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HomeMy WebLinkAboutModa Operandi o�OgUf FOt,�-�O ELIZABETH A. NEVILLE,MMC hZ+ l/y Town Hall,53095 Main Road TOWN CLERKC P.O.Box 1179 CIO Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p Fax(631)765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER �V,1 .#�� Telephone FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov 765-1800 www.southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT Issued to: Moda Operandi Date(s), Time(s) and Location: May 27, 2014 9:00 am to 6:00 pm 67 Steps Beach, end of Sound Road, Greenport,NY Permit No. . 038 Issue Date: 5/22/14 Elizabeth A. Neville Southold Town Clerk (Town Seal) ELIZABETH A. NEVILLE,MMC �� �/y Town Hall, 53095 Main Road TOWN CLERKo P.O. Box 1179 2 ? Southold,New York 11971 REGISTRAR.OF VITAL STATISTICS O Fax(631)765-6145 MARRIAGE OFFICER �'� �� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �.� `�►� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT DATE: TUESDAY, MAY 279 2014 TIME: 9:00 A.M. TO 6:00 P.M. LOCATION: 67 STEPS BEACH, end of Sound Road, Greenport Moda Operandi PLACE THIS PERMIT ON THE DASHBOARD, PASSENGER SIDE OF VEHICLE Elizabeth A. Neville Town Seal Southold Town Clerk �SUFFat�►�o ELIZABETH A.NEVILLE,MMC �+�►� GTown Hall,53095 Main Road TOWN CLERK 0 P.O.Box 11.79 y Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p + Fax(631)765-6145 MARRIAGE OFFICER 'y� �" Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER '�.l "�►� wwwsouthold� p FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK MAY 2 2 2014 TOWN OF SOUTHOLD APPLICATION FOR FILMING/STILL PHOTOGRAPI&uthold Town Clerk PERMIT NO: Please Print or Type APPLICATION DATE: 2� 1� NAME OF APPLICANT: R40W cr—l-'a, MAILING ADDRESS: 100k2,;' . PHONE: BUSINESS: HOME: NAME OF ORGANIZATION/COMPANY: MAILING ADDRESS:—31S PHONE: 24,37 DS Qc( (q7 FAX: DESCRIBE TYPE OF ACTIVITY (e.g. Motion Picture, Commercial, Television. Catalog, Magazine,etc.): DATE(S)AND TIME(S) OF PROPOSED FILMING/PHOTOGRAPHY: MA-\< a"t� a A-AA P M PROPOSED LOCATION(S) OF FILMING/PHOTOGRAPHY: (attach additional sheet, if necessary) NAME OF PERSON IN CHARGE AT SITE: 1b aj�LA k pr t_pN Cs 1 NO'S NUMBER OF PERSONS AT LOCATION(cast & crew included): O . NUMBER AND TYPE OF VECHILES AT LOCATION: UoCA-' \0t"A TYPE OF SPECIAL EQUIPMENT: jEj \P q\X tSN�A' ANY SPECIAL REQUIREMENTS: Signature Return to: Southold Town Clerk Southold Town Hall .M 53095 Main Road P.O. Box 1179 Southold, NY 11971 i i I APPLICANT'S CHECKLIST FOR FILMING PERMIT / NOTE: All payments must be cash or certified check. V mpleted application /$100 nonrefundable application fee Certificate of insurance that evidences a public liability insurance policy covering the town as an additional insured in the amount of$1,000,000 (one million dollars)per occurrence for the duration of the filming or still p tography. Indemnification agreement stating the applicant agrees to assume all liability for and will indemnify and hold the town harmless of and free from any and all damages that occur to persons or property by reason of said filming or still photography. Permit Fees (Prior to issuance of permit): V Fi in Fee - $100 per day of each day covered by the permit Cleanup deposit: Separate check for$250 for each day covered by the / ermit. N( Traffic control fee-$1000 for each day covered by the permit if required y the Chief of Police. Beach Parking fee- $10 per vehicle,per day between May I and September 30. ALL CHECKS MUST BE CERTIFIED NOTE: Additional fees for Cleanup and Traffic Control may be required at the direction of the Chief of Police and Superintendent of Highways INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT The Applicant shall indemnify and hold harmless the Town from and against all