HomeMy WebLinkAbout2014 ®`� RESOLUTION 2014-114
'� ADOPTED DOC ID: 9480
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2014-114 WAS
ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON
JANUARY 14, 2014:
RESOLVED that the Town Board of the Town of Southold hereby grants permission and
authorizes the Town Clerk to issue a Special Events Permit to the Mattituck Presbyterian Church
to hold a Tent Revival "Awakening `14" for various North Fork churches at Strawberry Fields
on Thursday, July 31 through Sunday, August 3, 2014 from 8:00am to 10:00 pm each day,
provided applicant meets all of the requirements as listed in the Town Policy on Special Events
and Use of Recreation Areas and Town Roads. All fees shall be waived.
Elizabeth A. Neville
Southold Town Clerk
RESULT: ADOPTED [UNANIMOUS]
MOVER: Robert Ghosio, Councilman
SECONDER:Louisa P. Evans, Justice
AYES: Ghosio, Dinizio Jr, Ruland, Doherty, Evans, Russell
O��gUFfO[�c�G
ELIZABETH A.NEVILLE,MMC ti� y Town Hall, 53095 Main Road
TOWN CLERK G P.O. Box 1179
H Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS p yc Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �Oj `��
FREEDOM OF INFORMATION OFFICER www.southoldtownnygov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
February 19, 2014
Alex Nyilas
3105 Little Neck Rd
Cutchogue NY 11935
Re: Awakening `14
Dear Mr. Nyilas:
Enclosed herewith is a certified copy of the Southold Town Board resolution No.
2014-114 adopted on Tuesday, January 14, 2014. Also included is a copy of the
town's Policy for Special Events on Town Property. Please be sure to contact this
Captain Kruszeski at the Southold Town Police Department to coordinate traffic
control.
Very truly yours,
41)c�j, ( �V J
Linda J. Cooper
Deputy Town Clerk
Enclosures
Cooper, Linda
From: Flatley, Martin
Sent: Friday, January 10, 2014 1:47 PM
To: Cooper, Linda
Cc: Kruszeski, Frank; Blasko, Regina
Subject: RE: Mattituck Tent Revival Request
Attachments: CA For Church Tent Revival.xls
Hi Linda,
I have on objections to this event being approved at the Strawberry Fields Fairground in Mattituck. Attached is the
cost analysis for our department
%aroc o
Chief of Police
Southold Town Police Department
41405 State Rt. 25
Peconic, N.Y. 11958
631-765-3115
From: Cooper, Linda
Sent: Friday, January 10, 2014 10:25 AM
To: Flatley, Martin
Cc: Kruszeski, Frank; Blasko, Regina
Subject: Mattituck Tent Revival Request
1
Town of Southold Police Department
Special Event Cost Analysis
Event: Mattituck Presbyterian Church Tent Revival
Date(s): July 31- August 3, 2014
Location: ' Strawberry Fields Fairground, Mattituck
T
Patrol _ . opiort►t .
Re_ g Hours IOT Hm Hrly Wage Total Comments
Poticecars
special Patrol
Reg Hours 'OT Hrs Hrly Wage Total Comments
CRL
Bicycle Patrol
K-9 Urft
Hwway Petrof
l6rina klnits
fi
Traffic Control
Reg Hours OT Hrs Hrly Wage Total Comments
16 $16.46 ' $263.36
16 $16.46 ' $263.36
Equipment Costs
Total Department Cost for Event= $ $526.72
Prepared by Capt.M. Flatley 1/13/2014 Page 1
�o�OgUFFOt4,
ELIZABETH A. NEVILLE,MMC h Gy Town Hall,53095 Main Road
TOWN CLERK C P.O.Box 1179
COD 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS p • Fax(631)765-6145
MARRIAGE OFFICER �� �` Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �j �,�
FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Chief Martin Flatley
From: Linda J. Cooper, Deputy Town Clerk
Dated: January 10, 2014
Re: Mattituck Presbyterian Church Tent Revival
Transmitted herewith is a request by the Mattituck Presbyterian Church to hold a
Tent Revival with other churches at Strawberry Fields.
Please review this request and send me your recommendation.
LL1GefUr.117 H.1\IL'Y1LLL'.runt-,l.1Tl�. U6UNV-*
1 V Wll C1A/1, JJVYJ 1YLiull RVQu
IrMITNT f`i Vow nn D__ 11_90
Southold NY 11971
REGISTRAR OF VITAL STATISTICSTelephone: (631)765-1800
MARR1AUL VFN1l:1!K Fax: (631)765-6145
RPMRDS MANaf:FMENTOFFiCER
FREEDOM OF INFORMATION OFFICER
www.souttiolatownny.gov
0-nn_CF.OF TNR TOWN CLERK
[111 Lll-A 11V1\1'VA M
SPECIAL EVENTS PERMIT
Organization's Name: M.4 rITVGK WE_i6YT£,-1/U) CHWIU{
Mailing Address: MA—j^) ILD M&-jr "1lGK AJ'!
