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The Artists Company
o��OG SO!/j�ol ELIZABETH A.NEVILLE '` O Town Hall, 53095 Main Road TOWN CLERK 1I P.O. Box 1179 REGISTRAR OF VITAL STATISTICS G Southold,New York 11971 MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Ol� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �OUNTY,� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD June 22, 2006 CERTIFIED MAIL RETURN RECEIPT REQUESTED Attn: Accounting Department The Artists Company 38 West 21St St, 12th Fl New York NY 10010 Re: Southold Town Filming Permit No. 18 Dear Sir or Madam: Enclosed herewith is a check in the amount of$516.50 representing a refund of fees collected for highway cleanup and police assistance as required by the Southold Town Code, Chapter 44A. An inspection of the permit site was made and no highway cleanup was necessary so you are entitled to the return of the $500 Highway Cleanup Deposit. The actual cost for the police detail was $1783.50; the Chief of Police had required $1800 therefore you are entitled to a refund of$16.50 for the police traffic control fee. I hope everything went well with the filming. If I can be of any assistance in the future, please do not hesitate to contact me. Very truly yours, �," � eeLe Linda J. Cooper Deputy Town Clerk Enc. (2) 7 0 0 3,311 0 0001e5 y-7 7s Qt# fi)TO- S#MW WWROACUADWHALI SDUTHMD,hW 11971 **st6so r e� xteadSo/IBEX*#** * ***s * *****z **s * *s * ** * xg��it#l8-Traffic MEMO �O��pF SO!/lyolo ELIZABETH A.NEVILLE Town Hall, 53095 Main Road TOWN CLERK l [ P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS • �� Fax.(631) 765-6145 MARRIAGE OFFICER Telephone (631) 765-1800 RECORDS MANAGEMENT OFFICERcourm southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER Ir 1 1 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD RECEIPT $ 700.00 Certified Check dated April 28, 2006 —Received 5/2/06 $200 Daily Fee (2 days @ $100 each) $500 Highway Clean Up Deposit (2 days @ $250 each) $1800.00 Cash (Traffic Control Fees per Chief Cochran) $ 100.00 Cash Non-Refundable Application Fee k` The Artists Company Permit No. 018 Received by S3 7�( /�s� "VI V Y V V It Li U 1 J J.L r aA V J l 1 V,) V 1-k,) V V V 111 V L V 1 V 111\ 4"1%11 wjV V V soU�yo! ELIZABETH A.NEVILLE Q Town Hall,53095 Main Road TOWN CLERK [ P.O. Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145 MARRIAGE OFFICER �O RECORDS MANAGEMENT O� � CER Telephone(631)765-1800 co FREEDOM OF 1NFORMATTON OFFICER o southoldtown_northforltnet OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION;FOR FILMING/STILL PHOTOGRAPHY Please Print or Type APPLICATION DATE: /Z L LO 6 P 6RMIT NO: ( 0 T _ I NAME OF APPLICANT: � A2TI • N JD n N �k- MAILING ADDRESS: 3�S �il�Pi5I �/5� c�f )Z ny F/W't N PHONE: BUSINESS: 7 M n A OME: ?'J/y o�4�-S3-3 9- NAME OF ORGANIZATION/CONTANY: TS CD M new MAILING ADDRESS: SAme As Above, PHONE: 2,17- 6 7F- 72219 FAX: ZJ 2 " 7y/' /S/F (i DESCRIBE TYPE OF ACTIVITY(e.g.Motion Picture, Commercial,Television.. Catalog,Magazine, etc.): eoly rn eee i-c l DATES AND TIME(S) OF PROPO RD FILMING/PHOTOGRAPHY: S o� PROPOSED LOCATI?ON(S) OF FILMING/PHOTOGRAPHY7,1016Z6' ach additional sheet,it necessary) f J`- . f7j (�!L onJ � `eve4 e) ve 42egw 12VC'u NAME OF PERSON IN CHARGE AT SITE: �o� N GtJ. GUa /iE, ct2 NUMBER OF PERSONS AT LOCATION(cast&crew included): NUMBER AND TYPE OF VECHILES AT LOCATION- R/ur d✓c h CA' �2,�cts I mohit luvne j/S;0&SS TYPE OF SPECIAL EQUIPMENT: V4-A;S t Sc„n c �Qe/1 sc+Nctl r/t h c ki ANY SPECAIL REQ(JIREMENTS: LU!0 F1 5tAPe h oT D 6-co, ped ,v A20A)4- W 7YS-A 'V3 02e nN P2.d c a✓e4,4 w/ o;,) L✓��&Yert W d,A z f Signature Return to: Southold Town Cleric Southold Town Hall 53095 Main Road P.O.Box 1179 Southold,NY 11971 MAP NOT TO SCALE Date: Friday, May 5, 2006 Times 10:00am-8:pm Depot Ln Requesting Police assistance for the following: 10:00am 2 Police officers to control traffic while approximate one lane of Oregon Road at and around the driveway of 7745 B # 3 Oregon Road is lightly covered with dirt & dust. Then during filming to control flow of traffic. Then upon completion to control traffic during clean up. Also, requesting Police assistance during filming of postal truck driving up and down depot lane. X Oregon Road 4 F1 7745 B #3 Oregon R On CI v X Loi V4 Vo 11=) 10:01 rAA 001 !oa 014a ' uULinuLL 1UNN 4LGn11 L:J VV4 INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD PTLMING/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 ox 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. i iatuire )ate Printed name _._._.. //<Lsolt Title i I i ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/24/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE DeWitt Stern Group,Inc. PROVIDED IN THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 420 Lexington Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES HEREIN. New York, NY 10170 COMPANIES AFFORDING COVERAGE Stacie O'Beirne Tel: 212-297-1427 COMPANY Fireman's Fund Insurance Company A INSURED COMPANY Chubb The Artists Company B 38 West 215`Street, 12th Floor COMPANY New York,NY 10010 C COVERAGES This certificate su eroedes and repIaces any reviousl issued certificate for the policy period noted below. THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 ® COMMERICAL GENERAL LIABILITY XXC 80419715 2/1/06 2/1/07 PRODUCTS-COMP/OP AGG $1,000,000 ❑CLAIMS MADE® OCCURRENCE PERSONAL&ADV INJURY $1,000,000 ❑OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $1,000,000 FIRE