HomeMy WebLinkAboutGardiners Bay Estates Homeowners AssocKEN REEVES
RECREATION SUPERVISOR
TOWN OF SOUTHOLD
970 Peconic Lane ~-
P.O. Box 267
Peconic, NY 11958
631.765.5182
Ken. Reeves~town.southold.ny.us
TOWN OF SOUTHOLD
RECREATION DEPARTMENT
APPLICATION FOR USE OF SOUTHOLD PARKS FACIILITIES
PLEASE PRINT LEGIBLY
,~, APPLICATIONS DUE AT LEAST TWO (2) MONTHS BEFORE EVENT
sb ~TODAY'S DATE: J~l ~ '
t
HO~ PHONE: ~9l' ~l '7~1 BUSmESS:6J/ 75~- ~Z4 CELL:
~D~SS: dooy ~SH 7 ~ ~ ~ta.~m
DAY(S)~DDATE(S)OFUSE: ~ ~OL~/~ D~ ~. ~0~
REQUESTED TIME FOR FIELD/pARK/COURT USE:
FROM: k :~Y'~ /~ TO:' ~: ~t~ ?~
REQUESTED TIME FOR LIGHTS TO BE ON OF APPLICABLE}:
FROM: TO:
NOTE: LIGHTS MUST BE TURNED OFF BY 10:00 P.M.
REASON FOR USE(PLEASE BE SPECIFIC AND GIVE DETAILS):
~. · '-
~ u 0
IS ~MISSION BErG C~GED? YES NO
~ YES, HOW MUCH IS BErG C~GED?
PLEASE PROVIDE A DETAILED EXPLANATION OF HOW THE PROCEEDS ARE
TO BE USED:
It' ..... .c/ - 0
HOLD HARMLESS AGREEMENT
The applicant/group/organization agrees to indemnify and hold harmless the Town of
Southold, its officials, employees, and/or agents from all claims, lawsuits, hospital and/or
doctor bills, actions, proceedings, and liabilities for the loss or damage to property, or a~,~_
injury, the death of a person, including' ' any expenses incurred by the Town of $outholdl~
defending any claims, lawsuits, or action that may arise as a result of the conduct, actions,
including the negligence of the xpplicant/grouP/o~ganization to the fullest extent permitted
by applicable law.
I have read the attached "SOUTHOLD TOWN FACILITY RULES AND
REGULATIONS" and agree to abide by them.
NAME OF ORGANIZATION: ~. ~/~iL~.~/9~ ~'5~'/°~'~/~ ~/O~e~.¢ ~O~., .
PLEASE PlglNT
¢ D~.TE PLEASE PRINT (PRINCIPAL/AUTHORIZED REPRESENTATIVe) r~
z.z. z z~.z.~.zz.~.z z ~. zzzzz, z~. z. z. zzzz~.
FOR OFFICE USE ONLY
FACILITY IS: REQUEST IS:
AVAILABLE { ~1 ' APPROVED
NOT AVAILABLE { } DENIED { }
Town of Southold Police Department
Special Event Cost Analysis
Event: Community Yard Sale
July 16, 20t1~ /
Date(s): ; _
Location: Old Schoolhouse Park, Rt. 25, East Marion
Patrol Allocation for Event
PoIk~ Oltl~ Reg Hours OTHrs
Hrly Wage Total
Comments
spec~l e~trol
Bicycle P-.tml
K-9 Unit
Highway PM~oi
TC Officer
TC Officer
TC Officer
TC Officer
TC Officer
Equipment Costs
Reg Hours lOT Hrs Hrly Wage
$15.83
Total : Comments
$126.64
Total Department Cost for Event = $
$126.64~
Prepared by Capt. M. Flatley 4/11/2011,~
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