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Home My WebLink AboutUtopia • - pF SO(/r�Ol ELIZABETH A.NEVILLE, RMC, CMC '` O Town Hall, 53095 Main Road TOWN CLERK J [ 1 [ P.O. Box 1179 REGISTRAR OF VITAL STATISTICSSouthold, New York 11971 G �pQ Fax (631) 765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICERl Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �COUNMV, southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD August 5, 2010 Attn: Sarita Dan Utopia 601 W 26`h St #1223 New York NY 10001 Dear Ms. Dan: Returned herewith is your Clean-Up Deposit in the Amount of$250. Also enclosed are your copies of the money orders for the various fees for Filming/Still Photography Permit No. 28. It was a pleasure doing business with you. Very truly yours, Linda J. Cooper Deputy Town Clerk Enclosures (4) —'WIN TAU6-WATE HOLD DOCUMENT UP...TO-THE LX3k4T:TO=VIEW TRUE.WATERMARK c tibanW 120439465 20 Citib n N.A. 6311 F�:#00410 FA# 0,3611 �,J r 3„ 070-04 Ck- Ser. # 120 0 7 / 1 4 / 1 0 PAY ****TWO HUNDRED F"IF TO 8 j> THE Y OFDER w I a o NOMEMT GOOD FOR MORE THAN $1,000.1 ��Oi a _ Citibank,N.A.One Penn's Way ?" 7 z New Castle,DE 19720 — — ------------------------------- -- 11. L an �g�S Su■ ._ 2411' — PERSONAL c ONE ORDER O Chiba k SERVICE INSTRUCTIONS 120439466 V PIES ANY OTHER SERVICE REQUIREMENT, X"IKAN THIN-AN41AI�CEE NTER OR CALL 800 627-3999 TO LOCATE ONE. 62_20 W �U t T r z . . w H LLI h w � �w Ix o o NOT C / Dw > Crl T j= Citibank, C �J R .. O New Cast �. 1 1- 'AT"Pp � I LL TERMS % A PAYEE AND SIGN THE INSTRUMENT IMMEDIATELY UPON PURCHASE. LASER BEARING THE RISK OF ANY LOSS OR THEFT OF THE INSTRUMENT. � PERSONAL -_--_-- >- Cii 1 �-Yyl1�t6oT ONEY ORDER SERVICE INSTRUCTIONS 1- 20439464 V Citibank 10TOCOPIES OR ANY OTHER SERVICE REQUIREMENT, N flgl VdAN(#tA4 CENTER OR CALL 800 627-3999 TO LOCATE ONE. 62-2( C) 311 fV, � z� W . o ¢j Q 4 o Z a 0 ?� U N_a W s � w (L j o NOT G a, m Citibank.N "'✓' 1'1/ z New Castle / o� LL O TERMS �.�..r.� PAYEE AND SIGN THE v uv aU WILL RESULT IN THE PURCHASER BEARING THE RISK OF ANYENT LOSS ORD HIATELY EFT OF TO EPINSTRUMENT. A a � PERSONAL o Chi I ONEY ORDER V Citibank I C !V NJ SERVICE INSTRUCTIONS 1. 20439463 10TOCOPIES OR ANY OTHER SERVICE REQUIREMENT, FNIVAN"CENTER OR CALL 800 627.3999 TO LOCATE ONE. – 62-20 OF SO(/ryo! ELIZABETH A.NEVILLE,RMC,CMC O Town Hall,53095 Main Road TOWN CLERK J�[ l P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER • �O Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER � Telephone (631) 765-1800 COMM FREEDOM OF INFORMATION OFFICER , southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT Issued to: Utopia The Azency (Sarita Dan) Date(s), Time(s) and Location July 21, 2010—8:00 am to 8:00 pm—Road End Beaches at: Sound Road, Greenport Rocky Point Road, East Marion Permit No. 28 Issue Date: 7/19/2010 Elizabeth A. Neville _ Southold Town Clerk (Town Seal) OG SO!/ryol ELIZABETH A.NEVILLE,RMC,CMC '` O Town Hall,53095 Main Road TOWN CLERK l J P.O. Box 1179 REGISTRAR OF VITAL STATISTICSN Southold, New York 11971 G p MARRIAGE OFFICER Fax(631) 765-6145 .t` i RECORDS MANAGEMENT OFFICER `, , Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ouf 1M,, southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING PERMIT NO 28 OF 2010 PARKING PERMIT DATE: JULY 219 2010 TIME: 8:00 AM to 8:00 PM LOCATION: Road End Beaches: Sound Road, Greenport Rocky Point Road, East Marion *pF SO�jyo ELIZABETH A.NEVILLE,RMC, CMC 'tom l0 Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS N Southold, New York 11971 MARRIAGE OFFICER • �O Fax(631) 765-6145 RECORDS MANAGEMENT OFFICERl Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER yC�UIY 1�,`` southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Cochran, Southold Town Police From: Linda J. Cooper, Deputy Town Clerk Dated: July 15, 2010 Re: Filming Permit Transmitted herewith is the application of Saria Dan filming/photo shoot permit. In accordance with Section 139.0 of the Town Code please review the application and advice of approval or disapproval of the application and whether a traffic control fee is required and the amount needed. RECEIVED JUL 15 2010 Southold Town Clerk APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT NO: Please Print or Type APPLICATION DATE: �y 1 NAME OF APPLICANT: S av-I,-t& 'Oct n., MAILING ADDRESS: (001 V QS-t 2-(JM— -5+ 122 f�`� 16 O o 1 PHONE: BUSINESS: '?