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HomeMy WebLinkAbout247a r BOARD MEMBERS Leslie Kanes Weisman, Chairperson Eric Dantes Gerard P. Goehringer George Horning Kenneth Schneider �oorif SO!/r�o O http://southoldtown.northfork.net 4 Southold Town Hall 53095 Main Road • P.O. Box 1179 Southold, NY 11971-0959 Office Location: Town Annex /First Floor, Capital One Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809 • Fax (631) 765-9064 APR 2 6 2014 Land & Sea Sports Club Motorcycle Run for Autism 945 Smithtown Avenue Bohemia, NY 11716 Attn: Andrea.McCallan Re: Event Permit #WP247 — Motorcycle Run for Autism at Pugliese Winery Dear Ms. McCallan: Enclosed is the Special Permit for the event planned for September 28, 2014. A duplicate of this permit must be continuously posted during the event. This permit is granted as applied for, based on information supplied in the application. There are several conditions written into the permit. Please be aware that under the State Fire Code, the number of persons occupying the building and/or tent area is limited. The use of a tent will require an application and approvals at least three days before the event, from the Building Department. A Town Building Inspector must inspect the tent, before occupancy, they can be reached at 765-1802 between the hours of 8 a.m. and 4 p.m. This permit does not authorize parking on Suffolk County Right of Way located in front of the property or any lands owned by County of Suffolk, Town of Southold or Peconic Land Trust. All parking and traffic controls are the responsibilities of the event operators, and their agents. Note that parking on any County or State Roads are not authorized under this permit. Any violations of this permit can be cause for revocation. The Town also reserves the right to revoke any permit or deny future permits if the event(s) generates unforeseen impacts to the health, safety or welfare of residents and guests of the Town. cere LAS W�V� Leslie Kanes Weisman Chairperson Encls. Copies of Event Permit to: Town Building Department Town Police Department Fire Inspector, Building Department s ` land preserved through the sale of development rights to the county of Alk with a permit issued by the Suffolk County Farmland Committee. If food is to be served, it must be catered and prepared off-site by food vendors who hold a permit to operate issued by the Suffolk County Bureau of Public Health Food Protection Unit. ; APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVENT Please provide ALL of the information requested below. Incomplete applications IL,L-NOT be reviewed. /1 -os -2 n Special Event Permit # r o2 1 Date of Submission q - t_ Name of Event SCTM #'s 1000 -Section bV Block -_&_0 Lot(s) / b • I U �Or Dates of Each Event: I - 2 8�' I q Nature of Event f (.LAAtL tS24- (Please attach a detailed description to this application) Time Period (Hours) of Event: From to Maximum Number of Persons Attending At One Time: Number of cars expected C� Is a Tent or other temporary structure being used? LSees [ ] No If yes provide size(s) Will foodbe served? Yes [ ] No If yes provide number and name(s) of food vendor(s) c -Tr c_ -e_11;3 q --)g1 Suffolk County permit# (s)� Will other vendors be on the premises during the event? [k] Yes [ ] No If yes how many? ALJ Describe type of vendor( Contact Person and Contact Tel. # Event Location: Street -Hamlet Address: U Mailing Address to Send Event Permit to: �h�(`�,�t Q l 1 `e � 94S xif \H'h wo Have any of the develqpment rights been sold to the Town of Southold [ ] Yes kNo and/or Suffolk County? [ ] Yes kNo If yes to either or both also indicate on the attached plan the boundaries of the reserved area upon which the event will take place. YOU MUST ATTACH A PARK yAgel ReattyConner-W SA ,TTACH IF THE EXPECTED ATTEND) America's Real Estate Coiuiection A TRAFFIC CONTROL PLAN Andrea McCallan Cell: 631-848-0402 Licensed Sales Associate Phone: 631-881-5171 2 i Fax: 631-245-6002 35 Arkay Drive, Hauppauge, NY 11788 the subiect property. INDICATE ON THE PLAN ALL of the following information• A parking/event plan showing: (1) The size of the property and its location in relation to abutting streets or highways. (2) The size and