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HomeMy WebLinkAbout1999I~TICE OF CANCELLATION, NONRF:~WAL, coNDITIONED RENEW4 OR C"ANC~,IN .~lr: · (New York} ~ · · INSURANCE COMPANY NAME AND ADDRESS OFINSUREO The Southold Historical Society P.O. Boxl Sou~hold,Neu York 11971 TERMS, CONDITIONS OR RATES K~D OF POLICY: E~LICY NO.: ]{~A 19~2~ ~NCELLATION, EXPIRATION OR CHANGE WILL TAKE EFFECT AT: :.~-17-99 (DATE) 12:01 Il.lie (HOUR-ST^ND^RD TIMEI ~,TE OF MAILING: 7~[--~ ~GH AGENCY OR OFFICE AT: RECEIVl JUL 19 9 (Specific information concerning the cancellation or nonrenewal has been given to the Insured,) TO UENHOLDER: [] You are hereby not fled tha the agreemen under the Loss Payable Clause payable to you as Lienholder, which is a part of the above policy, issued to the above insured, is hereby cancelled or nonrenewed in accordance with the conditions ol the policy, said cancellation or nonrenewal to be effective on and after the hour and date mentioned above. TO BORTGAGEE: DATE OF MAILING: 7-01-99 ~Effective, 9-17-99 ,at. 12:01 a.m. (Standard Time), we hereby canceVnonrenew the Mortgagee Agreement ?hich is m. adepart of the above mentioned policy and also the above mentioned policy issued to the insured named above covefir~ on h~s tot at 54235 Main Road,Soul:hold,NY 11971 & Lighthouse Road,Soutt~old,N 11971 and made payable to you as n~rtgagee (or trustee), in the event of lose. INSURANCE COMPANY Woz~estez Tusuraace Company 120 Y~ont Slmeet,Suite .500 Worcester,MA 01608-1408 Towo of Southold Judil:h Terry,Tow~ Clerk (Volunl:eers) Main Road Southold,New York 11971 GU 323d (Ed. 8-97) UNIFORM PRINTING & SUPPLY, INC. © 1996 LIENHOLDER'S/tJORTGAGEE'S COPY ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1.179 Southold, New York 11971 Fax (516) 765-6145 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 the Southold flistorlcal Society to hold their Annual Ice Cream Social on the Southold Historical Society grounds, Main Road and Maple Lane, Southold, New York, on Saturday, August 7, 1999, from 1:00 P.M. to 4:00 P.M. (rain date: Sunday, August 8, 1999), 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 29, 1999 Southold Town Clerk June 29, 1999 (Certificate on File) cc: Chief of Police Conway Building Department (tents) 5~5 M^IN RO^D, P.O. BOX 1 SOUTHOLD, LONG ISLAND, NEW YORK 11971 RECEIVED JUN 15 1900 June 11, 1999 Tel. (516) 765-§500 Ms. Elizabeth Neville Town Clerk Southold Town Hall Southold, NY 11971 Dear Ms. Neville: The Southold Historical Society plans to hold an Ice Cream on their grounds at the corner of Main Road and Maple Lane on Saturday, August 7 from 1 to 4 p.m. The rain date is Sunday, August 8. We are requesting a permit for this event and enclose a a diagram of the grounds and placement of tents. An insurance form should be on file with you. Sincerely, Nancy Pettit, Chair NP:scy Enclosure ELIZABETH A. NEVILLE TOWN C LF.~K REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION 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) 765-1800 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 the Southold Historical Society to hold its Southold Founders Weekend, Civil War Living History F, Encampment, on the 5outhold Historical Society grounds, Main Road and Maple Lane, 5outhold, New York, on Saturday, May 29, 1999, and Sunday May 30, 1999 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: March 22, 1999 eville~ Southold Town Clerk March 22, 1999 (Certificate on File) cc: Chief of Police Conway Building Department (tents) Sent by: WorkCenten 250 5167653846 03/22/99 14:34 Job 469 Page 1/2 INS//H.4NCE !:flt!)Nl!: t51(,) 765-]~1 I RE~IVED lIAR *&~ F'AX ME:MO FAX PlIONh: (516) l'O: TOWN OF SOUTHOLD ATFENTION' ELIZABETH NEVILLE, TUWN CI.ERK F.