_(2 (dLl 9 Z b d HOME: 2-t -2— Cp3y 4 Z ejCp NAME OF ORGANIZATION/COMPANY: j.OL- MAILING ADDRESS: 01 West Cam # 2Z C?n0 PHONE: 1.47 &_3q q 2 q)o FAX: 2-12- 60 3 L f DESCRIBE TYPE OF ACTIVITY(e.g. Motion Picture, Commercial, Television. Catalog,Magazine,etc.): D h 6fbq 17-4 Li A- a_e DATE(S)AND I (S)OF PROPOSED FILMING/PHOTOGRAPHY: PROPOSED LOCATION(S)OF FILMING/PHOTOGRAPHY: (attach additional sheet,if nec sary) ac SO kr-d- G� k � 610 p NAME OF PERSON IN CHARGE AT SITE: CWc' c' R 0- NUMBER NUMBER OF PERSONS AT LOCATION (cast&crew included): NUMBER AND TYPE OF VECHILES AT LOCATION: WI S O I�Gylry TYPE OF SPECIAL EQUIPMENT: C&Wt,,co- 00M ANY SPEC L REQUIREMENTS: N0 . Oignature Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P.O. Box 1179 Southold,NY 11971 CERTIFICATE OF LIABILITY INSURANCEOP ID WA DATE("MIA)DAWY) CREAT-4 07/14/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Suburban General Insurance Agy HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 625 From Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Paramus NJ 07652 Phone:201-225-9099 Fax:201-225-0253 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: The Hartford 19682 INSURER B'. 929lReepretsCy, Inc. INSURER C 601 West 26th street 12th Fl. INSURER er NeYork NY 10001 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. LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD DATE(MMO)A TY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X COMMERCIAL GENERAL LIABILITY 13SBALQ5878 05/25/10 05/25/11 PREMISES(Ea occcui rence) $300000 CLAIMS MADE a OCCUR MED EXP(Any one person) $10000 PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GEN'LAGGREGATE LIMIT APPLIESPER: PRODUCTS-COMP/OPAGG $2000000 POLICY JEa LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ --EAUTO ONLY. AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE s4,000,000 A X7 OCCUR EICLAIMS MADE 13SBALQ5878 05/25/10 05/25/11 AGGREGATE $4,000,000 $ DEDUCTIBLE X RETENTION $10,000 $ WORKERS COMPENSATIONTL AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEElE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E .DISEASE-POLICY LIMIT $ OTHER PROPERTY 106600 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSUIENT/SPECIAL PROVISIONS TOWN OF SOUTHOLD IS AN ADDITIONAL INSURED FOR THE DURATION Or FILLING VOR STILL PHOTOGRAPHY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN TOWN Or sOUTHOLD NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL SOUTHOLD TOWN CLERK IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 53095 MAIN ROAD REPRESENTATIVES. PO SOX 1179 AUTH PRESE ATIVE SOUTHOLD NY 11971 ACORD 25(2009/01) bi IRMIM-200ft-CORDMORPORATIM. AN rights reserved. The ACORD name and logo are registered marks of ACORD 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 a plicable policies. 7 11,ho Si a Date t° Printed name Title Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 07/19/10 Receipt#: 87890 Transaction(s): Reference Subtotal 1 1 Application Fee- Non-Refund 28 $100.00 1 1 Beach Permits 28- $10.00 1 1 Daily Filming Permit 28 Day $100.00 Check#: MONEY ORDERS Total Paid: $210.00 Name: Utopia, The Agency Sarita Dan 601 W 26th St#1223 New York, NY 10001 Clerk ID: LINDAC Internal ID:28 Page 1 of 1 Cooper, Linda From: Flatley, Martin Sent: Monday, July 19, 2010 10:54 AM To: Cooper, Linda Subject: Filming Permit Good morning Linda, With regards to the application for the filming/photography permit submitted by Sarita Dan, I spoke to her this morning about her project and it does not look like they will require any services from us. I did advise them to place some type of placard on their dashboards of their vehicles indicating they were with the photo shoot so they don't get beach permit parking tickets while there. So, I approve of this permit being issued and it will not require traffic control or any expense to the PD. Hope this is sufficient for a response as no secretary today-if you need a letter, please let me know. Captain Martin Flatley Executive Officer Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 7/22/2010