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Home My WebLink AboutInsurance Proposals.tf RECEIVED io :1" d.v. DEC .14 1984 TfA► rIA-If CnIo"ld P R E M I U M Q U O T A T I O N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VMM All Risk Annual Cost $ 500 $60832 $530 $78362 $ 5000 58876 _ 456 69,331 Carrier: Continental Assurance Company Policy Period: 1/1 85-1/1/86 Premium Payment Plan: Quarterly Comments: B. Valuable Papers Deductible $ 500 $63.00 $ 500b 54.00 Carrier: Continental Assurance Company Policy Period: 1/1/85-1/1/86 Premium Payment Plan: Quarterly Comments: C. Comprehensive General Liability a. First dollar coverage: $791509 b. (18) Police Professional liability, additional cost: 1. First Dollar Coverage: $8,928 IF C. Comprehensive General Liability Rating basis: Annual Budgpt (exp PndifurPs)� GtrPPt miles, etc. Carrier: Continental Assurance Company (MW Premium Payment Plan: Quarterly Comments: *Police Professional Liability has a $1,000 Deductible D. Automobile Insurance Limits 4500,000 C.S.L. Rate per vehicle: $481.70 Carrier: Continental Assurance Company (CNA) Policy Period: 1/1/85-1/1/86 Premium Payment Plan: Quarterly E. Contractors Equipment Floater Deductible Rate uer 100 Exposure $ 500 $45.00 Carrier: Continental Assurance Company (CNA) Policy Period: 1/1/85-1/1/86 Premium Payment Plan: Quarterly Comments: Annual cost: $3,073 F. Umbrella Liability First $ 59000,000: $25,000 Next $ 5,000,000: 5,000 Rating Basis: Annual Budget (Expenditures), Street miles, etc. Carrier: Integrity Insurance Company s r R F. Umbrella Liability Policy Period: 1/1/85-1/1/86 Premium Payment Plan: Annual R Comments: G. Yacht Insurance Physical Damage - Deductible S 500 Premium: Included Carrier: Policy Period: Comments: included H. Public Employee Blanket Bond Premium: $18488 Carrier': Continental Policy Period: 1/1/85-1/1/86 Comments: - PRB'NIUM QUOTATION SUN -MARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible: $164,923 $ 5,000 Deductible: 1631892 Val Stype & Sons, Inc. Name of Agent/Broker Main Road Street or P.O. Box Mattituck, N.Y. 11952 City, State, and Zip An a 0S N e%�fers� mpleting Quotation Signature U Vice -President Title Date: 12/14/84 BALD OttZ WJk,- 1 �Ci• ALL FORMS OF INSURANCE Licensed Brokers ALBERT A. BRISOTTI, JR. DANIEL V. BRISOTTI RECEIVED JOHN P. BRISOTTI RUSSELL A. HALL P December 14, 1984 Town of Southold Main Road Southold, NY 11971 Attn: Francis J. Murphy, Supervisor Dear Mr. Murphy: Offices Box 1448, Main Rd., Mattituck, N.Y. 11952 Telephone (516) 2984747 Box 888, Division St., Sag Harbor, N.Y. 11963 Telephone (516) 725-3013 Enclosed herewith find completed premium quotation for your insurance program. You will,note we have not quoted Umbrella Liability. We are promised a quote for the cost of this coverage hourly and just as soon as it is received we will transmit it to your office. We have checked and would be able to arrange financing of your premium with a 20% down payment and nine (9) installments at 11.258 annual precentage rate. Thank you for opportunity to prepare this quotation and we look forward to being of service. 7_ Very truly yours—_ Daniel V. Brisotti Vice President DVB:krc enc P R E M I U M Q U O T A T I O N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VMM All Risk Annual Cost $ 500 Included Included $19,751.73 $ 5000 -Will obtain quote if necessary. Time restraints prohibit quoting at this time. Carrier: New Hampshire Policy Period: 1/1/85 - l/1/86 Premium Payment Plan: Comments: B. Valuable Papers Deductible $ 500 $ 5000 Carrier: Included in A. Building & Contents Above. Policy Period: Premium Payment Plan: Comments: C. Comprehensive General Liability $500,000. Combined Single Limit a. First dollar coverage: Broad Form CGL - $59,500. b. (18) Police Professional liability, additional cost: 1. First Dollar Coverage: $8,050. (See Limits Below) $ 500,000. Per Person 1,000,000. Per Incident 1,000,000. Annual Aggregate C. Comprehensive General Liability CGL: Per Town Budget Rating basis: Police Professional: $230./Paid Law Enforcement Officer CGL: American Home Carrier: P,, - i P prnfccc i nna 1 , Ci tv Tnsliranc Cn __ Premium Payment Plan: Comments: Public Official E & O Excluded. Currently covered by Forum Insurance Company. D. Automobile Insurance Limits — $500,000. CSL; Comprehensive & Collision Per Specs fi;Xk2XXXE2XX: Total $58,700. Carrier: American Home Policy Period: 1/1/85-1/1/86 Premium Payment Plan: E. Contractors Equipment Floater Deductible Rate per 100 Exposure $ 500 Carrier: Included in A - Building & Contents Above. Policy Period: Premium Payment Plan: Comments: F. Umbrella Liability First $ 5,000,000: Next $ 5,000,000: Rating Basis: Carrier: F. Umbrella Liability Policy Period: Premium Payment Plan: Comments: G. Yacht Insurance Physical Damage — Per specs Deductible $ 500 Premium: $1,488. Carrier: New Hampshire Policy Period: 1/1/85-1/1/86 Comments: H. Public Employee Blanket Bond & Money & securities Premium: $1,318. Carrier: National Grange Mutual Policy Period: 1/1/85-1/1/86 Comments: - 9 PREMIUM QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible: $ 5,000 Deductible: BRISOTTI & SILKWORTH, INC. Name of Agent/Broker Main Road, P. 0. Box 1448 Street or P.O. Box Mattituck, New York 11952 City, State, and Zip Daniel V. Brisotti ame of Person eting Quota ion Signature Vice President Title Date : _ t az/ C -/z, � � McMANN -PRICE AGENCY WILLIAM H. PRICE 828 FRONT STREET GREENPORT• N. Y. 11944 prr �+ t� TEL.: 516 - 477-1680 iiECT V ,E"Ll, 14 1984 December 14th 1984 ��.�: rte+lt Ctlw�ni Mr. Frank Murphy, Supervisor Southold Thwn Board Southold, New York 11971 Dear Frank: RE: INSURANCE QUOTE We regret not meeting the 10:00 a.m. deadline for these quotes. Of all our markets, we have only one company who is willing to write this business and it does not meet all the specifications. However, should you be interested, we submit the following: 1. Liability Coverage $500,000. Combined Single Limit Excluding Land Fill Area Including Employees Benefit Liability, Host Liquor, XCU and other. $500. Deductible per claim Premium: $133,987.00 2. Physical Damage Buildings, Police Boats, Valuable Papers, Blanket Bonds, Money & Securities, Contractors Equipment Premium: $ 12,054.00 3. Public Officials Liability $1,000,000. Claims Made Basis $2,500. Deductible No Retroactive Coverage Premium: $ 8,644.00 4. Law Enforcement $500,000. Conbined Single Limit -No Deductible Premium: $ 10,394.00 (1) 5. Automobile $500,000. Combined Single Limit Personal Injury Protection, Uninsured Motorists, Comprehensive and Collision.with a $500. Deductible. Includes Hired and Non -Owned Auto Premium: 42,884.00 6. Umbrella Coverage $5,000,000. Quote is not yet available. Promised to us next week, if you are interested. The company will not split the line. � (2) Very truly yours, William H. Price JUDITH T. TERRY TOWN CLERK REGISTRAR 01: VITAL STAT ISTICS ........10.r. . OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD December 28, 1984 Andrew D. Stype, Vice -President Val Stype 6 Sons, Inc. Main` Road Mattituck, New York 11952 Dear Andy: Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 TELEPHONE (516) 765-1801 This is to officially notify you that the Southold Town Board at their regular meeting held on December 28,:.1984 accepted your proposal for the Town's 1985 Insurance Program at a total cost of $164,923.00. Very truly yours, Judith T. Terry Southold Town Clerk JUDITH T. TERRY TOWN CLERK REGISTRAR 01' VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD December 28, 1984 Daniel V. Brisotti, 'Vice President Brisotti 8 Silkworth, Inc. Main`Road, Box 1448 Mattituck, New York 11952 Dear Dan: Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 TELEPHONE (516)765-1801 This is to officially notify you that the Southold Town Board at their regular meeting held on December 28, -1984 accepted the proposal of Val Stype 8 Sons, Inc. for the Town's :1985 Insurance Program at a total cost of $164,923.00. Very truly yours, Judith T. Terry Southold Town Clerk 46 JUDITH T. TERRY TOWN CLERK REGISTRAR OP VITAL STA IISTIC'S OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD December 28, :1984 Mr. William H. Price McMann -Price Agency 878 Front Street Greenport, New York 1.1944 Dear Bill: Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 TELEPHONE (516) 765-1801 This is to officially notify you that the Southold Town Board at their regular meeting held on December 28, 1984 accepted the proposal of Val Stype & Sons, Inc. for the Town's. 1985 Insurance Program at a total, cost of $164,923.00. Very truly yours, Judith T. Terry Southold Town Clerk rr RECEVED P R E M I UM Q U 0 T A T I ON UEC 141984 (To be submitted in duplicate) Tnwre ('#*' r gmmo ld V. A. Building and Contents Deductible Fire ec and VMM All Risk Annual Cost $ 500 $60832 $530 $71362 $ 5000 50876 456 61331 Carrier: Continental Assurance Company Policy Period: 1/1 85-1/1/86 Premium Payment Plan: Quarterly Comments: Valuable Papers Deductible $ 500 $63.00 $ 500b 54.00 Carrier: Continental Assurance Company Policy Period: 1/1/85-1/1/86 Premium Payment Plan: Quarterly Comments: C. Comprehensive General Liability a. First dollar coverage: $79.509 b. (18) Police Professional liability, additional cost: 1. First Dollar Coverage: $8.928 * w CO Comprehensive General Liability Rating basis: Annual Budget ntrpAf miles, etc. Carrier: Continental Assurance Company (CNA) Premium Payment Plan: o arterly Comments: *Police Professional Liability has a $1,000 Deductible D. Automobile Insurance E. Limits 4500,000 C.S.L. Rate per vehicle: $481.70 Carrier: Continental Assurance Company (CNA) Policy Period: 1/1/85-1/1/86 Premium Payment Plan: Quarterly Contractors Equipment Floater Deductible $ 500 Rate ver 100 Exoosure $45.00 Carrier: Continental Assurance Company (CNA) Policy Period: 1/1/85-1/1/86 Premium Payment Plan: Quarterly Comments: Annual cost: $3,073 F. Umbrella Liability First $ 5,000,000: $25,000 Next $ 5,000,000: 5,000 Rating Basis: Annual Budget (Expenditures), Street miles, etc. Carrier: Integrity Insurance Company F. Umbrella Liability Policy Period: 1/1/85-1/1/86 Premium Payment Plan: Annual Comments: G. Yacht Insurance Physical Damage - Deductible S 500 Premium: Included Carrier: Policy Period: Comments: included H. Public Employee Blanket Bond Premium: $10488 Carrier: Continental Policy Period: 1/1/85-1/1/86 Comments: PREMIUM QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible: $1641,923 $ 5,000 Deductible: 1630892 Val Stvne & Sons. Inc. Name of Agent/Broker Main Road Street or P.O. Box Mattituck, I.Y. 11952 City, State, and Zip An a D. Stype Nae%�ers mpleting Quotation S%gnature U Vice -President Title Date: 12/14/84 1 i P R E M I U M Q U O T A T I O N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VMM