suits, claims, demands or actions for any damage and/or injury sustained or alleged to be sustained by any party or parties in connection with the performance of filming or still photography by the Applicant,his employees or agents or any subcontractor and in case of any such action brought against the Town,the applicant shall immediately take charge of and defend the same at his own cost and expense. In addition, the Applicant will name the Town as an additional insured on any applicable policies. , Stature Date Printed name Title i i i CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDYYYY) 5/21/2014 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: ARM-Capacity of New York, LLC PHOtAIC.NENo, 4 -4 -24 a/c No: 4 -4 -24 1 90 Broad Street, Suite 1503 E-MAIL New York NY 10004 ADDRESS:of r n . INSURERS AFFORDING COVERAGE NAIC# INSURERA:LI Ins. UnderwritersIn INSURED 3352 INSURERB:ChU b National In . CQ. Moda Operandi Inc. INSURER C:F r In 2-Q281 315 Hudson Street#5th Floor INSURER D:Great Northern New York NY 10013 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:2059267583 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 ADDL SUBRI LTR TYPE OF INSURANCEPOLICY LICY EXP IN R WVD POLICY NUMBER 'S MM/DDYEYYY MM/DD YYYY LIMITS D GENERAL LIABILITY Y Y 35987719 /15/2013 /15/2014 EACH OCCTURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE RENTED PREMISES Ea occurrence $1,000,000 CLAIMS-MADE IT] OCCUR MED EXP(Any one person) $10,000 _ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GE 1-AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 X JECT POLICY PRO- LOC $ C AUTOMOBILE LIABILITY 73581012 p/15/2013 /15/2014 BINED SINGLE LIMIT— (Ea accident $Included ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED ', PROPERTY DAMAGE AUTOS Per accident $ C X UMBRELLA LIAB X OCCUR 79890895 7/15/2013 /15/2014 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X I RETENTION$10.000 $ C WORKERS COMPENSATION 71740141 /15/2013 /15/2014 1 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N 1() TER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 4, Crime LP46 C U0127 13 16/1/2013 /1/2014 Limit $1,000,000 B Inland Marine 096 6/1/2013 /1/2014 Limit $600,000 D&O/EPLI B U0563 13 6/1/2013 /1/2014 D&O/EPLI Limits $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Included is Policy#0CA9X8H13,Aspen American Ins. Co. Line of Business-Transportation. Effective 6/1/2013-14. Limit$25,000. Deductible $500. Also included is Policy ESB01051264, Lloyds of London. Line of Business-Cyber/General Liability. Effective 6/1/2013-14. Limit$1,000,000 Deductible$500. See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Hall, 53095 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold, NY 11971 AUTHORIZED REPRESENTATIVE J ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r, AGENCY CUSTOMER ID: 3352 LOC#: A�I.l► ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED ARM-Capacity of New York, LLC Moda Operandi Inc. POLICY NUMBER 315 Hudson Street#5th Floor New York NY 10013 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Also included is Policy#PHFD37549381 001. ACE America Ins. Co. Line of Business-World Wide Liability. Effective 9/14/2012-13. General Aggregate-$2,000,000/Each Occurrence-$1,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 5/21/2014 FedEx Ship Manager-Print Your Label(s) From: (646)741-1814 Origin ID:AYZA Ship Date:21MAY14 Shipping Department m ActWgt:1.0 LB Express CAD:104742926ANET3490 315 Hudson St 5th FI Delivery Address Bar Code New York,NY 10013 J14101402070326 III IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII SHIP TO: (347)255-0967 BILL SENDER Ref# STUDIO Town Hall Invoice# PO# 33095 Main Road PO Box 1179 Dept# SOUTHOLD, NY 11971 TH U - 22 MAY AM TRo 7700 5868 4846 STANDARD OVERNIGHT Rz ' 11971 EL W NY-US K JFK � A 522G1/62D3/F220 After printing this label: 1. Use the'Print'button on this page to print your label to your laser or inkjet printer. 