Contact's Name- AwN NY1(,&S
Contact's Phoue Number: 631 - L/15- - 717`i
F,mail Address: /:�1 SH MS O M F,1J , M Pf-J—H 41~1 N t g B G/+^A��- • L�'y'
Type of Event: Cf441.GH ff^T kq ✓1 ✓jft_ �1✓Ilfik^i1N(r ty 11
July,� 1
Date(s)of Event: AW—
Time of Event XQ(�,-
Location of Event: 51Y_AW R E"Y dC-fFt,-DS
/T T..-....1J- --.....1 .. w-!w-..............1
i.....................1.:"1.x. .. .........,...J i
Auticioated number of attendees/oarticinants: 300
:..tet? V:•.-..r N-� `A
If Not-for-Profit.identlfv the Reciuient of Proceeds: NC1 CHAfLc-C
A w..nWwn�..n..i..l ..i....,..n..1n n.....l...l Pnr 1W�in n nnt'1 to n 11dw..i��..nlinn .. 1.,..., eft.) 10
.r r..-�... .�.1...........»................. ........ .-._. _. 1..-.. _1 .. .......... a .i
please attach an explanation to this application. �tCtIVE fm 1cE `7@') c c�.inl9c.
AT cyto-c-F , S0?�E his 4d£�h- Iwl aoa)
Have you read the copy of the Town's regulations concerning Special Permits attached to this
j 40
-rr-
S ature Date
970 Peconic Lane
Ken Reeves ,.'v' P.O.Box 267
Recreation Supervisor F Peconie,NY 11958
Town of Southold 631.765.5182
Ken.Reeves@townsouthold.ny.us
TOWN OF SOUTHOLD
RECREATION DEPARTMENT
APPLICATION FOR USE OF SOUTHOLD PARKS FACHLITIES
PLEASE PRINT LEGIBLY
APPLICATIONS DUE AT LEAST TWO (2)MONTHS BEFORE EVENT
Today's Date: luW 13
Requesting organization: + %ri r✓cec —
Applicant's Name: At-L-v r✓y t t.a c
Address; 31oS t t, N£c.H.. 2D cf-C�i mac--✓T a.�Y
Home Phone: 631 7 3Y 4 y-}c Business: Cell: 6 it 4 i S -7 .1-7q
E-mail Address: ,s H e i_S oan. N n&Trtkr 0 N t R Co G M} c. CGm
Facility Requested: 5 ✓�q –1�c
Day(s)and date(s)of use: Jth-Y 31ST Nc-vsr I5r- Jam ) 3
Requested Time for ISeld/ParklCourt(Use:
From: 9l. o o A-V'- To: /o : ou C r 5 d✓Jr•/
Requested dme for lights to be on(If applicable):
From: To:
NOTE: LIGHTS MUST BE TURNED OFF BY 10:00 P.M.
Reason For Use(Please be specific and give details):
---rd Hct., a. »wi-s 2-,✓i ✓w-f cc,2 j/n-n wS G-[✓2tH fS w tw t ✓G�vJ F,
CN/G t S 11 A'n. M ur t r R.o.1 S t C c�a.� (i�nt$_T6 j a LE S /1/t�
Is admission being charged? Yes No x
U yes,how much is being charged?
Please provide a detailed explanation of how the proceeds are to be used:
Applicant's Signature:
HOLD HARMLESS AGREEMENT
The applicant/group/organization agrees to indemnity and hold barmless 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 any
Injury, the death of a person, including any expenses incurred by the Town of Southold
defending any ciahns,lawsuits,or action that may arise as a result of the conduct,actions,
including the negligence of the applicant/groupfoganiration to the fullest extent permitted
by applicable law.
I have read the attached "SOUPHOLD TOWN FACILITY RULES AND
REGULATIONS"and agreeto abide by them. �
Name ofOrganizadon:. Ma tt luck lire bU /t�Plpy, C�
Pleas4 Print
►t � l� �l �a?� f'Y)a�'feton� pres,8c�u�Tr�s��Ps
Date Please Print(Prindpal/Authorired Representative)
Applicant's Signature: ll/
We are glad that we are able to provide your group/organizationReague
with a facility. Your group is required to make certain that the
field is free of debris when you leave for the day.
We appreciate every effort you make to clean up after your event
is over. Our staff has maintenance schedules exclusive of
outside groups who use our facilities and we need to make sure
that the field is ready for future groups and activities.
Thank you for your time and cooperation regarding this matter.
MEN
FOR OFFICE USE ONLY n
Certificate of Insurance Required? YES LINO
Special Events Application Required? L:I YES LINO
N yes,please fill out the attached application.