All Risk Annual Cost $ 500 $68832 $530 $7,362 S 5000 5,876 456 60331 Carrier: Continental Assurance Company Policy Period: 1/1 85-1/1/86 Premium Payment Plan: Quarterly Comments: B. Valuable Papers Deduc+ible S 500 $63.00 S 50ob` 54.00 Carrier: Continental Assurance Company Policy Period: 1/1/85-1/1/86 Premium Payment Plan: Quarterly Comments: C. Comprehensive General Liability a. First dollar coverage: $791509 b. (18) Police Professional liability, additional cost: 1. First Dollar Coverage: $81,928 * C. Comprehensive General Liability Rating basis: Annual BudQPt (extend' eras). straat miles, etc. Carrier: ContinentAl Assurance Company (CKA) Premium Payment Plan: Quarterly Comments: *Police Professional Liability has a $1,000 Deductible D. Automobile Insurance Limits 4500,000 C.S.L. Rate per vehicle: $481.70 Carrier: Continental Assurance Company (CNA.) Policy Period: 1/1/85-1/1/86 Premium Payment Plan: Quarterly E. Contractors Equipment Floater Deductible Rate per 100 Exposure $ 500 $45.00 Carrier! Continental Assurance Company (CNA) Policy Period: 1/1/85-1/1/86 Premium Payment Plan: 1 Quarterly Comments: Annual cost: $3,073 F. Umbrella Liability First $ 5,000,000: $25,000 Next $ 5,000,000: 5,000 Rating Basis: Annual Budget (Expenditures), Street miles, etc. Carrier: Integrity Insurance Company • F. Umbrella Liability Policy Period: 1/1/85-1/1/86 Premium Payment Plan: Annual Comments: G. Yacht Insurance Physical Damage - Deductible $ 500 Carrier: Policy Period: _ Comments: included Premium: Included H. Public Employee Blanket Bond Premium: $11488 Carrier: Continental Policy Period: 1/1/85-1/1/86 Comments: PREMIUM QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible: $164,923 $ 5,000 Deductible: 1631892 Val Stvpe & Sons. Inc. Name of Agent/Broker Main Road Street or P.O. Box Mattituck, N.Y. 11952 City, State, and Zip And D. Stype Name ot/)P*r* ,mpleting Quotation Signature Vice -President Title Date: 12/14/84 LA . r 0 V 13Ari.D ottz' & �iJC.i2.w o►�rlA� •� +tics• ALL FORMS OF INSURANCE Licensed Brokers Offices ALBERT A. BRISOTTI, JR. Box 1448, Main Rd., Mattituck, N.Y. 11952 DANIEL V. BRISOTTI RM Telephone (516) 2984747 JOHN P. BRISOTTI vroom Box 888, Division St., Sag Harbor, N.Y. 11963 RUSSELL A. HALLSEC 14 1984 Telephone (516) 725-3013 Town CA►k 'Rotftm December 14, 1984 Town of Southold Main Road Southold, NY 11971 Attn: Francis J. Murphy, Supervisor Dear Mr. Murphy: Enclosed herewith find completed premium quotation for your insurance program. You will note we have not quoted Umbrella Liability. We are promised a quote for the cost of this coverage hourly and just as soon as it is received we will transmit it to your office. We have checked and would be able to arrange financing of your premium with a 20% down payment and nine (9) installments at 11.258 annual precentage rate. Thank you for opportunity to prepare this quotation and we look forward to being of service. Very truly your Daniel V. Brisotti " Vice President DVB:krc enc P R E M I U M Q U O T A T I O N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VMM All Risk Annual Cost 500 Included Included $19,751.73 5000 -Will obtain quote if necessary. Time restraints prohibit quoting at this time. Carrier: New Hampshire Policy Period: 1/1/85 - 1/1/86 Premium Payment Plan: Comments: B. Valuable Papers Deductible $ 500 $ 5000 Carrier: Included in A. Building & Contents Above. Policy Period: Premium Payment Plan: Comments: C. Comprehensive General Liability $500,000. Combined Single Limit a. First dollar coverage: Broad Form CGL - $59,500. b. (18) Police Professional liability, additional cost: 1. First Dollar Coverage: $8,050. (see Limits Below) $ 500,000. Per Person 1,000,000. Per Incident 1,000,000. Annual Aggregate C. Comprehensive General Liability CGL: Per Town Budget Rating basis: Police Professional: $230. /Paid Law Enforcement Officer CGL: American Home Carrier: Pr,l ira Prnfaccinnal a CitU Tncurnn Cn_ Premium Payment Plan: Comments: Public Official E & O Excluded. Currently covered by Forum Insurance Company. D. Automobile Insurance Limits — $500,000. CSL; Comprehensive & Collision Per Specs fkXk2XXNX)hXE2XX: Total $58,700. Carrier: American Home Policy Period: 1/1/85-1/1/86 Premium Payment Plan: E. Contractors Equipment Floater Deductible Rate per 100 Exposure $ 500 Carrier: Included in A - Building & Contents Above. Policy Period: Premium Payment Plan: Comments: F. Umbrella Liability First $ 59000,000: Next $ 5,000,000: Rating Basis: Carrier: F. Umbrella Liability Policy Period: Premium Payment Plan: Comments: G. Yacht Insurance Physical Damage - Per Specs Deductible $ 500 Premium: $1,488. Carrier: New Hampshire Policy Period: 1/1/85-1/1/86 Comments: H. Public Employee Blanket Bond & Money & Securities Premium: —$1,318. Carrier: National Grange Mutual Policy Period: 1/1/85-1/1/86 Comments: - r PREMIUM QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible: $ 5,000 Deductible: Date: �a� C/A� BRISOTTI & SILKWORTH, INC. Name of Agent/Broker Main Road, P. O. Box 1448 Street or P.O. Box Mattituck, New York 11952 City, State, and Zip Daniel V. Brisotti `"-,- Name of Person eting Quota ion Signature Vice President Title p P R E M I U M 0 U 0 T A T I 0 N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VMM All Risk Annual Cost $ 500 Included Included $19,751.73 $ 5000 -Will obtain quote if nepessary. Time restraints prohibit quoting at this time. Carrier: New Hampshire Policy Period: 1/1/85 - 1/1/86 Premium Payment Plan: Comments: B. Valuable Papers Deductible $ 500 $ 5000 Carrier: Included in A. Building & Contents Above. Policy Period: Premium Payment Plan: Comments: C. Comprehensive General Liability $500,000. Combined Single Limit a. First dollar coverage: Broad Form CGL - $59,500. b. (18) Police Professional liability, additional cost: 1. First Dollar Coverage: $8,050. (See Limits Below) $ 500,000. Per Person 1,000,000. Per Incident 1,000,000. Annual Aggregate C. Comprehensive General Liability CGL: Per Town Budget Rating basis: Police Professional: $230. /Paid Law Enforcement Officer CGL: American Hqme Carrier : p,,, i no prnf- i --A 7 n City Tnsjn ranee Cn _ Premizzm Payment Plan: Comments: Public Official E & O Excluded. Currently covered by Forum Insurance Comoanv. D. Automobile Insurance Limits — $500,000. CSL; Comprehensive & Collision Per Specs fiaeX XJ z2XX: Total $58,700. Carrier: American Home Policy Period: 1/1/85-1/1/86 Premium Payment Plan: E. Contractors Equipment Floater Deductible Rate per 100 Exposure $ 500 Carrier: included .in A - Building & Contents Above. Policy Period: Premium Payment Plan: Comments: F. Umbrella Liability First $ 59000,000: Next $ 5,000,000: Rating Basis: Carrier: F. Umbrella Liability Policy Period: Premium Payment Plan: Comments: G. Yacht Insurance Physical Damage — Per Specs Deductible $ 500 Premium: $1,488. Carrier: New Hampshire Policy Period: 1/1/85-1/1/86 Comments: H. Public Employee Blanket Bond & Money & Securities Premium: X51,318. Carrier: National Grange Mutual Policy Period: 1/1/85-1/1/86 Comments: - r PREMIUM QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property co-verage. $ 500 Deductible: $ 5,000 Deductible: BRISOTTI & SILKWORTH, INC. Name of Agent/Broker Main Road, P. O. Box 1.448 Street or P.O. Box Mattituck, New York 11952 City, State, and Zip Daniel V. Brisotti Name of Person Completing Quotation Signature Vice President Title Date:�� • • f McMANN - PRICE AGENCYWmetW WILLIAM H. PRICE 828 FRONT STREET GREENPORT, N.Y. 11944 TEL.: 516 - 477-1680 RECOVED ()EC 141984 December 14th 1984 Town r1ork RwdhoW Mr. Frank Murphy, Supervisor Southold Tbwn Board Southold, New York 11971 Dear Frank: we regret not meeting the 1.0:00 a.m. deadline for these quotes. Of all our markets, we have only one company who is willing to write this business and it does not meet all the specifications. However, should you be interested, we submit the following: 1. Liability Coverage $500,000. Combined Single Limit Excluding Land Fill Area Including Employees Benefit Liability, Host Liquor, XCU and other. $500. Deductible per claim Premium: $133,987.00 2. Physical Damage Buildings, Police Boats, Valuable Papers, Blanket Bonds, Money & Securities, Contractors Equipment Premium: $ 12,054.00 3. Public Officials Liability $1,000,000. Claims Made Basis $2,500. Deductible No Retroactive Coverage Premium: $ 8,644.00 4. Law Enforcement $500,000. Combined Single Limit -No Deductible Premium: $ 10,394.00 (1) It 5. Automobile $500,000. Combined Single Limit Personal Injury Protection, Uninsured Motorists, Comprehensive and Collision with a $500. Deductible. Includes Hired and Non -Owned Auto Premium: 42,884.00 6. Umbrella Coverage $5,000,000. Quote is not yet available. Promised to us next week, if you are interested. The company will not split the line. (2) Very truly yours, L William H. Price s 4 t! � 111 JUDITH T. TERRY `"'Srrrt *IM Ri,GISTRAR 01'VITAL S] \I IS FICS OFFICE OF THE TOWN TOWN OF SOUTHOLD To Whom It May Concern: December 14, 1984 Town Hall, 53095 Main Road P.O. BOX 728 Southold, New York 11971 TELEPHONE (516) 765-1801 Re: "Insurance Proposals" No insurance proposals were received at 10:00 A.M., Friday, December 14, 1984. There were three (3) proposals received after 10:00 A.M. during the course of the day as follows: 1. Val Stype & Sons, Inc., received at 10:10 A.M. 2. McMann -Price Agency, received at 3:12 P.M. 3. Briscotti & Silkworth, received at 3:59 P.M. I stamped them received with the date and time, put them in a sealed envelope and put them in the safe. No one has examined them and no copies were made or distributed. The foregoing procedure was followed in accordance with instructions from the Town Attorney Robert Tasker. Eli abeth A. Nevil e Deputy Town Clerk LEGAL NOTICE REQUEST FOR PROPOSALS NOTICE _IS HEREBY GIV- EN THAT the Town Board of the Town of. Southold is hereby ,extending the date for receipt of proposals for their Insur- ance Program from 10:00 A.M., Friday, November 30, 1984 to 10:00 A.M., Friday, December 14, 1984, at which time proposals will be received for Fiscal.Year 1985 and/or a three-year alternate proposal for Fiscal Years 1985, 1986, 1987. The Special Multi -Perils, Umbrella, and Automobile Po- licies expire on January 1, 1985. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York until 10:00 A.M., Friday, December 14, 1984, at which time they will be publicly opened and read aloud. All proposals must be sign- ed and sealed in an envelope plainly marked: "Town Insur- ance Program Proposal." DATED: December 4, 1984. JUDITH T. TERRY SOUTHOLDJOWN CLERK 1T-12/6/84(8) COUNTY OF SUFFOLK ss: STATE OF NEW YORK Patricia Wood, being duly sworn, says that she is the Editor, of THE LONG ISLAND TRAVELER -WATCHMAN, a public newspaper printed at Southold. in Suffolk County; and that the notice of which the annexed is a printed copy, has been published in said Long Island Traveler -Watch- man once each week for .........................!...............weeks .