DAMAGE(Anyone fire) $ 300,000 ❑ MED PAY(Any one person) $ 10,000 A AUTOMOBILE LIABILITY ❑ANY AUTO XXC 80419715 2/1/06 2/1/07 COMBINED SINGLE LIMIT $1,000,000 ❑ALL OWNED AUTOS BODILY INJURY $ ❑ SCHEDULED AUTOS (Per person) ® HIRED AUTOS BODILY INJURY $ (Per accident) ® NON-OWNED AUTOS MPT 07105750 Physical Damage $Incl.in Misc. ® NON-OWNEDMIRED PHYSICAL DAMAGE 2/1/06 2/1/07 Equipment Limit GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ❑ANY AUTO OTHER THAN AUTO ONLY: ❑ EACH ACCIDENT $ AGGREGATE $ B EXCESS LIABILITY EACH OCCURRENCE $19,000,000 ®UMBRELLA FORM 79541069 2/1/06 2/1/07 AGGREGATE $19,000,000 ❑OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATIONWC STATUTORY OTHER AND EMPLOYERS'LIABILITY ❑ LIMlrs ❑ EL EACH ACCIDENT $ THE PROPRIETOR/ ❑INCL EL DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE ❑EXCL EL DISEASE-EACH EMPLOYEE $ OTHER Errors&Omissions MSF 07003553 2/1/06 2/1/07 Limit$1,000,000/$3,000,000 Ded.$25,000 Miscellaneous Equipment Limit$2,000,000 Ded.$ 2,500 A Props/Sets/Wardrobe Limit$1,000,000 Ded.$ 1,500 Third Party Damage MPT 07105750 2/1/06 2/1/07 Limit$2,000,000 Ded.$ 2,500 DESCRIPTION OF OPERATIONcKOCATIONS✓VEHICLES-SPECIAL ITEMS(LIMITS MAYBE SUBJECT TO DEDUCTIBLE OR RETENTIONS) Certificate Holder is included as an Additional Insured and Loss Payee as their interest may appear as respect production work done on behalf of Agency:Ogilvy&Mather NY;Client:Merck Inc;Job No:MKCOR603182(F);Commercial Title:"Believe,Wish, Ellen McGrath,Lisa Garcia, Emma Fields". With respect to others,coverage is worldwide,in transit and All Risk. With respect to Automobile Rentals,Non-Owned&Hired Auto Physical Damage,limits are included in Miscellaneous Equipment.Deductible:10%of loss;$2,500 Min./$7,500 Max(per occurrence). WPP. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE Town of Southhold THEREOF,THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL$Q DAYS WRITTEN NOTICE TO Town Hall, 53095 Main Road THE CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR Southhold, New York 11971 LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES. ftt Stern Gro p Inc. Stacie O'Beirne By: MM7 9P99 VALID AS OF 4/24x2006 Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/06/06 Receipt#: 45507735 Transaction(s): Reference Subtotal 1 1 Application Fee- Non-Refund 018 $100.00 2 2 Daily Filming Permit 018a $200.00 1 1 Traffic Control Fee 018b $1,783.50 Cash* 45507735/cash Total Paid: $2,083.50 Name: The, Artists Company 38 W 21st St, 12th FI New York, NY 10010 Clerk ID: LINDAC Internal ID:018 Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/06/06 Receipt#: 45507735 Transaction(s): Reference Subtotal 1 1 Application Fee- Non-Refund 018 $100.00 2 2 Daily Filming Permit 018a $200.00 1 1 Traffic Control Fee 018b $1,783.50 Cash#: 45507735/cash Total Paid: $2,083.50 Name: The, Artists Company 38 W 21 st St, 12th FI New York, NY 10010 Clerk ID: LINDAC Internal ID:018 POLICE DEPARTMENT TOWN Of &OUTKOLD CARLISLE E. COCHRAN,JR- Chief of Police Telephone Emergency Dial 911 MEMORANDUM TO: Linda J. Cooper, Deputy Town Clerk FROM: Chief Carlisle E. Cochran, Jr. Lam/ DATE: May 26, 2006 RE: Filming Permit-The Artists Company-John Walker The actual cost for the police detail with reference to the above permit is 41405 Route 25 • P.O. Box 911 • Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 9 Fax (631) 765-2715 MEMORANDUM TO: Linda J. Cooper, Deputy Town Clerk FROM: Chief Carlisle E. Cochran, Jr. DATE: May 26, 2006 RE: Filming Permit- The Artists Company- John Walker The actual cost for the police detail with reference to the above permit is SUB36k ELIZABETH A.NEVILLE "'; Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER aw` Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL To: Johnnie Walker 212-741-1519 From: Linda J. Cooper, Deputy Town Clerk Dated: April 26, 2006 Re: Application for Filming Permit Number of Pages (including cover): 9 If total transmittal is not received, please call 631-765-1800. COMMENTS: As requested. Call if you have any questions. I'm here from Sam to 4pm b l ELIZABETH A. NEVILLE '`� 0 Town Hall, 53095 Main Road TOWN CLERK 1 [ c P.O. Box 1179 REGISTRAR OF VITAL STATISTICS CA, Southold, New York 11971 MARRIAGE OFFICER �O Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER l Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER yCUUN 1, southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD RECEIPT $ 700.00 Certified Check dated April 28, 2006 — Received 5/2/06 $200 Daily Fee (2 days @ $100 each) $500 Highway Clean Up Deposit (2 days @ $250 each) $1800.00 Cash (Traffic Control Fees per Chief Cochran) $ 100.00 Cash Non-Refundable Application Fee The Artists Company Permit No. 018 Received by ` S 3 0045507735 JBPMoogan Chase Bank i CHASE 12204 14202 D,6te APRIL 28,2006 fi i REMITTE�R THE 1A�2Tl8�'S,COMpANY Pay to thee--hOWN OF SQUT OBD 7000`0 ' a order of Amount SEVEN HUNDRED DOLLARS AND 00 CENTS U.S. Dollars Nion N6,10tila 1- 1 CASHIER'S CHECK ' Authorized Signature If not used as intended redeposit to your account.Do not destroy your check. 11'004 5 50 7 7 3 5118 1:0 2 200084 21:60 1 6000 34,18 JPMorgan Chase Bank10-84 0045507735 Buffalo, NY 14202 0 CHASE 220 Date APRIL 28 2006 REMITTER THE ARTISTS COMPANY Pay to the $ 700.00 order of TOWN OF SOUTHOLD Amount SEVEN HUNDRED DOLLARS AND 00 CENTS U.S. Dollars CASHIER'S CHECK Authorized Signature ii'004 5 50 7 7 3 5ii' 1:0 2 200084 21:60 16000 3411' APPLICANT'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check. 