Loading...
HomeMy WebLinkAboutMore Magazine �O�� ,� g�FFO( �oG ELIZABETH A. NEVILLE,MMC y Town Hall, 53095 Main Road P.O. Box 1179 TOWN CLERK H Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 6 Fax(631)765-6145 MARRIAGE OFFICER 'f'� a��' Telephone(631)765-1800 RECORDS OF MANAGEMENT OFFICER �l �► southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD August 6, 2011 Attn: Dena Zemsky On The Mark Locations 310 Greenwich Street, Suite 38G New York, NY 10013 Re: Southold Town Filming Permit No. 032 Dear Ms. Zemsky: Returned herewith is Check No. 9219 in the amount of$250.00 for the cleanup deposit as required by the Southold Town Code. An inspection of the permit sites was made and no cleanup was necessary. Very truly yours, Lynda M Rudder Deputy Town Clerk Enc. Page 1 of 1 Rudder, Lynda From: Blasko, Regina Sent: Tuesday, August 21, 2012 2:54 PM To: Rudder, Lynda; Flatley, Martin; Sinramm, Joan; Harris, Peter Subject: RE: filming The Chief has visited 67 Steps Beach and confirmed that it is OK to release the clean up deposit from last Thursday's photo shoot. Thank you. Regina Blasko Secretarial Assistant Southold Town Police Department 765-2758 From: Rudder, Lynda Sent: Tuesday, August 21, 2012 10:03 AM To: Flatley, Martin; Blasko, Regina; Sinramm, Joan; Harris, Peter Subject: filming Importance: High Please let me know if I can release the clean up deposit for the photo shoot that took place on 8/16 at 67 steps beach. 8/21/2012 44F F 01 ELIZABETH A.NEVILLE,MMC �� OGy Town Hall,53095 Main Road TOWN CLERK p P.O. Box 1179 W Z Southold,New York 11971 REGISTRAR.OF VITAL STATISTICS Q .F Fax(631)765-6145 MARRIAGE OFFICER y RECORDS OF MANAGEMENT OFFICER '��j �a0 Telephone n.no 7 fork. 0 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT Issued to: Gabrielle Sirkin—MORE MAGAZINE Date(s), Time(s) and Location Thursday, August 16, 2012 10:00 am to 7:30 pm 67 Steps, Sound Road, Road End and Beach, Greenport New York Permit No. 032 Issue Date: August 7,2012 Elizabeth A. Neville Southold Town Clerk (Town Seal) Page 1 of 1 Rudder, Lynda From: Flatley, Martin Sent: Tuesday, August 07, 2012 1:28 PM To: Rudder, Lynda Subject: RE: Filming permit Application OK From: Rudder, Lynda Sent: Tuesday, August 07, 2012 8:14 AM To: Flatley, Martin Subject: RE: Filming permit Application The girl. I. have been working with dial. not seem. to think they would need security but T will. check again. In the filming code there is a, provision for parking along with. a fee and. special. parking permit placards to be displayed. From: Flatley, Martin Sent: Monday, August 06, 2012 4:10 PM To: Rudder, Lynda Cc: Blasko, Regina Subject: RE: Filming permit Application Hi Linda, I have no objections to this taking place as long as the Board has waived the parking restrictions there and the participants use some type of placard to identify their vehicles. I'm just assuming they are not looking for any type of security around their shoot? Martin Flatley Chief of Police Southold Town Police Department 41404 State Rt. 25 Peconic, N.Y. 11958 631-765-3115 From: Rudder, Lynda Sent: Monday, August 06, 2012 1:02 PM To: Finnegan, Martin; Andaloro, Jennifer; Flatley, Martin; Kruszeski, Frank Cc: Krauza, Lynne; Blasko, Regina Subject: Filming permit Application please review the attached filming permit application and .let me know if you approve or disapprove and. if there are any costs involved 8/7/2012 SFFOL t ELIZABETH A.NEVILLE,MMC �� �G.y Town Hall,53095 Main Road TOWN CLERK p P.O.Box 1179 CA Z Southold,New York 11971 REGISTRAR.OF VITAL STATISTICS Q Fax(631)765-6145 MARRIAGE OFFICER 'J� ! � Telephone(631)765-1800 RECORDS OF MANAGEMENT OFFICER ��! '1►a southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PHOTO SHOOT PARKING PERMIT DATE: Thursday, August 16, 2012 TIME: 10:00 AM to 7:30 PM LOCATION: 67 Steps