• Lam' successively, commencing on the :............... .......----�.............. _1/ Sworn to before me this................................ day of ' 19. ........... ...,G.. K ... ..... . ..................... Notary Public BARBARA FORBES Notary Public, State of New York No. 4806546 Qualified in Suffolk County Commission Expires Marc:, 1J " COUNTY OF SUFFOLK ss: STATE OF NEW YORK Patricia Wood, being duly sworn, says that she is the Editor, of THE LONG ISLAND TRAVELER -WATCHMAN, a public newspaper printed at Southold. in Suffolk County; and that the notice of which the annexed is a printed copy, has been published in said Long Island Traveler -Watch- man once each week for ....................... .............weeks successively, commencing on the day............................................ . 19...'.� .....P .......................... ........1„r�„l rl Sworn to before me this ................................ day of .. ::...`.............1 19....... !/...L. ••. •••••••...................... Notary Public BARBARA FORBES Notary Public, State of New York No. 4806846 Qualified in Suffolk County Commission Expires Marc.-, s,,, 190 LEGAL NOTICE REQUEST FOR PROPOSALS NOTICE IS HEREBY GIVEN THAT the Town Board of the Town of Southold is hereby ex- tending the date for receipt of proposals for their Insurance Program from 10:00 A.M., Fri- day, November 30,1984 at 10:00 A.M., Friday, December 14, 1984, at which time proposals will be received for Fiscal Year 1985 and/or a three year alter- nate proposal for Fiscal Years 1985, 1986, 1987. The Special Multi -Perils, Umbrella, and Au- tomobile Policies expire on Janu- ary 1, 1985. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York until 10:00 A.M., Friday, December 14, 1984, at which time they will be publicly opened and read aloud. All proposals must be signed and sealed in an envelope plainly marked: "Town Insurance Prog- ram Proposal." DATED: December 4, 1984. JUDITH T. TERRY SOUTHOLD TOWN CLERK 1TD6-4731 A. NOTARY PUBLIC, St teiEN o New York No, 4796131 Suffolk County Term E puns Mo�:!t 3(j 191�; STATE OF NEW YORK 1 1 SS: COUNTY OF SUFFOLK 1 ANNA LEKKAS of Greenport, in said County, being duly sworn, says that he/she is Principal Clerk of THE SUFFOLK TIMES, a Weekly Newspaper, published at Greenport, in the Town of Southold, County of Suffolk and State of New York, and that the Notice of which the annexed is a printed copy, has been regularly published in said Newspaper once each week for ONE weeks successively, commencing on the 6 th day of T)PCPmhar 19_84_ Principal Clerk Sworn to before me this 6th dayof December 19 84 arc STATE OF NEW YORK: SS: COUNTY OF SUFFOLK: JUDITH T. TERRY, Town Clerk of the Town of Southold, New York, being duly sworn, says that she is over the age of twenty-one years; that on the 4th day of December 19 84 , she affixed a notice of which the annexed printed notice is a true copy, in a proper and substantial manner, in a most public place in the Town of Southold, Suffolk County, New York, to wit:' Town Clerk Bulletin Board, Southold Town Hall, Main Road, Southold, New York 11971. i' Legal Notice - Request for Proposals - Extend time for receipt of Request for Proposals for Insurance Program for Fiscal Year 1985 and/or a three year alternate proposal for Fiscal Years -1985, 1986, 1987, The Special Multi -Perils, Umbrella, and Automobile Policies which expire on January 1, 1985. Dated extended from 10:00 A.M., November 30, 1984 to 10:00 A.M., December 14, 1984. Judith T. Terry Southold Town Clerk �j Sworn to before me this 4th day of December 1984 ! Notary Publi ELIZABETH ANN NEVILLE ' NOTARY PUBLIC, Stab of New York N0. 52-81258% Suffolk Cou* Tom Expire: unh 9Q IL X6 LEGAL NOTICE REQUEST FOR PROPOSALS NOTICE IS HEREBY GIVEN THAT the Town Board of the Town of Southold is hereby extending the date for receipt of proposals for their Insurance Program from 10:00 A.M., Friday, November 30, 1984 to 10:00 A.M., Friday, December 14, 1984, at which time proposals will be received for Fiscal Year 1985 and/or a three-year alternate proposal for Fiscal Years 1985, -1986, 1987. The Special Multi -Perils, Umbrella, and Automobile Policies expire on January 1, 1985. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York until 10:00 A.M., Friday, December 14, 1984, at which time they will be publicly opened and read aloud. All proposals must be signed and sealed in an envelope plainly marked: "Town Insurance Program Proposal." DATED: December 4, 1984. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, DECEMBER 6, 1984, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971. Copies to the following: The Long Island Traveler -Watchman The Suffolk Times Town Clerk's Bulletin' Board Town Board Members � �� . � � � _ _ �� ✓ L��-tom � �i LEGAL NOTICE REQUEST FOR PROPOSALS NOTICE IS HEREBY GIVEN THAT the Town Board of the Town of Southold is hereby extending the date for receipt of proposals for their Insurance Program from 10:00 A.M., Friday, November 30, 1984 to 10:00 A.M. Friday, December 14, 1984, at which time proposals will be received for Fiscal Year 1985 and/or a three year alternate proposal for Fiscal Years 1985, 1986, 1987. The Special Multi -Perils, Umbrella, and Automobile Policies expire on January 1, 1985. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York until 10:00 A.M., Friday, Dece 14, 1984, at which time they will be publicly opened and read aloud. All proposals must be signed and sealed in an envelope plainly marked: "Town Insurance Program Proposal." DATED: December 4, 1984. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, DECEMBER 6, 1984, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971. Copies to the following: The Long Island Traveler -Watchman The Suffolk Times Town Clerk's BulletinBoard Town Board Members t� tLA t t 2�1 g • LEGAL NOTICE REQUEST FOR PROPOSALS NOTICE IS HEREBY GIVEN THAT the Town Board of the Town of Southold is hereby extending the date for receipt of proposals for their Insurance Program from 10:00 A.M., Friday, November 30, 1984 to 10:00 A.M., Friday, December 14, 1984, at which time proposals will be received for Fiscal Year 1985 and/or a three year alternate proposal for Fiscal Years 1985, 1986, 1987. The Special Multi -Perils, Umbrella, and Automobile Policies expire on January 1, 1985. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York until 10:00 A.M., Friday, December 14, 1984, at which time they will be publicly opened and read aloud. All proposals must be signed and sealed in an envelope plainly marked: "Town Insurance Program Proposal." DATED: December 4, 1984. JUDITH T. TERRY SOUTHOLD TOWN CLERK P1 -;EASE PUBLISH ONCE, DECEMBER 6, 1984, AND FORWARD ONE (1) FIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, WN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971. Copies to the following: The Long Island Traveler -Watchman The Suffolk Times Town Clerk's Bulletin` Board Town Board Members LEGAL NOTICE REQUEST FOR PROPOSALS NOTICE IS HEREBY GIV- EN THAT the Town Board of the Town of Southold is interested in receiving propos- als for their Insurance Pro- gram for Fiscal Year 1985 and/or a three year alternate proposal for Fiscal Years, 1985, 1986, 1987. The Special Multi -Perils, Umbrella, and Automobile policies expire on January 1, 1985. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York until 10:00 A.M., Friday, November 30, 1984, at which time they will be publicly opened and read aloud. All proposals must be sign- ed and sealed in an envelope plainly marked: "Town Insur- ance Program Proposal." DATED: November 8, 1984 JUDITH T. TERRY SOUTHOLD TOWN CLERK IT -11/15/84(83) - COUNTY OF SUFFOLK ss: STATE OF NEW YORK Patricia Wood, being duly sworn, says that she is the Editor, of THE LONG ISLAND TRAVELER -WATCHMAN, a public newspaper printed at Southold. in Suffolk County; and that the notice of which the annexed is a printed copy, has been published in said Long Island Traveler-Wotch- man once each week. for ....................... /..............weeks S � successively, commencing on the .................................... j-, a l� day of .............................................. 19...JIV ..... Sworn to before me this r ........ day of ...................... 19.... 04� Z ........................... 4., ................. Notary Public BARBARA FORBES Notary Public, State of New York No. 4806846 Qualified in Suffolk County Commission Expires March 30, 194"Z- LEGAL NOTICE REQUEST FOR PROPOSALS STATE OF NEW YORK 1 NOTICE IS HEREBY GIVEN THAT the Town Board of the ► SS, Town of Southold is interested in COUNTY OF SUFFOLK ► receiving proposals for their In- surance Program for Fiscal Year 1985 and/or a three-year alter- ANNA �EK7�2 Of Greenport, in nate proposal for Fiscal Years 1985, 1986, 1987. The Special said County, being duly sworn, says that he/she is Multi-Perils,mloli Umbrella, and Au- Au- tomobile policies expire on Janu- Principal Clerk of THE SUFFOLK TIMES, a Weekly ary 1, 1985. Policies and Loss Newspaper, published at Greenport, in the Town Run figures are available at the Southold Town clerk's Office, of Southold, County of Suffolk and State of New Southold Town Hall, Main Road, Southold, New York._ York, and that the Notice of which the annexed is Proposals will be received by a printed copy, has been regularly published in the Southold Town Clerk at the Southold Town Hall, Main Road, said Newspaper once each week for ONE Southold, New York until 10:00 A.M., Friday, weeks successivelyy commencing on the 15 November 30, 1984, at which time they will be day of Novembier 19 84 Publicly opened and read aloud. All proposals must be signed and sealed in an envelope plainly marked: "Town Insurance Pro- gram Proposal." DATED: November 8, 1984. Principal Clerk JUDITH T. TERRY SOUTHOLD TOWN CLERK lTN15-4706 Sworn to before me this 15 1EN A l day of November jg 84 TARy PUBLIC, StDITH "'^ e s of New York :40. 