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Home My WebLink AboutBMS Designs �O�Os�\ ELIZABETH A. NEVILLE,MMC r/y Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 CA 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p • . Fax(631)765-6145 MARRIAGE OFFICER y� fit' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �.� `�►a www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT Issued to: BMS Designs, Inc. Date(s), Time(s) and Location: Total of 1 DAY. Monday,June 30, 2014 + Beach at Rocky Point Road, East Marion, New York Permit No. 040 Issue Date: June 26, 2014 C"C?'oeoe�& Elizabeth A. Neville Southold Town Clerk (Town Seal) O`OS�rfO�X n� ELIZABETH A.NEVILLE,MMC �� 4 G,f, Town Hall,53095 Main Road TOWN CLERKo P.O.Box 1179 H = Southold,New York 11971 REGISTRAR,OF VITAL STATISTICS p ' Fax(631)765-6145 MARRIAGE OFFICER �'� �� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER a FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING PERMIT NO 040 PARKING PERMIT DATE: Monday, June 30, 2014 TIME: 7:00 AM to 7:00 PM LOCATION: Rocky Point Road end beach, East Marion Photo Shoot PLACE THIS PERMIT ON THE DASHBOARD, PASSENGER SIDE OF VEHICLE * * * RECEIPT * * * Date: 06/26/14 Receipt#: 173087 Quantity Transactions Reference Subtotal 1 Clean-Up Deposit 40 $230.00 Total Paid: $230.00 Notes: Payment Type Amount Paid By CK# $230.00 Mazzoni, Henry Name: Mazzoni, Henry 146-04 25th Road Flushing, NY 11354 Clerk ID: LYNDAR Internal ID:40 APPLICANT'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check. 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. Permit Fees(Prior to issuance of permit): Film Fee - $100 per day of each day covered by the permit Cleanup deposit: Separate 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. f Beach Parking fee - $10 per vehicle, per day between May 1 and September 30. ALL CHECKS MUST BE CERTIFIED NOTE: Additional fees for Cleanup and Traffic Control may be required at the direction of the Chief of Police and Superintendent of Highways Package ExPrewUSAirbill 8030 0250 0523 1 From Awppvwm4prv@vkwd 4 Fxpm Pecimp Seryice -%motssede e. r pa..prmrias Senders FedEx M SWIF .rr.. NOlE service order hes changed.Please eelael carefully. awraeagrSWAIM Date 10 q Account Number �`� `� �r106'71a7CY"' 1, 1. seeders ,( w-/ dem Name V 11&CJr'f� Phone( 631 765-11 00 � n,eOWMipht h E] A • [J w�+o'•nwwlil�o�`o+:vb •don s.e.a.vwrweor.weu. company TOWN OF SOUTHOLD ❑ FWrxkPo"R', Overnight rrab. 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Part 163134•Rev.Date 2/12 • * * * RECEIPT * * * Date: 06/27/14 Receipt#: 173255 Quantity Transactions Reference Subtotal 1 Clean-Up Deposit 40 $20.00 Total Paid: $20.00 Notes: Payment Type Amount Paid By CASH $20.00 Mazzoni, Henry Name: Mazzoni, Henry 146-04 25th Road Flushing, NY 11354 Clerk ID: CAROLH Internal ID:40 * * * RECEIPT * * * Date: 06/26/14 Receipt#: 173087 Quantity Transactions Reference Subtotal 1 Clean-Up Deposit 40 $230.00 Total Paid: $230.00 Notes: Payment Type Amount Paid By CK# $230.00 Mazzoni, Henry Name: Mazzoni, Henry 146-04 25th Road Flushing, NY 11354 Clerk ID: LYNDAR Internal ID:40 Rudder, Lynda From: Flatley, Martin Sent: Thursday, June 26, 2014 3:32 PM To: Rudder, Lynda; Finnegan, Martin Cc: Blasko, Regina Subject: RE:filming permit I have no objections to this permit being issued,other than they should try planning ahead next time with their request rather than trying to make us jump through hoops at the last minute. Martin Flatley Chief of Police Southold Town Police Department 41405 State Rt. 25 Peconic, N.Y. 11958 631-765-3115 -----Original Message----- From: Rudder, Lynda Sent:Thursday,June 26, 201412:52 PM To: Flatley, Martin; Finnegan, Martin Subject: filming permit Importance: High Please approve/disapprove permit asap. 1 guFFoc,�c ELIZABETH A.NEVILLE,MMC �� , Zbwn Hall,53095 Main Road TOWN CLERK p P.O.Box 1179 H 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O - Fax(631)765-6145 MARRIAGE OFFICER. IPWA Ot' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT NO: Please Print or Type APPLICATION DATE: June 25, 2014 NAME OF APPLICANT:-Henr)l Mazzoni MAILING ADDRESS: 146-04 25th Road, Flushing, NY 