Sound Road, Road End Greenport, N Y Elizabeth A. Neville Town Seal Southold Town Clerk PLACE THIS PERMIT ON THE DASHBOARD, PASSENGER SIDE OF VEHICLE reg ► s6-cf APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT N0: Please Print or Type APPLICATION DATE: August 7 2012 NAME OF APPLICANT: Gabrielle Sirkin MAILING ADDRESS: 805 Third Avenue,251"Floor New York,NY 10022 PHONE: BUSINESS: 212.499.1735 HOME: 650.814.7201 (CELL) NAME OF ORGANIZATION/COMPANY: MORE MAGAZINE MAILING ADDRESS: SEE ABOVE PHONE: SEE ABOVE FAX: 212.499.1790 DESCRIBE TYPE OF ACTIVITY(e.g. Motion Picture, Commercial, Television. Catalog,Magazine, etc.): MAGAZINE PHOTO SHOOT FOR NOVEMBER 2012 FASHION STORY DATE(S)AND TIME(S) OF PROPOSED FILMING/PHOTOGRAPHY: THURSDAY AUGUST 16TH 201210:00 AM—7:30 PM(NO OVERTIME) PROPOSED LOCATION(S) OF FILMING/PHOTOGRAPHY: (attach additional sheet,if necessary) 167 STEPS, GREENPORT NY' NAME OF PERSON IN CHARGE AT SITE: GABRIELLE SIRKIN & NATASHA LUNN NUMBER OF PERSONS AT LOCATION(cast&crew included): 13 NUMBER AND TYPE OF VECHILES AT LOCATION: 2 CAR SEDANS, I TALENT MOTORHOME, I PRODUCTION MOTORHOME, I PHOTOGRAPHER VAN TYPE OF SPECIAL EQUIPMENT: CAMERA,TRIPOD,LIGHTS, DIGITAL TECH PACKAGE ANY SPECIAL REQUIREMENTS: NO PROPS WILL BE USED. WARDROBE ONLY. Signature Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P.O. Box 1179 Southold,NY 11971 APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT NO: 2) o� Please Print or Type APPLICATION DATE: August 6,2012 NAME OF APPLICANT: Gabrielle Sirkin MAILING ADDRESS: 805 Third Avenue,25t"Floor New York,NY 10022 PHONE: BUSINESS: 212.499.1735 HOME: 650.814.7201 (CELL) NAME OF ORGANIZATION/COMPANY: MORE MAGAZINE MAILING ADDRESS: SEE ABOVE PHONE: SEE ABOVE FAX: 212.499.1790 DESCRIBE TYPE OF ACTIVITY(e.g. Motion Picture, Commercial,Television. Catalog, Magazine,etc.): MAGAZINE PHOTO SHOOT FOR NOVEMBER 2012 FASHION STORY DATE(S) AND TIME(S) OF PROPOSED FILMING/PHOTOGRAPHY: THURSDAY AUGUST 16""'201210:00 AM—7:00 PM PROPOSED LOCATIONS) OF FILMING/PHOTOGRAPHY: (attach additional sheet, if necessary) '67 Steps, Greenport NY' NAME OF PERSON IN CHARGE AT SITE: NATASHA LUNN,DIRECTOR OF PHOTOGRAPHY NUMBER OF PERSONS AT LOCATION(cast&crew included): 13tl ®1'[ NUMBER AND TYPE OF VEHICLES AT LOCATION: TALENT MOTOR �[ E,PRODUCTION MOTORHOME,PHOTOGRAPHER'S VAN TYPE OF SPECIAL EQUIPMENT: CAMERA,TRIPOD,LIGHTS,DIGITAL TECH PACKAGE ANY SPECIAL 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. S. 6. 1rot �- Sign tur Date Printed name Title Page 1 of 1 Rudder, Lynda From: Finnegan, Martin Sent: Tuesday, August 07, 2012 9:14 AM To: Rudder, Lynda Cc: Krauza, Lynne Subject: RE: Filming permit Application don't have any problem with this as long as they get the insurance. From: Rudder, Lynda Sent: Monday, August 06, 2012 1:02 PM To: Finnegan, Martin; Andaloro, Jennifer; Flatley, Martin; Kruszeski, Frank Cc: Krauza, Lynne; Blasko, Regina Subject: Filming permit Application please review the attached filming permit application and let me know if you approve or disapprove and if there are any costs involved 8/7/2012 Page 1 of 1 Rudder, Lynda From: Flatley, Martin Sent: Monday, August 06, 2012 4:10 PM To: Rudder, Lynda Cc: Blasko, Regina Subject: RE: Filming permit Application Mi Linda, I have no objections to this taking place as long as the Board has waived the parking restrictions there and the participants use some type of placard to identify their vehicles. I'm just assuming they are not looking for any type of security around their shoot? Martin Flatley Chief of Police Southold Town Police Department 41404 State Rt. 25 Peconic, N.Y. 11958 631-765-3115 From: Rudder, Lynda Sent: Monday, August 06, 2012 1:02 PM To: Finnegan, Martin; Andaloro, Jennifer; Flatley, Martin; Kruszeski, Frank Cc: Krauza, Lynne; Blasko, Regina Subject: Filming permit Application