4796131, Suffolk County Perm Expires March 30 19 STATE OF NEW YORK: SS: COUNTY OF SUFFOLK: JUDITH T. TERRY, Town Clerk of the Town of Southold, New York, being duly sworn, says that she is over the age of twenty-one years; that on the 9th day of November 1984 she affixed a notice of which the annexed printed notice is a true copy, in a proper and substantial manner, in a most public place in the Town of Southold, Suffolk County, New York, to wit: - Town Clerk Bulletin Board, Town Clerk Office, Main Road, Southold, New York 11971 Legal Notice, Request for Proposals for Town of Southold Insurance Program for Fiscal Year 1985 and/or a three year alternate proposal for Fiscal Years 1985, 1986, 1987. Proposal opening: 10:00 A.M., November 30, 1984, Southold Town Hall. Judith T. Terry Southold Town Clerk Sworn to be before me this 9th day of November lg 84 Notary Publi �s of NW yak �a�qq� Tints 8*0 March 30,19.tllz LEGAL NOTICE REQUEST FOR PROPOSALS NOTICE IS HEREBY GIVEN THAT the Town Board of the Town of Southold is interested in receiving proposals for their Insurance Program for Fiscal Year 1985 and/or a three year alternate proposal for Fiscal Years 1985, 1986-, 1987. The Special Multi -Perils', Umbrella, and Automobile policies expire on January 1, 1985. Policies and Loss Run figures are ava'il'able at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York until '10:'00 A.M., Friday, November 30, 1984, at which time they will be publicly opened and read aloud. All proposals must be signed and sealed in an envelope plainly marked: "Town Insurance Program Proposal." DATED: November 8, 1984. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, NOVEMBER 15, 1984, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, , NEW YORK 11971. Copies to the following: The Long Island Traveler -Watchman The Suffolk Times Town Board Members Town Clerk's Bulletin Board LEGAL NOTICE REQUEST FOR PROPOSALS NOTICE IS HEREBY GIVEN THAT the Town Board of the Town of Southold is interested in receiving proposals for their Insurance Program for Fiscal Year 1985 and/or a three year alternate proposal for Fiscal Years 1985, 1986, 1987. The Special Multi -Perils, Umbrella, and Automobile policies expire on January 1, 1985. Policies and Loss Run figures are ava'il'able at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York until •10:00 A.M., Friday, November 30, 1984, at which time they will• be publicly opened and read aloud. All proposals must be signed and sealed in an envelope plainly marked: "Town Insurance Program Proposal." DATED: November 8, 1984. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, NOVEMBER 15, 1984, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 1.1971. Copies to the following: The Long Island Traveler -Watchman The Suffolk Times Town Board Members Town Clerk's Bulletin Board X131 Kg - LEGAL NOTICE REQUEST FOR PROPOSALS NOTICE IS HEREBY GIVEN THAT the Town Board of the Town of Southold is interested in receiving proposals for their Insurance Program for Fiscal Year 1985 and/or a three year alternate proposal for Fiscal Years 1985, 1986, 1987. The Special Multi -Perils, Umbrella, and Automobile policies expire on January 1, 1985. Policies and Loss Run figures are available at the Southold Town Clerk's Office, Southold Town Hall, Main Road, Southold, New York. '. Proposals will be received by the Southold Town Clerk at the Southold Town Hall, Main Road, Southold, New York until •10:00 A.M., Friday, November 30, 1984, at which time they will- be publicly opened and read i f� aloud. I� All proposals must be signed and sealed in an envelope plainly marked: "Town Insurance Program Proposal." DATED: November 8, 1984. JUDITH T. TERRY SOUTHOLD TOWN CLERK PLEASE PUBLISH ONCE, NOVEMBER 15, 1984, AND FORWARD ONE (1) AFFIDAVIT OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971. i Copies to the following: The Long Island Traveler -Watchman The Suffolk Times Town Board Members Town Clerk's Bulletin Board i P R E M I U M Q U O T A T I O N (To be submitted in duplicate) V. A. Building and Contents Deductible Fire ec and VMM All Risk Annual Cost $ 500 $ 5000 Carrier: Policy Period: _ Premium Payment Plan: _ Comments: B. Valuable Papers Deductible $ 500 $ 5000 Carrier: Policy Period: Premium Payment Plan: Comments: C. Comprehensive General Liability a. First dollar coverage: b. (18) Police Professional liability, additional cost: 1. First Dollar Coverage: r C. Comprehensive General Liability Rating basis: Carrier: Premium Payment Plan: Comments: D. Automobile Insurance Limits - Rate per vehicle: Carrier: Policy Period: Premium Payment Plan: E. Contractors Equipment Floater Deductible - Rate per 100 Exposure $ 500 Carrier: Policy Period: Premium Payment Plan: Comments: F. Umbrella Liability First $ 5,000,000: Next $ 5,000,000: Rating Basis: Carrier: 0 • F. Umbrella Liability Policy Period: Premium Payment Plan: Comments: G. Yacht Insurance Physical Damage - Deductible $ 500 Premium: Carrier: Policy Period: Comments: H. Public Employee Blanket Bond Premium: Carrier: Policy Period: Comments: t r PREMIUM QUOTATION SUMMARY Total annual cost of all coverages with deductibles in the property coverage. $ 500 Deductible: $ 5,000 Deductible: Name of Agent/Broker Street or P.O. Box City, State, and Zip Name of Person Completing Quotation Signature Title Date: no The Town of Southold is interested in receiving quotations for their insurance program. The Special Multi -Perils, Umbrella, and Automobile'policies expire on 1/1/85. Policies and Loss PunfiQures are available at the Southold Town Clerk's Office, Southold Town Hall, `Macri Road, Southold, New York 11971. The Named insured is: " The Town of Southold - All Elected or Appointed Boards of Commissioners, Officials, Officers, Employees, Volunteers both individually and collectively, when acting or deemed by majority of Town Board to have been acting within the scope and performance of their duties for the Town . " Under the Special Multi -Peril policy the following coverages are now and shall be provided for. Section I - Property Coverage - all risk $500 deductible Btanket coverage preferred. BUILDING Town Hall Beach House Toilets Animal Shelter Animal Shelter (rear) Land Fill Storage Bldg. Equipment Test Bldg: Main Garage, Office Storage Barn &Garage Garage & Equipment Lawn Mower Repair Salt Storage Bldg. Police Headquarters Steel Radio Tower (rear) Senior Citizen & Youth Center LOCATION Main Rd., Southold New Suffolk n/s Main Rd., Peconic -n/s Main Rd., Peconic n/s RT 48, Cutchogue n/s RT 482 Cutchogue w/s Peconic Lane, Peconic w/s Peconic Lane, Peconic w/s Peconic Lane, Peconic w/s Peconic Lane, Peconic w/s Peconic Lane, Peconic n/s RT 25, Peconic n/s RT 25, Peconic e/s Peconic Lane, Peconic Police Boats - all risk $500 deductible r COVERAGE 800,000 B. 10,000 B. 35,000 B. 10,000. B. 220,000 B. 25,000 B. 200,000 B. 25,000. B. 60, OPO B: 18,000 B. 15,000 B. 180,000 B. 4,000 B. 200,000 B. 1. 1981 Privateer Motor Boat - 24' length with (2) 150 HP Mercury Outboard Motors, Radar, VHF Radio, Depth Finder and other equipment. Value -$36,000. 2. 1966 Boston Whaler - 13' length with 1980 40 HP Mercury Engine & Trailer. Value $2,000. 3. 1967 Boston Whaler - 13' length with 1968 40 HP Evin rude Engine & Trailcr. Value $2,000. 75,000 10,000 ( 35,000 C 15,000 C 25,000 C 7,000 C 5,000 C 50,000 C 15,000 C (2) " 4. 1968 Well Craft - 19' length with 1968 150 HP Mercury Engine. Value $2,500. Valuable Papers - coverage located at Town Hall, Southold $50,000. $500 deductible. IBlanket Bond - coverage for all employees ( Insuring Agreement i #4), $25,000 each with excess amounts of coverage for: L. Supervisor $190,000. 2. Deputy Supervisor $190;000. 3. Tax Receiver $75,000. 4. Town Clerk $50,000. I Money & Securities - coverage. Loss Inside and Outside Premises, $2,500 each except during periods 12/10 to 1/10 and 5/1 to 5/31 when coverage is increased to $10,000 each. Coverage to apply only at the Town Hall location. Contractor Equipment - all risk $500 Deductible per attached list of equipment totalling $682,889. Section II - $500,000 CSL liability per occurrence including Personal Injury all employees. Exclusion "C" to be deleted. If Police Dept. is excluded from the Personal Injury, separate Law Enforcement coverage must be provided. In addition --the following coverages are to be provided: 1. Broad Form Coverage 2. Blanket Contractual Liability 3. Independent Contractors 4. Incidental Medical Mal practice 5. XCU exclusions to be deleted 6. Host Liquor Liability 7. Employees Benefit Liability - limits 100/300 0 1 'r 0 1 an ar tac Weights $ 9,564. (1) Brown Bear Cub Tractor w/ Compost Auger & Brush $ 74,706. 1 1962 CONTRACTOR"S EQUIPMENT $ 8,000. (1) TOWN OF SOUTHOLD Ford Payloader #4.47259 $ 31,894. AMOUNT YPE OF EQUIPMENT SERIAL NUMBER OF INSURANCE 15,000. (1) 1974 Mobile Sweeper (1) 1984 Ford Tractor, Model YT16 #YC031194BO1112 $ 2,585. (2) Tractor Lawn Mowing Attachments #0040010 & #0039806 0],400 $ 2,800. (1) Highway Sand Spreader, Model E2020 #E74707 $ 8,262. (1) Caterpiller Bull D6zer MDLD6D #4X9006 $ 922198. (1). 1984 Miniliner, Model 2500B4 #21-HC-63 $ 20,330. (1) 1980 International Payloader #51903 $ 25,000. (1) 1981 International Payloader #3268 $ 1.40, 000. (1) Morback Super Beaver Chipper & Attachments $ 539475. (1) Hustler Tractor, Model 275.w/ Mower Deck 1973 Mobile Sweeper #411643 A Re S k 10,000. (1)1979 0 1 an ar tac Weights $ 9,564. (1) Brown Bear Cub Tractor w/ Compost Auger & Brush $ 74,706. 1 1962 International onal Dump Truck #FD5293F $ 8,000. (1) 1975 Ford Payloader #4.47259 $ 31,894. (1) 1967 Mobile Sweeper #2TE4742630 _ $ 15,000. (1) 1974 Mobile Sweeper #412103 $ ;10,000. (1) 1975 Sidewalk Roader $ 5,500. (1) 1963 International Backhoe #4165ZGG $ 9,119. (1) 1981 Giant V.A.C. Tri. #S 19.1 $ 2,269. (1) 1981 Dynahoe Backhoe #Dl90-D50417E $ 78,400. (1) 1981 Mobile Sweeper #820-4-1263 $ 53,787. (1) 1973 Mobile Sweeper #411643 $ 10,000. (1)1979 Fiat Payloader #145C64M04089 $ 30,000, $ 682,889.1 0 1 i (3) ii 8. Additional Insured to be added to policy: (a) Parking Area - Main St. Riverhead Auto Parts Southold, N.Y. Ruth Rothman (b) Parking Area - Foot of South E.E. Wortis Harbor Rd. Southold, N.Y. (c) Parking Area - R.R. Station L.I. Railroad, (M.T.A.) Southold, N.Y. (d) Parking Area - R.R. Station L.I. Railroad, (M.T.A. Mattituck, N.Y. ) (e) Storage Area - e/s Peconic Lane Agnes Reinhard Peconic, N.Y. 9. Include in coverage also for liability: (a) 1.3 acres of Vacant Land, 360' frontage, awned b:y Town on Narrow River Rd. , Orient. (b) Parking area, owned by Town, 37,000 sq., ft.located e. o Westphalia Rd., Mattituck. (c) For Roads and Sidewalk coverage - 179 miles. (d) Six Public Bathing-beaches with life guard protection located on Sound and Bay. (e) Liability coverage for Police boats. (f) Restaurant and Products Liability for Senior Citizens lunch meals at the St. Agnes Hall, 6th Street, Greenport, N.Y. Area 2000 sq., ft. Receipts 7000. There are also in existance two other liability ;policies that you may wish to included in the SLIP. If not, separate policies must be written. 