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Home My WebLink About1991 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, permission is hereby granted to the Oysterponds Historical Society Inc. to hold the following events, provided they secure and file with the Town Clerk a One Million Dollar Certificate of Liability Insurance naming the Town of Southold as an additional insured: June 29, 1991 (rain date-June 30, 1991), between the hours of 5:00 P.M. and 8:00 P.M., a Homecoming Celebration on the Poquatuck Park grounds of the Oysterponds Historical Society Inc., Village Lane, Orient, New York. August 3, 1991 (rain date-August 4, 1991), between the' hour's of 10:00 A.M. and 3:00 P.M., Second Annual Lawn Croquet Tournament on the front lawn of the Village House property of the Oysterponds Historical Society Inc., Village Lane, Orient, New York. Auc21ust 31, 1991 (rain date-Septernber 1, 1991), between the hours of 10:00 A.M. and 4:00 P.M., Oysterponds Country Fair on the Poquatuck Park grounds of the Oysterponds Historical Society Inc., Village Lane, Orient, New York. December 15, 1991, between the hours of 4:00 P.M. and 8:00 P.M., Seventh Annual Christmas House Tour, a walking tour of about ten houses with participants walking between the homes at Orient, New York. Dated: June 20, 1991. cc: Police Chief Droskoski Supt. of Highways Jacobs JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road PiO. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1801 May 23, 1991 Barbara Fertig Oyster Ponds Historical Society Inc. Village Lane P.O. Box 844 Orient,' New York 11957 Dear Ms. Fertig: We recently received the enclosed Certificate of Insurance on behalf of the Oyster Ponds Historical Society Inc.. The certificate cites numerous special events planned by the Society, but I am unable to issue the required Special Permit without some additional information, i.e. location of the .event, and hours to be conducted. If you would be kind enough to supply me with the above information, I will immediately issue the Special Permit. You may include all of the events planned through December in the one request and the permit will reflect same. Many thanks for your cooperation. Very truly yours, Judith T. Terry $outhold Town Clerk Enclosure e~HT~FICATE OF INSOPJU~CE: ID BM 05/03/91 PRODUCER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Alegand.er & Rlexan.der,Ino. SYR~ CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE The Rtrl~l)~l~ at 2 Clinton SRo DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE P.O. Box 4883 POLICIES BELOW. Syracuse, NY ........................................................................... 13221 COMPANIES AFFORDING COVER~kGE ] PHONE315--424--8088 IINSURED COMPANYLETTER~ FIREMAN'S FOND INSURANCE CO Oysger Ponds Historical . Sgczety Inc. % Barbara Fertlg Vl%lage Lane~ PO Box 844 Orzent NY 11957 COMPANY LETTERS RECEIVED COMPANY LETTER C ................................................. UAY---- 8-199-I ......... COMPANY LETTER D CORPANY LETTER E ~OI19~'~T ..... CI~ COMMERCIAL GEN LIABILITY [ ] CLAIMS MADE III OCC. O~NERS'S & CONTRACTOR'S PROTECTIVE COVERAGES T< ............................. - ..... = ...................... -===----=----=--= ............ --===--=------=------=------= ..... = ....... THIB IS.0 CERTIFY THAT POLICIES OF IN~J;,~I~E LISTED BELOW HAVE .EE~I IS;~J~:~) ;J ;HE INSURED MA;ED ~.B~)~/~: 7~)~ ;~ ;J[;~Y ' PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO ~HICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. LIMITS SH~N MAY HAVE BEEN REDUCED BY PAID CLAIMS. m---m GENE~L LIABILITY GENERAL AGGREGATE 12,000, OOC 23aMXXB0476214 03/[[/9[ mo3/ / 2 ~ERS, & ADV. INJURYI~¢O00~O0( (ANY ONE FIRE) mso~ooo ~ED. EXPENSE I (ANY ONE PERSON) SRO00 .................................. m ........................... m ............... m ............................................... R~O~OBI~ ~IR~ C~B. S~NOLE Lm~T [~O00~OOC [ ] ANY AUTO B~ILY INJURY SCHEDULED AUTOS ...................... A{~ HIRED AUTOS 238"XX80476214 03/11/91 03/11/92 B~IL' I"JOR, [ NON-~NED AUTOS (PER ACCIDENT) ~[ ] GARAGE LIABILITY ................... [ .............. ][ ] PROPERTY DAMAGE [ EXCESS LIABILITY EACH OCCURRENCE [ ] OTHER THAN UMBRELLA FORM AGGREGATE m