2. Fold the printed page along the horizontal line. 3. Place label in shipping pouch and affix it to your shipment so that the barcode portion of the label can be read and scanned. Warning: Use only the printed original label for shipping. Using a photocopy of this label for shipping purposes is fraudulent and could result in additional billing charges,along with the cancellation of your FedEx account nurr>ber. Use of this system constitutes your agreement to the service conditions in the current FedEx Service Guide,available on fedex.corrmFedEx w ill not be responsible for any claim in excess of$100 per package,w hether the result of loss, damage,delay,non-delivery,rrisdelivery,or misinformation, unless you declare a higher value,pay an additional charge,document your actual loss and file a timely claim.Lin-itations found in the current FedEx Service Guide apply.Your right to recover from FedEx for any loss, including intrinsic value of the package, loss of sales, income interest, profit,attorney's fees,costs,and other forms of damage w hether direct, incidental,cons equential,or special is limited to the greater of$100 or the authorized declared value. Recovery cannot exceed actual documented Ioss.Maximum for items of extraordinary value is$1,000,e.g.jewelry,precious metals, negotiable instruments and other items listed in our ServiceGuide.Written claims must be filed w ithin strict time limits,see current FedEx Service Guide. https:/AmAw.fedexcorrVshipping/shipmentConfirmabonAction.handle?method=doContinue 1/1 ELIZABETH A.NEVILLE,MMC �� G.j, Town Hall,53095 Main Road TOWN CLERK o P.O. Box 1179 c/o 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p �C Fax(631)765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER �Ol �a� Telephone 765-1800 www.southoldtldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Flatley, Southold Town Police Martin, Finnegan, Town Attorney From: Lynda M. Rudder, Deputy Town Clerk Dated: May 22, 2014 Re: Filming Permit Transmitted herewith is the application of Moda Operandi for a photo shoot permit to take place on the beach at the end of Sound Road, Greenport on Tuesday, May 27, 2014 from 9am to 6pm. In accordance with Section 139.0 of the Town Code please review the application and advice of approval or disapproval of the application and whether a traffic control fee is required and the amount needed. Rudder, Lynda From: Flatley, Martin Sent: Thursday, May 22, 2014 1:52 PM To: Rudder, Lynda; Kruszeski, Frank; Krauza, Lynne; Finnegan, Martin Cc: Blasko, Regina Subject: RE: Filming Permit I have no objection to this permit being issued. I thought you were referring to the verbal okay I gave the other day, sorry 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:Thursday, May 22, 2014 11:26 AM To: Flatley, Martin; Kruszeski, Frank; Krauza, Lynne; Finnegan, Martin Subject: Filming Permit Importance: High Attached please find a filming permit for Moda Operandi for Tuesday, May 27, 2014. Please respond as soon as possible because there is very little turnaround time. TOWN CLERK'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check Applicant: 1' odo— ODer&-YNA i Date Received: S��I y Completed application ✓ $100 nonrefundable application fee Certificate of insurance that evidences a public liability insurance policy covering the town as an additional insured in the amount of$1,000,000 (one million dollars) per occurrence for the duration of the filming or still photography. ✓ Indemnification agreement stating the applicant agrees to assume all liability for and will indemnify and hold the town