location of any existing building(s) or structure(s) that will be in operation during the course of the event and any proposed building, structure, or signs to be erected temporarily for the event. (3) The location of the stage or tents, if any. (4) The designated areas of use for spectators, exhibitors, vendors, employees and organizers. (5) Location of all exits. (6) The location of all fire extinguishers and other fire safety equipment. (7) The location of all temporary utilities to be installed for the event, if any. (8) The layout of any parking area for automobiles and other vehicles and the means of ingress and egress for such parking areas. The parking spaces must allow for 300 sq. ft. per car. (9) A traffic control plan for vehicles entering and leaving the site for the proposed event. (10) Plan for the use of live outdoor music, loudspeakers and other sounds which will be used, if any, and the type and location of speakers and other audio equipment. (11) A description of emergency access and facilities related to the event. (12) Provisions to dispose of any garbage, trash, rubbish or other refuse. (13) Location and description of any additional lighting to be utilized in conjunction with the event. (14) Location of sanitary facilities on site. Traffic Control Plan Events for three hundred (300) or more people also require submission and approval of a traffic control plan, acceptable to the Town of Southold, AND a qualified traffic controller must be provided. Please attached a written description and/or notate on the parking event plan the following: 1. who will be conducting traffic, 2. where they will be stationed on site, 3. how they will direct the entrance, circulation, parking, and exiting of cars on site, and 4. contact information for use by Southold Town Police. I am the Owner of the Property where this event is to be held and do agree to comply with the laws, rules, regulations, conditions, and requirements of the Code of the Town of Southold, including but not limited to the conditions listed below, as well as all other applicable agency rules and regulations pertaining to the activities under this event. -1 A 4-P r (7 r.4 zt) e-ilose I 1 124-10— - (;;� Pri t o a of caner aAe'.N0wiier- 1\tlf-c cV(' A,,�-n Print name of Authorizea Person filling out application Sigpadire of Authorized Person filling out application PERMISSION IS HEREBY GRANTED, SUBJECT TO THE FOLLOWING CONDITIONS: 1. By acceptance of this permit, applicant agrees to adequately supervise and direct all parking to be on the premises or at another site, and to provide parking assistants and any additional traffic controls necessary for this event. Parking is strictly prohibited on ANY Town. County or State Roads or Rigbts of Way. 2. Traffic control at events for three hundred (300) or more people shall be provided by a qualified traffic controller in accordance with the attached, approved traffic control plan. 3. One "on -premises" sign not larger than six (6) square feet in size may be displayed not longer than thirty (30) days before this event, and removed immediately after the event. Directional parking signs shall be adequately displayed. Pa�7 3 4. Applicant indemnifies and holds harmless the Town of Southold from all claims, damages, expenses, suits and losses including but not limited to attorney's fees arising from activities under this permit. 5. Tent proposals must receive permit approval from the Southold Town Building Inspector before placement on the property and must meet all fire and safety codes. 6. This permit is valid only for the time, date, place and use specified above, and for the designated event. Each additional day will require a separate permit application, fee, and related documents for review, etc. at least 60 business days prior to the scheduled event. 7. Adequate temporary sanitary facilities must be provided by applicant for this event and applicant agrees to remove the temporary facilities from the premises within 48 hours after the day of the event. 8. On-site food preparation is NOT permitted, although food may be catered subject to all Suffolk County Department of Health regulations. 