Facility Is: Request Is:
Available {v)/ Approved { }
Not Available { ) Denied { }
9 1 N44--
Recreation Department Supervisor
"� CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 12/Nail%013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
Willie of Ohio, Inc. Ai N 866-217-7737
c/o 26 Century Blvd. EAICNE
HMAIL EXT: 877-945-7378 FAX
P. O. Box 305191 ADDR certificates®willis.com
Nashville, IN 37230-5191
INSURER(S)AFFORDNG COVERAGE NAIC#
INSURERA: Lexington Insurance Company 19437-002
INSURED (0000005590) Mattituck Presbyterian ChurchINSURERB: National Union Fire Ins. Co.. of Pittsburg 19445-001
P.O. Box 1411 INSURERC:
Mattituck, NY 11952
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 20920434 REVISION NUMBER:
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.
ILTR NSR TYPEOFINSURANCE DD' SUB POLICY NUMBER POLICY EFF POLICYEXP LIMITS
A GENERAL LIABILITY y 11449743 E 048409888 1/1/2014 1/1/2015 EACHOCCURRENCE $ 2,000,000
J70ON1,ML,ERCIAMEENE RALLIABILITY DAMAGE TO RENTED
PREMISES Ea occumnce $ 500 000
CAIMS- DEO OCCUR MED EXP(Any one Person) $ 10,000
PERSONAL B ADV I WILEY $ 2 000 000
GENERAL AGGREGATE $ 4,000,000
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 4,000,000
X POLICY F7 PRO- LOC
AUTOMOBILE LIABILITYEa accident)
LE LIMIT $
ANY AUTO BODILY INJURV(Per person) $
ALLOWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) 1$
HI RED AUTOS NON-OWNED -nZPTATY DAMAGE
AUTOS Peraccident Is
8UMBRELLALIAe X OCCUR 3464079 1/1/2014 1/1/2015 EACHOCCURRENCE $ 4,000,000
X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000 000
DED RETENTION$ $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILRY Y/N
I TORY IM IS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE F N/A E.L.EACH ACCIDENT $
OFFICEWMEMBER EXCLUDED?
pMandatory in NH1 E.L.DISEASE-FSI EMPLOYEE $
f yes,descd0e un er
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICYLIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Afmch Acord 101,Additonai Remarks Schedule,if more apace Is refulred)
Re: The Great North Fork Awaking 2 being held on 7/31/14 through 8/3/14.
The Town of Southold is an Additional Insured with respects to General Liability as required by
written contract.
CERTIFICATE HOLDER RECEIVED CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
JAN 1 0 /0I1 G ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Town of Southold
53095 Southolld, NRoa11971 Southold Town Clerk
Coll:4297270 Tpl:1755478 Cert: 9 04 ®1988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
This endorsement,effective: 1/1/2014
Forms a part of Policy No.: 11449743 & 048409888
Issued to: The United Church Purchasing Group of Colorado
By: Lexington Insurance Company
ADDITIONAL INSURED REQUIRED BY WRITTEN CONTRACT
ENDORSEMENT
A. Section II—Who is an Insured is amended to include any person or organization you
are required to include as an additional insured on this policy by a written contract
or written agreement in effect during this policy period and executed prior to the
"occurrence" of the"bodily injury' or"property damage".
B. The insurance provided to the above described additional insured under this
endorsement is limited as follows:
1. This insurance provides coverage with regard to COVERAGE A BODILY
INJURY AND PROPERTY DAMAGE (Section I —coverages only.)
2. The person or organization is only an additional insured with respect to liability
arising out of"your work", 'your product", or your operations.
3. In the event that the Limits of Insurance provided by this policy exceed the
Limits of Insurance required by the written contract or written agreement,the
insurance provided by this endorsement shall be limited to the Limits of
insurance required by the written contract or written agreement. This
endorsement shall not increase the Limits of Insurance shown in the
Declarations pertaining to the coverage provided herein.
4. This insurance does not apply to"bodily injury' or"property damage" arising
out of"your work", "your product", or your operations included in the
"product-completed operations hazard" unless you are required to provide
such coverage by written contract or written agreement and then only for the
period of time required by the written contract or written agreement and in no
event beyond the expiration date of the policy.
5. Any coverage provided by this endorsement to an additional insured shall be
excess over any other valid and collectible insurance available to the additional
insured whether primary, excess, contingent or on any other basis, unless the
written contract or written agreement with additional insured specifically
requires that this insurance be primary and non-contributory with any other
insurance carried by the additional insured. In such case, this insurance shall
be primary and non-contributory with any other insurance carried by the
additional insured.
C. In accordance with the terms and conditions of the policy and as more fully
explained in the policy, as soon as practicable, each additional insured must give us
prompt notice of any"occurrence"which may result in a claim,forward all legal
papers to us, cooperate in the defense of any actions, and otherwise comply with all
of the policy's terms and conditions. Failure to comply with this provision may, at
our options, result in the claim or"suit" be denied.
All other terms and conditions of the policy remain the same.