-\ ;< PHO~qE: ', PAGES IN T~NSM1S~ION (INCLUDING COVER .SHEET) CECELiA CERTIFICATE t)F INSURANCE FOLLOWS FOR SOOTIIOLD NISTORICAL SOCIETY FOR ~.1_ EVENTS BEING HELD 9/98 THRU 9/99 ANY QIJESTIONS, PI,EASE CAI,L. TtlAN~ ................................................................................ ............................................................................................................. "The BIG Oi~ere.ce I~ Our Service" Wayne DePetris John Kramer Jeff Rehm Lynda Rehm Sent by: WorkCenter 250 5167653846 03/22/99 14:34 Job 469 Page 2/2 .ODUCER (S Iff) 7~' ~1~ k~_~9~T~PON THE CERTIFICATE R Insurance Services ~ ~R. THIS CERTIFICATE DOES NOT AMEND, EXTEND O ~5 t End [ ALTER THE COVE~GE AFFORDED BY THE POLICIES BELOW 3ePetr-is & Kramer Agency ~nc. ~4985 Mai~ St:, , PO Box 1406 COMPANIES AFFORDIN~ COVERAGE %ouThatd, NY 11971 0966 Attn: Southold Historical Society P.O~ Box ] Southold, NY 11971 Ext: COMPANY B COMPANY C COMPANY D THiS il TO CERTIFY THAT THE ~0LI~iF~ :oF iNSu~NCE Ll§~b ~ELOW M~E ~EN iSSUE~ T© T~E iNSURED NAMED ABOVE FOR TH~ POLICY PERIOti ~ iN[JlCATED, NO~ITHSTANDING ANY REQUIREMENT, ~ OR CONDITION OF ANY CONTACT OR OTHER ~CUMENT Wl~ RESPECT TO WHICH l HI~ CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSU~NCE AFFORDED BY THE P~ICIES OESCRlaED HEREIN IS SUBJECT TO ALL Tile ] ERMS ~ EXCt US~ONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAiD CLAIMS. POLICY EFFECTIVE POUCY EXPIRATION LIMITS ~ occur MPA193236 09/17/1998 09/17/1999 A BA223195 09/17/1998 09/17/1999 WORKER$ C OMPE NSAIION AND X tORY LIMitS E~ ~MPL.OYERS' LIABILITY A 'HEpR¢)pRiF'rr~R, INCL WC811776 05/0]./1998 05/01/1999 EL~CHACCIDENI $ ~{~ FOR AI.L EVENTS BEING HELD BY SOUTHOLD H~STOR~{AL SOE~E~ ~OWN OF SOUTHOLD NANED AS ADDiTiONAL ~NSURED TOWN DE SOUTHOLD EXPIRATIONDA?Ell'IENEOF, THEISSUINOCOMPANYVVILLENOEAVORTOMA~ [' [ I ZAB ETH NEVI L L E, TOWN CLERK .~ DAYS ~N NOTICE. TO THE CERTIFICATE HOLDER NAMED TO THE LI ~ ' 530g~ MAZN ROAD BUTFAILURET~HNO~CE~LLIMPOSENOOBLIGATIONORLIAB~' 54325 MAIN ROAD, P.O. BOX 1 SOUTHOLD, LONG ISLAND, NEW YORK 11971 Tel, (516) 765-5500 March 16, 1999 Mrs. Elizabeth A. Neville Southold Town Clerk P.O. Box 1179 Southold, New York 11971 Dear Mrs. Neville: The Southold Historical Society will hold its Southold Founders Weekend this year on Saturday and Sun- day, May 29 and 30, on the Museum Grounds, Main Road and Maple Lane, Southold. Program: Civil War Living History & Encampment Organization: Fourteenth Brooklyn Regiment N.Y.S.M. Co. E 7500 Fourth Avenue #F5 Brooklyn, NY 11209 As part of the camp scenarios and demonstrations, muskets with blanks will be fired. The Regiment is not required to have a permit or license for this. A permit to hold this event on the Museum Grounds is requested. A One Million Dollar Certificate of Liability Insurance naming the Town of Southold as an additional insured is on file in your office covering all events for 1999. Thank you for your attention to this request. ,Very truly yours, Maureen C. Ostermann President