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. 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 by the permit. Traffic control fee - $1000 for each day covered by the permit if required by the Chief of Police. Beach Parking fee- $10 per vehicle, per day between May 1 and September 30. NOTE: Additional fees for Cleanup and Traffic Control may be required at the direction of the Chief of Police and Superintendent of Highways o��OF SOUTyoI ELIZABETH A.NEVILLE Q Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER Q Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER Ol�, � Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER UNTY,� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION FOR FILMING/STILL PHOTOGRAPHY Please Print or Type APPLICATION DATE: PERMIT NO: NAME OF APPLICANT: MAILING ADDRESS: PHONE: BUSINESS: HOME: NAME OF ORGANIZATION/COMPANY: MAILING ADDRESS: PHONE: FAX: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * DESCRIBE TYPE OF ACTIVITY(e.g. Motion Picture, Commercial, Television. Catalog, Magazine, etc.): DATE(S)AND TIME(S) OF PROPOSED FILMING/PHOTOGRAPHY: PROPOSED LOCATION(S) OF FILMING/PHOTOGRAPHY: (attach additional sheet, it necessary) NAME OF PERSON IN CHARGE AT SITE: NUMBER OF PERSONS AT LOCATION(cast & crew included): NUMBER AND TYPE OF VECHILES AT LOCATION: TYPE OF SPECIAL EQUIPMENT: ANY SPECAIL REQUIREMENTS: Signature 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. Signature Date Printed name Title Chapter 44A, FILMING [HISTORY: Adopted by the Town Board of the Town of Southold 2-27-2001 by L.L. No. 6-2001. Amendments noted where applicable.] §44A-1. Purpose. The Town Board of the Town of Southold recognizes that the town's natural beauty and historical sites are attractive to individuals, organizations, corporations, groups and other entities involved in the businesses of still photography, motion pictures and television. Because such filming activities may create a threat to public safety, health or welfare due to the time, location or duration of the filming, or may unduly interfere with vehicular and/or pedestrian traffic, the town desires to regulate such activities through the issuance of permits. The purpose of this chapter is to set forth the procedure governing such permit process. § 44A-2. Permit required; exemption. A. General. A permit issued pursuant to this chapter is required prior to any person, organization, corporation, group or other entity engaging in the activity of filming or photographing a commercial,movie, documentary, television program, catalog or magazine layout, or any other presentation upon the streets, sidewalks or any other property owned by the Town of Southold, exclusive of the Village of Greenport. The application process for obtaining a permit is set forth in,§ 44A-3. B. Exemption. A permit pursuant to this chapter shall not be required if five or fewer individuals constitute the entire cast and crew engaged in one of the activities described in Subsection A above. § 44A-3. Application for a permit. A. Application form. An applicant may obtain an application form from the Town Chief of Police or the Town Clerk. The information requested on the application form shall include, without limitation, the following: (1) The name and address of the applicant. (2) The proposed location(s) of the filming or still photography. (3) The date(s) and time(s)the permit is intended to cover. (4) The number in the cast and crew. (5) The number of vehicles. (6) The person in charge on site. B. Submission to Town Clerk. The following materials shall be submitted by the applicant to the Town Clerk at least seven days before the proposed date to start the filming or still photography: (1) A completed application form. (2) A one-hundred-dollar nonrefundable application fee. (3) A certificate of insurance and indemnification agreement pursuant to § 44A-11. C. Review by Chief of Police. The Town Clerk shall forward the application to the Chief of Police for approval or disapproval. Said approval or disapproval shall be based on the Chief of Police, or his designee, making a determination on whether the proposed filming or still photography will constitute a threat to public safety, health or welfare by reason of time, location or duration of the activity or will unduly interfere with vehicular and/or pedestrian traffic. Approval of the application by the Chief of Police, or his designee, may be conditioned on the payment of the traffic control fee set forth in § 44A-4. The Chief of Police shall send the approved or disapproved application back to the Town Clerk. D. Review by Town Attorney. The Town Clerk shall forward the certificate of insurance and the indemnification agreement to the Town Attorney for approval. The Town Attorney shall send such approved or disapproved documents back to the Town Clerk. E. Permit fee. The Town Clerk shall calculate the permit fee required to be paid by an approved applicant as follows: (1) Film fee. One hundred dollars per day shall be paid for each day covered by the permit. (2) Cleanup deposit. A separate certified check in the amount of$250 for each day covered by the permit shall be paid pursuant to § 44A-5. (3) Traffic control fee. One thousand dollars shall be paid for each day covered by the permit if the Chief of Police, or his designee,requires payment of the traffic control fee pursuant to § 44A-4. (4) Beach parking fee. If the permit includes one