9. NO activities associated with this event, including but not limited to parking, ingress/egress/access, tents or temporary structure(s), or temporary sanitary facilities, shall be conducted on Town of Southold Purchase of Development Rights land. 10. NO activities associated with this event, including but not limited to parking, ingress/egress/access, tent(s) or temporary structure(s), or temporary sanitary facilities, shall be conducted on Suffolk County Purchase of Development Rights land without a permit issued by the Suffolk County Farmland Committee. 11. Issuance of this permit does not authorize in any manner the occupancy of any building exceeding the legal limitations under the fire code or other codes which would prohibit such increased occupancy. 12. Access shall be provided for emergency vehicles, to all public assembly areas, all buildings, all work areas and any additional area where emergencies may occur. Two emergency -fire exits and exit paths from the building(s) on the property, to a public way or remote safe area, shall remain open and unobstructed at all times. 13. Owner assures that all fire, safety, building, and other laws will be complied with. 14. Music, when outdoors, is required to stop at the time specified in the permit. Placement of the speakers must be in a location that affords the greatest protection from noise intrusion upon adjacent properties. 15. ADDITIONAL CONDITIONS: ANY VIOLATIONS IN CONNECTION WITH THE CONDITIONS LISTED HEREIN WILL TERMINATE THIS PERMIT. 1a Date Issued: APPROVED, ZBA Chairperson ZBA Town of Southold Office Location: D 54375 Main Road (Capitol One 1'` floor) I PO Box 11971-0959 Southold, NY 11971-0959 Tel: (631) 765-1809 (press 5012 at voice recording) Updated August 2013 Fax (631) 765-9064 4 nr� vc� owi i r - wvvi IM upm,2,t%iH vainc - u �t��uy1 File Edit View toolbar Window Help 6()�c� �% PI -1.11t kDW)g Maps My Notes �P RECEIVED On the QD? USCm.bing.Com to find t 1 &ections, businesses. arc wre BOARD OF APPEALS 0 Page I of I Print— Maps I lDjrl<g Maps 2705 Bridge Ln, Cutchogue, NY 11935 My Notes ECEIVED 41 APR 18 2014 1 BOARD &- A"PPEAL.S On the '? Use €n bing.aom to fiirvd Vis, / (firectmns, businesses, and nwe Page 1 of 1 Bird's eye view maps can't be printed, so another map view has been substituted. http://www.bing.com/maps/print.aspx?mkt=en-us&z=18.768430 l 56034874&s=b&cp=41.... 8/27/2013 M 4 VL Sunday 8'ortx C L Sunday September _ ANDTHERAOfUI/C S P O. R..T.S`C-t-VU-B, i �''� •moo �. WITH SPEE\A����oS Meeting at Suffolk County Police Headquarters 30 Yaphank Ave, Yaphank NX 11980 9:30A]d REGISTRATION ~ 11:30AM KICKSTANDS UP! All riders, friends, family andPorters of Individuals with Autism are welcome at Pugliese Vineyards. 25 Festivities from PASSENGERS $15 Pugliese Vineyards Main Rd., Cutchogue, NY PAs Genoa Dnterprlse .rICKETS 00 V- 13NDORS `1TA\,na)! Tent Rentals GENERAL- ADM' IDIVIDUAL VATIt DISABILITIES For information contact 631.872.9295 & CHILDREN UNDER 5 FREE Andrea McCallan at _ — iceman99821 @aol.com or EAST END HOTRODS 631.848.0402 CAR SHOW 16od Urrnks Raffles >Uds_�ctw�t�es 50/50 Raffle Games forMs Bounce flouW To ride, sponsor or volunteer contact Andrea McCallan at iceman99821 @aol.com or 631.848.0402 M; P • CERTIFICATE OF LIABILITY INSURANCE DaTE 1 5/9/2014YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dominique PHONEC, Ext : 888-288 1829 ac Nn : 630-393-5666 DHC INSURANCE L.L.C. ADDRESS: info@dhcins.com P.O. BOX 948 INSURER(S) AFFORDING COVERAGE NAIC# WARRENVILLE, IL 60555 www.dhcins.com INsuRERA: United States Fire Insurance Company 21113 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND INSURER B : ITS PARTICIPATING MEMBERS: INSURER C Land and Sea Sports Club, Inc. INSURERD: P.O. Box 1688 CLAIMSMADE[X] OCCUR Westhampton Beach, NY 11978 INSURERE: INSURER F : 014 12:01 AM 12:01 AM 011=11mi lm NI IMRPR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR I LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICYNUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY GENERAL AGGREGATE $2,000,000.00 PRODUCTS - COMP/OP AGG $2,000,000.00 X COMMERCIAL GENERAL LIABILITY PERSONAL & ADV INJURY $1,000,000.00 A CLAIMSMADE[X] OCCUR X SRPGP-101-0414 014 12:01 AM 12:01 AM 05/15/2015 12:01 AM EACH OCCURRENCE $1,000,000.00 FIRE