==tph q��
Authorized Representative
ACoORDOCERTIFICATE OF LIABILITY INSURANCE page 1 of 1 07/0/D2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
Willis of Ohio, Inc. PHONEFAX
c/o 26 Century Blvd. NO EXT: 877-945-7378 N : 866-217-7737
P. O. Box 305191 ADDRESS: certificates@willis.com
Nashville, TN 37230-5191
INSURER(S)AFFORDINGOOVERAGE NAIC p
INSURERA: Lexington Insurance Company 19437-002
INSURED (0000005590) Nattituck Presbyterian Church INSURERB: National Union Fire Ins. Co. of Pittsburg 19445-001
P.O. Box 1411 INSURER C:
Nattituck, NY 11952
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:21781739 REVISION NUMBER:
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.
INSR TYPE OF INSURANCE ADD'L SUOR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
A GENERAL LIABILITY Y 11449743 & 048409888 1/1/2014 1/1/2015 EACHOCCURRENCE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY PREMSES Eaoccurence $ 500RENTED 000
CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10,000
PERSONAL&ADV INJURY $ 2,000,000
GENERAL GRE ATE $ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 4,000,000
X -[71 jECTPRO LOC $
AUTOMOBILE LIABILITY C MBINE INGL LIMIT
(Ea accident) $
ANYAUTO BODILY INJURY(Per person) $
ALLOWNED SCHEDULED BODILY INJURY(Pe
AUTOS AUTOS raccident) $
HIREDAUTOS NON-OWNED P AM
AUTOS Per accident $
B UMBRELLALIAB X OCCUR 3464079 1/1/2014 1/1/2015 EACHOCCURRENCE $ 4,000,000
X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000
DED I I RETENTION$ $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y/N R T
ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
f yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Additional Remarks Schedule,if more space is required)
Event:8/2/14 & 8/3/14 Awakening 2014 at Strawberry Fields Fairground, Nattituck, NY
Town of Southold is an Additional Insured with respects to General Liability as required by
written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Town of Southold
P.O. Box 1179
Southold, NY 11971
Coll:4453884 Tpl:1600505 Cert: 7 17 01968-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
This endorsement,effective: 1/1/2014
Forms a part of Policy No.: 11449743&048409888
Issued to:The United Church Purchasing Group of Colorado
By: Lexington Insurance Company
ADDITIONAL INSURED REQUIRED BY WRITTEN CONTRACT
ENDORSEMENT
A. Section II—Who is an Insured is amended to include any person or organization you
are required to include as an additional insured on this policy by a written contract
or written agreement in effect during this policy period and executed prior to the
"occurrence" of the"bodily injury' or"property damage".
B. The insurance provided to the above described additional insured under this
endorsement is limited as follows:
1. This insurance provides coverage with regard to COVERAGE A BODILY
INJURY AND PROPERTY DAMAGE (Section I —coverages only.)
2. The person or organization is only an additional insured with respect to liability
arising out of"your work", "your product", or your operations.
3. In the event that the Limits of Insurance provided by this policy exceed the
Limits of Insurance required by the written contract or written agreement, the
insurance provided by this endorsement shall be limited to the Limits of
insurance required by the written contract or written agreement.This
endorsement shall not increase the Limits of Insurance shown in the
Declarations pertaining to the coverage provided herein.
4. This insurance does not apply to"bodily injury'or"property damage" arising
out of"your work", "your product", or your operations included in the
"product-completed operations hazard" unless you are required to provide
such coverage by written contract or written agreement and then only for the
period of time required by the written contract or written agreement and in no
event beyond the expiration date of the policy.
5. Any coverage provided by this endorsement to an additional insured shall be
excess over any other valid and collectible insurance available to the additional
insured whether primary, excess, contingent or on any other basis, unless the
written contract or written agreement with additional insured specifically
requires that this insurance be primary and non-contributory with any other
insurance carried by the additional insured. In such case, this insurance shall
be primary and non-contributory with any other insurance carried by the
additional insured.
C. In accordance with the terms and conditions of the policy and as more fully
explained in the policy, as soon as practicable, each additional insured must give us
prompt notice of any"occurrence" which may result in a claim,forward all legal
papers to us, cooperate in the defense of any actions, and otherwise comply with all
of the policy's terms and conditions. Failure to comply with this provision may, at
our options, result in the claim or"suit" be denied.
All other terms and conditions of the policy remain the same.
= I. �' 1w p ,
#
Authorized Representative
T
o��g�FFO�,�co
ELIZABETH A.NEVILLE,MMC �� r/y Town Hall,53095 Main Road
TOWN CLERK o= P.O. Box 1179
Z
REGISTRAR OF VITAL STATISTICS y Southold,New York 11971v' • .�C
MARRIAGE OFFICER Fax(631)765-6145
O'f' �`' Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �,( �a
FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 20, 2014
Judy Risoli
Chairperson
MPC Summer Fair
Mattituck Presbyterian Church
PO Box 1411
Mattituck,NY 11952
Dear Ms. Risoli:
The Southold Town Board, at its regular meeting held on July 29, 2014, granted permission to
the Mattituck Presbyterian Church to hold its annual Summer Fair on August 23, 2014. A
certified copy of this resolution is enclosed along with the Town of Southold Policy for Special
Events on town Properties and Roads. Failure to heed the policy may result in the loss of
Clean-up deposit. An insurance policy naming the Town of Southold as additionally insured
has been filed with this office. Please contact Captain Kruszeski at the Police Department, as
soon as possible, to coordinate traffic control.