or more town beaches as location sites, a ten-dollar-per-vehicle fee for each day covered by the permit shall be paid if the permit covers any day falling between May 1 through September 30. F. Issuance of permit. The Town Clerk shall countersign an approved application. The Town Clerk shall collect the permit fee calculated pursuant to Subsection E from the applicant. Payment of the permit fee shall be in the form specified in § 44A-6. Upon payment of the permit fee, the Town Clerk shall issue the permit to the applicant. The permit shall set forth the name of the applicant and the location(s), date(s), and time(s) of the filming or still photography. §44A-4.Traffic control fee. A. In the event that the Chief of Police or his designee determines that the police officers or traffic control officers will be necessary for the protection of the citizens or for the control of traffic during the filming or still photography, the applicant shall submit to the Town Clerk a fee of$1,000 for each day covered by the permit pursuant to Subsection F of§ 44A-3. B. If the Chief of Police determines that the one-thousand-dollar-per-day traffic control fee will be fully expended prior to the termination of the permit period, the Chief of Police shall notify the Town Clerk. The Town Clerk shall contact the applicant in writing and require payment of additional sum of money, said specific amount to be determined by the Chief of Police based on the salaries and the number of hours to be worked by the town police and traffic control personnel. Said additional traffic control fee shall be paid within seven days of said notice. The applicant's failure to pay such additional fee within said seven-day period shall result in the Town Clerk's providing the applicant with written notice that the permit has been suspended and the date of such suspension. The applicant's receipt of the Town Clerk's suspension notice shall not be construed as altering the date of suspension set forth in said written notice, the effective date of the suspension being the day immediately following the completion of the seven- day notice period. C. The procedure set forth in Subsection B may be repeated as necessary to ensure that the applicant pays for all costs included by the town in providing traffic control services. D. After termination of the filming, the Chief of Police shall provide the applicant with a statement regarding the actual cost to the town of providing said police officers or traffic control officers. If the actual cost is less than the moneys that the town has collected pursuant to Subsection A, B or C, the town shall remit the balance to the applicant. If the actual cost is more than the moneys that the town has collected pursuant to Subsections A, B or C, the applicant shall be responsible for providing the balance to the town within 30 days of the termination of the filming or still photography. E. The Chief of Police shall forward a copy of the statement of actual cost to the Town Clerk who will file said statement with the original application form. §44A-5. Cleanup deposit. A. Each applicant whose application has been approved shall give the Town Clerk a certified check in the amount of$250 for each day covered by the permit, which check shall be held and not deposited by the town during the duration of the permit period. B. At the termination of the permit period, the Town Superintendent of Highways, shall inspect the locations listed on the permit and determine if the locations require cleanup efforts by town personnel. C. If cleanup is required, the Town Superintendent of Highways will coordinate that effort. Said Superintendent will provide the Town Clerk with a statement setting forth the actual cost to the town of providing said cleanup services. If the actual cost is less than the deposit collected pursuant to Subsection A, the town shall remit the balance to the applicant. If the actual cost is more than the deposit collected pursuant to Subsection A, the applicant shall be responsible for providing the balance to the town within 30 days of the termination of the filming or still photography. D. If no cleanup is required, the Town Superintendent shall notify the Town Clerk of that fact, and the Town Clerk shall promptly remit the certified check to the applicant. § 44A-6. Payment of fees. Any fee collected under this chapter shall be paid either in cash or by certified check made payable to the Town of Southold and shall be delivered to the Town Clerk. § 44A-7. No donations accepted. Other than the required fees, the town shall not accept any donations from the applicant in connection with the granting of the permit. In addition, no town official or employee shall make a recommendation to the applicant regarding a donation to a third party. § 44A-8.Notice to other officials. The Town Clerk shall give notice to the Chief of Police, the Chief Building Inspector, the Code Enforcement Officer, the Fire Marshal, the Superintendent of Highways and the Superintendent of Parks and Recreation of each permit issued pursuant to this chapter. §44A-9. No alterations to town property. A permit holder shall be responsible for any damage to town property or facilities that may result from the permit holder's activities. No alterations are to be made at filming or photography sites, including, without limitation, cutting trees, digging holes and trimming bushes, without the express authorization of the Town Board. 