1. $1,000,000 CSL per occurrence Owners & Contractors Protection Liability insuring Town of Southold, N.Y. i Telephone and L.I. Lighting for Town lights attached to the poles of those companies. Hold Harmless agreement with N.Y.T. and Lilco. I I (4) 2. $500,000 CSL per occurrence M. & C. liability covering Home Aid program administered by the Town and funded by Suffolk County covering both parties. Hold Harmless agreement with County. I A third Liability Policy exists covering the Fishers Island Airfield..This is a specialty item that has been written for years through U.S.A.I.G. Policy number is LG 17312 written with limits of $5,000,000 B.I. and $200,000 P.D. Policy period 3/02/84 to 3/02/85. Umbrella Coverage•- $5,000,000 with $10,000 Retention. Policy to be following form over all underlying coverage. Workers Compensation coverage provided by State Fund. Public Official Liability Coverage - Claims Made - $1,000,000. per occurrence. Present coverage with Forum Insurance Co. Policy Period 11/17/84 to 11/17/87. Automobile - $500,000 CSL - P.I.P. - Uninsured Motorists - Non -Owned and Hired Vehicles. $500 Deductible applies to Comprehensive and Collision Coverage. (See attached list for all vehicles and their departments. C & C indicates Comp. & Coll. coverage applies. C indicates only Comp') Policy is available At Town Hall for your inspection and any further information you may need. i HIGHWAY DEPARTMENT VEHICLES Page 1 COMMENTS YR. TRADE NAME TYPE ID.NO. COST NEW COLL.DED. COMP.DED. (6 Ford w/lift F37YEC26061 $13,525 $500.00 $500.00 75 Ford dump F37YEV63895 $6200 ------- $500.00 77 Dodge dump D81GR7JO01431 $12,983 ------- $500.00 77 Dodge dump D81GR7JO01432 $12,983 ------- $500.00 • 79 Intl. dump CA252JHA33268 $21,878 $50,0.00 $500.00 77 Ford pickup F26HEY62696 $4179 $500.00 $500.00 75 Ford pkup FlOBEV62286 $3800 81 Chev. dump 1GBJC34M8BV101386 $9119 $500.00 $500.00 81 Chev. dump 1GBJC34M2BV101383 $9119 $500.00 $500.00 81 Intl. dump CA255BHA10967 $35,469 $500.00 $500.00 78 Ford passg. 8B63S16337 $5,000 $500.00 $500.00 84 Ford dump 1FDYK80UEVA5820 $34,665 $500.00 $500.00 76 Dodge pickup D27BE6S255602 $2,000 ------- $500.00 82 Ford passg. 2FABP35F5CB211223 $11,298 $500.00 $500.00 82 Dodge pickup JB7P2474CY704104 $6803 $500.00 $500.00 82 Dodge pickup JB7P2472CY704067 $6803 $500.00 $500.00 82 Dodge van 287B13E6CK173879 $6999 $500.00 $500.00 84 Chev. dump 1GBHC3476EV127732 $12,128 $500.00 $500.00 71 Ford MN900 F90HUM142276 $25,000 $500.00 $500.00 84 Chev. Dump 1GBHC34M3EV127963 $12,128 $500.00 $500.00 84 Dodge ram JB7FP24D6EY700869 $8000 $500.00 $500.00 COMMENTS YR. 66 60 62 67 68 69 70 66 72 73 74 73 66 63 62 56 78 77 64 TRADE NAME Ford Int 11. F.W.D. Int 1. Int 1. Int 1. Int 1. Int 1. Int 1. Int 1. Int 1. Int 1. Int 1. Int 1. Int 1. Int 1. Int 1. Ford Int 11. HIGHWAY DEPARTMENT VEHICLES TYPE ID.NO. 875478 dump RD406142890 dump J31072 dump 211912G229173 dump 1201?G278950 dump 7179116329500 dump 707211G374933 truck FD112534H dump 707211G475279 dump 70721CGB11058 dump 70721DGB13421 dump 3H3AOCHB42352 dump 211912G205375 dump FD37896G dump FD5293F dump RD4066889 dump D1222HGB18578 pkup FlOGEY44701 dump RD406192699 COST NEW $10,698 $10,880 $12,700 $10,880 $20,000 $4179 COLL.DED. Page 2 $500.00 $500.00 $500.00 COMMENTS Yr. TRADE NAME TYPE 65 Intl. dump 58 Intl. dump 81 Dodge dump 59 Intl. dump 81 Int'l., dump 78 Ford pickup HIGHWAY DEPARTMENT VEHICLES ID.NO. RD4O61O0565 1B7HD24P1BS12O6O3 $7890 RD4O6119167 1HTCA2556BHA27031 $33,993 FlOGEBA3544 $5107 COMMENTS .. 1 PAGE3 COLL.DED. COMP. DED. $500.00 $500.00 $500.00 $500.00 $500:00 $500.00 COMMENTS .. 1 l Ul 11`ItN T S V POLICE DEPARTMENT VEHICLES VA 111 • TR A TW 1\7 AMT 111C1LL 1V Al1L TVDL' 1 11 L Til TT (1 1L . 1VU . nnc'IT' ATrT.TnnT �lUJ j INrjw T T%rr% LULL . UL,U . nnxer UVl"l t' . llC,U . 69 Willys truck 29859 78 Ford pickup F26HECE1535 $6000 $500.00 $500.00 80 Plym pass. JL42LAA140938 $7200 $500.00 $500.00 80 Plym pass. JL42LAA141294 $7200 $500.00 $500.00 81 Ford pass. 2FABP31G1BB136453 $8500 $500.00 $500.00 82 Plym pass. 2F3BB26L2CR133594 $10,548 $500.00 $500.00 82 Plym pass. 2P3BB26N62CR83383 $10,548 $500.00 $500.00 82 Plym pass. 2P3BB26N1CR183386 $10,548 $500.00 $500.00 83 Plym pass. 2P3BB26S3DR229386 $11,988 $500.00 $500.00 83 Plym Pass. 2P3BB26S5DR229387 $11,988 $500.00 $500.00 83 Plym. pass. 2P3BB26S7DR229388 $11,988 $500.00 $500.00 83 Plym. pass. 2P3BB26S9DR229389 $11,988 $500.00 $500.00 83 Plym. pass. 2P3BB26S5DR229390 $11,988 $500.00 $500.00 84 Plym. pass. 1P3BB2653EX580530 $500.00 $500.00 $11,016 84 Plym. pass. 1P3BB26P3EX542615 $9250 $500.00 $500.00 84 Plym. pass. 1P3BB26S5EX580531 $119016$500.00 $500.00 84 Plym. pass. 1P3BB26S7EX580532 $11,016 $500.00 $500.00 84 Plym. pass. 1P3BB26S9EX580533 $11,016 $500.00 $500.00 84 Plym. pass. 1P3BB26SOEX580534 $11,016 $500.00 $500.00 l Ul 11`ItN T S V MISCELLANEOUS VEHICLES YR. TRADE NAME TYPE ID.NO. COST NEW COLL.DED. COMP.DED COMMENTS 78 Ford pickup FlOBECC1228 $4501 $500.00 $500.00 custodian 78 Plym. van BC2BE8K124662 $7430 $500.00 $500.00 nutrition 76 Ford sedan F6B53A221502 $6125 -------- $500.00 bldg.insptr 80 Dodge van B32JEAK111393 $8000 $500.00 $500.00 nutrition 80 Plymouth van BC6KTAK137973 $11,000 $500.00 $500.00 nutrition 81 Chevrolet wag. 2GlAL�5J6B1150063 $7004 $500.00 $500.00 youth , 79 AMC pass. A9057E234661 $3875 $500.00 $500.00 bldg. 81 Ford pass. 2FABP3167BB136456 $8500 $500.00 $500.00 bldg. 77 Ford pass. 7B63A252461 $6500 $500.00 $500.00 super. 79 Chrys. pass. TH42L9A199306 $7000 $500.00 $500.00 bldg. 83 Dodge van 2B4HB23HODK353964 $8400 $500.00 $500.00 nutrition 84 Plym. pass. 1P3BM18CHED275873 $14,000 $500.00 $500.00 assessor 84 Plym. pass. 1P3BM18C2ED302293 $14,000 $500.00 $500.00 bldg. DEPARTMENT OF PUBLIC WORKS YR. TRADE NAME TYPE ID.NO. COST NEW 71 Brockway $500.00 73488 84 Steco trlr. 1S9ESR2T4E1007077 $47,900 84 Steco trlr. 1S9ESR2T2E1007076 $47,900 82 Plymouth passg. 2P3BB26N4CR183382 $10,548 COLL.DED. COMP.DED. COMMENTS $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 6 A. ROC C0399SALU1J01 _ LM 09/U5/54 UTICA NATIONALLINSURANCE•GROUP REPORT 09/0;/84 [ME 12a07sS4 . POLICY INQUIRY - REQUEST FOR PRINT PAGE...... 9 )JESTED ars PERSON t BURKE ` OFF NYMRO DEPT 4ARKETIN(, MIME• TOWN OF SOUTHOLD `ILICY NUMBER 022672-7 XICY EFF DT 01/82 ISS PERIOD 01/01/82 ThRU 01/01/85 .ME/AGNT/CO •-Y2229-2 AIM CLASS DRIVER ACCIDENT NUM LINE CLAIMANT MD OA YR DACCIDENTESCRIPTION PAID TO DATE % 40867122 INCURRED LOSS EXPENSE F O 03/29/84 FALLING OR FLYIN6 O�BJ�,E,,C_Tl,(,,,� 6221 TAMOSUINAS,.t 1. QCGtcit Klii��h �' ivy - nofo d0 ' a 19267 -T ,-UAck-1 1b47v '&U868lb3 CLAIM TOTAL 1.267 ty5/21/84 IMPROPER CIRECTIOI OR SUPERVISION BY INSURED 6221 CICw►NOwICZsF.Ai 1Y ` 1 �d QMamck.d e ea, na" ,c4"c' OX4 eez.6 y obR1 tdCl[d�� , w/ �lcun rga lO a"/. 800 .0!!68996 CLAIM TOTAL 800 04/18/84 FALL OUTSIDE BUILDING, SAME LEVEL 6211 MALOSKI,JOSEPHINE i" w 04-'L1 to k In, 1,0,cv. L., hIkrmalek, 104 104 •0871309- CLAIM TOTAL 104 104 00/28/84 ROADWAY OR PARKING LOT CONDITION e21I . WATAN•BE, YASUSHI. ek,',r ' &,a4 AcG 1,f a ,C,�, C1a ,,(z, ed Zed dck�yl�cY �� d':ltKi.,Cs�(.f I.st ..:,:c _ �'� .�ir.� 6fh.� .�ttct La,.y, 1,000 �' t lcvz* and t 1xt.�nt, �y CLAIM TOTAL 1,Ouu 08730e5 66/01/84 CONDITION OF Pi(EM1SES - EXTERIUR 6221 GULL POND G�asnus�.�,c,�/y,� aclua1t�c d� l7y„-,� 11 zenfCJ% -tucL� fxj t�J.c,dcd CLAIM TOTAL "J" el INQUIRY TOTAL 115,872 27,555 -.. 8,158 TOTAL CLAIMS FOR THIS INQUIRY = 33 r O 0 F 0 0 OG CO3995ALO1 N 09/05/84 ME 22tu7:5• •• U N 1— C LI M S •• UTICA NATIONAL ItURANCE GROUP POLICY INQUIRY — R VEST FOR PRINT UeSTED BY: 197 PERKE 197 OFF FNYMRO 79 DEPT MARKETING 'WAME 79 . TOwn OF SOUTHOLD IICY NUMBER C22672-7 600 — 'LICY EFF DT 01/82 179500 SS PERIOD OL/01/62 THRU 01/01/85 .NE/AGNT/CO •—Y2229-2 L 41" CLASS DRIVER NUM LINECLAIMANT ACCIDENT Af,CIGENT MO DA YR CRIPTION 0618935 11/25/83 FALLING OR FLYING06 CT 6221 ALEKSANOER, ROBERT �urcllteun LatutGl CtAt, 4 -1/au m /Z�ZcajaA. A&." t CLAIM TOTAL 0619505 12/Oo/83 MALPRACIILE UR PERSONAL INJURY — FALSE ARREST SLAM � 6212 ADAMS, JODY � jeZ 1"'^jCt 'c" 4tClL CfCt,�l l /�MtC u� a -K4 o' a-tt CLAIM TOTAL !.ue2U895 a ul/07/&4 ROADWAY OR PARKING LOT LUNOITION 6221 MINDSMAY t$LDG.CORP 0,4-,t?iaAt ;'U -4t :-V-1.1, �latiC ,e h, CLAIM TOTAL 90861449• 02/OB/84 FALL OUTSIDlB'u1LDI SAME LEVEL Clot/n2.ct tt !(� 44 6211. ROTHM AN, kUTH C �'` Fry jam• �, 4, �,� CLAIM TOTAL •0861451 11/26/83 UNCLASSIFIED 6221 LUYSTER, EMILY ) taAW4t 010 I Ston Catyc�/ by LbIQiA,t.s cKfLtttp,t,�"ittcJ� �,�• CLAIM TOTAL t,9862a4y U1/27/84 GONU1T10N OF —tXrTtEt RIOR Torun•.rirt.+.hunrl PRernMI r 6221 KOHL9GEORGE rand-('rL&'-cL tawCS kJ2tuL�ha}Gv CbWl Xhp lu Ct and eaA r,'tKxdt#L A4A.tl %b • Ti c CLAIM TOTAL 52e? 03/29/84 FALLING OR FLYING OBJECT 6221 CARR, MYRTLE. k"i4:dsls>nl 'tufa .Z /d ,alit el,wctc� is C�aaKQari . tiiowic- da.,,�q � u!��ccd Gox / CLAIM TOTAL REYU111 U"1/01/!f♦ PAGE...... b INCURRED LOSSID TO tAT XPENSE F O C) F 19500 197 1,500 197 79 79 79 79 600 600 600 000 179500 17,500 L 197 197 197 197 ISO 150 150 150 3X35 'FITS 0 C F F i 494 O 494 F F L C -c C _ . t 7 FROG C0399SAL61 turf 09/0'i/84 'IME 22:07:54 OUESTFO bY: 01/01/eS •• PERSON S bURKE Off NYMRO DEPT MARKETING irAME TRIM OF SOUTHOLD POLICY NUMBER 02L672-7 1X ICY EFF OT 01/E2 UTICA NATION L • ALINSURANCEGROUP POLICY INQUIRY - RtOUEST FOR PRINT REPORT 09/u5/84 PAGE...... 7 r .OSS PERI00 01/01/82 THRU 01/01/eS INE/AGNT/CO •-Y2229-2 f C LA 104 F NlM CLASS LINE DRIVER CLAIMANT ACCIDENT MO DA Yk ACCIDENT PAID TO DATE % 40609136 OiSCRIPTION INCURRED- LOSS EXPENSE F 06/17/83 FALL OUTSIDE BUILDING, SAME LEVEL — 6211 LEHNER, BEATRICE. elac'naAt tl-pptd+ (cLQ d» .0„40 e j % ?o y - �rctur� .lr�t•d ` 3,278 3s278 1 F _40610874 CLAIM TOTAL 05/05/83 ROADWAY OR PARKING LOT - CONDITION 39278 3,278 1 6211 SIMONS,RObERTA u4s�Mk�i.37rcc� tcl' Ott C y7 n � � x" awl 9 1.250 1 s 250 F C 4d611005 — CLAIM TOTAL 19250 1,250 06/30/83 MALPRACTICt OR PERSONAL INJURY - FALSE ARREST SLAN _ 6211 AOAMS,JODY ��c.r:cuar : ,�a.tttiZLy .�usccCL-uL.Gtf a :%!tcc {�,et,� tc•1cK P. o. .:1.tcJ 250 En ��r �:: �•> �,cr rc lrcld ,ui�Mt c'i.:+.M,t, a �lG �' ` F u 4061160♦ fA Toi'A 07/28/83 CLAIMANTS PRtMISES OR QAOPERTY DAMAGED BY INS OR E 250 6221 WALTEkS,HAkOLO T`n`y' .t c/xCCc �•��✓< G!R MAo&za Wet vc,•d ifQec(C- 704 7U4 37 F 40617363 - CLAIM TOTAL 704 704 37 10/11/83 ROADWAY OR PARKING LOT CONUITION 0221 VERITY, MRS. Ce—;n� rt.pYad e --c /' : ! eA r 4nm-pA,t•, 0,1r o,� l�r�o ilfn.Y ,. C � 37 37 F 406181u7 • 10/31/63 CONDITION OF PkeMISES = EXTERIOR CLAIM TOTAL 37. 37 • 6211 SILVERSTONE, R. &,t-"raAt rn y«. E _Z i4e»ri k4d -"4"lt ,4"4LZVC (ELt"ll W/NIw 79500 268 0 S -.1863.s — CLAIM TOTAL 7000 268 11/11/83 FALLING Uk FLYING OBJECT 6221 STARES, ROBEkT. (TR�� {.IM$ f�1+1 7o vwnb) �- _DNB 616 616 F CLAIM TOTAL 616 616 a � 0 PROG C03995ALOI RUN 09/05/84 •• U N I- C L A I M Ss -O UTICA NATIONAL INSUMAkC. REPORt 09/OS/tl4 TIME 22:07:54 GROUP r POLICY INQUIRY - REQUEST FOR PRINT PAGE...... 6 f REVUESTEO BY: - • PEkSON S BURKE OFF NYMRO DEPT MARKEI1Nb • A NAME TOWN OF SOUTHOLD S POLICY NUMBER 022672-7 - POLICY EFF OT 01/82 r ` LOSS PERIOD 01/01/82 THRU _ 01/01/65 - LINE/AGNT/CO *-Y2229-2 • CLAIM CLASS (DRIVER OFF NUM LINE CLAIMANT ACCIDENT ACCIDENT MO OA YR DLSCkIPTIUN PAID TO DATE % •� 01 40596352 11/18/82 FALL OUTSIDE BUILDING• SAME LEVEL INCURREO LOSS EXPENSE F 6211 SHANKS•MRS.