11354 PHONE: BUSINESS: 347-672-2051 HOME: 347-672-2051 NAME OF ORGANIZATION/COMPANY: BMS DESIGNS, INC. MAILING ADDRESS: 146-04 25th Road, Flushing, NY 11354 PHONE: 347-672-2051 FAX: 718-822-4634 DESCRIBE TYPE OF ACTIVITY(e.g. Motion Picture,Commercial, Television, Catalog, Magazine,etc.): Magazine/Catalog DATE(S)AND TIME(S) OF PROPOSED FILMING/PHOTOGRAPHY: Monday, June 30 2014 T PROPOSED LOCATION(S) OF FILMING/PHOTOGRAPHY: (attach additional sheet, if necessary) P,ihlic Reach at Rorky Point Road, East Marion, NY 11939_ NAME OF PERSON IN CHARGE AT SITE: Henry Mazzoni NUMBER OF PERSONS AT LOCATION(cast& crew included): 12 NUMBER AND TYPE OF VECHILES AT LOCATION: 3 vehicles. (2 cars and 1 RV) TYPE OF SPECIAL EQUIPMENT: Photographic equiDment ANY SPECIAL REQUIREMENTS:none Of At /Signature Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P.O. Box 1179 Southold,NY 11971 j * * * RECEIPT * * * Date: 06/26/14 Receipt#: 173084 Quantity Transactions Reference Subtotal 1 Application Fee- Non-Refund 40 appl $100.00 3 Beach Permits 40 clean up $30.00 1 Daily Filming Permit 40 permit fee $100.00 Total Paid: $230.00 Notes: Payment Type Amount Paid By CK# $230.00 Mazzoni, Henry Name: Mazzoni, Henry 146-04 25th Road Flushing, NY 11354 Clerk ID: LYNDAR Internal ID:40 permit fee APPLICANT'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check. �X Completed application $100 nonrefundable application fee _X 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. X 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): x Film Fee- $100 per day of each day covered by the permit x Cleanup deposit: Separate check for$250 for each day covered by the permit. i X 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, ALL CHECKS MUST BE CERTIFIED NOTE: Additional fees for Cleanup and Traffic Control may be required at the direction of the Chief of Police and Superintendent of Highways I 1 I 1 (i I j I I. 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. C-1i .111up 25 2014 Signature Date f Henry Mazzoni Printed name Pr sident Title i E t I i Mr-l"Mcacty I A I rot UK F'KUUUGER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poticy(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 endorsements). PRODUCER BAYOUTH INS.AGENCY I NCAMNEACT LARRY 804 EAST TAFT G PHONE _. (A/C Na,,,Extp 918 227 0900 ., I FAX (AIC. 918.224 0886 SAPULPA ADDRESS. TULS LARRYB ACOXMAIL.COM OKLA, ST 74066 @— I --. INSURER(S)AFFORDING COVERAGE NAIC# INSURED -- INSURER A CNA .._.. _.. _ .._. -.. .. _._.. -. --.-_. NSURER B .. ._. ._. IINSURER_C: BMS DESIGNS INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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 SHOWN MAY HAVE BEEN REDUCED_ BY PAID CLAIMS. ,NSR _..... ._ �ADOL SUER -__. _ ---- LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POUCY EXP�-- .........-. __ (MMIDDIYYYY) {MWDDIYYYY) LIMITS GENERAL LIABILITY .. - 62084522469 10/28/2013110/28/20141 EACH OCCURRENCE $ 1000000 X COMMERCIAL GENERAL LIABILITY DAIWGE TO RENTED -- PREMISES(Ea occurrence) X CLAIMS-MADE OCCUR S 1000000 -- - - MED EXP(Any one person).._ I$ .. rj-000 ' -- ---- - 4 PERSONAL&ADV INJURY ($ 1000QOQ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2000000JECT LOC PRODUCTS- POLICY COMP/0P AGG .. POLICY PRO- ! i --- -- AUTOMOBILE UABIUTY � I :ANY AUTO (Ea awl deo SINGLE LIMIT- $ - --- __ ...ALL RrEO - SCHEDULED BODILY INJURY(Per person) $ OSS AUTOS NON-OWNED BODILY INJURY(Per accident) S HIRED AUTOS AN ? 1 (PRBOPPR YDAMAGE-- ........S --' ' -UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB ,- CLAIMS-MADE'.. __A....GGRETE . -GA..r._..... _ _��mDED (RETENTIONS -- _ i WORKERS COMPENSATION _ ....._.. _ _ ...—._. ..---. .. __._.__ __-. S AND EMPLOYERS,UABILITY I 1.WC STATU - OTH Y 1 N - . :_TORY LIMITS _ER ANY PROPRIETORIPARTNERIEXECUTIVE NIA E L EACH ACCIDENT OFFICERIMEMSER EXCLUDED? $ ...N yyeess,describe underE.L.I I DISEASE.-_E- A EMPLO_Y_EE.