44A-10. Compliance with other laws. Issuance of a permit pursuant to this chapter does not relieve the permit holder of its duty to comply with all other town local laws, ordinances and regulations during the duration of the filming or photography. §44A-11. Insurance requirements. Every application for a permit pursuant to this chapter shall include a certificate of insurance that evidences a public liability insurance policy covering the town as an additional insured in the minimum amount of$1,000,000 per occurrence for the duration of the filming or still photography. The applicant shall also submit an indemnification agreement that states that 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. §44A-12. Permit available at film site. The permit holder shall be required to have the permit available for inspection by the Town Police Department, or its designees, at the site of the filming or still photography for the duration of the permit period. § 44A-13. Extension of permit period. An applicant which has been granted a permit may submit to the Town Clerk a request to extend the duration of the permit. The Chief of Police, or his designee, will make the decision whether or not to grant such request. If permission is granted, the Town Clerk shall collect from the applicant an additional $100 for each additional day added to the permit period. The Town Clerk shall then modify the applicant's permit to indicate the granted extension period. §44A-14. Penalties for offenses. A. Any action by any person, organization, corporation, group or other entity which violates or does not comply with any provision of this chapter shall be punishable by a fine of not less than $100 and not more than $1,000, and, in addition, anyone convicted hereunder of not complying with the requirements of§ 44A-4 and/or § 44A-5 may be subject to a fine of not less than the amount of the actual costs incurred and owed to the town, and not more than an amount to twice said actual costs. r B. Each continuing day of violation of this chapter shall constitute a separate offense. C. In addition to the above provided penalties, the town may also maintain an action or proceeding in the name of the town in a court of competent jurisdiction to compel compliance with, or to restrain by injunction the violation of this chapter. § 44A-15. Severability. The provisions of this chapter are severable. If any provision of this chapter or its application to any person or circumstance is held invalid, said invalidity shall not affect any other provision or application of this chapter which can be given effect without the invalid provision or application of the chapter. § 44A-16. When effective. This chapter shall take effect immediately upon filing with the Secretary of State as provided by law. O�*OF SO�jyol ELIZABETH A.NEVILLE ti O Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS A �_hgr Southold,New York 11971 MARRIAGE OFFICER % Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Oly Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER IOUs 1�,� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT Issued to: The Artists Company Date(s), Time(s) and Location Thursday, May 4 and Friday, Mav 5,2006 6am to 8nm Oregon Road, Cutchoaue Permit No. 018 Issue Date: May 3,2006 i Elizabeth A. Neville Southold Town Clerk (Town Seal) �©��pF SO!/T�ol ELIZABETH A.NEVILLE O Town Hall, 53095 Main Road TOWN CLERK J J P.O. Box 1179 REGISTRAR OF VITAL STATISTICS G Southold, New York 11971 MARRIAGE OFFICER Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER OIyC Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD RECEIPT $ 700.00 Certified Check dated April 28, 2006—Received 5/2/06 $200 Daily Fee (2 days @ $100 each) $500 Highway Clean Up Deposit(2 days @ $250 each) $1800.00 Cash (Traffic Control Fees per Chief Cochran) $ 100.00 Cash Non-Refundable Application Fee The Artists Company Permit No. 018 Received by POLICE DEVAQTMENT TOWN Of SOUTHOLD CARLISLE E. COCHRAN,JR. Telephone Emergency Dial 911 Chief of Police MEMORANDUM RECEIV iD M AY 3 2006 TO: Linda J. Cooper, Deputy Town Clerk Clerk FROM: Chief Carlisle E. Cochran, Jr. DATE: May 3, 2006 RE: Filming Permit-The Artists Company -John Walker As per Section 44A.3 of the Southold Town Code,it is the recommendation of the Chief of Police that application dated April 26, 2006, The Artists Company/John Walker,be APPROVED. As per Section 44A.4, Traffic Control Fee,the projected cost for traffic control will be approximately$1800.00. 41405 Route 25 • P.O. Box 911 • Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 • Fax (631) 765-2715 0045507735 JPMorgan Chase Bank i CHASE 12 04 Buffalo, NY 14202 _ Date APRIL 28, 2006 , , i R�MltTER TIHEIAf T S,COMpANY i 700;00 Ply t�the,,,";�OVtlf� O SS,0UTHO(D;D—i order'of + PREP POLL, AN 00 ibENTS U.S. Dollars Amount S,EVEi� �. p Ikonlow. s _ CASHIER'S CHECK Authorized Signature if not used as intended redeposit to your account.Do not destroy your check. 11500 4 5 50 ? ? 3 5ll■ 1:022000811, 211:60 L 6000 3 411' 0045507735 JPMorgan Chase Bank OCHASE 10-84 Buffalo,NY 14202 220 Date APRIL 28 2006 REMITTER THE ARTISTS COMPANY _ t Pay o'the Payordof TOWN OF SOUTHOLD U.S. Dollars Amount SEVEN HUNDRED DOLLARS AND 00 CENTS CASHIER'S CHECK Authorized Slg—nature7440�W Il'004 5 50 ? ? 3 511' 1:0 2 200084 21:60 L6000 3411' TOWN CLERK'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check Applicant: Date Received: 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 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 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. 