DAMAGE (Any one fire) $300,000.00 GEN'L AGGREGATE LIMIT APPLIES PER MED EXP (Any one person) $5,000.00 $ X POLICY j LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) BODILY INJURY (Per Person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTO NON -OWNED AUTOS PROPERTY DAMAGE (Per acci tlent) $ $ Ilvl 1iAWvvv// V UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS- MADE �� et DED RETENTION S $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WCSTATU- DTH- $ TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR!PARTNER/EXECUTIVE OFF I CER/MEMBER EXCLUDED" (Mandatory in NH) N I. ZONING BOA n OF APPS E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below GL Premium: $934.00 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Sports Activities !^COTICI!`ATC ILI r1CR UANGtLLAI IUN Land and Sea Sports Club, Inc. P.O. Box 1688 Westhampton Beach, NY 11978 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Francis L. bean O 1988-2010 ACURD GUKI'UKA I IUN. An ngnis reserveu. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ACO DATE IMM/DD/YYYYO) ADDITIONAL INTEREST SCHEDULE 5/9/2014 AGENCY BUILDING: CARRIER ADDITIONAL INSURED NAIC CODE LOSS PAYEE Town of Southold Town Hall Annex United States Fire Insurance Company BOAT: 21113 POLICY NUMBER EFFECTIVE DATE NAMED INSURED(S) AIRPORT: SRPGP-101-0413/USP151100 05/15/2014 Land and Sea Sports Club, Inc. OWNER Southold, NY 11971 ITEM CLASS: 12:01 AM EMPLOYEE AS LESSOR ADDITIONAL INTEREST (Not all fields a[)aly to all scenarios — provide only the necessary data) REGISTRANT INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE Town of Southold Town Hall Annex VEHICLE: BOAT: BEACH OF WARRANTY MORTGAGEE 54375 Route 25 P.O. Box 1179 AIRPORT: AIRCRAFT: CO-OWNER OWNER Southold, NY 11971 ITEM CLASS: ITEM: EMPLOYEE AS LESSOR REGISTRANT ITEM DESCRIPTION LEASEBACK OWNER TRUSTEE REFERENCE / LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A1C, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE I POLICY I I SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X NSIREDAL LOSS PAYEE Pugliese Vineyards VEHICLE: BOAT: BEACH OF WARRANTY MORTGAGEE 34515 Main Road AIRPORT: AIRCRAFT: CO-OWNER OWNER Cutchogue, NY 11935 ITEM CLASS: ITEM: EMPLOYEE AS LESSOR REGISTRANT ITEM DESCRIPTION LEASEBACK OWNER TRUSTEE REFERENCE /LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A1C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X DDIIREDAL LOSS PAYEE Suffolk County Dept of Parks BEACH OF WARRANTY MORTGAGEE PO Box 144 VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER W. Sayville, NY 11796-0144 ITEM CLASS: ITEM: EMPLOYEE AS LESSOR REGISTRANT ITEM DESCRIPTION LEASEBACK OWNER TRUSTEE REFERENCE I LOAN 1: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE Cutchogue East Elementary School g VEHICLE: BOAT: BEACH OF WARRANTY MORTGAGEE 34900 Main Road AIRPORT: AIRCRAFT: CO-OWNER OWNER Cutchogue, NY 11935 ITEMITEM: CLASS: EMPLOYEE AS LESSOR REGISTRANT ITEM DESCRIPTION LEASEBACK OWNER TRUSTEE REFERENCE / LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A1C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE St. Joseph College Danzi Athletic Center p 9 VEHICLE: BOAT: BEACH OF WARRANTY MORTGAGEE 155 West Roe Boulevard AIRPORT: AIRCRAFT: CO-OWNER OWNER Patchogue, NY 11772 ITEM CLASS: ITEM: EMPLOYEE AS LESSOR REGISTRANT ITEM DESCRIPTION LEASEBACK OWNER TRUSTEE REFERENCE /LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: The above are added as additional insured but only vjFspp t911jjpility arising out of operations of the named insured during the policy period. ZONING BOARD OF APPEALS ACORD 45 (2009104) © 1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL /4 s� X DATE (MM/DD/YYYY) �....