If you have any questions please contact me at the Town Clerk's office at 631-765-1800.
Good Luck with your event.
Sincerely,
V&.� "06-U-A�
Lynda M Rudder
Deputy Town Clerk
enc
Southold Town Board - Letter Board Meeting of July 29, 2014
WfF°(
` RESOLUTION 2014-646 Item # 5.19
ADOPTED DOC ID: 9994
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2014-646 WAS
ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON
JULY 29, 2014:
RESOLVED that the Town Board of the Town of Southold hereby grants permission to the
Mattituck Presbyterian Church to hold its Annual Summer Fair and close Old Sound Avenue, in
front of the church and supply traffic control, from 8:00 am to 4:00 pm on Saturday, August 23,
2014 , provided they comply with all of the restrictions in the Town's Events Policy. Support is
for this year only, as the Southold Town Board continues to evaluate the use of town roads. All
fees associated with this event have been waived with the exception of the Clean-up Deposit, are
waived.
"a
Elizabeth A. Neville
Southold Town Clerk
RESULT: ADOPTED [UNANIMOUS]
MOVER: James Dinizio Jr, Councilman
SECONDER:Louisa P. Evans, Justice
AYES: Ghosio, Dinizio Jr, Ruland, Doherty, Evans, Russell
Generated July 30, 2014 Page 29
* * * RECEIPT * * *
Date: 08/11/14 Receipt#: 176541
Quantity Transactions Reference Subtotal
1 Clean-Up Deposit 8/23/14 $250.00
Total Paid: $250.00
Notes:
Payment Type Amount Paid By
CK# $250.00 Mattituck, Presbyterian
Church
Name: Mattituck, Presbyterian Church
Main Road
P O Box 1411
Mattituck, NY 11952
Clerk ID: LYNDAR Internal ID:8/23/14
MATTITUCK PRESBYTERIAN CHURCH
16220
Vendor: Town of Southold Date: 07/29/2014 Amount: 250.00
INVOICE INVOICE INVOICE INVOICE DIST. DIST.
DATE NUMBER DESCRIPTION AMOUNT ACCOUNT AMOUNT
07/29/2014 Deposit/Clean up for 8/23/14 250.00
004203 250.00
Mattlotuck Presbyterian Church
Rev. R Patrick Smith Mr. Patrick Hanly Kay Zegel Caren Heacock
Interim Pastor Pastoral Associate Clerk of Session Pastoral Care
Assistant
July 16, 2014
To: Elizabeth A Neville, Town Clerk RECEIVED
Town of Southold
P.O. Box 1179 JUL 1 8 2014
Southoid NY i 1971
Fax: 631-765-6145
Southold Town Clerk
Dear Elizabeth,
I am requesting permission for the Mattituck Presbyterian Church to hold it's annual Summer
Fair on August 23, 2014. We would like traffic control at the intersection of Love Lane and Old
Sound Avenue for the fair between the hours of 9:00 am and 3:00 pm. We would like Old Sound
Avenue, in front of the church closed, if'possible, during the fair.
I am the Chairperson for the Fair so if you need to contact me, please call at 208-1395.
A Certificate of Insurance to cover the fair has been faxed to you by our insurance company.
Thank you for your time and consideration with this matter.
$t4� i4�L
Judy Risoli
Chairperson, MPC Summer Fair
12605 Main Road ♦ P.O. Box 1411 ♦ Mattituck,New York 11952 ♦ (631)298-4145
♦ Fax: 631-298-5356 ♦ e-mail:mattpres@optonline.com
Rudder, Lynda
From: Rudder, Lynda
Sent: Tuesday, July 22, 2014 2:15 PM
To: Flatley, Martin; Kruszeski, Frank
Subject: Mattituck Presb Summer Fair
Attachments: matt presb fair_20140722131059.pdf
Can't remember if I sent this or not, so here it comes again. Please provide approval/disapproval and cost analysis
i
Rudder, Lynda
From: Flatley, Martin
Sent: Wednesday, July 23, 2014 10:22 AM
To: Rudder, Lynda
Subject: RE: Emailing: summer fair_20140722075404.pdf
Attachments: Matt Presbyterian Summer Fair.xls
I have no objections to this event being held and the road closure, my cost analysis is attached.