4 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 Chief of Police 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. 06/05/2006 02:15 2127411519 THE ARTISTS COMPANY PAGE 01/04 Date'. 16 Attention : J ` Company . Phone From : AAJ�Q i . Number of Pages + Cover: .� The Artists Company 38 West 21 st Street } 12th Floor 1 New York, NY 10010 0 - 212,679.7199 f - 21 2.741A 519 email: Info@theartistscompany.com web: www.theartistscompany.com Notes: l�ea� , G/N��� llae'ke'l x /ease f'tid 4.e ..�: ,'c � aS�0l/ tJau�2 a VC' f��4,5e /✓P. Me Q e7a'.N� /fir ydU /�i �.N 06/05/2006 02: 19 2127411519 THE ARTISTS COMPANY PAGE 03/04 DATE(MMIDt)Ct'YYY) ACQRD CERT��i�i�TE��:�f''LIABIL;17�1'�L�ISUR�4'N�CE ° ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL PRODUCER Y ND CONFERS No RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOASE DeWitt Stern Group,Inc. PROVIDED IN THE POLICY. THIS c[RTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES HEREIN, 420 Lexington Avenue COMPANIES AFFORDING COVERAGE New York, NY 10170 COMPANY Stacie OBelrne Tel: 212-297-142.7 A Fireman's Fund insurance Company INSURED COMPANY Chubb The Artists Company COMPANY 3S West 21"Street, 12' Floor C New York, NY 10010 COVERAGES.....:,. " T fiscettiflb2tCe su'dieede513ri'd.re laees:ah `. rdviousl'.:isgue'd'.ceRificate.fo�ttie. olll; 6dod note : sow.. THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN I8SUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR N S OF SUCH POLICIES.LIMITS SHOW PERTAIN,THE wsUF1ANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSION N MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR TYPE OF INSURANCE DATE(MM/DD/YY) DATE(MMMDrYY) GENERAL AGGREGATE $2,000,000 A GENERAL ueB1uTY ®COMMERICALGENERALLIAeILITY XXC 80419715 2h/06 2!1/07 PRODUCTS-COMPIOP AGG $1.000,000 PERSONAL d ADV INJut3Y $1,D00,000 ❑CLAIMS MADE® OCCURRENCE EACH OCCURRENCE $1,000,000 ❑OWNEA'S&CONTRACTOR'S PROT FIRE DAMAGE(Any one Ore) $ 300,000 ❑ MED PAY(Any aria person) 10,000 A AUTOMOBILE LIABILITY PJ1106 2/1/07 COMBINED SINGLE LIMIT $1,000,000 ❑ANY AUTO XXC 90418715 BODILY INJURY $ ALL OWNED AUTOS (Per person) ❑scHEDULED AUTOS BODILY INJURY $ HIRED AUTOS (Peraoddent) ® NON-OWNED AUTOS MPT 07105750 $Incl.In Mlso. 2/1/06 2/1107 Physical Damago Equipment Limit NON•OWNEDIHIRFD PHYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY•EA ACCIDENT $ OTHER THAN AUTO ONLY ❑ ANY AUTO EACH ACCIDENT $ ❑ AGGREGATE $ B EXCESS LIABILITY EACH OCCURRENCE $19,000,000 ®UMBRELLA FORM 79541069 2/1106 2/1/07 AGGREGATE $19,000,000 [] OTHER THAN UMDRELLA FORM $ WC STATUTORY OTHER W RK-PSCOMPENSATION ❑ LIMITS AND EMPLOYERS'LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ ❑INCL EL DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE EL DISEASE-EACH EMPLOYEE $ OFFICERS ARE ❑EXCI, OTHER Errors&Omissions MSF 07003553 2/1/06 2H/07 Limit$1,000,000/$3.000,000 Dad.$25,000 Migcelleneous Equipment Limit$2,000,000 Dad,$ 2,500 A Props/3et8/vNerdrobo Limit$1,000,000 Dad,$ 1,500 Third Pariy Damage MPT 07105750 2/1/06 2/1107 Limit$2,000,000 ped•$ 2,500 AFSCRfPTION of ORF.RATION&LOCAT10NSIYEHICI-F$,SPECIAL ITEMS(LM , Y HE SUBJECT Tri DEDUCTIBLE OR RETENI'IOIVS) Certificate Holder is included as an Additional Insured and Loss Payee as their interest may appear as respect production work done on behalf of Agency:Ogilvy&Mather NY;Client:Merck Inc;Job No:MKCOR6031 B2(F);Commerclal Title:"Believe,Wish,Ellen McGrath,Lisa Garcia,Emma Fields". With respect to others,coverage is worldwide,in transit and All Risk. With respect to Automobile Rentals,Non-Owned&Hired Auto Physical Damage,limits are included In Miscellaneous Equipment,Deductible:10%of loss;$2,500 Min,/$7,500 Max(per occurrence)_ WPP. CERTIFICATE HOLDER CANGb&LATION SNOULD ANY OF THE ADDVF DEECRIDrD POLICICS DE CANCELLED DEFORE THE EXPIRATION DATE Town of SOUthhold THEREOF,THE INSURER AFFORDING COVERACF,WILL ENDLIAVOR TO MAIL AR DAY:WRITTEN NOTICE TO Town Hall, 53095 Main Road THE GINITIFICATE HDLDGR NAMED HEROIN.RIJT FAILURC TO DC BO BHALL JMrOSF•NO OBLIGATION OR Southhold, New York 11971 LIABILITY OF ANY KIND UPON THL'INSURER AFFOnplNel COVERAGP-,rr8 AGENTB OR REPRE'SENTATIvEB. DeWitt Stnrn tacie 05Beirne Group Inc. W4 _ 06,10512006 02: 19 2127411519 THE ARTISTS COMPANY PAGE 04104 -- USL /�U ulya PUlI.tnui.0 1Unm. �.LFAa� Lo/uw UU itr,11 .k-j:01 VAA it INDEM;IIFICATIOIN AGRE5I=MENT 'SOWN OF SOUT14OLD p'TLMMG/TILL P>-Y0T0GRAPTiy T"Mm T The,Appli,cant shall irtdemDlfy and hold harmlcss the Town from and against;all suits,claints,demands or ucti.o�s for any dar"ftgi and/ox' injury sustained or alleged to Ite sustained by any party ox parties in connection:with the performance of filming;or still.photography bY, the Applicant,his eaiplr�yees or agents or any subeontr Actor;tind in case of any such action brought agtlinst the Town,the applicant sh,l1 immediately tal{e ch.argc of and defezid kite sanae at his ovvn Gast and expense, ,l.n additior+,the App#eant will uame the Town ae an additional insured on any applicable policies. i ILApt G d 6 ,ahwe ,Jo�N V, dial -rte Printed.name yT Title I i 06,105/2006 02:15 2127411519 THE ARTISTS COMPANY PAGE 02/04 ..._ _ .. ...__. .,_ ..