-- ADDITIONAL INTEREST SCHEDULE 5/9/2014 AGENCY BOAT: CARRIER BEACH OF MORTGAGEE WARRANTY NAIC CODE CO-OWNER OWNER United States Fire Insurance Company AIRPORT: 21113 POLICY NUMBER EMPLOYEE REGISTRANT AS LESSOR EFFECTIVE DATE NAMED INSURED(S) ITEM: SRPGP-101-0413/USP151100 05/15/2014 Land and Sea Sports Club, Inc. I REFERENCE/LOAN k: INTEREST END DATE: LIENHOLDER 12:01 AM ADDITIONAL INTEREST (Not all fields apply to all scenarios — provide only the necessary data) FAX (AIC, No): INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X DDIIRIED AL LOSS PAYEE Sayville Yacht Club LOCATION: BUILDING: VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY 123 Boylan Ln CO-OWNER OWNER Blue Point, NY 11715 AIRPORT: AIRCRAFT: EMPLOYEE REGISTRANT AS LESSOR ITEM CLASS: ITEM: ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE/LOAN k: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: ------- CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL LOSS PAYEE INSURED Kidnastics LOCATION: BUILDING: VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY 23 Frowein Road CO-OWNER OWNER Center Moriches, NY 11934 AIRPORT: AIRCRAFT: EMPLOYEE AS LESSOR REGISTRANT ITEM CLASS: ITEM: ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE I LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X DDIITIO AL LOSS PAYEE URE Remsenburg-Speonk Elementary VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY 11 Mill Rd AIRPORT: AIRCRAFT: CO-OWNER OWNER Remsenburg, NY 11960 ITEMITEM: CLASS: EMPLOYEE AS LESSOR REGISTRANT ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE /LOAN N: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL LOSS PAYEE INSURED BEACH OF MORTGAGEE WARRANTY VEHICLE: BOAT: CO-OWNER OWNER AIRPORT: AIRCRAFT: EMPLOYEE AS LESSOR REGISTRANT ITEM CLASS: ITEM: ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCEILOAN#: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A)C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL LOSS PAYEE INSURED VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY r� F� RECEIVED CO-OWNER OWNER EMPLOYEE REGISTRANT AS LESSOR (µ� '° fl I AIRPORT: AIRCRAFT: ITEM ITEM: CLASS: ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER nr1 C g REFERENCE I LOWNING BOARD OFF APPS1$REST ENO DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: The above are added as additional insured but only with respect to liability arising out of operations of the named insured during the policy period. ACORD 45 (2009/04) © 1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INTEREST NAME AND ADDRESS RANK: EVIDENCE: DATE ) �..... ADDITIONAL INTEREST SCHEDULE 5/9/2014 AGENCY LOSS PAYEE CARRIER NAIC CODE LOCATION: United States Fire Insurance Company VEHICLE: 21113 POLICY NUMBER BEACH OF MORTGAGEE WARRANTY EFFECTIVE DATE NAMED INSURED(S) CO-OWNER SRPGP-101-0413/USP151100 05/15/2014 Land and Sea Sports Club, Inc. AIRPORT: AIRCRAFT: 12:01 AM EMPLOYEE AS LESSOR REGISTRANT ADDITIONAL INTEREST (Not all fields apply to all scenarios — provide only the necessary data) INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL INSURED LOSS PAYEE LOCATION: BUILDING: VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY CO-OWNER OWNER AIRPORT: AIRCRAFT: EMPLOYEE AS LESSOR REGISTRANT ITEM CLASS: ITEM: ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE / LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL INSURED LOSS PAYEE LOCATION: BUILDING: VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY CO-OWNER OWNER AIRPORT: AIRCRAFT: EMPLOYEE AS LESSOR REGISTRANT ITEM ITEM: CLASS: ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE I LOAN#: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE BEACH OF WARRANTY MORTGAGEE VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER ITEMITEM: CLASS: EMPLOYEE AS LESSOR REGISTRANT ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE / LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE BEACH OF WARRANTY MORTGAGEE VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER ITEM ITEM: CLASS: EMPLOYEE AS LESSOR REGISTRANT ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE I LOAN#: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE VEHICLE: BOAT: BEACH OF WARRANTY MORTGAGEE 74^'� CO-OWNER OWNER AIRPORT: AIRCRAFT: EMPLOYEE AS LESSOR REGISTRANT ZOrITx'-- ITEM ITEM: CLASS: ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE / LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: The above are added as additional insured but only with respect to liability arising out of operations of the named insured during the policy period. ACORD 45 (2009/04) © 1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD REVi5iDns 011 SEE SEC NO 085 SEE SEC. NO 085 0&12-% y 1&97 N31BOW MATCH UNE MATCH LINE MATCH UNE MATCHUNE M47GH 03% 02- --_--- --_Z---_ ----_-� -_ a 12W eRJ FOR PCL NO, b s 5 MATCH _ L _ _ _ _ _ _� LINE 12.7 s, 12.12 74 J7 a SEE SEC NO - 6 1 FOR PCL. NO. 02-26-01 W �' 1127 2.9A FOR PCL NO. 051&01 mac/ 085-02-010.3 m pic\ y FOR PCL NO 11 SEE SEC. NO. SEE $EC. NO. SEE SEC. NO 2 OS -1&01 (M" OF sourrro,n G �, y� \ 311 1 08503008 085-03012.2 OBS03-070.4 0321-01 J OEVEL?