Martin Flatley
Chief of Police
Southold Town Police Department
41405 State Rt. 25
Peconic, N.Y. 11958
631-765-3115
-----Original Message-----
From: Rudder, Lynda
Sent: Tuesday,July 22, 2014 9:50 AM
To: Flatley, Martin; Kruszeski, Frank
Subject: Emailing: summer fair_20140722075404.pdf
Your message is ready to be sent with the following file or link attachments:
summer fair 20140722075404.pdf
Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file
attachments. Check your e-mail security settings to determine how attachments are handled.
1
Town of Southold Police Department
Special Event Cost Analysis
jl
- - 1
-
Event. hutch Summer Fair
Date(s): August 23, 2014
Location: Mattituck Presbyterian-Church j
I
Patrol Allocatik!went
g y g _
i Re Hours I OT Hrs Hrl Wage � Total �� Comments
Police Officer
Special Patrol'
Reg Hours OT Hrs Hrly Wage Total Comments
CRU
+ i
11 '
Bicycle Patrol
h ;
it
Krt$Unit �
j
Highway Patrol
M4 ne Unit
i � I
Traffic G "t
Reg_Hours_1OT H_rs Hrly Wage Total Comments
TC Officer - 7 - -
1 $16.46 $115.22TC Officer '
TC Officer i 7{ $16.46 $115.22 j
T Officer
� - _ if
TC Officer
Equipment Costs
Total Department Cost for Event = $ $230.44
Prepared by Chief M. Flatley 7/23/2014 Page 1
JUL-23-2014 10:57A FROM:MATTITUCK PRESBYTERI 631-298-5356 TO:7656145 P.2/3
CERTIFICATE 4F LIABILITY INSURANCE Pa e 1 of 1 0�/a/2014
9
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed:df SUBROGATION 18 WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such andorsement(s).
PRODUCER CONTACT
KIAUP
Willis of Ohio, Inc. ONE
c/o 26 Century Blvd. r-(�/G..N • 877-945-7378
- - 378 FAX 866-217-7737
P. O. Sox 305191 E-MAIL i Ca i
Nashville, TN 37230-5191 INSURERS FFORDINGCOVERAGE NAZCA
INSURERA: Lexington Insurance Company 19437-002
INSURED (0000005590) Mattituak Presbyteries Church INSURERB:NAtiOAal Union Hire Ins. Co. of Pittsburg 19445-001
P.O. Box 1411 INSURERC,
MAttituck, NY 11952
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:21852437 REVISION NUMBER:
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 REOUIREMENT,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,
INSR TYPE OF INSURANCE DD' BUB POLICY NUMBER POLICYEFF POLICY EXPITR LIMITS
A GENERAL LIABILITY Y 11449743 a 048409888 /1/2014 1/1/2015 EACH OCCURRENCE $ _2j000.000
COMMERCIAL GENERAL LIABILITY 1 E 500,000
CLAIMS-MADEQ OCCUR MED EXP An one Bon S 10,000
PERSONAL A ACV INJURY _$ 2 O-OA,0 0 0
GENERALAGGREGATE S 4,090,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP/OPAGG S 4,000,000
PQLICYF_J PRO-IEMLOC $
AUTOMOBILE LIABILITY a81N�D SINGLE LIMIT :
ANY AUTO BODILY IINJURYIPer parson) S
AUTOS OWNED AUTOSULED BODILY INJURYIPeraccldent) $
HIREDAUTOS NON-OWNED
AUTOS eracddent S
$
BUMBRELLALIAB X OCCUR 3464079 /1/2014 1/1/2015 EACH OCCURRENCE S 4.000.00g
X EXCESS LIAR CLAIMS-MADE AGGREGATE _ $ 4,900,000
DED I IRETENTION S $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY I
ANY PROPRIETORIPARTNEWEXECUTWE NSA E.L.EACH ACCIDENT S
OFFICER/MEMBER EXCLUDED?
ryaerill lbaNunder E.L.DISEASE-EA EMPLOYEE $
OESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT s
0 ESC RIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach Acord 101,Additional Ramerko Schedule,If mon apeee to roqulred)
Ret Summer Fair/Church Yard Sale being held on 8/23.
Town of Southold in an Additional Insured with respects to General Liability as required by
written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
Town of Southold
PO Box 1179
Southold, NY 11971
Coll:4470633 Tp1:1763356 Cert: 8 24 ®19 8-2010ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
JUL-23-2014 10:58A FROM:MATTITUCK PRESBYTERI 631-298-5356 TO:7656145 P.3/3
This endorsement,effective: 1/1/2014
Forms a part of Policy No.: 11449743&048409888
Issued to: The United Church Purchasing Group of Colorado
By: Lexington Insurance Company
ADDITIONAL INSURED REQUIRED BY WRITTEN CONTRACT
ENDORSEMENT
A. Section 11—Who Is an Insured is amended to include any person or organization you
are required to include as an additional insured on this policy by a written contract
or written agreement in effect during this policy period and executed prior to the
"occurrence"of the"bodily injury'or"property damage".