please review the attached filming permit application and let me know if you approve or disapprove and if there are any costs involved 8/7/2012 Page 1 of 1 Rudder, Lynda From: On The Mark Locations [dena@onthemarklocations.com] Sent: Tuesday, August 07, 2012 8:51 AM To: Rudder, Lynda Subject: Re: filming hi Tell the police captain that On the Mark will have a local person on site for the day to keep an eye on things and help them with any local needs. Crew is only 13, so can't see why they would need more than the police doing their normal rounds during the day stopping by. let me know thanks Dena On Aug 7, 2012, at 8:31 AM, Rudder, Lynda wrote: yes. From: On The Mark Locations [mailto:dena@onthemarklocations.com] Sent: Tuesday, August 07, 2012 8:18 AM To: Rudder, Lynda Subject: Re: filming I don't see why I would need it, unless they want "crowd control" for the "big star", haha I will talk to her once business hours start for them and see what they think I really don't think so, once we figure this out, then I will know costs, correct? thanks Dena On Aug 7, 2012, at 8:15 AM, Rudder, Lynda wrote: I just heard from the Chief. He has no objections but wanted to make sure that you did not require any sort of security from the Police Department. Still waiting for the Town Attorney. 8/7/2012 A� oe/ 7/2CERTIFICATE OF LIABILITY INSURANCE DATE07/2/Y012 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 1-800-247-7756 CONTACT NAME: Holmes Murphy & Assoc - WDM PHONE FAX A/C No]: PO Box 9207 E-MAIL ADDRESS: Des Moines, IA 50306-9207 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Sentry Insurance A Mutual Company INSURED INSURER B: St. Paul Fire & Marine Insurance Company Meredith Corporation Attn: Sheila Weirich INSURER C: 1716 Locust Street INSURER D: Des Moines, IA 50309-3023 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 28603721 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 ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY 90-02693-03 07/01/1 07/01/13 EACH OCCURRENCE $ 1,000,000 4C-10M DAMAGE TO RENTED MERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 250,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $NotProvided PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $5,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PROJEC LOC $ A AUTOMOBILE LIABILITY 90-02693-06 07/01/12 07 O1 13 COMBINED SINGLE LIMIT A X 90-02693-04 07/01/1 07/01/13 Ea accident 2,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED i Per accident)AUTOS AUTOS BODILY INJURY( ) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOSX AUTOS Per accident $ B X UMBRELLA LIAB X OCCUR ZUP-1OT39950-12-NF 07/01/1 07/01/13 EACH OCCURRENCE $ 51000,000 ElEXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED I I RETENTION$ $ A WORKERS COMPENSATION 90-02693-0107/01/12 WCSTATU- OTH- AND EMPLOYERS'LIABILITY 07/01/13 X A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 90-02693-02 07/01/1 07/01/13 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? F N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) On the Mark Locations, Ltd is included as an Additional Insured on the Commercial General Liability policy when required by contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE On the Mark Locations, Ltd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 295 Greenwich Street, #526 AUTHORIZED REPRESENTATIVE New York, NY 10007 �,.,,�•__- USA "�01N_ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ssteinbachwdsm DATE(MM/DD/YYYY) A� CERTIFICATE OF LIABILITY INSURANCE 08/07/2012 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 1-800-247-7756 CONTACT NAME: Holmes Murphy & Assoc - WDM PHONE FAX AIC No): PO Box 9207 E-MAIL ADDRESS: Des Moines, IA 50306-9207 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Sentry Insurance A Mutual Company INSURED INSURER B: St. Paul Fire & Marine Insurance Company Meredith Corporation Attn: Sheila Weirich INSURER C: 1716 Locust Street INSURER D: Des Moines, IA 50309-3023 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 28603739 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY 90-02693-03 07/01/1 07/01/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occu encs $ 250,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $NotProvided PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $5,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY 90-02693-06 07/01/12 07 1 13 COMBINED SINGLE LIMIT 2,000,000 Ea accident A X ANY AUTO 90-02693-04 07/01/1 07/01/13 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X rX NON-OWNED PeOracidentDAMAGE $ HIRED AUTOSAUTOS B X UMBRELLA LIAB X OCCUR ZUP-1OT39950-12-NF 07/01/1 07/01/13 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 51000,000 DED RETENTION$ $ A WORKERS COMPENSATION 90-02693-01 07/01/1 07/01/13 X WC I IMIT O R AND EMPLOYERS'LIABILITYTORY A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A 90-02693-02 07/01/1 07/01/13 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? IN I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 67 Steps Beach is included as an Additional Insured on the Commercial General Liability policy when required by contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 67 Steps Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Road End Sound Road AUTHORIZED REPRESENTATIVE Greenport, NY 11944 ��'�,,..,,^,�•.4_-w- USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD sateinbachwdsm A� CERTIFICATE OF LIABILITY INSURANCE DATE 07/2 2 oa/o7/zolz 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 1-600-247-7756 CONTACT Holmes Murphy & Assoc - WDM PHONE FAX A/C No): PO Sox 9207 E-MAIL ADDRESS: Dee Moines, IA 50306-9207 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Sentry Insurance A Mutual Company INSURED INSURER B: St. Paul Fire & Marine Insurance Company Meredith Corporation Attn: Sheila Weirich INSURERC: 1716 Locust Street INSURER D: Dee Moines, IA 50309-3023 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 28603791 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD A GENERAL LIABILITY 90-02693-03 07/01/1 07/01/13 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 250,000 CLAIMS-MADE II OCCUR 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/OP AGG $ 1,000,000 X POLICY PRO- LOC $ A AUTOMOBILE LIABILITY 90-02693-06 07/01/12 07 O1 COMBINED SINGLE LIMIT 2,000,000 A X 90-02693-04 07/01/1 07/01/13 Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED P BODILY INJURY(Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE X HIRED AUTOS rx AUTOS Per accident $ S X UMBRELLA LIAB X OCCUR ZUP-IOT39950-12-NF 07/01/1 07/01/13 EACH OCCURRENCE $ 51000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ r $ A WORKERS COMPENSATION 90-02693-01 07/01/1 07/01/13 X WCSTATU- OTH- AND EMPLOYERS'LIABILITYER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 90-02693-02 07/01/1 07/01/13 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? NN N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Town of Southold is included as an Additional Insured on the Commercial General Liability policy when required by contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Road AUTHORIZED REPRESENTATIVE Southold, NY 11971 USA Q�t, ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD asteinbachwdsm TOWN CLERK'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check 1 Applicant: IA b r'\e- e S'% yn Date Received: U�uS ✓ Completed application / $100 nonrefundable application fee v Certificate of insurance that evidences a public liability insurance policy covering the town as an additional insured in the amount of$1,000,000 (one million dollars)per occurrence for the duration of the filming or still / photography. ✓ \ Indemnification agreement stating the applicant agrees to assume all liability for and will indemnify and hold the town harmless of and free from any and all damages that occur to persons or property by reason of said filming or still photography. Forward completed application to Chief of Police for approval or disapproval nd determination if Traffic Control Fee is required Approved / Disapproved No Fee Required Fee in the amount of$ required Forward certificate of insurance and indemnification agreement to Town Attorney r 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. 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. Rudder, Lynda From: On The Mark Locations [dena@onthemarklocations.com] Sent: Tuesday, August 07, 2012 11:19 AM To: Rudder, Lynda Subject: Re: application she said hard out at 7:30 I told her cops will be there at 7:30 to make sure all are gone, I am playing hard ball with them, do you want her to redo the applications with corrected cars and times? I think it couldn't hurt, please advise Dena On Aug 7, 2012, at 1108 AM, Rudder, Lynda wrote: > They would be pushing it with 7:30. Don't know how long it would take > to clean up and pack up. If they want 8, it will probably need a town > board resolution. The Town Board doesn't meet again until 8/14, > cutting it close. > -----Original Message----- • From: On The Mark Locations [mailto:dena@onthemarklocations.com] > Sent: Tuesday, August 07, 2012 1105 AM > To: Rudder, Lynda > Subject: application > hi > I think I am going to ask them to redo the application with times and > vehicles because now they are saying they want to shoot possibly until > 8PM is this even allowed? > please find out what time they have to be off the beach and out of the > parking lot as in my experience, if you don't make it in writing, they > will ask for more and not follow the rules. > Dena i ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/07/2012 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 1-800-247-7756 CONTACT NAME: Holmes Murphy & Assoc - WDM PHONE FAX 'JC. /C No): PO Box 9207 E-MAIL ADDRESS: Des Moines, IA 50306-9207 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Sentry Insurance A Mutual Company INSURED INSURER B: St. Paul Fire & Marine Insurance Compare Meredith Corporation Attn: Sheila Weirich INSURER C: 1716 Locust Street INSURER D: Des Moines, IA 50309-3023 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 28611564 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 ADDL SUBR POLICY NUMBER MPOLICY I DY /YYYY MM/DD/YYYY LIMITS Y EXP LTR A GENERAL LIABILITY 90-02693-03 07/01/1 07/01/13 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO REN ED 250,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE a OCCUR MED EXP(Any one person) $NotProvided PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,000 X POLICY 7 PRO- LOC $ A AUTOMOBILE LIABILITY 90-02693-06 07/01/12 07/01/13 COMBINED SINGLE LIMIT 2,000,000 A 90-02693-04 07/01/1 07/01/13 Ea accident X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ B X UMBRELLA LIAB X OCCUR ZUP-1OT39950-12-NF 07/01/1 07/01/13 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I I RETENTION$ $ A WORKERS COMPENSATION 90-02693-01 07/01/1 07/01/13 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY — -ER --- A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 90-02693-02 07/01/1 07/01/13 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? FN ] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Town of Southold is included as an Additional Insured - State or Political Subdivisions for which the state or political subdivision has issued a permit. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Road AUTHORIZED REPRESENTATIVE Southold, NY 11971 USA AWUD�. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ssteinbachwdsm