cenificlte holder, but failure to mail such notic4 ~ail impose no obligation or lilbili~y of any kind upon ~4 company. ARTHUR J. GALLAGHER & CO. DATE 8/24/90 kma BY ~ (~/'~ Our Lady of Ostrabrama, R.C. Church August 23, 1990 Mrs. Judith Terry Southold Town Clerk 53095 Main Road Southold, New York 11971 RECEIVED AU0 2 3 lggo Dear Mrs. Terry: Our Lady of Ostrabrama Roman Catholic Parish has again been offered free of charge, the use of the barn owned by Glovers Farm, Inc. for a dance which will be held on Saturday evening, September 15, 1990. The total proceeds from the dance will be for the benefit of the parish, the barn is located on Cox Lane in Cutchogue. I am requesting a permit for the parish to conduct this dance in this barn on the above stated date. I have contacted the diocesan insurance agency, and have secured an insurance certificate for the coverage of this affair naming Southold Town, Mr. June Glover, Sharon and Mark Burden on the certificate. The certificate has been mailed directly to you. With gratitude for your consideration of this request, I am (Rev.) Yours truly, Richard P. Kopinski, Pastor JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS 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 Our Lady of Ostrabrama Roman Catholic Parish to hold a dance in the barn owned by Leander Glover, Jr., Cox Lane, Cutchogue, on the evening of Saturday, September 9, 1989, provided they secure and file with the Town Clerk a Certificate of Insurance for at least one (1) million dollars liability insurance covering the Town of Southold as a named insured. Dated: August 30, 1989. Southold Town Clerk CC: Police Chief Winters Supt. of Hwys. Jacobs Building Department L ARTHUR d. GALLAGHER & CO. - LOS ANGELES 21600 Oxnard Street, Woodland Hills, CA 91367 (818) 340-3642 CERTIFICATE OF INSU :I CE Southold Town Main Road Southold, NY 11971 Attn: Judith Terry -AND- Leander Glover, Jr. J Roman Catholic Diocese of Rockville Centre, NY 50 North Park Ave. Rockville Centre, NY 11570 -AND- Our Lady of Ostrabrama Cuchogue, NY 11935 COMPANY Lloyds of London KIND OF INSURANCE ~OUC¥ NO. XL006359 ISL4358/ICO5940 EXPIRATION 9/1/90 9/1/90 Excess Liability Insurance including General Liability, LIMITS OF LIABILITY $1,000,000 for any One Occurrence and Annual Aggregate wherever applicable Excess for Existing Underlying Insurance. REFERENCE With reference to the use of Glover's Barn for annual dance from September 7 through September 10, 1989 at various times. ADDITIONAL INSURED Southold Town, Leander Glover, Jr. and Glovers Barn, Inc, are hereby named as Additionally Insured limited to and arising solely out of the the negligent use of the premises by agents, servants or employees of the above named insured. R~C~IVED SEP 7 1989 C4nedlstion: Should my of ~he Ibove~dflcribed p?llcles be?lncdled Imfom the eXlZir~tion date thereof, the iuulng company will encle~vor to mail ' u days written notice to th~ d)ove nan~cl ,-r~ificit. hold~, but failure m m~ll luch notice ihlll Impow no obligation or liability of Bny kind upon the ix)mpmy. ARTHUR J. GALLAGHER &CO. DATE 8/31/89 kmD A-~lO (REV. I/~l) ~ ARTHUR J, GALLAGHER & CO. - LOS ANGELES 21600 Oxnard Street, Woodland Hills, CA 91367 (818) 340-3642 CERTIFICATE OF INSURANCE Southold Town Main Road Southold, NY 11971 Attn: Judith Terry -AND- Leander Glover, Jr. Roman Catholic Diocese of Rockville Centre, NY 50 North Park Ave. Rockville Centre, NY 11570 -AND- Our Lady of Ostrabrama Cuchogue, NY 11935 COMPANY National Casualty Co. Lloyds of London KIND OF INSURANCE _POLICY NO. XL006359 ISL4358/ICO5940 Excess Liability Insurance including General L~IMITS OF LIABILITY Liability, EXPIRATION 9/1/90 9/1/90 $1,000,000 for any One Occurrence and Annual Aggregate wherever applicable Excess for Existing Underlying Insurance. REFERENCE With reference to the use of Glover's Barn for annual dance from September 7 through September 10, 1989 at various times. ADDITIONAL INSURED Southold Town, Leander Glover, Jr. and Glovers Barn, Inc, are hereby named as Additionally Insured limited to and arising solely out of the the negligent use of the premises by agents, servants or employees of the above named insured. RB~IV~D SEP 7 1989 p m ,rurality O! ~1¥ klflC( Upon h GOrily. , ~ ,a~url ~ ~ IUCII ARTHUR J. GALLAGHER & CO, DATE__ 8/31 /89 km9 ~ BY a-~ tO (REV. ~ll ) r Our Lady of Ostrabrama, R.C. Church ~ Box 997- Depot Lane ~ Cutchogue, LJ., New York 11935 RECEIVED AUB :3 0 1989 August 25, 1989 Mrs. Judith Terry Southold Town Clerk 53095 Main Road Southold, New York 11971 Dear Mrs. Terry: Our Lady of Ostrabrama Roman Catholic Parish has again been offered free of charge, the use of the barn owned by Mr. June Glover for a dance which will be held on Saturday evening, September 9, 1989. The total proceeds from the dance will be for the benefit of the parish. The barn is located on Cox Lane in Cutchogue. I am requesting a permit for the parish to conduct this dance in this barn on the above stated date. I have contacted the diocesan insurance agency, and have secured an insurance certificate for the coverage of this affair naming Southold Town, and Mr. Glover on the certi- ficate. The certificate has been mailed directly to you. With gratitude for your consideration of this request, I am, (Rev.) Yours truly, Richard P. Kopinski, Pastor ARTHUR d. GALLAGHER & CO. - LOS ANGELES 21600 Oxnard Street, Woodland Hills, CA 91367 (818) 340-3642 CERTIFICATE OF INSU t CE Southold Town Main Road Southold NY 11971 Attn: Judith Terry g Nlml lid Iddflml of Imrld Roman Catholic Diocese of Rockville Centre, NY 50 North Park Ave. Rockville Centre, NY 11570 -AND- Our Lady of Ostrabrama Cuchogue, NY 11935 COMPANY National Casualty Co. Lloyds of London KIND OF INSURANCE POLICY NO. ×~006359 ISL4358/ICO5940 EXPIRATION 9/1/90 9/1/90 Excess Liability Insurance including General Liability LIMITS OF LIABILITY $1,000,000 for any One Occurrence and Annual Aggregate wherever applicable Excess for Existing Underlying Insurance. REFERENCE With reference to the use of Glover's Barn for annual dance September 7 through September 10, 1989 at various times. ADDITIONAL INSURED Southold Town is hereby named as additional insured. from R~D AUG ~ 4 1989 C4mcelbtlofl: ~hould any of the Idmvs described policies be cancelled before the expiration date thereof, the issuing cx)mpmy will endeavor to mai(._,],~_ days written notice to the above nam~l mrtificata holder, but failure to mail tach notice shall impo~ no oMigatlon or liability of any kind upon the conq)my. DATE 8/22/89 kmp ARTHUR J. GALLAGHER & CO.