harmless of and free from any and all damages that occur to persons or property by reason of said filming or still photography. Forward completed application to Chief of Police for approval or disapproval and determination if Traffic Control Fee is required ✓ Approved Disapproved No Fee Required Fee in the amount of$ required 1 Forward certificate of insurance and indemnification agreement to Town Attorney for/approval ✓ Approved Disapproved COLLECT FEES AS FOLLOWS: Permit Fees (Prior to issuance of permit): Film Fee - $100 per day of each day covered by the permit Cleanup deposit: Separate certified check for$250 for each day covered I A by the permit. Traffic control fee - $1000 for each day covered by the permit if required by the Chief of Police. NOTE: Additional funds may be required by Police if it is determined that $1000 per day fee will be expended prior to the termination of the permit period. Beach Parking fee - $10 per vehicle, per day between May 1 and September 30. ISSUED PERMIT ✓ Countersign application Issue permit with name of applicant, locations(s), date(s), and time(s) NOTIFICATION of ISSUED PERMIT V Chief of Police V Chief Building Inspector ✓ Fire Marshal ✓ Code Enforcement Officer Superintendent of Highways ►✓ Superintendent of Parks and Recreation REQUEST FOR EXTENSION OF PERMIT Forward extension permit request to Chief of Police If granted, collect additional $100 per day filming fee Amend permit to indicate granted extension period COMPLETION OF PERMIT PERIOD Chief of Police to provide applicant with statement of cost for providing Traffic Control and police coverage. (Refund overpayment or collect for additional costs within 30 days of termination of permit) Superintendent of Highways inspections locations listed on permit and determine if cleanup efforts by town personnel is required. *If cleanup is required, Superintendent will provide Town Clerk with a statement of actual costs. (Refund overpayment or collect for additional costs within 30 days of termination of permit) *If not cleanup is required, Superintendent of Highways will notify Town Clerk and Town Clerk will remit the $250 certified check to applicant. . . .. US DOLLAR R, FT 1 l►►JJJJ44�- (OFFICIAL CHEC Branch 612 - -10215 -77-8 MODA OP—;:RAND'I INC, z��n���� a51 125 REMITTER DATE PAY USD THUNDRED FIFTY ONLY � $ e TWO L.S.DOLLARS TO SOUTHOLD TOWN CLERK* D ec HS Bank USA,NA, � S16 TURES REQU! R kJNf 0 ABOVE THE ORDER ! _� OF � AUTHORIZEDs►t;NATu�E AUTHORIZED E Payable through HSBC Bank USA,N.A. 11' L02L5873L11' �:02230L253�: 7L30LL55611' � HOLD D. -71 RM HSBC 1IS11} V 14 Branch: 692 : i R�4L�A(3PEf3ANDi M21May2U14 REMITTER DATE PAY USO TWO HUNDRED TEN ONLY � � O w�� ye } U S. 45 Dra c'HSBC Bank USA, A - e TO 54UTCLi Tt3l SLE `� `�UNTfioa Tw SI6NATU U Eb THE . ORDER OF AUTHORIZED SIqlNA117RE Payable through HSBC Bank USA,N.A. [in L02Ill 58730115 1:02230L2531: 7L30L1, 556ii' Rudder, Lynda From: Rudder, Lynda Sent: Thursday, May 22, 2014 3:29 PM To: Flatley, Martin; Kruszeski, Frank;Verity, Mike; Fisher, Robert; Doherty,Peter; Orlando, Vincent (vincent.orlando@town.southold.ny.us); Standish, Jeff, Foote, Nancy Subject: filming Permit Issued Attachments: film_20140522142700.pdf Importance: High Your message is ready to be sent with the following file or link attachments: fi l m_20140522142700.