WORKERS' COMP EACH ACCIDENT ~ AND D[SEASE-POL. LIMIT [ I EMPLOYERS' ~I~ DISEASE-EACH EMP. OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL [TENS Certifioateholder is named as additional insured for the .following special.even.ts: 6/29/91 (rai.n date 6/.30/91 Homecoming Celebratlon~7/4/91 ~ommunlty P.zcnlc~8/3/91 (rain date 8/4) 2nd a.nn Lawn Croquet Tournament~ 8/31/91 lrazn 9/1/91) Oysterponds Country Fazr~ 12/15/917th annual christmas House Tour. CERTIFICATE HOLDER < > CANCELLATION ============================================================= Town of Southold attn: Ms. Judith Te.rryz Clerk Town Hall, 53095 Main Road PO Eox 1179 Southold NY 11971 _ACORD 2S-S (7/90) = SH~LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX' = PIRATION DATE THEREOF, THE ISSUING C~PANY WILL ENDEAVOR TO MAIL 10 = 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 0 PRESENTATIVES. Barbara J. McGarrzt¥ CIZXCGCOH 10-88 cms 36 EFCGO154CO7E101 Fireman's Fund RECEIVED MAY 2 41gAl POLICY NUMBER 2 38 NXX 8067 62 lt~ Named Insured OYSTER PONDS HISTORICAL Sequential Endorsement Number 0 0 1 PORTFOLIO CHANGE ENDORSEMENT Effective 03/11/91, 12:01 A.M., Standard Time at the address of the insured This is an Endorsement only. Other than changes shown, all other pre-existing coverage remains in ful! force and effect. Premium adjustments are shown. PREMIUM SUMMARY: ADDITIONAL PREMIUM DUE NOH ~.00 The following other General Liability endorsement(s) are amended to apply as sholqn: GENERAL AMENDMENT 140519 1182 THE FOLLOWING IS ADDITIONAL INSURED AS RESPECTS TO SPECIFIC EVENTS LISTED BELOW: TOHN OF SOUTHOLD ATTN: MS. JUDITH TERRY, TOWN CLERK TOWN HALL, 55095 MAIN ROAD P.O. BOX 1179 SOUTHOLD, NEW YORK 11971 JUNE 29, 1991 (RAIN DATE JUNE $0) - HOMECOMING CELEBRATION; JULY 4, 1991 - COMMUNITY PICNIC; AUGUST 5, 1991 (RAIN DATE AUGUST 4) - SECOND ANNUAL LAWN CROQUET TOURNAMENT; AUGUST 51, 1991 (RAIN DATE SEPTEMBER 1) - OYSTER PONDS COUNTRY FAIR; DECEMBER 15, I99I - 7TH ANNUAL CHRISTMAS HOUSE TOUR. Countersignature of Authorized Agent: Producer ALEXANDER & ALEXANDER, INC. P 0 BOX 4883 SYRACUSE NY 15221 CHANGE ENDORSEMENT CONTINUED ON PAGE D~e 05/09/91 2 Page 1 CIZXCGCI 1048 CIS 36 EFCG.OI54COTE101 POLICY NUMBER 2 38 NXX 8047 62 14 Named Insured OYSTER PONDS HISTORICAL Sequential Endorsement Number 00! (continued) RATING PERIOD 05-11-91 TO 05-11-92 PPemtse 01 Location 001 GENERAL LZA~ZLZTY SCHEDULE VILLAGE LANE (VILLAGE HOUSE) ORIENT NY 11957 Location 002 VILLAGE LANE (HALLOCK HOUSE) ORIENT NY 11957 Location 005 VILLAGE LANE (POINT SCHOOL HOUSE) ORIENT NY 11957 Location 006 VILLAGE LANE (SIENE HOUSE) ORIENT NY 11957 Location 005 VILLAGE LANE (SHIN BONE ALLEY) ORIENT NY 11957 Location 006 VILLAGE LANE (AMANDA DROHN SCHOOL HOUSE) ORIENT NY 11957 Location 007 VILLAGE LANE (PARK BLDG.) ORIENT NY 11957 Location 008 VILLAGE LANE (NEBB HOUSE) ORIENT NY 11957 Location 009 VILLAGE LANE (HOOD SHED) ORIENT NY 11957 Location 010 VILLAGE LANE (POQUATUCK PARK-NEAR HEBB HOUSE) ORIENT NY 11957 CHANGE ENDORSEMENT CONTINUED ON PAGE $ Page 2 CIZXCGC 1 lO-gg CIS 36 EFCGO154CO7E101 POLICY NUMBER 2 38 llXX 8047 62 3.4 Named Insured OYSTER PONDS HISTORICAL Sequential Endorsement Number 00! (continued) RATING PERIOD 03-11-91 TO 03-11-92 GENERAL LIABILZTY SCHEDULE (continued) Classification(s) ~ases of Premium Exposure Rate Premise 01 Premises/Operations HUSEUHS AREA incl Products/Completed Operations CEHETERIES ACRES inc! Produc~s/Comple~ed Operations VACANT LAND ACRES ~nc! Produc~s/Comp~e~ed Operations 8,605 627.6450 6 60.6217 6 23.1000 END OF CHANGE ENDORSEHENT Page CIZXPFPO 1-90 CIS 36 EFCG.OI54.C07EI01 Fireman's Fund Final Premium Summary POLICY NUMBER 2 38 NXX 80476Z14 Insured OYSTER PONOS H'rSTOR'rCAL Producer Code 51-067-907 AID 01 Produc~ Name and Address ALEXANDER & ALEXANDER, INC. P 0 BOX 6885 SYRACUSE NY 15221 Policy Period 03-11-91 to 03-11-92 Rating Period 03-11-91 to 03-11-92 Sequential Endorsement Number (AO/WC O01/ Effective Date 05-11-91 Quote 58-07785-09 Poi Sub Code Under Grp 2 Under ID Risk ID 536 Member Branch SYRACUSE SIC Code 8612 ~~~ PVR ENTRY REQUIRED COVERAGE TOTAL PRERZUM DUE NOg COMM PREMIUM FLAT SIZE EXPER SCHED EXPEN · 00 AP Coverage GENERAL LIABILITY Adjust Freq NOT AUDITABLE Coverage Adjust Freq Page