�.:u, u cuixdr rz �cy ar.JrRµc,u, G•i.,rru ale-kc�fc+J f 0150 F CLAIM TOTAL ISO 01 40599199 01/02/83 MALPRACTICE OR PERSONAL INJURY - FALSt ARREST SLAM 6 21 k ADAMS 9 JO DY . C(4.z"It t t.�Jiz1 al aYQ� ,Q�':{7i eJ r /YO:CYlI C �/ i C/C t� A.Lt uL ) g '�7r." v "o plraM 0Z1 �'^Cc!G .0=:L(. ,,,:.. rZ1 Yci- njh 270 0 CLAIM TOTAL 6 270 D1 40602846 12/25/82 ROADWAY OR PARKING LOT CONDITION 6211 KREMtMS• CHESTER. c4ox"11 , !l(� ^� A-4 PJ&& -.4a414 l�[aCA - cid • y Jetitift�li r �ixwr: "LUAd/d4k*bpatLq�tatARJ Q- 2 746 0 CLAIM TOTAL G 746 t D1 ♦0604193 03/21/83 FALL OUTSIDE BUILDING• SAME LEVEL 6211 PURICH•MRS. 1Lcf. ta' `> -,vet Bl. �•�� ,; .' J✓ .ty►t l� ri /1l!.lirC 2.000 a1'�k[f /ntJtd06 lea ia`1lj_t/ 2x000 F e — CLAIM TUTAL 2.000 2.000 Dl 40604194 03/20/83 FALL OUTSIDE BUILDING• SAME LEVEL 6211 PETTY•EMELINE �lk�i�flj iq/ im! qr� ,J y _. _L,� • 1 1.000 1.000 F CLAIM TOTAL 1.000 1.000 i 01 40604624 Cd/28/82 ROADWAY OR PARKING LO.T CONDITION • 6211 DEVINE• ANN .l.cCt�c4 2; 1 .ar--.CC .C;, a.-L!r4,1 `ecd :Li�lCt ►►� . 4y, I ' da,.ac. .. y, F • GLAIM tOTAL �, 40605362 01/25/83 KOAGWAY OR PAkKING LOT CONDITION 6211• 7�Miw Ga•1a •:tccdtJJ ,cl:.c etaQ' ..., Cn ti'YS L'Ct: Z$ 509000 2.184 0 CLAIM TOTAL Sol OW 2.184 • C0399SAL61 09/OS/d4 21tC71S4 •• U» 1- C LIS I N S p UTIL'A NATIUNA� INSURANCE GROUP POLICY INQUIRY - REQUEST FOtt Pk INT REPORT 09/u5/84 PAGE...... 9 .TED nit • PERSON S BURKE Oc NYMRO UttPT MARKFTINC, E. TOWN OF SOUTHOLD Cv NUMAER 022672-7 CY EFF OT O1/d2 ' PERIOD 01/01/82 THRU 01/01/45 /AGhT/CO •-Y2229-2 M CLASS DRIVE.t LINE CLAIMANT ACCIDtNT ACCIDENT MU DA YR DESCkIPT1UN PAID TO DATE % 97447 05/30/82 CONOITIO/t OF PREMISES - EXTERIOR INCURRED LOSS EXPENSE F 6 211 LO P Ed, K . �•.••4aC aAc�'ui # 44& c+t -46 t✓ 44tolha n" Aet7 d C.ctL'tR� -44C C• ' duPp u� .? lCI JA, 40 40 F CLA104 TOTAL 40 28719 06/415/82 MATth DAMAGE OR SPRINKLER LEAKAGE 6221 HANAUER,S +t! / _ Ilt!r -rI - "'t III' r Afitc, h`Ci( tie/• CLAIM TOTAL love 3092b 04/32/82 ROADWAY OR PARKING LOT CONDITION 6211 LARANGER,JOHt uQsr+►<wl.r• qt•�� .•'�ut.'t/ l.vo� /r� «//�;/.% ••. t!r�/ )It J%A N!n:tt:ti:�) cn Cb-tc.dcCC�IVY 1G7 F CLAIM TOTAL NG �.9/:� 40673 07/29/22 LItwmTNING 107 6410 TOM% OF SOUTHLLO ,01� .'•'_tr�t� -.• •,. UME� a . � 71I�ptC1?fjL E F CLAIM TOTAL ':t:i• �29t.7 V6/23/b2 PLAYGRC'UNO EQUIPMENT OR AMUSEMtNI UEVICE nwclt[r�e� P.,a 6211 CUREVICH,t. .'t-c(RltPu../ �4tG)R7[./. l• -t ott o!?_: '� .utrl%,^> fit!:. • ,.ter-!; p� t....I.1.� .. -c 'i..•. '...,r /✓O drCJ9*vt `- lQ`OT .. T• CLAIM TOTAL `' ^ Tcuu RFSR��SIB►ttr/ 309 F I)3SS1 C9/23/d2 kOADWAY Ok PARKING LOT CONDITION eldllre,� 3U9 a 6211` MCC AFFF.RY, 9. tom _&. a Ak., sn ' i rtrr! (,#.e t• . `�ur,A �.sfe MT -,4.) stn ryniv �ts�.j fn wc1a ctct s bra ! .on curt Ajou n.ron,• k (` 500 6eoArrp4crc)a I.587 0 CLA114 TOTAL B,SUU NbC�✓ErD.� 1,587 rb '%b/12/82 MALPRACTICE OR PEANOhAL INJURY - FAISt APREST SLAN 5211 TAYtD4,J. C iutw �w: ._•l.;:,c_: /,t(.' �:ft �u.t.�Ct1•IdO �!:. tel:•+ ., 17,Stru 17,St.0 2,405 F ' CLAIM TOTAL 179500 179500 29005 P 0 ROG C03995AL+11 Of U N 1— C L A I M S •• RUN 09/u5/d4 UTICA NATIONAL INSUKAWt GROUP REPORT 09/u5/tl4 TI4t 22:07:54 POLICY INQUIRY — REQJEST FOR PRINT VALE...... 4 REOUESTEJ HYi PtkSON S EUkRF OFF NYMRO DEPT IIARKE (ING NAME TOWN OF SOUTHOLU POLICY NUMBER 022672-7 POLICY tFF UT 0I/P1 LOSS PERIOD 01/01/81 THRU c.•1/01/62 LINE/AGNI/CO •-Y2229-2 CLAIM CLASS DRIVER ACC1D►Ni ACCIDENT 0 OFh NUM LINE CLAIMANT MU DA YR DESCQIVTIJN INCURREV RAID LOSS f0 DATE O1 40561527 (:2/20/81 TH[F f t:XDA ENSE F 6428 TOWN OF SOuTHOLD cmrnc r r0.,•dal ;,cc& :krr[ ..:•.pw:r..l P4. S '",r). • !'FC•.r, •rr,t lr�Nr-nr, 1 -it :.i Cl <t r -t 1,_ 1,584 1,584 F CLAIM TOTAL 1,5t+4 1,564 D1 40561657 01/2U/dl ROAL)WAY OR PAKKING LOT LONDITION 6211 HEINS,R. C�:',i,..! AlatCr.;t -n t, ;y ,ry rcee4 '� :•,,-.:ou,d i',c U ,4eneebe.? -r it/rlr.rb L4 y .,... .r r,. i, r( rr trk cCr 160,000 10,000 b,621 F CLAIM TOTAL 160,00-3 10,000 b,621 D1 405b7.)43 Uo/n4/81 FALL INSILE dUILI,ING FK:'M SAME LEVEL 6211 MERWf ANN P/. ✓ •+ r. /,r, o, .r, ,E wai be k. '/r cl j, SCu, off. -gLDE• I 14 116 F CLAIM TUTAL 116 Ilb D1 40570965 L7/27/81 FALL INSIUE,CUILDTNG FxuM SAME LEVEL �% Lrr•r 6211 °HARK , S r .i ti r , Ile" ,.r: vr�. 'r, %/r,v of 'rr I�:'r, . =• i - i "r:,r 1. „ r 1,000 1,00(0 400 F CLAIM TOTAL 1,Ou0 1,000 400 D1 4057'320b Cd/31/.81 SnJKF. 6428 TOWN OF SOUTMULU /✓C nl N. It. ICrs',A/ F:, -.1 Clc:t F CLAIM TUTAL 01 4057485d 7/14/81 14PROPE4R UIKECTIGN OR SuPtAVISION BY INSURED 0222 RDA Ci1E,JAMES CCrr;F:rd1z r. Circ+w..cam .,•-. , . t:, to r nr1 .a `�u ! ,�: c••. ; Nc c�A/M H•C', _ • � 'j;nr �C., r/L Ic _oda 174 F •w CLAIN TOTAL 174 INQUIRY TOTAL , 162000 12,700 7,195 TOTAL CLAIMS FOR THIJ INOUIRY a e 70 , — INSURANCE — 1�IN ROAD MATTITUCK•Y. 11952 PHONE 516-298-8481 PDi�T C C5EC). ql� tele_ - -(nm"04 Ba nrnn 'F � .--- ch'cc��CC -70 �d- t W10 IT Pko ow _ -- ---- ._._--�;��1-- /,B 1, Ig18? cirnr (h - — - — - ---__ _ 18 PATuc _ _ -- - pi IDLI 193 --- r'T'r' f^ .'ir . n M t tf i1 i f •�r{ .- ' I L• - _ - ._ ._.__..._...�_____.— ...._ . r _ . �_ i r � r� - �1 q h�,, _ __ _ o i c fq I_ — - - ' tZi 1� V�111( � - - - ►! y - c- �f.i� {l �'J 1 `�' f - , C> - Ro { G G a�J r �'rJ I X11 cg' - _ rl Q 5Y!) - ,!- - �w`�y c !Al _ IAcL174AY '{-N/r EXPERIENCE RECORDED POLICY E>:!)EfllF`1`E REPORT COPY 2 ir�sur�fo SOUTHOLD,TOWN POLICY NO. 2027573 POLICY YEAR 1983 PAGE 1 LE721;IE f. Xl`I q.OATE JEVAL.DAfE FlU'J UAEF GlcOUP �Fl PI AI:l. O: hl T i 19. JE n[r ��-7 i,l Cf;lrCODE2027573 12-28-83 12-28-8409-01-84 08-25-84 4011 1407 IN UTj- _ 151155^TYPE & SONS I14 73 HELVILLE' - 11LIn7175-- - - I'D L1m;Is AUDIT DATE. EST. AN!JUAI M W/C G!L A/lI'D I;�A MT. EAJ 71711 1.7 t( I C rIIC E!L lIIL a.ID !'IA 1 hJP- URC,. 17311 ANN' 0500 0500 2T2t•ilt 00 062 067 20 LINE A/S DEP PREM AUD PREM ****** PREMIUM A14D LUSS SUMMARY STD/EARN PRE RET ADJ/DIV PD PAID LOSSES PAID EXP RESERVES TOTAL INC L/R 34 A 14,199 564, 3.6 10,057 Ir 0 4 .1 4 4 35 A 7,754 5,492 0 564 AUTO T 21,953 15,549 0 564 36 A 3,659 2,592 0 37 A 7,258 5,141 0 PHY D T 10,917 7,733 0 GRAND TO 32,870 23,282 0 564 ***** CLAIM DETAIL LOCN PS CLAIM NO ACC—DT CLAIMANT NAME AS Mt. SL * PAID LOSSES 8888 97 00--23186-61 021784 NELSON E BEEBE 31 35 39 1 112.61 2 PARKED 1 BACKED UP AND STRUCK 2 8888 97 00--23186-66 030984 HENRY SANTACROCE 31 35 33 1 2fr9.09 STONE FLEW OFF TRUCK STRUCK CLMT WINDSHIELD CRACKI14G 8888 97 31-242909-01 030984 C014NOLLY MICHAEL 31 35 33 1 202.60 PAUL G INSD VEH SKID ON SNOW COLLIDED WITH CLMT VEH TOTAL ALL 34 TOTAL ALI. 35 TOTAL ALL AUTO ACCIDENT COUNT LOSSES LOSSES LOSSES 3 m 5611 . 30 564.30 249.0 202.6 :OU 564 10.? .00 564, 3.6 ` Ir 4 4 .1 4 4 4 1 5684 PAID EXP RESERVES TOTAL INC 112.6 249.0 202.6 :OU .00 564.? .00 5(&? 1,?)4 1 LINE U° Bll$INE'S JI ,Ir11c 1,:,• xn ?11111101 1&1v.I".1, 1.",v n— N1 711,11 r. p•I 1.,11, 011-7 ,I !� AIIU W, I IA AUDIT :n. 11,11 6 L It Irl•', 01"., 7 1.1' "," ;. •T;, I• A As AMWNISTATE 9 ML- :INl 01 Ru:: �rlF S: 10 SLS S,, I ,.E 11 r' r ) , rr l r 1•. 1. 1 1: .,. i�f' , i. i ` I, Air. , .. I EXPERIENCE RECORDED POLICY E;CPERIErJt;'E FiEPOR"f COPY 2 iNSL1r,Ln SOUTH0LD,TOWN POLICY NO. 2027573 POUCY'YE^.R 1983 PAGE 2 CRNIH UItIE k.V+1 l.. Di1TF-- II "J UAfI- .._.—__ 1'OU{' k'71'i 1--i;U`JI �JIi. .—_-- 4GGIt[,. Pii,-III Cf'I:.IC L1'-�(t.- 2027573 t12 2883 12-28-8409-01-84 08-25-84I'""14011 NOT IN USE ��151115STYPE�- &'SOUS IN 73 MELVILLE __ REU 1III LINVIS [F651�-ITIE �gl1DIT DALE LJP FiEMIIPub I u � ViC 1,,,TL Mk. 1%J U :;h1 ��'t1U1'. ?UIi G. �OI NEIi � ff lIV OFF!E *X,****** CLAI11 DETAIL ;'*****y* LOCN PS CLAIM NO ACC—DT CLAIMANT NA11E AS 11L SL * PAID LOSSES PAID EXP RESERVES 8888 97 31-242909-00 030984 TOWN OF SOUTHOLD 31 37 33 1 3.50 PAUL G INSD VEH SKID ON SNOW COLLIDED WITH CL1dT VE11 TOTAL INC 3. 5,C TOTAL ALL LOSSES 1+WUn.MIN'SCl1!+. U 11—C LIAR NI 17MISC IIAP. 00 13-70131 ]'5.1111)1'. 11.14\' 11.'1 N1 ""1111 �`.'+,I' 11 i•'+'• A" •I'Ll-O', n�l'.I �`. f'.1.�'t'\( 'ti ",At' -.I :.'. �f, 'y"1"i.T'.'� j TYI'E J' L+ISS 1 I"" ",i`1 � •; f.: '.:..! 36 .00 .00 S AU i"I."A Aunn U TOTAL ALL 37 LOSSES i .00 3.50 3.5C TOTAL ALL PHY D LOSSES .00 3.50 3. 5C', ACCIDENT COUNT 1 1 GRAND TOTAL ALL 564.30 3.50 567.8C • s 1 LINE UI 110SINFSS 1+WUn.MIN'SCl1!+. U 11—C LIAR NI 17MISC IIAP. 00 13-70131 ]'5.1111)1'. 11.14\' 11.'1 N1 ""1111 �`.'+,I' 11 i•'+'• A" •I'Ll-O', n�l'.I �`. f'.1.�'t'\( 'ti ",At' -.I :.'. �f, 'y"1"i.T'.'� j TYI'E J' L+ISS 1 I"" ",i`1 � •; f.: '.:..! 7 •l S " : ri^1: •, t i "Ef f�11 :+ t" r+�., •' 'I S AU i"I."A Aunn U Pnln.uu!1 6L11-5'.A11a 7P'S• PIIE1n1"M STATE aAS, •Ccv17N1S1.Arl 'J NIT- a•n "�-IA IO SI s'rlyd IL'�'1 uC('b' n.n n. ..: n'.•. nil �.,, 11 ;C;'lFd irS .r a,.r�','-.,. cT', �. ., I: ,r r T.n 1 111 "" EXPERIENCE RECORDED POLICY EXFERIEfJCE REPORT' COPY 2• IUSUItk!', SOUTHOLD, TOWN POLICY NO. 2027573 POLICY YEAR 1982 PAGE 1 E' to%.! uv Cf f. nIf CYf lft D.11E [VI, L. UAfE Itllrl UnfF t,HOl1PpN.'F1 C .GU'J1 NU. iGGFlEt15115STYPE �ri,;nt:H �--_`--`---"� Cr)hE NEW_ 12-28 82 12-28-83 09-01-84 _08-25-$4 4011 NOT IN USE & SONS IN 73 MELVILLE (.cft C:I LIr,71T5 f D LIMI1. - ---�- --- -- �..�---^'•.. - ^_ --- S C.UI)Ii UA iE ESi. FlN!nlnl. pp i7iC G,L lrl ,7 i) I,'f.1 PHOP. F.UiiG. --r_ r77 �—�' 1:777(],mu-i AN OfIlL Lt .1 v ;�(; „L 'D I/t.l Pff Ul'� aNN / --- 0500--- 0500_NAL �124`iZ.. .°.�.�075] 075 ...__� 2b * * PREMIUM AND LOSS SUMMARY EINE A/S DEP PREM AUD PREM STD/EARN PRE RET ADJ/DIV PD PAID LOSSES PAID EXP RESERVES TOTAL INC L/R 134 * 11,974 1,252 13, 226 0 59 59 .4 35 * 6,620 695 7,315 0 212 (AUTO T 18,594 212 2.9,. 1 ,947 20,541 0 212 59 271 1.3 36 A 2,358 2,358 0 2,080 53 37 A 4,975 2,133 90,5 4 ,975 p 'PHY D T 7,333 7,333 0 2,080' 53 2,133 290 ;RAND TO 25,927 1,947 27,874 0 2;<:92 112 2,404 8.6 *X)txy*** CLAIM DETAIL *x* **** LOCI -I PS CLAIM NO ACC—DT CLAIMAIIT NAME AS NL SL * PAID LOSSES PAID EXP RESERVES TOTAL INC 8888 97 31-237263-00 052483 HEACOCK GENE 31 35 33 1 C1,113 FRA14K W CLMT ALLEGES STONE FROM IVSD VEIL HIT HIS VEI-I 8888 97 31-239875-00 061383 DORMAN MARY 31 35 33 1 C{,IP KING CEROCK FELL OFF INSD VEH BROKE CLMT VEH WINDSHIELD 8888 97 31-238576-00 072883 WALTERS H 31 35 33 1 CWP ANDREW HIINSD VEH BACKED INTO CLI1T VEH 8888 97 00-- , 22030-27 080383 IREIIE GAUE<AS 31 35 35 1 212.17 r 212.17 TWO VEH PASSED EACH OTHER GRAVEL FLEW OFF 1GRACICING WSH 8888 97 31-240496-01 112383 UGIII 14ELLIE 31. 34 39 1 8888 97 31-240496-02 112383 NEGRO EMMA CWP 31 34 39 1 58.50 58. 0 IVSD VEH PARKED STOLENRECOVERED DAMAGED OTAL ALL 34 LOSSES .00 58.50 58.50 NOTAL ALL 35 LOSSES 212.17 ,00 212.17 TOTAL ALL AUTO LOSSES 212.17 58.50 IC-CIDENT COUNT 5 270.67 I ,�I f4, flr.l t'.\, ,, ••!',tnr., J; „i 11<I N ) r.n'.c "'s .'U '11, 1.11 J', n ,,, •.� ., r. t n, ..TIFF n'1 )I• I•." I",�,I 9 :S nrI IIIVI ^inrr 41 - ,�,.i��. 