� ..... v.. r.r ra:v vv..aaav u✓ avi 4JrY1'\lY Y•J��� ELIZABEtIC A NEVILLE ,�4�4 Y� 'Town HM11,68095 Main Road TOWN CLLRK 1>-0. Box 1179 REGISTRAR OF VITAL STATISTICS on Southold,New Xorli 11971 MARRIAGZ QFr4 XCX.K � � ,�q Fax(691) 765-6145 RFC;ORID S MANAGEMENT O+ + CER �y � Telephone(631) 765-1800 PF.EEUOM OF INFORMATION OFFICER �'QUNT(, southoldtown_northfork.net OFnOn OT TRE TOWN CLERK towJN or 00UTHbLD APPLICATIONFOR FILMING/STILL PHOTOGRAPHY Please Print or Type APTLICATION DATE: '�I/L O P FRMT NO, NAME OF APPLICANT: / - �42Ti5TS N jD N &k•lt�-epc MAILING ADDRESS: L)e 6 PHONE: BUSINESS: - / HOME: _ .�/�aZ�a^.25"s3 fr' NAME OF ORGANIZATION/COMPANY: ArL,7"1 5?S eO M P/+� MAILING ADDRESS: e AbovL PHONE: 6 '�.7_,�C9 FAX: l 2 DESCRIBE TYPE OP ACTIVITY(e. ,M4tion Picture, Commercial,Television.. Catalog,Magazine, etc.): DATE(S) AND TIMES) OF 7?,OPO,9Bb FILMING/PHOTOGRAPHY: 'j C41m e ea PROPOSED LOCATION(S) OF FUJ&j TG/PHOTOGRAPHY;(altach additional sXteet,it necessary) 17"�- /3 � �� /atlas or �,� PLVC� 1ey�, NAME OF PERSON IN CHARGE AT SITE: t/o N GtJ. fi{ r/iE, y NTJMMER OF PERSONS AT LOCATION(cast&crew included); N17NMU.,AND TYPE OF VECHILES AT LOCATION P"d oc4l n� %2��Ls /�+aloa l o.s►e. ,�/f�sS TYPE OF SPECIAL EQUII?MENT: V.kNS f ScTrr /I��soNa./ vc,h /es ANY SP•ECAIL REQUIREMENTS; 24 P 5-eA ti o f O&C,b au �,d � r✓bA,* 674 77 y,5-A 3_ p2 p,,fwd f e✓� J,&yek o�Q.ii,f J-51 It a Signature Return to: Southold Town Clerk Southold TownHall 53095 fair Road P.O.Box 1179 Southold,NY 11971 OG/05/2006 02:19 2127411519 THE ARTISTS COMPANY PAGE 02104 vJ Irui 1J J.l r nA 11.11. 1 UJ UJ1111 JVV111U lIY lUlll\ 4+Y1Jau FLIZABI; "I1 A.N VILT.� ti© 'Town 14:111,53095 Mei» 2aa�d TOWN CLERK )?,0.fax 1179 Southold,New York 11971 R.EGISTR.&R OF VITAL S"VATISTICS ad Fax(GSl)766-6146 MAR23AC.11;OX'TICER ^•�' Telephone(533,)?65-1800 RFCOjZDS 1Vf F1NAGEMENT O 1 + CER �I�CQ��,�y aouthaldtown.northforlt_nct r-REEDOU OF T.NFORMATION OFFICER 1�+ 0-FiFT6,F, Ort TRE TOWN CLERK tO'WN OF SOUTHOLD APPLICATION FOR FILMING/STILI PTdOTOGRAP:E Y Please Pftt or Type P 1IRMIT NO: APPT.ICATION DATE: Z 0 NAMEOFA�'PLTCANT % �(z7� T1 -j2d-A) M'AWNG ADDRESS: 5- 657' PHONE: BUSINESS: Z12-6_ I _L—__— ROME NAME OF ORGAW-ATION/COMPANY: /-r127t MAILING ADDRESS: 5/AM-0 , FA 7/99 �Ax= q/- /s')4i PZIONE; L-6-7 :F: eF: :ist :ki, lk � kd"• �' * fi >lekNrkk� N * �: :k _h %k # tW Mk=11 * * * k # skkkkte :Mvkk �' :� k * N +!' k * k '� � * * 11 D1 SCRIBE TYPE OF ACTIVITY (e.g.:Motioli Picture, Commercial,Television, Catalog,Maganlie, etc.), D,ATF7�T— TIMES) 01 PR OPO Bb FILNU NG/PHOTOGMPHY: !o ' PROPOSED T OCATION(S)OF FILMING/PHOTOGRAPHY-.(a ac additi,anal sljaet,it necessary) D22 OnJ / �„iG or v� / ZS 044 gel ec"&�O �, g_ a 3 _ NAME OF PERSON IN CHARGE AT SITE: �/o�► N GcJr GUa.1k,�02 0 NCTMBER OF PERSONS AT LOCATION(cast&crew inaludEd): #0" old.�1 pN C/LJc.�s I�hofia/L lapin e, /yM-95 NUMBER AND TYPE OF�TECHILES!AThO CAT 1 4 r p.c� so�ai l/C.h c ks I TYPE OF SPECML'EQp PMENT: A.NY SPECAIL UQUIUMENTS: l c?O fl. Sh o�02c6 au jed %N Fi A,+ cs>< 77/5`8 ,93 Do- n sr--s Return to: Southold Town Cleric Signature Southold Towt Hall j 53095 Main Road P.O.Brox 11,79 Southold,NY 11971 06!05!2006 02:19 2127411519 THE ARTISTS COMPANY PAGE 01104 Date: /�z6 Attention : ' Company .- Phone #. From , Number of Pages + Cover; The Artists Company 38 West 21 $t Street 12th Floor New York, NY 10010 p - 212,f79.'7199 f - 212,741 .1519 email: info Qtheartistscompany.cem web: ww�k.theartlstscompany.com lease a 1.ea ffovj Gi•r� ,fr,�Sui2ai..c� 7iG� you. ae m ��ease e.y� ;: f ves 4-r 06105/2006 02: 15 2127411519 THE ARTISTS COMPANY PAGE 03/04 401 U4 VU 11W) 14.01 CAIS UJ1 IUJ 0140 av�i uivi.✓ ��i+ �+J++•u I i INDEM;INIFICATION AGREEMENT 'SOWN OF SOUTIlOLD FJL W, NO/STILL PHOTOGRAPHY P ERM.IT i The Applicant shall iudemWjfyi and hold harmless the'Town from and against all suit's, ala.inLa,demands or actions for any damage and/or iun.jury sustained or alleged to be sustained by any party oaf parties in connection;wittll the perform uce of filming or sdU photography by the Applicant,his employees or agents or any subcontractor and in case of airy such action brought againo the Town,the applicant sliall immediately take charge of and defend the same at his own cost and • i expense. In addition,the Applicant will name the Town as an addition-at insxired on any kip,pl,ieable policies. • (/�'.' �'(/ �. � �C.f+9"SC�6, � �to �6 i iature )ate ��N l.</• 7NGrr�it _ Punted namc f p�G4 DN JCS � I/e�orL. itic i i I 0610512006 02: 15 2127411519 THE ARTISTS COMPANY PAGE 04/04 . DAT ) ACRD CERT�FIGit' E:C 'F :I1�1 �71'`-�IVSUkitl�I�i�RTIFIcAre Is ISSUED .. . E(4/2412006 PRODUCER AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE ,Inc. PROVIDED IN THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR DeWitt Stern Group, ALTER THE COVERAGE AFFORDED BY THE POLICIES HEREIN, 420 Lexington Avenue COMPANIES AFFORDING COVERAGE New York, NY 101.70 COMPANY Stacle O'Beirne Tel: 21.2-297-1427 A Fireman's Fund Insurance Company INSURED COMPANY Chubb 13 The Artists Company 38 West 21"Street, 1,24'Floor COMPANY New York, NY 10010 C COVERAGES .. . . =: 'This Certificate=sU dreede�s:agd.re laces ah'. rdlliousl'issue'd'I:eRiticate 1firttie policy 06dod note a ow: THIS Is TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED I4EREIN FOR THF POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 8UPJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.LIMI78 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. c0TYPE.OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMMPIYY) DATE(MM/DD/YY) A GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 COMMr_RICnLGENERAL LIABILITY XXC 80419715 