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Home My WebLink AboutHidden Hill Productions Page 1 of 1 Cooper, Linda From: McMahon, James Sent: Tuesday, June 12, 2007 11:21 AM To: Cooper, Linda Subject: RE: Inlet Park Suffolk County is processing a filming permit for Inlet Park......I assume it the same company/person From: Cooper, Linda Sent: Monday, June 11, 2007 4:25 PM To: McMahon, James Subject: Inlet Park I have received a request for a filming permit at Inlet Park. I know it's a County Park but do we manage it? Linda J. Cooper Deputy Town Clerk Town of Southold 631-765-1800 6/12/2007 APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT NO: Please Print or Type / APPLICATION DATE: 7 NAME OF APPLICANT- MAILING ADDRESS: 32- y5"'✓ PHONE: BUSINESS: �/"Z. - ,�$2 - U11 HOME: $ S- 706 7 NAME OF ORGANIZATION/COMPANY: N6' .-t�/�>/) 1p{bd4.J,ia►1S MAILING ADDRESS: s/ PHONE: _ Z/-Z S`SZ - $?�11 � FAX: Z i-?--SSl� - �r233 DESCRIBE TYPE OF ACTIVITY (e.g. Motion Picture, Commercial, Television. Catalog, Magazine, etc.): P DATE(S) AND TIME(S) OF PRO OSED FILMING /PHOTOGRAPHY: a ,7 .,3PO " 9�1l PROPOSED LOCAT ON(S) OF FILMING/PHOTOGRAPHY: ('attach additional sheet, if necessary) - 131Z r.-C4 !2,1 &tvj &aaj NAME OF PERSON IN CHARGE AT SITE: /l/ G� NUMBER OF PERSONS AT LOCATION (cast& crew included): NUMBER AND TYPE OF `V"ECHILES AT LO/CATION: TYPE OF SPECIAL EQUIPMENT: T y/ ANY SPECIAL REQUIREMENTS: r Signature Return to: Southold Town Clerk Southold Town Hall 53095 Main Load P.O. Box 1179 Southold,NY 11971 Z0 39Vd QONJ -PIHN3GGIH 66Z8-Z89-ZZZ 60:tT L00Z/90/90 INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT The Applicant shall indemnify and hold harmless the Town from and against all suits, claims, demands or actions for any damage and/or injury sustained or alleged to be sustained by any party or parties in connection with the performance of filming or still photography by the Applicant, his employees or agents or any subcontractor and in case of any such action brought against the Town, the applicant shall immediately take charge of and defend the same at his own cost and expense. In addition, the Applicant will name the Town as an additional insured on any applicable policies. GA; o -7 Signature Dat Printed name Title 60 39Vd aMld T1IHN3QQIH EEZ8-Z89-ZZZ 60:bt L00Z/90/90 II tV:27486 HIDDEPRODU ACORDI. CERTIFICATE OF LIABILITY INSURANCE 013010; ►aooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION D. R,Reiff&Associates(212)603-0231 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR CA License Number 0759214 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 320 West 57th Street New York,NY 10019 INSURERS AFFORDING COVERAGE NAIC M INSURED IN$VRFRA. Travelers Hiddenhill Productions,Inc. NSURERB 432 West 45th Street INSURER C 5th Floor INSURER D. New York,NY 10036 NSURER E: COVERAGES THE POLICIES OF INSURANCE LISYED BELOW HAVE:BEEN ISSUEO TO THF-INSURED NAMED ABOVE FOR THE:POLICY PERIOD INDICATED NOTWITHSYANDING ANY REOUIREVENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER.DOCuMENT wITH RESPECT TO WMICM 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 PATO CLAIMS YR N R TYPE OF INSURANCE POLICY NUMBER P ATC YMMjQD IY U XNIODO ION LIMITS A GENERAL LIABILITY CK0611A72Z 03131!01 03131108 EACNOCCVRRENCE 161,000 000 i AWG 1Q RENTED t50 000 z COMMERCIAL GENERAL LIABILITY CLAIMS MADE Q OGOUR MED EXP IAA vi.P.no., 55,000 PERSONAL E AQV INJURY $1,000.000 GENERAL AGGREGATE SZ 00O 000 GEN!AGGREGATE LIMIT APPLIES PER PROOUCY$•COMP,OP AGO 11 000 000 PR0 LOC 17 POLICY E T A AVTOMOBILE LIABILITY CK06114722 03/31107 03131/06 COMBINED SINGLE UMIY ANY AVIC Physical Damage 51,000,000 ALL OWNED AUTOS 5125,000 Per Yh BODILY IN,ILIRY $CHf0ULE0 AUTOS 52,000,000 Agg (D"°"'0") t X HIPED AUTOS Ded 10%Of loss BODILY INJURY X (P.,.lGC.AII NUN•QN'NhD AU TUS 2,500 Irvin $7,500 mai PROPERTY DAMAGE ri IP-(SCBI06n11 f GARAGE UABILITY AUTO ONLY-fEA KrIDENr 5 MY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG S EXCESSIUM6RELLA LIABILITY EACH OCCURRENCE f OCCUR CLAIMS MADE AGGREGATE f DEDUCTIBLE S REYENYIQN 5 3 TATu A WOaKERi CoM►ENSATION ANO XACRUSA69SY77907 03131107 03131106 X 'OR CY LIMIT M EMPLOYERS'LIASIUYY E EACH ACCIDENT S1 000 000 ANY►aQPRIETOR;P►RTNERIExFCUTIVE OFFIC4Rl.AEMBER EXCLUDEDT E.L DISEASE•EA EMPLOYEE S 1,000,000 II re..d.—b.vna.I SP961AL PROVI IONS 0.,0, E.L.DISEASE POLICY NsIR _111100 0 000 A OTHER 3rd Party PD 15IM06103015 03131/07 03/31/08 51,000,000 Dad: 52,500 Misc.Equipment $750,000 Dad;53,500 Pro Sets,Wardrbe $250,000 Ded;$2,500 DEICRIPTION OF OP(RATIONS T LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORS[MONY I yPECIAL PROVISIONS Cenificate Holder is included as Additional Insured as respects to liability coverage and the sole negligence of the named insured. CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF TOE ABOVE OSSCRIBEO POLICIES BE CANC94LE6 BEFORE THE EXPIPAYION DAVE THEREOF.TNS I$SUINC INSURER WILL ENDQAvOR TO MALL an OAY7 WRITTEM NOTICE TO TNe cEATIFICATE HOLPaR NAMIED TO TOE LEFT.BVI YAILUAE TO DO SO 34AL6 IMPOSE NO OSLICATION OR LIABILIYY OF ANY RIND UPON YHr INSURER.ITS AGENT]OR REPRESENYAYIvES. AUI RC[OXA-yl ATIVE ACORO 2S(Z00110S) 1 9S27633/M27627 !^r,' R7711 0 ACORD CORPORATION 1999 VO 39dd QO�ld -nIHN3QQIH EEZB-ZBS-ZTZ 60:t1T l00Z190190 HIDDENHILL PRODUCTIONS 432 West 45'" Street Phone; (212) 582-8211 New York, NY 10038 Fax; (212) 582-8233 FACSIMILE ©t U TO: L-1 VL FAX: ��- FROM: cc c,L. PAGES (including cover sheet): S ' I9 3E)Vd (IMId -nIHN3QQIH EEZ8-Z85-ZZZ GOVT L90Z/99/99