$(Mandatory in DESCRIPTION, OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ . DESCRIPTION_ —.. ..J, ... OF OPERATIONS I LOCATIONS I VEHICLES Attach ACORD 101,Additional Remarks Schedule,if mores ace Is - (A)PUBLIC LIABILITY INSURANCE TO AFFORD PROTECTION AGAINST ANY AND ALL CLAIMS FOR PERSONAL INJURY, DEATH OR PROPERY DAMAGE OCCURRING IN, UPON,ADJACENT TO OR CONNECTED WITH THE DEMISED PREMISES,OR ANY PART THEREOF IN AN AMOUNT OF NOT LESS THAN$1,000,000.00 COMBINED SINGLE LIMIT FOR INJURY OR DEATH ARISING OUT OF ANY OCCURANCE OR IN ANY INCREASED AMOUNT REASONABLY REQUIRED BY OHEKA MANAGEMENT CORP.(OHEKA);AND(B) INSURANCE AGAINST LOSS OR DAMAGE BY FIRE,AND SUCH OTHER RISKS AND HAZARDS AS ARE INSURABLE UNDER THAN AVAILABLE STANDARD FORMS OF FIRE INSURANCE POLICIES WITH EXTENDED COVERAGE,AND SHALL SIMULTANEOUSLY WITH THE EXECUTION HEREOF AND IN NO EVENT LATER THAN THIRTY(30)DAYS PRIOR TO THE DATE OF AFFAIR DELIVER TO OHEKA ,.CERTIFICATES OF INS NCE AS FOL WS: CERTIFICATE HOLDER CANCELLATION *stored HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF SOUTHOLD H THE OLICY PROVISIONS. PO BOX 1179 SOUTHOLD,NEW YORK 11971 TATIVE 1988-2010 AC CORPORATION. All rights reserved. ACORD 25(2010!05) The ACORD name and logf ACORD Rudder, Lynda From: Martin Finnegan Forward Sent: Thursday,June 26, 2014 1:53 PM To: Rudder, Lynda Cc: Flatley, Martin; Finnegan, Martin Subject: Re:filming permit Fine by me. Sent from my Whone >On Jun 26, 2014,at 12:52 PM, "Rudder, Lynda" <Ivnda.rudder@town.southold.nv.us>wrote: > Please approve/disapprove permit asap. ><film permit_20140626115003.pdf> 1 V Beach Parking fee - $10 per vehicle, per day between May 1 and 3 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. TOWN CLERK'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check Applicant: d ' Date Received: to 1/ 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$1,000,000 (one million dollars) per occurrence for the duration of the filming or still photography. Indemnification agreement stating the applicant agrees to assume all liability for and will indemnify and hold the town harmless of and free from any and all damages that occur to persons or property by reason of / said filming or still photography. V Forward completed application to Chief of Police for approval or disapproval and determination if Traffic Control Fee is required Approved Disapproved No Fee Required Fee in the amount of.$ required Forward certificate of insurance and indemnification agreement to Town Attorney fobapproval 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. Vendor No. Check No. Town of Southold, New York - Payment Voucher Vendor Name Vendor Address Entered by Henry Mazzoni 146-04 25th Road Flushing, NY 11354 Audit Date Vendor Telephone Number Towii Clerk Vendor Contact -- -- Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services Ckmal Ledger Fund and Account Number i 250.00 250.00 Clean-up Deposit Refund T1A30 i i Total 250.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and p en is approved. Signatu Title Si tur Company Name Date Titl Date Southold Town Board - Letter Board Meeting of August 12, 2014 RESOLUTION 2014-687 Item# 5.14 ADOPTED DOC ID: 10031 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2014-687 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON AUGUST 12, 2014: WHEREAS Henry Mazzoni has supplied the Town of Southold with a Clean-up Deposit fee in the amount of$250.00 for their Photo Shoot and WHEREAS the Southold Town Police Chief, Martin Flatley, has informed the Town Clerk's office that this fee may be refunded, now therefor be it RESOLVED that Town Board of the Town of Southold hereby authorizes a refund be issued in the amount of$250.00 to Henry Mazzoni, 146-04 25`h Road, Flushing NY 11354 Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER:William P. Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Evans, Russell ABSENT: Robert Ghosio Generated August 14, 2014 Page 20 Rudder, Lynda From: Flatley, Martin Sent: Wednesday,July 30, 2014 12:49 PM To: Rudder, Lynda Subject: RE: Clean-up deposits Yes Lyn 7&$ Chief of Police Southold Town Police Department 41405 State Rt. 25 Peconic, N.Y. 11958 631-765-3115 From: Rudder, Lynda Sent: Wednesday, July 30, 2014 12:37 PM To: Flatley, Martin Subject: Clean-up deposits Can the following be released? Cutch-NS Historical Society—Antique Show 7/5 Atelier Management—filming 7/25 Henry Mazzoni -filming 6/30 1