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Home My WebLink AboutLadies Home Journal Magazine o�*OF SO�jyOl ELIZABETH A. NEVILLE '` Town Hall, 53095 Main Road TOWN CLERK Y.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER �� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER �l�'`► Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �U + southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Returned to: Ladies' Home Journal Magazine $250.00 Cash Deposit for Cleanup Received b b Signature Date Print Name and Title f ti� FILMING/STILL PHOTOGRAPHY PERMIT Issued to: Ladies' Home Journal Magazine Date(s), Time(s) and Location Friday, June 29, 2007 Permitted for public areas only and provided shooting will not interfere with traffic. Love Lane, Mattituck; along Oregon Road, between Bridge Lane, Cutchoizue and Wickham Avenue, Mattituck, along Moore's Lane, Cutchogue; "downtown"New Suffolk; by New Suffolk School; and Jackson Street,New Suffolk. Permit No. 21 Issue Date: June 29,2007 Elizabeth A. Neville Southold Town Clerk (Town Seal) RECEIPT $100.00 Application Fee - Permit No. 021 $100.00 Daily fee—June 29, 2007 $250.00 Cleanup Deposit for 1 day $450.00 Cash Film Permit No. 021 —Ladies' Home Journal Received by Date Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/29/07 Transaction(s): Reference Subtotal 1 1 Application Fee- Non-Refund 021 $100.00 1 1 Daily Filming Permit 021a $100.00 Cash Total Paid: $200.00 Name: Ladies', Home Journal 375 Lexington Ave New York NY Clerk ID: LINDAC Internal ID:021 APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT NO: Please Print or Type APPLICATION DATE: l0 NAME OF APPLICANT: MAILING ADDRESS: PHONE: BUSINESS: - C I HOME: NAME OF ORGANIZATI N/COMPANY: MAILING ADDRE1ScS::1, �, PHONE: 0�1 ,- `t `I�'� �� FAX: a -was" a- 0 u DESCRIBE TYPE OF ACTIVITY (e.g. Motion Picture, Commercial,Television. Catalog, Magazine, etc.): DATE(S) AN TIME(S) OF PROPOSED FILMING/ PHOTOGRAPHY: PROPOSED LOCA11 N(S) OF FILMING/PHOTOGRAPHY: (attach additional sheet, if necessary) NAME OF PERSON IN CHARGE AT SITE: C610- Z02► eT- NUMBER OF PERSONS AT LOCATION (cast &crew included):,�1( 1� NUMBER AND TYPE OF VECHILES AT LOCATION: I m `J V) TYPE OF SPECIAL EQUIPMENT:[ U ANY SPECIAL REQUIREMENTS: Signatu , Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P.O. Box 1179 Southold, NY 11971 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. Signa ure Date U Printed name Title 06/27/2007 12;12 FAX 00003/0009 Tue,Jun 26, 2007 2:34 PM Subject: Locations for permit Date: Tuesday, June 26, 2047 12:53 PM From: Carla Engler <Carla.Engler@meredith.com> To: Marybeth Welsh-Dulany <Marybeth.Welsh-dulany@meredith.com> Conversation: Locations for er ' Here's a list I think will work for the permit: Love Lane in Mattituck Krupski's vegetable stand in Cutchogue on Route 25. Vegetable stand near Indian Neck Lane and Route 25 in Peconic The "Down Home Store at Skunk Lane and Route 25 Along Oregon Road between Bridge Lane, Cutchogue and Wickham Avenue, Mattituck. Along Moore's Lane in Cutchogue By the New Suffolk school and "downtown" New Suffolk Jackson Street by Kimogenor Point in New Suffolk Page 1 of 1 ACORCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY) 06/28/0DATE PRODUCER 1-800-247-7756 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Holmes Murphy & Assoc - WDM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 9207 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Des Moines, IA 50306-9207 INSURERS AFFORDING COVERAGE INSURED INSURER A:St. Paul Fire & Marine Insurance Company Meredith Corporation dba WFSB Attn: Sheila Weirich INSURER B:Sentry Insurance A Mutual Company 1716 Locust INSURER C: Des Moines, IA 50309-3023 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLTR DATE(MM/DO(YY1 LIMITS B GENERAL LIABILITY 90-02693-03 07/01/06 07/01/07 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $250,000 CLAIMS MADE FKOCCUR MED EXP(Any one person) $NotProvided PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $1,000,000 X POLICY PRO LOC B AUTOMOBILE LIABILITY 90-02693-04 07/01/06 07/01/07 COMBINED SINGLE LIMIT $2,000,000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS LIABILITY QK05501138 07/01/06 07/01/07 EACH OCCURRENCE $5,000,000 X OCCUR F�CLAIMS MADE AGGREGATE $5,000,000 DEDUCTIBLE $ X RETENTION $10,000 $ B WORKERS COMPENSATION AND 90-02693-02 07/01/06 07/01/07 X WCSTALIMTU-DRY I OTH- B EMPLOYERS'LIABILITY 90-02693-01 07/01/06 07/01/07 E.L.EACH ACCIDENT ER $500,000 E.L.DISEASE-EA EMPLOYEE $500,000 E.L.DISEASE-POLICY LIMIT $500,000 OTHER a a $ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Ladies' Home Journal photo shoot June 29, 2007. CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The Town of Southold and the Village of Greenport DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL P.O. Box 1179 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Southold, NY 11971 AUTHORIZED REPRESENTATIVE USA ACORD 25-S(7/97) ssteinbachwdsm O ACORD CORPORATION 1988 6548736 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(7/97) 06/27/2007 12;11 FAX Q0001/0009 LADIES' HOME JOURNAL Marybeth Welsh Dulany Photography Director 375 Lexington Avenue/9'Floor New York,New York 10017 212-499-2014; fax: 212-499-1824 email: mdulany@mdp.com June 27, 2007 Hello: Carla Engler, our fashion creative director, spoke with someone in your office about obtaining a permit for a shoot we're doing this Friday, June 29'. The permits were sent to her and I am faxing them back to you. There is the issue of a $100 fee...how do we handle that? Can we pay by credit card? Or does Carla have to pay that to you, in cash, the day of the shoot? What is the best way to work that? Also, she spoke with the Chief of Police who said there wasn't any need for any police involvement. Thanks so much and please call me when you have a moment so we can discuss the payment. Thank you,