'I,.,1 .'1 �1, '1 •�. ��, � �;: • .� .. r.� ] . ('ii lC'S': I. i'.f r..^.• i,, . SGV,': '1 i, i r�,. �. , EXPERIENCE RECORDED INSURED SOUTHOLD, TOWN POLICY EXPERIENCE REPORT POLICY NO. 2027573 POLICY YEAR 1982 COPY.2 " PAGE 2 ( w.i,,;NI. OF [ f F . GA 1'E NEW 12-28-82 EXFI R. DATE 12-28-83 JEVA L. DATE 09-01-84 RUN DATE 08-25-84 GROUP c�D PR!PT 4011 ACCOV'J'F IJO. NOT IN USE AGGREG. A ,C P1T OH PltOgllCER F3RA171CH TYPE 15115STYPE & SONS IN 73 MELVILLE ❑1 LIA11TS 1'U LIMAS AU DIT DATE EST. ANNUAL M W/CT AFD I1'd PROP. CITFIER A1KT. C J1C G/L E/L AFD H IER PREMIUM O r[L__ laullG. DIV. �� T77 177 D m .R ******** CLAIM DETAIL ******4* —LOCN PS CLAIM NO ACC—DT CLAIMANT NAME AS ML SL * PAID LOSSES PAID EXP RESERVES 8888 97 00--21522-65 062383 ROBERT STENARD 31 36 33 1 167.42 STRUK TIRE AND ALIGNMENT DAMAGING 8888 97 31-240496-00 112383 TOWN OF SOUTHOLD 31 36 39 1 1,912.55 52.50 8888 97 31-240496-80 112383 SALVAGE/SUBROGATION 31 36 39 1 INSD VEH PARKED STOLEN RECOVERED DAMAGED DOTAL ALL 36 LOSSES ''OTAL ALL 37 LOSSES ''OTAL ALL PHY D LOSSES ,CCIDENT COUNT RAND TOTAL ALL E Ll 2,079.97 52.50 .00 .00 2,079.97 52.50 2,292.14 111.00 TOTAL INC 167.42 1,9655 LINE OF BUSINESS 31 WUB1 FN'SCOTIP. 31 MISC. LIAB 8.1 33 MISC. LAB. P.D. 34 AUTO91. 35 AUTOPD 36PHY. DAM NON COLLISION 37 PHY. DAM. COLLISION 591NL.>NDA'ARINE 15 PLATE GLaS� 86 Z • - TYPE CF LOSS I • Tj)E\I1,11 ) - •.IED;C+1 3 As = AJDIT ST Us d LEP P'.FrA - DEFT ALIO P' EM = AIDIT PR -111:M 6 LIR . LO!S HAT TO TI'S' PHETIIUM STATE 8. AS - ACCIDENT STATE 9. ML = LINE OF BUSINESS 10. SL -SUB LINE 11, GROUP CODE = IN CUSTRIAL CLA:'.IF CATI11`. 12 AGGREG - YF`, IF AG;RE A—F 3P *S TU P: Llr I-), IE A_ IIF.G.\iF COFS f -f APPLN 10-1,1 2,132.47 .00 2,132.47 2,403.14 LIN iL CONTINENTAL CUMULATIVE CLAIMS RUN DATE IS OCTOBER 5, 1984 PAGE 1, INSURED INFORMATION AGENT INFAATION NAME- TONN OF SOUTHOLD NAME' CODE - 33812 POLICY NUMBER - LBA1951123 VAL STYPE 8 SONS C LOCATION NAME: ADDRESS - P. 0. BOX 63 CITY / STATE - MATTITUCK NY 11952 ` LOCATION CODE - - CODE - +j POLICY PERIOD FROM 01/D1/B2 TO 01/31/83 PROGRAMMER'S REQUEST -ID- nq 70 84 /33812/- CLAIM#" .cam s q M M o y CLAIMANT NAME 0R DRIVER'S NAME ACCIDENT CLAIM STATUS AND DATE TOTAL INCURRED LOSS LOSSES OTHER THAN MEDICAL MEL' PAYE K F S C ILE X V NNO252 ly 04 04 53 52 53 0777Pl827(APAC FLATLEY MARTIN 05/09/8 CLOSED06/8 ACCIDENT C DE : 803 COLLIDED WITH kEHICLE MOVING IN INTE ECT1 ]APPE FLATLEY MARTIN CLOSED06/8 2836N5804(APPE F FIEDLER IN1S 04/27/8 CLOSED08/8' 168 168 ACCIDENT C DE : 899 NON COLLISION ACCIDENT N.O.C. 0772TO504 APA CHARTERS BETH 12/02/82CLOSED12/82 303 303 ACCIDENT C DE 1803 COLLIDED WITH `EHICLE MOVING IN INTEVSECT7 3APPE CHARTERS BETH CLOSED12/8e 522 522 0776TO521CAPAC CONWAY ROBERT J 12/07/82CLOSED12/82 315 315 ACCIDENT CODE : 804 RAN INTO STANDING VEHICLE IN ROADWAY FIRST YEAR = 4 =__> 1,308 1,308 LOCATI — = 4 =__> 1,308 1,308 POLICY LBA19.511 3 m 4 ==_> 1,308 1,308 POLICY EFFECTIVE YEAR 1982 = 4 ===> 1,308 1,308 INSURED 33812 Is 4 =__> 11308 R 1,308 1PCon.inental _Insurance ; TARGET AND DET WITH LOSSES AS OF09/30/8 OFFICE / ZONE 04 RETORT NO. - - 4391241 ALLOCATEDOUTSTANDING EXPENSES RESERVES s T T E Q A T R L I N E K 1 N D RECOVERIES/ DEDUCTIBLES NY0253 NNO252 ly 04 04 53 52 53 r 4- • MCMANN E AGENCY WILLIAM H. PRICE DONALD L. GULLAKSOI�t i OG? 1 01984 Mr. Frank Murphy, Supervisor Town of Southold Southold, N.Y. 11971 Dear Frank: 828 FRONT STREET GREENPORT, N. Y. 11944 TEL.: 516 - 477-1680 October 10, 1984 Re: Insurance - Southold Town As we have discussed recently Utica Mutual has indicated to us that they do not wish to renew the Multi -peril insurance policy covering the fire, liability,, and various coverages, as well as the Umbrella policy when these policies expire on 1/1/85. At your request we have drawn up the specifications or summary of the insurance for your use in obtaining quotes from other agents. We are seeking quotations from several other markets we have access to. We have included the "loss -run's' or experience figures, for the SMP policy since January, 1981. We have requested from Utica the automobile experience for the year 1981. As I mentioned the Stype Agency should provide you with the experience figures for automobile for the years 1982, 1983 & 1984. Should you need any further information, or if I can be of any further assistance, please do not hesitate to call me. Sincerely yours, c William H. Price WHP:tk The Town of Southold is interested in receiving quotations for their insurance program. The Special Multi -Perils, Umbrella, and Automobile'policies expire on 1/1/85. Policies and Loss Run figures are available at the Supervisor's office. The Named insured is: " The Town of Southold - All Elected or Appointed Boards of Commissioners, Officials, Officers, Employees, Volunteers both individually and collectively, when acting or deemed by majority of Town Board to have been acting within the scope and performance of their duties for the Town." Under the Special Multi -Peril policy'the following coverages are now and shall be provided for. ISection I - Property Coveraize - all risk $500 deductible Btanket i coverage preferred. i BUILDING LOCATION COVERAGE Town Hall Beach House Toilets Animal Shelter Animal Shelter (rear) Land Fill Storage Bldg. Equipment Test Bldg.- Main ldg:Main Garage, Office Storage Barn & Garage Garage & Equipment Lawn Mower Repair Salt Storage Bldg. Police Headquarters Steel Radio Tower (rear) Senior Citizen & Youth Center Main Rd., Southold New Suffolk n/s Main Rd. , Peconic n/s Main Rd. , Peconic n/s RT 48, Cutchogue n/s RT 48, Cutchogue w/s Peconic Lane, Peconic w/s Peconic Lane, Peconic w/s Peconic Lane, Peconic w/s Peconic Lane, Peconic w/s Peconic Lane, Peconic n/s RT 25, Peconic n/s RT 25, Peconic e/s Peconic Lane, Peconic ( Police Boats - all risk $500 deductible I 800,000 B. 10,000 B. 35,000 B. 10,000, B. 220,000 B. 25,000 B. 200,000 B. 25,000, B. 60,000 B: 18,000 B. 15,000 B. 180,000 B. 4,000 B. 200,000 B. 1. 1981 Privateer Motor Boat - 24' length with (2) 150 HP Mercury Outboard Motors, Radar, VHF Radio, Depth Finder and other equipment. Value $36,000. 2. 1966 Boston Whaler - 13' length with 1980 40 HP Mercury Engine & Trailer. Value $2,000. 3. 1967 Boston Whaler - 13' length with 1968 40 HP Evinrude Engine & Trailer. Value $2,000. 75,000 C 10,000 C 35,000 C 15,000 C 25,000 C 7,000 C 5,000 C 50,000 C 15,000 C I (2 ) 4. 1968 Well Craft - 19' length with 1968 150 HP I Mercury Engine. Value $2,500. Valuable Papers - coverage located at Town Hall, Southold $50,000. $500 deductible. Blanket Bond - coverage for all employees ( Insuring Agreement #4),$25,000 each with excess amounts of coverage for: 1. Supervisor $190,000. 2.'. Deputy Supervisor $190;000. 3. Tax Receiver $75,000. 4. Town Clerk $50,000. Money & Securities - coverage. Loss Inside and Outside Premises, $2,500 each except during periods 12/10 to 1/10 and 5/1 to 5/31 when coverage is increased to $10,000 each. Coverage to apply only at the Town Hall location. Contractor Equipment - all risk $500 Deductible per attached list of equipment totalling $682,889. Section II - $500,000 CSL liability per occurrence including Personal Injury all employees. Exclusion "C" to be deleted. If Police Dept. is excluded from the Personal Injury, separate Law Enforcement coverage must be provided. In addition the following coverages are to be provided: 1. Broad Form Coverage 2. Blanket Contractual Liability 3. Independent Contractors 4. Incidental Medical Mal practice 5. XCU exclusions to be deleted 6. Host Liquor Liability 7. Employees Benefit Liability - limits 100/300 r • (3) t 8. Additional Insured to be added to policy: (a) Parking Area - Main St. Riverhead Auto Parts Southold, N.Y. Ruth Rothman (b) Parking Area - Foot of South Harbor Rd. Southold, N.Y. (c) Parking Area - R.R. Station Southold, N.Y. (d) Parking Area - R.R. Station Mattituck, N.Y. (e) Storage Area - e/s Peconic Lane Peconic, N.Y. 9. Include in" coverage also for liability: E.E. Wortis L.I. Railroad, (M.T.A.) L.I. Railroad, (M.T.A.) Agnes Reinhard (a) 1.3 acres of Vacant Land, 360' frontage, owned by Town on Narrow River Rd., Orient. (b) Parking area, owned by Town, 37,000 sq., ft.located e.o Westphalia Rd., Mattituck. (c) For Roads and Sidewalk coverage - 179 miles. (d) Six Public Bathing beaches with life guard protection located on Sound and Bay. (e) Liability coverage for Police boats. (f) Restaurant and Products Liability for Senior Citizens lunch meals at the St. Agnes Hall, 6th Street, Greenport, N.Y. Area 2000 sq., ft. Receipts 7000. There are also in existance two other liability policies that you may wish to included in the SNIP. If not, separate policies must be written. 1. $1,000,000 CSL per occurrence Owners & Contractors Protection Liability insuring Town of Southold, N.Y. Telephone and L.I. Lighting for Town lights attached to the poles of those companies. Hold Harmless agreement with N.Y.T. and Lilco. . 4 • r t CONTRACTOR"S EQUIPMENT TOWN OF SOUTHOLD YPE OF EQUIPMENT SERIAL NUMBER AMOUNT OF INSURANCE (1) 1984 Ford Tractor, Model YT16 #YCO31194B01112 $ 2,585. (2) Tractor Lawn Mowing Attachments #0040010 & #0039806 @4400 $ 2,800. (1) Highway Sand Spreader, Model E2020 #E74707 $ 8,262. (1) Caterpi.11er Bull Dozer MDLD6D #4X9006 $ 92,198. (1). 1984 Mi.niliner, Model 2500B4 #21 -HC -63 $ 20,330. (1) 1980 International Payloader #51903 $ 25,000. (1) 1981 International Payloader #3268 $ 140, 000. (1) Morback Super Beaver Chipper & Attachments $ 53,475. (1) Hustler Tractor, Model 275.w/ Mower Deck and Rear Stack Weights $ 9,564. (1) Broom Bear Cub Tractor w/ Compost Auger & Brush $ 74,706. 