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. Rudder, Lynda From: Martin Finnegan Forward Sent: Thursday, May 22, 2014 11:51 AM To: Rudder, Lynda Cc: Flatley, Martin; Kruszeski, Frank; Krauza, Lynne; Finnegan, Martin Subject: Re: Filming Permit No objection. Sent from my Whone >On May 22, 2014, at 11:25 AM, "Rudder, Lynda" <Ivnda.rudder@town.southold.nv.us>wrote: >Attached please find a filming permit for Moda Operandi for Tuesday, May 27, 2014. Please respond as soon as possible because there is very little turnaround time. ><filming permit_20140522102120.pdf> 1 MIODA OPERANDI W W W.M()DAOPERANDI.COM 72 MADISON AVENUE 3RD FLOOR NEW YORK, NY 10016 • T: +l 212 796-5704 T: +I 888 797-2741 Package Fd& US 567 N" 8030 0250 0 ' Y 1 Express — 1 Froin Pkimpinwapermagskat 4 ExpimPackageSerAce -bosom ��Prya�ap.aapbxl�R L / Senders FedEx NOTE Service order has changed.Please select carefully. lir ydbtapeM rysa"i= Date J 111U[L((Y�� Account Number 10667""7029"8 Senders J ` , Fed&FiratOve FedEx2DeyAM. Name L Wrier( IJOC�I�,r' Phone( 631) 765-1600 ❑ rw..xNdbae:.. deArwybemeot ❑ seedEx2D..n.r . loeetl...Ridsy �be MKwed on seosdeY OMrerYHOTewlable. 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Agreement To Terms By giving us your package:o deliver, addressing or those of the recipient or anyone eisa with You may sa our Customer Service oepart�-ent at v u agree*to all The terms on this Airbill and in thea nt an interest In the package. 1.800 GoFedEx 1800 463.3339.c report a claim,however, dEx Service Guide,wh�ch is available at fedex.com or ata you must t'i`i!e a t me. :n.t �claim.We aren't obit atad —if you or the recipient violates any of the terms of g Ex on.Yo,also agree to those terms on bena'i of any to act on a v Na m unfit ypu have Pa(t4ah trarisportation our Agreement. itr an interest in the package If there is a conflict charges,and you mDv n t deduct the amount Of your claim FedEx Service Guide and this Nidio'i :he —for loss of or damageto shipments of prohibited items- from thD__t g s. _ _.. to Guide will control.No cne is a th ized:c —for loss,damage,or delay caused by events we cannot Ir the recp�eat accepts r,our caakeoe without noting ge cur Agreement l 0 ontrol,Incuding but not I�mited to acts of God,perms of damage I,dobe ass,—,e the package Responsibility For Packaging And Completing Airbill heair, eat,e ccnd.tions,acts of public enemies,war a h li c _ o e�roqess your claim, er adegoare y packagping your p_2hs . c � r_es c. �cmrrot&s,or acts ,f pupils authorities Von m,�s: exons and packing h s rb�l If you omi t,- rumber D` actual oT apparent autncricy ar a,ao: car o xag, . v✓ a Declared Value Limits Right To Inspect ;a n,open and inspect ti i,imbei­Of Lac a ��ec he- re us to de! d �c ��d`craFetlExEnvelops^r YPurpac r F a� ver u a na; __s!SS50c Right Of Rejection _ o reject a �. s-ipmen su_ c d r r to cause Responsibility For Payment E�r 'f err; o r t `r Ti �m u,deciared value allowed is Resp y Y CC d �d/Dr oelac on ��:,or ti a ,aes be D e c u C - «y ess your package contains items � of extraercm a ie,in which case the maximum declared pe s nre if t-a c� ldseI;, ttty;or if the any cost wa incur' e,' r r �,'ng �hipmen' r lC:o a*e pftur A� Or juent pecK ge'o f .o *arehousing it penng dispostc�� a,uc arowe s USS',000 per package FedEx Service Guide •Items of ext ac dinary value include shipments containing Limitations On Our Liability And Liabilities C.O.D.Services S -iCE IS fkp VA!LABLE Nll?H Not Assumed sunt nems as artwork jewelry,furs,precious metals;nego- T 1 �,,� , liable instruments,and other items listed in thacurrent FedEx HIS A 9B LL.If C-u t ce is requireo plea,--use a FedEx •Umess a higher value is deciared and cold for,our liability for S. .�ce Guide. C.0.0.A olii. eac'r p nage is irrited to US$100.YOU may pay an additional Air Transportation Tax included A federal excise d - :�,ar "cr each a'�100 of declared va'ue The •You may send more than one package on this Airbill and f II P deC,ared value Lues not constitute,nor do we Provide,cargo in the total declared value for all packages,not to exceed tax when required io the Internal Revenue,is p idori the air iiaoi y insurance the USS500,'JS$1,000,or USS50.000 noir package �t t'a'sp�i touch portio of this service,if any,is paid.by us. V Described above (Example.5 packages can have a total Money-Back Guarantee In the event of untimely delivery, • In ary event,we velli Oot ba liable lot any Damage whether declared value of up to US$250,000.)In that case,our liability FedEx wm at,o�r request ane nein some Imitations,refund direct,incidental,special,or consequential,in excess of the is limited to the actual value of the packages)lost or damaged, cr crPd!