2/1/06 2/1/07 PRODUC73-COMP/0P AGG $1,000,000 PERSONAL BADV INJURY $1,000,000 ❑ CLAIMS MADE® OCCURRENCE EACH OCCURRENCE $1,000,000 © OWNER'S&CONTRACTOR'S PROT FIRE DAMAGE(Any one fire) $ 300,000 ❑ MED PAY(Any on1)prrnon) S 10,000 A AUTOMOBILE LIABILITY ANY AUTO XXC 60419715 2/1/06 2/1/07 COMBINED SINGLE LIMIT $1,000,000 ❑ pODILY INJURY ALL OWNED AUTOS (Por person) I $ Q SCH�DUURD AUTOS BCAILY INJURY $ HIRED AUTOS (Por amIdenl) ® NON•OWNED AUTOS MPT 07105750 $Incl,In MIs., ® NON-OWNEDMIRED PHYSICAL DAMAGE 2/1/08 2/1107 Physical Damage Equipment Limit GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ❑ANY AUTO OTHER THAN AUTO ONLY: ❑ EACH ACCIDENT $ AGGREGATE $ g EXCESS LIABILITY EACH OCCURRENCE $19,000,000 UMBRELLA FORM 79541069 2/1/06 2/1/07 AGGREGATE $19,000,000 ❑OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION ❑ WcSTATUTOFlY LIOTHFM AND EMPLOYERS'LIABILITY MCr3 EL EACH ACCIDENT $ THE PROPRIETOR/ ❑INCL EL DISEASE-POLICY LIMIT $ r•ARTNERSIEXECUTIVE OFFICERS ARE ❑EXCL EI,DISEASE-EACH EMPLOYEE $ OTHER Errors&Omissions MSF 07003553 2/1/06 9/1/07 Llmlt$1,000,0001$3,000,000 Dod.$25,000 Wacellaneous Equipment Limit$2,000,000 Dad.$ 2,500 A Props/Sots/Wardrobe Llmlt$1,000,000 Dad,$ 1,500 Third Party Damago MPT 07105750 2/1/06 2/1/07 Limit$2,000,000 Dod.$ 2,500 DESCRIPTION OFOPERATIONS/LOCATIONS.,VEHICL,E"PFCIAL ITEMS(LlMIT5'MAYBE SUBJECT TO DEDUCTIBLE OR REMN77ONS) Gertlflcaw Holder is included as an Additional Insured and Loss Payee as their interest may appear as respect production work done on behalf of Agency;Ogilvy&Mather NY;Client:Merck Inc;Job NO:MKCOR803182(F);Commercial Title:"Believe,Wish, Ellen McGrath,Lisa Garele, Emma Fields"- With respect to others,coverage Is worldwide,in transit and All Risk, With respect to Automobile Rentals,Non-Owned&Hired Auto Physical Damage,limits are Included in Miscellaneous Equipment.Deductible-10%of loss;$2,500 Min,/$7,500 Max(per occurrence). WPP. CERTIFICATE HOLD9R CANCELLATION SHOULD ANY OF THn ADOVF DESCRIBED POLICICG 01!OAN(:F,LLED BEFORE THE EXPIRATION DATE Town of Southhold THEREOF.THE INSURER ArPODDING COVERAGE WILL I_Nlsnavon TO MAIL as DAYS WRITTEN NOTICE TO Town Wall, 53095 Main Road Tilt OrRTN'IGATF HOLDER NAMED HEREIN,DLIr FAILURE TO DO SO SMALL IMPOSD NO 001.I0ATION OR Southhold, New York 11971 LIAGILITYOPANYI(INDlIPON7HEINSURERArrOADIN(COVERAGE,MSAGENTSORR2PRE5CNTATIVF- DeWittStrim IStOeO'Beirne Group Inc. ey I M1 9198 - 1lAl:D`AS dF 0 ' 26/04 '06 WED 13:53 FAX 631 765 6145 SOUTHOLD TOWN CLERK Q001 TX REPORT xc TRANSMISSION OK TX/RX NO 2511 CONNECTION TEL 912127411519 CONNECTION ID ST. TIME 26/04 13:50 USAGE T 03'02 PGS. SENT 9 RESULT OK ELIZABETH A.NEVILLE "?, Town Ball, 53095 Main Road TOWN CLERK to P.O. Box 1179 RHGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE Fax (631) 765-6145 M RE CORDS MANAGEMFNI"OFFICER r�''-� "' ".�`r Telephone (631) 765-1800 rRE-EDOM OF INFORMATION ION OFFICER ';�µ"•:;1�;u` OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL To: Johnnie Walker 212-741-1519 From: Linda J. Cooper,Deputy Town Clerk Dated: April 26,2006 Re: Application for Filming Permit Number of Pages (including cover): 9 If total transmittal is not received,please call 631-765-1800. COMMENTS: As requested. Call if you have Any questions. I'm here from 8am to 4pm 26/04 '06 WED 14:53 FAX 631 765 6145 SOUTHOLD TOWN CLERK Im001 xc TX REPORT TRANSMISSION OK TX/RX NO 2513 CONNECTION TEL 97652715 CONNECTION ID Police Dept ST. TIME 26/04 14:52 USAGE T 00'45 PGS. SENT 1 RESULT OK a6/05/201d6 02:15 2127411519 — — —' — — — — THE ARTISI''> COMPANY PAGE 62/04 I 4"71"Z'Tfi A. N'EVILLE ,� d TOWN CL3ERg Tawe ag" 63065 Mala R."'i REGISTRAR OF VrrAL STATISTICS 17'O'fox 117$ M ACa obk"rc}L i �`'"� Svuthgld,New York 11071 RFC"ORDF MANACrIII'mF +NT O CER yr , Fux(631)765.GJ.4.5 FRE-EDOlv1 OF IIVPORMATTON C)r CEP ycQ� TajephaAe(631) 765-lAoO sont]�oldtown_nox�orlt,net oFFr E or' THE TOWN CL1ERK I OWN OP SO-UTHbLD i APPLICATION:FOR FILMING/STILL.PHOTOGRAPRY Plcasc Print or Type A•PPLICATION'DATE: 4D P�I�MXT NO: NAME OF APPLICANT: �ry • - MAILING ADDRESS:�sr c _LU oz/� c5y 2 rte F-foa� /lj N PHONE-- BUSINESS: Z_.l Z � HOME: . 1�aha NAME OF ORGATMgZATICOAVkNY: lZ �IZ,'r s-75 eo M P/40j MAILING,ADDRESS: e PxaNE' Z12� 6 a ' __ rx 2�/ 2 - 7W DES CRIBB 'I PF-Off'ACTIVI'[Y(e.g.Potion Picture, CommercitJI,Television, Catalog,Magazine. Elc.): Clo In ege is. DATES AND Tuvfr, ( (S) OP ROPOSAb FJJ,,MWC-r/P.FIOTOGRAPHy; s ©9 PROPOSED LOCATIONS ( )OF 1~MMTNrjt P'HOTOGRApk�Y,( ,rlc,�additional slipet,it z�eceasa7y) .- S, � -0'? ole .J 'AG�fL� a NANM OF PERSON 1N CHARkG$AT SITE: N7J-NfBFR OF PERSONS AT LOCATION(cast&crew included):, lt�rr GfQ — ■ Complete items 1,2,and 3.Also complete A Signatwe Item 4 If Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse Add so that we can return the cans to you. g, Received by(PdnW Name)— ■ AtUlph this card to the back of the mailpieos, e front if space permits. - -_ - -- - I. -ndd to: D. Is dWMwy addrees different from Item 14 0_ ir�a/ ' If YES,enter delivery address below: ❑No 1❑r CertMied Mail 13 Express Mail Registered C3 Return Receipt for Merchandise ❑Insured Mall ❑C.O.D. 14. Restricted Delivery?(Exha Fee) ❑Yes ft. Ardis Number _ ._. frrer�re.from sense AW 311 0001 8547 7546 Ml 1dF4��R*I i I i� � R.ecelpt �ozaes as�t•t UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box• OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD ®� ELIZABETH A.NEVILLE,TOWN CLERK P.O.BOX 1179 SOUTHOLD,NEW YORK 11971 N#5 £ w ti s .