1 () 1962 International Dump Truck #FD5293F $ 8,000. (1) 1975 Ford Payloader #447259 $ '31,894. (1) 1967 Mobile Sweeper #2TE4742630 $ 15,000. (1) 1974 Mobile Sweeper #412103 $ 1.0,000. (1) 1975 Sidewalk Roader $ 5,500. (1) 1963 International Backhoe #4165ZGG $ 9,119. (1) 1981 Giant V.A.C. Tri. ##191 $ 2,269. (1) 1981 Dynahoe Backhoe #Dl90-D50417E $ 78,400. (1) 1981 Mobile Sweeper, #820-4-1263 $ 53,787. (1) 1973 Mobile Sweeper #411643 $ 10,000. (1) 1979 Fiat Payloader #145C64M04089 $ 30,000. $ 682,889.1 2. $500,000 CSL per occurrence M. & C. liability covering, Home Aid program administered by the Town and funded by Suffolk County covering both parties. Hold Harmless agreement with County. A third Liability Policy exists covering the Fishers Island Airfield. This is a specialty item that has been written for years through i U.S.A.I.G. Policy number is LG 17312 written with limits of $5,000,000 B.I. and $200,000 P.D. Policy period 3/02/84 to 3/02/85. Coverage— age - $5,000,000 with $10,000 Retention. Policy to be following form over all underlying coverage. Workers Compensation coverage provided by State Fund. Public Official Liability Coverage - Claims Made - $1,000,000. per occurrence. Present coverage with Forum Insurance Co. Policy Period 11/17/84 to 11/17/87. Automobile - $500,000 CSL - P.I.P. - Uninsured Motorists - Non -(honed and Hired Vehicles. $500 Deductible applies to Comprehensive and Collision Coverage. (See attached list for all vehicles and their departments„ C & C indicates Comp. & Coll. coverage applies. C indicates only Comp!) Policy is available at Town Hall for your inspection and any further information you may need. r' ROG C0399SALLil UN 09/05/64 IME 22&07&54 'QUESTED dY& PERSON S WAKE OFF NYMRO DEPT 4ARKETIN(, N)IM E• TOWN OF SOUTmnin 'ILICY NUMBER 022672-7 XICY EFF DT 01/82 ]SS PERIOD 01/01/82 ThRU 01/01/8S .ME/AGNT/CO s—Y2229-2 UTICA NATION AL LINS jRANCE*GROUP POLICY INQUIRY — REQUEST FOR PRINT REPORT 09/05/84 PAGE...... 9 AIM NUM CLASS DRIVER ACCIDENT LINE ACCIDENT CLAIMANT MO UA YRDESCRIPTION 40867122 PAID TO INCURRED LOSS 03/29/84 FALLING Ok FLYIN6 OBJECT DATE 0 EXPENSE F II' 6221 TAMOSUINAS,O.t L. ddc"&-.t lteu.ud-;. Ad w ' Ny - no 1s267 xWA k-1 7ba~ O 40868163 (y5/21/84 IMVROPER CIRECTtUI OR CLAIM TOTAL 19267 SUPERVISION BY INSURED � C i�1 0221 CICHANOMIC2rF.A(— �d 1ue d Gl4cmQ,�ty ,C �� 494 l 1'Clcitft thp¢ucvcC y A.rtec td(6cal� 4+/ ucu,. p 800 0 40868996 CLAIM TOTAL 800 04/18/84 FALL OUTSIUE BUILDING, SAME LEVEL 6211 WALOSKI,JOSEPHINE /VPej" �teirn GM,� ¢.t.i hluc'k 104 104 F :0871309 CLAIM TOTAL 104 10♦ 00/28/84 ROADWAY OR PARKING LOT CONDITION b2ll WATANABE, YASUSHI.-1k.144 -,IcG 4y Q z Lte . -�cey: ecl zvd La,.Y, 19000 lccY d�teKe Cs�1 est . ,x _ 1J'l.�t� �'�ttet wce., �yy 0 08?30b5 p/'u lit�w '344i!� c�t,nE� ay�,i�,ti CLAIM TOTAL 19ouu 46/01/84 C04DITION OF PKEMIStS — EXTERIUR 6221 GULL POND .u6a/c� plrt.0 u'jd-j 'ko "Aj6lZcrt ,wc&L <�i oV� S6.�lu n.ecnnZ CLAyM TOTAL �+ INQUIRY TOTAL 1159872 27 55 S 89158 TOTAL T L CLA IMS FOR THIS INQUIRY = 33 /9SH. y•.� //?0, OG 09/05%8401 ME 22:u7:5 *# UIESTEO SYS 14E/AG4T/CO 0—Y2229-2 PERSON C BURKE OFF NVMRO DEPT 'QANE MARKETING . TOWN OF. SOUTHOLO UCY NUMBER 022672-7 'LICY EFF OT 01/82 UTICA NA110NALLIl�URANCE04 S 0GROUP POLICY INQUIRY — R�UEST FOR PRINT SS PERI00 01/01/82 THRU 01/01/85 14E/AG4T/CO 0—Y2229-2 AIN CLASS DRIVER ACCIDENT ALCIGENT NUM LINE CLAIMANT MO DA YR CRIPTION 40618935 11/25/83 FALLING OR FLYINGDO CT 6221 ALEKSANDER. ROBERT 4)CAdjr#Ua C4&jZCl Ctus6 4 -faUCV7 AZdUlllc,.& Z4,1,, CLAIM TOTAL 40619505 12/0o/83 MALPRACIILE UR PERSONAL INJURY — FALSE ARREST SLAN 6212 AUAMS s JOUY L�lcts.'ta.J {c Ma R ��1:: 4^ at4M dlcc� rr► rict;�► i`f p&U , " ax, tAXtLtZM. 0'�v 4.1.t _ J CLAIM TOTAL 4ub2U895 �a1 ul/07/&4 KJADWAY OR PARKING LOT LUNDITION 6221 MINDSMAY dLDG.CORP &,&,.PLL .i ;`zlcr. :VLt, Ilddt�tl afht,. 'QttliC curt ,{?itt� CLAIM TOTAL 40861449 02/08/84 FALL OUTSID /B�UILDI SAME LEVEL �t)!� Q�C�" 6211 ROTMIAN, KUTHtr174 M fOt''n d►;�L,/L CLAIM TOTAL 40861451 6221 LUYSTER• EMILYA,`p,�(�- 11/2b/83 JNCLASSIFIED Atma qt. b Cla,,.rr&AA AuLk"4 AU,4L J e« U df icon c..W by pr'h,'s cnitttltd,�,o'�%'t�l� gQ,v/� I l CLAIM TOTAL 40862o44 +• 6221 KOHL•GEORGE U1/27/84 GONOITION OF PRrMI — XTERIUR 7oton•.r�nswhunr/ racu�cnlicita.cn wQs Y ►uc�,r�y • cause I Watcl }v C!(ttt euk0 AucA 7 �.TrraCA +6 �+�» sod . ote"4i•tJtu�h,4G� and esA tatkid c& Atol-.ttEt ♦ LAWs T,& CLATM TOTAL 52e7 03/29/84 FALLING OR FLYING OBJECT 6221 CARR• MYRTLE. 4.u:ds/i>m lku,Ad Azz /o #M t 4J Avk w fve4wm4st; r►�6+c�t_ da-�►�y �� u!ced ire CLAIM TOTAL Rtmml (i9/05/t!ti PAGE...... b 0 PAID TO DATE / INCURRED LOSS EXPENSE F O v F 19 500 1,500 79 79 79 79 6430 600 600 b00 179500 179500 197 197 197 197 LSO 150 150 150 0 F F 494 0 494 F F IUNG 09%0'5/94t)1 TIME 22:07:54 :OUESTFO nY: .. PERSON S tlURKE OFF NYMRO DEPT MARKETING NANE TOWN OF SOUTHOLD - POLICY NUMBER 022672-i -OLICY EFF OT 01/N2 •� U N I- C L A I M S •• UTICA NATIONAL INSURANCE GROUP POLtCY INQUIRY - RtQUEST FOR PRINT ..OSS PERIOD 01/01/81 THRU 01/01/8S f INE/AGNT/CO s -Y2229-2 LA 114 CLASS DRIVER F NUM LINE CLAIMANT ACCIDENT ACCIDENT MO DA Yk OlESCRIPTION INCURRED -- 40609136 06/17/83 FALL OUTSIDE BUILDING* SAME LEVEL — 6211 LEHNER• BEATRICE. �l�tc'na.�C t'-pp(r/' e" 0ce*& &- 'c ,4 -ens/ J7 !fes 3.278 CLAIM TOTAL 3.278 _40610874 05iO5/83 ROADWAY OR PARKING LO L CONDITION 6211 SIMONS•ROBERTA ua �r=c` c� �'� Cacr#.rh F%tr-�y 1.250 - — CLAIM TOTAL 1,250 40611005 (16/33/0/83 MALPRACTICE OR PERSONAL INJURY — FALSE ARREST SLAN _ _ 6211 ADAMS•JODY a�1c�C4 ,-µ Ac AL /?0. Gltc.:� 250 K tna� '::cq�uT� ��t�d Ict/�cK1 oa C'/wrwutnll C�/flifr P4 � eQv f TOT'A� 250 40611604 07/28/83 CLAIMANTS PRrMISES OR OAOPERTY DAMAGED BY INS OR k 6221 MALTcKS•MAkOID � '- aCfC!✓trJo ua ms�0 C� 704 - CLAIM TOTAL 7O4 40617363 10/11/83 ROADWAY OR PARKING LOT CONDITION 0221 VERITY* MRS. a—;' ,t. /"P)"d tNt-t-tt o�, /.'-✓ mitgncZ,��u poi r- 37 Q r!. CLAIM TOTAL 37 40618107 10/31/63 CONDITION OF PkEMISES = EXTERIOR 6211 SILVERSTONE, R. C�u'rawt .t-pped" d Te'p" "ems.' 444ae -ztec heb� � Ad ,,aai ccp .unzrerz: t ELlgul W IMIIN 7,500 — CLAIM TOTAL 7.500 ,1863] 11/11/83 FALLING OR FLYING O@JtCT 6221 STAPLES• ROBEkT. f; t t- _ DNE 79 WINS) 616 CLAIM TOTAL 616 REPORT 09/05/84 PAGE...... 7 PAID TO DATE % LOSS kXPENSE F 3.278 3.278 1.250 1.250 704 704 37 37 616 616 1 F 1 F 0 37 F 37 F 268 0 268 F PROD CD3995ALOI RUN 09/05/84 •• U N I- C L A I M gg s• UTICA NATIONAL INSUK Ut GROUP REPORT 09/OS/o4 TIME 22:07:54 POLICY INQUIRY - REQUEST FOR PRINT PAGE...... 6 REQUESTED BY: + PEkSON S BURKE OFF NYMRO DEPT MARKEI1N(p NAME TOWN OF SOUTHOLD ` POLICY NUMBER 022672-7 POLICY EFF DT 01/82 ` LOSS PERIOD 01/01/82 THRU 01/01/65 LINE/AGNT/CO •-Y2229-2 • CLAIM CLASS E)RIVER OFF NUM LINE CLAIMANT ACCIDENT ACCIDENTPAID MO DA YR DESCkIPTIUN TO DATE 0 INCURRED LASS EXPENSE F 01 40596352 11/18/82 FALL OUTSIDE BUILDING• SAME LEVEL SHANKS,MRS. ��h(thi ld 4?,JrRuKlu, ( *Za 1)4& CaEit/ 96211 .. O 150 F CLAIM TOTAL 150 • D1 40599199 01/02/83 MALPRACTICE OR PERSONAL INJURY - FALSt ARREST SLAN 6212 ROAM$ s JOOY. ^#� =^ J!�ta� dC{v� uj tfokZrs.c l'ii!/C t� 4GCr�Ll0rctn ,Qct: � � � ,• .l,:_to � `��-.� ,,�_: u.. �;; ..' ,u : �� .cv� 270 O • CLAIM TOTAL a 270 D1 4060284e 12/25/b2 ROADWAY LAK PARKING L07C40 6211 KREMtMS9 LHESTER. 44 !��L coq • at.-,nt,Noftt�:rk;Q'c iF r �WpnQt�tq�"tta4� 7 t1�n 0 CLAIM TOTAL G 746 f D1 x0604193 03/21/83 FALL OUTSIDE BUILDING• SAME LEVEL 6211 PURICH+MRS. `1�l'%�° '� pkv �t Btu rt• tryt i - . �d �'kn...,�c; � 2.000 2.000 F — CLAIM TOTAL 29000 29000 01 40604*194 FALL OUTSIDE BUILDING• SAME LEVEL 03// j 6211 PETTY+EMELINE d-/20/83 Al&uq ig(/r&! Ltrrc/ .� ,xd_ _L,� ' 19000 1,000 F • +I CLAIM TOTAL 19000 1+00_0 01 40604624 Ca/28/82 ROADWAY OR PARKING LOT CONO1TIOh 6211 OEVINE9 ANN 4LUti c4 2: z`ccd u�cct / — CLAIM TOTAL 0- 40605362 01/25/83 KOAOWAY OR PAkKING LOT CONOITION 6211 7iMINft GiurD-41:cdIAJ cf:K ;_ •'c c! emd. .iu !n ti'YSL'CC u 509000 • 29164 0 CLAIM TOTAL 509000 29184 • C03995AL61 •* U h l— C L A INS 00 09/01%/d4 UTICA NATIONAL IftSURANCE GROUP 2]tC7t54 POLICY INQUIRY — REQUEST FOd PRINT ;TEO tilt � ...,�.r..- ,� •. - .... ,. .:,. / �;rr:: •�• !r.: .. • uAOCk D6V jCr1Bj.E • PERSON S BURKE '_A* /•' oar. NVMRO Ut-PT NARK FTINCO AA ,4A*4 •. u+E T(WPI OF SOUTMOLD CY NUMBER 022672-7 _ CLAIM TOTAL CY EFF OT 01/d2 C9/23/dZ kOADWAY Ok_ PARKING LOf CowirioN PERIOD 01/01/82 THRU 01/01/45 6,500 /AGNT/CO •-Y2229-2 CLAIM TOTAL e,suu R CLASS DRIVER ACCIOtNT ACCIDENT M LINE CLAIMANT MU OA YR OESCkIPT1UN INCURRED 47447 05/30/82 CONDITION OF PREMISES - EXTERIOR C ► `/' 1�i7✓`°' sr� .�000L 17,500 6211 LOPEJ4,K. aupp v� .t sccl!• 40 CLAIM TOTAL 40 J!8T19 06/05/82 WATtk DAMAGE OR SPRINKLER LEAKAGE r�C�Rt� [cYlt witrr 6221 HANAVER,S�� ' r CLAIM TOTAL A/^l -60926 04/32/82 RUADNAY OR PARKING LOT CUNOITIUN Glitsr+rct✓ e,•...a[-;r� [aic ...r c: 1.-rc`n I+�.eti�//�;/.� �� ,,. _ ,��! )n J7fi 6211 LARANGER,JOMN Prof: i:�) cn CjmkcdaCtw lw ND ev./9/M CLAIM TOTAL 190673 07/29/EI LIS,►+TNING REPORT 09/05/84 PAGE...... S PAID TO DATE % LOSS EXPENSE F 40 4u 6410 TOWN OF SnUTMVLO � ...,�.r..- ,� •. - .... ,. .:,. / �;rr:: •�• !r.: .. • uAOCk D6V jCr1Bj.E CLAIM TUTAL '_A* /•' X929&7 06/23/82 L7AY/GJRCUNO.UiSE O�GR? 6211 GORE/1CH,t. -0/4'0-4t1 aV�!I2•C.E .cEQUIPMENT n"41- P+a -: 'T — L4 OUaL 7r:Ae7M! �:. n1R/PP;�. AA ,4A*4 •. •r., _ CLAIM TOTAL , 43551 C9/23/dZ kOADWAY Ok_ PARKING LOf CowirioN - w 6211 MCCAFFFRY, S. CGt&ra#ZW _s.• a_ /u1L sP •f1 rtlii[f ![,sem • -%uto4 Ave.AOMT••rr.) %Atm egJ11 .w•c•1A .tt�w;rcv d*i ,A !n a l .,Cwt Ajatauva t,•k (` 6,500 ` �'OA/7RACICR /� CLAIM TOTAL e,suu V�/t/cL✓LrD tti I:b/12/82 MALPRACTICE OR PIAIONAL INJURY — FALSE APREST SLAN 5211 TAYLOR,J* t,c_Y i.tL' of !:. .4t .,..["'-cl•IrO ��+:� ;/ 179 sR.0 179s.,o • CLAIM TOTAL 17,500 179500 F F 107 F 107 F 309 F 3U9 1,587 0 1,587 2,005 F 2,005 ?ROG C03945ALdl *S U N 1— C L A 1 M S .s REPORT 09/u5/84 RUN 79/u3/d4 UTICA NAIIONAL 1NSUKANLt GROUP TIME 22:U7:54 POLICY INQUIRY — REQJES► FOR PRINT PAGE...... 4 REJUESTEJ HYt PEkSrMI S EUkKF OFL NYMRO • DEPT MARKETING • NAME TOWN OF SOUTHOLD POLICY NUMBER 022672-7 POLICY EFF UT 01/P1 LOSS PERIOD 01/01/81 THRU ;A/01/62 LINE/AGNF/CO •—Y2229-2 CLAIM OFf NUM CLASS DRIVER LINE CIAIMANi ACC1UrNT MU OA YR ALLIUENTPAID f0 OA TE 0/ DESCRIPTION INCURRED LOSS EXPENSE F 01 40561527 L2/2(j/81 TMtFf 6428 TOWN OF SOUTHOLD Scrncnc r ra. 100 :rccc :k..c ...:•y...:e..l OA. S•rc�rn. rr. •��rrc..cicr Irr,f �l �H,.r,r: 1. it 1,564 r�• 1,584 F CLAIM TOTAL 1,5t+4 195b4 01 40561657 U1/20/til kDAUwAY GR PAKKING LOT LONOITION 'A 6211 HEINS,R. ,i,..! ."1L •;s¢ •ry ♦Cr+rY _,e,< r,. ��Ud r•.•C �./ ,,,/nucha) r 111!,1, / rbL4 y Pctttr ,t Y .....r .1 r . r. ! �r trratl. 160,000 109000 69621 F CLAIM TOTAL 16ur00J 10,000 brb21 O1 405b7-543 Oo/1)4/81 TALL 1NSILE dU1L1,1NG Fn:'M SAME LEVEL 6211 MERU39ANN "/ r" /rrcr .t. ,� W4 /it..k, 'it nr.cd. TCu,Cty. $/,DE. 116 116 F CLAIM TUFAL 116 116 D1 40570985 L7/27/61 BALL INSIUE CUILOING FktjM SAME LEVEL 6211 or1ARR,S. .1: if,-. • r r %/r,i el 'rr I�: r r •.. - . � :c • rrr rr /; , 1 r 000 1 r ODU 400 F CLAIM TOTAL 19000 19040 400 01 4057320b Cd/31/81 SMJKF. 6428 TOWN OF SOuTHULU �/C =�[ N//' /('t�r,,,r,G:, ! Ur::C /'.tib /cJcJC t:citr bmb ad I/ -': tt err, .Sr? :.� •'�fr4 (rlic+ou.. ...r.'t a. r. F CLAIM TOTAL D1 4057465d 7/14/81 14PROPEA UIKECTIIA OR SuPLAVISION 8Y INSUREU 0222 ROACHE•JAMES rlrt;F:ra,< c CrrL+cv.c� ••. r t:i to r nr-1 -. ,i -tu f ,r+: (•,. NC C � A/M • Ic J • 174 F CLAIM T07AL 174 w INQUIRY IOTAL 1629700 12,)UO 79195 TOTAL CLAIMS FOR TnIN INQUIRY = b VAL STYPE & SONS, INC. - INSURANCE - MAIN ROAD MATTITUCK, N. Y. 11952 PHONE 516-298-8481 0 521, DATE: 10/11/84 _ -A I-1 uTo �ssEs 8 ,83 + 8y 1 Bamz)n ` �o - _ � _._. -_ L �c� -- -- -- ---- - _. _ 0 �0 �0 0 o �� b(�z Cw� -- PG R Kea�- _f LATUC ,, . X11: f �i � 1 01 q 8 }^3{'I lol 193 00 ri, kA -- 4N - � a� It �3 ,A; : 17 ,. ._ L) kk �'`lg �� - -Zl � t' i rl 0, 1.___ 11e7 a 77. Ir7 — — -- -- ---..............- - _. ----.�.............. . _.... x .a_ ..