- 1 o c"�a, e� Sea:he current FedEx U.c[ared value of a shipment,whether or not FedEx had but may not exceed me maximum allowable declared value(s)or sr"ice C -Or.���c r rc oowledge that such damages might be incurred,Including the total declared value vvnlcbever is less You are responsible not limited to loss of income or profits for provirq_tna actua�loss or damage_ Part 163134•Rev.Date 2/12 * * * RECEIPT * * * Date: 05/22/14 Receipt#: 170085 Quantity Transactions Reference Subtotal 1 Cleanup Fee -To 3t, IZErtlt2Ng:1) 038 clean $250.00 Total Paid: $250.00 Notes: Payment Type Amount Paid By CK# $250.00 Moda, Operandi �'IrWNCtsccl 7bak �jW tp Name: Moda, Operandi 315 Hudson Street, Floor 5 New York, NY 10013 Clerk ID: LYNDAR Internal ID: 038 clean f ' * * * RECEIPT * * * Date: 05/22/14 Receipt#: 170070 Quantity Transactions Reference Subtotal 1 Application Fee- Non-Refund 038 $100.00 1 Beach Permits 038 parking $10.00 1 Daily Filming Permit 038 permit $100.00 Total Paid: $210.00 Notes: Payment Type Amount Paid By CK# $210.00 Moda, Operandi Fr►ancesc4 Do -alto Name: Moda, Operandi 315 Hudson Street, Floor 5 New York, NY 10013 Clerk ID: LYNDAR Internal ID:038 permit Vendor No, Checic i�To Town of Southold, New York - Payment Voucher Vendor Name Vendor Address EaiLeCeia) :_: ..................................... ......................... ............ ... .... .............................. Moda Operandi 315 Hudson, Floor 5 New ..N__Y_ 10__0.13 _ _ ... ......... Vendor Telephone Number 3471255-0967 ocvii:GIerlc --- ....................... - ---- ----— -- - - ........................... Vendor Contact Francesca Del Balzo Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services C7eneial:I edgei Ftitid:and AbcouptNumber 7/11/2014 250.00 250.00 Clean-up Deposit Refund 1•'E: 3Q >: »: :: ............. .............................. Total 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. Signatut Signatur Company Name Date 11 Title�7[1-++ �,b,� Date Southold Town Board - Letter Board Meeting of July 1, 2014 WFFat RESOLUTION 2014-572 Item # 5.5 ADOPTED DOC ID: 9915 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2014-572 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JULY 1, 2014: WHEREAS Moda Operandi has supplied the Town of Southold with a Clean-up Deposit fee in the amount of$250.00 for their photo shoot 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 Moda Operandi, 315 Hudson Street, floor 5, New York,NY 10013. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: William P. Ruland, Councilman SECONDER:Louisa P. Evans, Justice AYES: Ghosio, Dinizio Jr, Ruland, Doherty, Evans, Russell Generated July 7, 2014 Page 12 Rudder, Lynda From: Flatley, Martin Sent: Monday, June 16, 2014 4:32 PM To: Rudder, Lynda Subject: RE: Cleanup deposit Yes Lyn,the only remnants are the paint markings that the Suffolk Bike Riders use that never seems to fade away �yGa�rt1� �G Chief of Police Southold Town Police Department 41405 State Rt. 25 Peconic, N.Y. 11958 631-765-3115 From: Rudder, Lynda Sent: Monday, June 16, 2014 8:50 AM To: Flatley, Martin; Orlando, Vincent Subject: Cleanup deposit Importance: High Can the following clean-up deposits be returned? North Fork Southold Little League Suffolk Biker Riders Association Filming Permit for 67 steps 1