B. The insurance provided to the above described additional insured under this
endorsement is limited as follows:
1. This insurance provides coverage with regard to COVERAGE A BODILY
INJURY AND PROPERTY DAMAGE (Section I—coverages only.)
2. The person or organization is only an additional insured with respect to liability
arising out of"your work", "your product", or your operations.
3. In the event that the Limits of Insurance provided by this policy exceed the
Limits of Insurance required by the written contract or written agreement, the
insurance provided by this endorsement shall be limited to the Limits of
insurance required by the written contract or written agreement.This
endorsement shall not increase the Limits of Insurance shown in the
Declarations pertaining to the coverage provided herein.
4. This insurance does not apply to"bodily injury"or"property damage"arising
out of"your work", "your product", or your operations included in the
"product-completed operations hazard"unless you are required to provide
such coverage by written contract or written agreement and then only for the
period of time required by the written contract or written agreement and in no
event beyond the expiration date of the policy.
5. Any coverage provided by this endorsement to an additional insured shall be
excess over any other valid and collectible insurance available to the additional
Insured whether primary, excess, contingent or on any other basis, unless the
written contract or written agreement with additional insured specifically
requires that this insurance be primary and non-contributory with any other
insurance carried by the additional insured. In such case,this insurance shall
be primary and non-contributory with any other insurance carried by the
additional insured.
C. In accordance with the terms and conditions of the policy and as more fully
explained in the policy, as soon as practicable, each additional insured must give us
prompt notice of any"occurrence"which may result in a claim,forward all legal
papers to us, cooperate In the defense of any actions, and otherwise comply with all
of the policy's terms and conditions. Failure to comply with this provision may, at
our options, result in the claim or"suit" be denied.
All other terms and conditions of the policy remain the same.
dpwir,�I?
Authorized Representative
JUL-23-2014 10:57A FROM:MATTITUCK PRESBYTERI 631-298-5356 TO:7656145 P.1/3
TO: Elizabeth A Neville, Town Clerk
Fax#: 631-765-6145
From: Mattituck Presbyterian Church
Re: Certificate of Insurance
Date July 23, 2014
Attached is a copy of our Certificate of Insurance for the Summer Fair/Yard Sale we wish
to schedule for August 23, 2014.
Thank You for your help.
Judy Risoli, Chairperson
MPC Summer Fair
Fax 631 -298-5356
web: www.mattpres.com
Mattituck Presbyterian Church
P.O. Box 1411 12605 Main Road
Mattituck NY 11952
(631) 298-4145
Fax(631) 298-5356
FAX ,
A CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 ATE
/014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
Willis of Ohio, Inc. PHONE FAX
c/o 26 Century Blvd. RECEIVED N EXT: 877-945-7378 No: 866-217-7737
P. 0. Box 305191 ADDRIEs : certificates@willis.com
Nashville, TN 37230-5191
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Lexington Insurance Company 19437-002
INSURED
(0000005590) Nattituck Presbyterian Church INSURERB: National Union Fire Ins. Co. of Pittsburg 19445-001
P.O. Box 1411 INSURERC:
Nattituck, NY 11952 Southold Town Clerk INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:21852437 REVISION NUMBER:
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.
INSR TYPE OF INSURANCE DD' SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS
A GENERAL LIABILITY Y 11449743 & 048409888 1/1/2014 1/1/2015 EACHOCCURRENCE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY DAMAPREMISES E ToEaoccurence $ 500RENTED 000
CLAIMS-MADE OCCUR MED EXP(Anyone person) $ 10.000
PERSONAL&ADV INJURY $ 2,000,000
GENERALAGGREGATE $ 4,000,000
GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 4,000,000
X POLICY PRO-jECT LOC
AUTOMOBILE LIABILITY COMBINEDIN L LIMIT
(Ea accident $
ANY AUTO BODILY INJURY(Per person) $
ALLOWNED SCHEDULED I
BODLY INJURY Per accident
AUTOS AUTOS ( ) $
HIREDAUTOS NON-OWNED PROPERTY DAMAGE
AUTOS Per accident $
$
B UMBRELLALIAB X OCCUR 3464079 1/1/2014 1/1/2015 EACH OCCURRENCE $ 4,000,000
X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 4,000,000
DED I I RETENTION$ $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y/N Y IT
ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
ff yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Additional Remarks Schedule,it more space is required)
Re: Summer Fair/Church Yard Sale being held on 8/23.
Town of Southold is an Additional Insured with respects to General Liability as required by
written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Town of Southold
PO Box 1179
Southold, NY 11971 6
Coll:4470633 Tpl:1763356 Cert:71852437 ®1988-2010ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
This endorsement,effective: 1/1/2014
Forms a part of Policy No.: 11449743& 048409888
Issued to: The United Church Purchasing Group of Colorado
By: Lexington Insurance Company
ADDITIONAL INSURED REQUIRED BY WRITTEN CONTRACT
ENDORSEMENT
A. Section II—Who is an Insured is amended to include any person or organization you
are required to include as an additional insured on this policy by a written contract
or written agreement in effect during this policy period and executed prior to the
"occurrence"of the"bodily injury' or"property damage".
B. The insurance provided to the above described additional insured under this
endorsement is limited as follows:
1. This insurance provides coverage with regard to COVERAGE A BODILY
INJURY AND PROPERTY DAMAGE (Section I —coverages only.)
2. The person or organization is only an additional insured with respect to liability
arising out of"your work", "your product", or your operations.
3. In the event that the Limits of Insurance provided by this policy exceed the
Limits of Insurance required by the written contract or written agreement,the
insurance provided by this endorsement shall be limited to the Limits of
insurance required by the written contract or written agreement. This
endorsement shall not increase the Limits of Insurance shown in the
Declarations pertaining to the coverage provided herein.
4. This insurance does not apply to"bodily injury" or"property damage"arising
out of"your work", "your product", or your operations included in the
"product-completed operations hazard" unless you are required to provide
such coverage by written contract or written agreement and then only for the
period of time required by the written contract or written agreement and in no
event beyond the expiration date of the policy.
5. Any coverage provided by this endorsement to an additional insured shall be
excess over any other valid and collectible insurance available to the additional
insured whether primary, excess, contingent or on any other basis, unless the
written contract or written agreement with additional insured specifically
requires that this insurance be primary and non-contributory with any other
insurance carried by the additional insured. In such case, this insurance shall
be primary and non-contributory with any other insurance carried by the
additional insured.
C. In accordance with the terms and conditions of the policy and as more fully
explained in the policy, as soon as practicable, each additional insured must give us
prompt notice of any"occurrence"which may result in a claim,forward all legal
papers to us, cooperate in the defense of any actions, and otherwise comply with all
of the policy's terms and conditions. Failure to comply with this provision may, at
our options, result in the claim or"suit" be denied.
All other terms and conditions of the policy remain the same.
ph R+:qr.-
Authorized Representative
�'WrFor+
obi®, RESOLUTION 2014-646
ADOPTED DOC ID: 9994
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2014-646 WAS
ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON
JULY 29, 2014:
RESOLVED that the Town Board of the Town of Southold hereby grants permission to the
Mattituck Presbyterian Church to hold its Annual Summer Fair and close Old Sound Avenue, in
front of the church and supply traffic control, from 8:00 am to 4:00 pm on Saturday, August 23,
2014 , provided they comply with all of the restrictions in the Town's Events Policy. Support is
for this year only, as the Southold Town Board continues to evaluate the use of town roads. All
fees associated with this event have been waived with the exception of the Clean-up Deposit, are
waived.
Elizabeth A. Neville
Southold Town Clerk
RESULT: ADOPTED [UNANIMOUS]
MOVER: James Dinizio Jr, Councilman
SECONDER:Louisa P. Evans, Justice
AYES: Ghosio, Dinizio Jr, Ruland, Doherty, Evans, Russell
Vendor No. Check No.
Town of Southold, New York - Payment Voucher j
Check Made Payable To: /1 Mail check to(mailing address): Entered by
P. 0 • �OX I —'i ( I Audit Date
Contact Telephone Number
cQq2>
_ Ll I L( 5 �'1 C�.kE''� -E' e l� �� \� �a Town Clerk
Contact Name
0.Y-) '%c2
Invoice Invoice Invoice Net Purchase Order
Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number
Special Event can-up
250.00 250.00 Deposit Refund T1.030
I
� I
I
Total 250.00
Payee Certification Department Certification
The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me
does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly
been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions
due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved.
Signatur Title Signature( T—Y-1
i^
Company Name Date__1O B Titla a n `tel Y4 tai Date l b .1
Southold Town Board - Letter Board Meeting of November 5, 2014
6 `° �'°��, RESOLUTION 2014-862 Item # 5.6
�` 'va6 ADOPTED DOC ID: 10195
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2014-862 WAS
ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON
NOVEMBER 5, 2014:
WHEREAS the Mattituck Presbyterian Church has supplied the Town of Southold with a Clean-
up Deposit fee in the amount of$250.00 for their Fair and
WHEREAS the Southold Town Police Chief, Martin Flatley, has informed the Town Clerk's
office that this fee may be refunded, now therefor be it
RESOLVED that Town Board of the Town of Southold hereby authorizes a refund be issued in
the amount of$250.00 to Mattituck Presbyterian Church, PO Box 1411, Mattituck,NY 11952.
Elizabeth A. Neville
Southold Town Clerk
RESULT: ADOPTED [UNANIMOUS]
MOVER: Louisa P. Evans, Justice
SECONDER:Robert Ghosio, Councilman
AYES: Ghosio, Dinizio Jr, Ruland, Doherty, Evans, Russell
Generated November 7, 2014 Page 15