-ENT RIGHTS) r r (��J�� 164 b •ry�`4 '� .4 g 1 s 10-03-01 n �,/1 �(1` �' w� �1 13 3A y ab 'T, • '5 ' 0&18-03 I IY,YV' C, - _/ (rown'oF sourHoto 7.9. a .$ 6 M11Pycl 030303 Q,~ DEVFlOI'MEN7 R1GiIr/s) ,y- JB i 9 (r 00-09-03 a I 'Jt �" q l:1 Sic/ fiAq�`� p ' s �• �y O 07-21-04 Z 1 m • '�. • Q• 1�0 Q 08-10.04 W116 s A d +n +KE 10-05-04 10-20-04 w I i�\'�. 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Y�� a"Wy , U��' J ` 1 1 x _ u y i z APR 18 2014 BOARD OF APPEALS r� �CEjL/E • L.1,' 1 AUG 2 6 2013 BOARD OF APPEALS r ' CERTIMATE OF LIABILITY INSMANCE DATE 5/16/20113 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dorninlque aZ o Ext): 888-288-1829 AICC No): 630-393-5666 DHC INSURANCE L.L.C. E-MAIL ADDRESS: info@dhcins.com P.O. BOX 948 WARRENVILLE, IL 60555 www.dhcins.com INSURER(S) AFFORDING COVERAGE NAIL # INSURERA: United States Fire Insurance Company 21113 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND ITS PARTICIPATING MEMBERS: INSURER B : INSURERC : Land and Sea Sports Club, Inc. P.O. Box 1688 INSURERD: INSURERE: Westhampton Beach, NY 11978 INSURER F : COVERAGES CERTIFICATE NUMBER: USP116228 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MWO POLICY EXP MMIDD LIMITS GENERAL LIABILITY GENERAL AGGREGATE $2,000,000.00 PRODUCTS - COMPIOP AGG $2,000,000.00 X COMMERCIAL GENERAL LIABILITY PER AL 8 ADV INJURY $1,000,000-00 CLnIMs-MADE Fx] OCCUR EACHOC URRENCE$1,000,000.00 A X SRPGP-101-0413 5/15/201 5/15/2014 FIRE DAIIAGE (Any one fire) $300,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: EXP (Any one person) $5,000.00 $ X POLICY JPER6 LOC., ~� AUTOMOBILE LUU31UTY --'" COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per acadent) $ NON -OWNED HIRED AUTO AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATIONWC EMPLOYERS' LIABILITY YIN STATU- OR TORY LIMITS ER $ E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) E.L. DISEASE - POLICY LIMIT $ • describe under If Yesescr DESCRIPTION OF OPERATIONS below GL Premium: $864.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, (f more space is required) Camp Activities CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Land and Sea Sports Club, Inc. 1 p�q (�v SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX 1688 ACCORDANCE WITH THE POLICY PROVISIONS. Westhampton Beach, NY 11978 AUTHORIZED REPRESENTATIVE Dominique Y Capper © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD INTEREST ACORO� CERTIFICATE POLICY SEND BILL DATE (MM/DDIYYYY) `., ADDITIONAL INTEREST SCHEDULE INSURED F5/16/2013 AGENCY CARRIER LOCATION: NAIL CODE VEHICLE: BOAT: United States Fire Insurance Company BEACH OF MORTGAGEE WARRANTY 21113 POLICY NUMBER CO-OWNER EFFECTIVE DATE NAMED INSUREDS) SRPGP-101-0413/USP116228 AIRPORT: 5/15/2013 Land and Sea Sports Club, Inc. EMPLOYEE AS LESSOR ADDITIONAL INTEREST /Not all fields anniv to all scenarios — nrovide oniv the necessary datal INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X INSURED LOSS PAYEE Sayville Yacht Club LOCATION: BUILDING: VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY 123 Boylan Ln CO-OWNER OWNER Blue Point, NY 11715 AIRPORT: AIRCRAFT: EMPLOYEE AS LESSOR REGISTRANT ITEM CLASS: ITEM: ITEM DESCRIPTION LEASEBACK OWNER TRUSTEE REFERENCE / LOAN #: INTEREST END DATE: LIENHOLDER UEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDINSURED LOSS PAYEE Westhampton Yacht Squadron LOCATION: BUILDING: VEHICLE: BOAT: WRRAOT, MORTGAGEE 9 Yacht Club Dr AIRPORT: AIRCRAFT: CO-OWNER OWNER EMPLOYEE AS LESSOR REGISTRANT Remsenburg, NY 11960 CLASS, REM: ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE / LOAN M INTEREST END DATE: UENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL UREDBEACH LOSS PAYEE St. Joseph's College LOCATION: BUILDING: VEHICLE: BOAT: OF WARRANTY MORTGAGEE Danzi Athletic Center AIRPORT: AIRCRAFT: CO-OWNER OWNER 155 West Roe Boulevard AS LESEMPLOYSOR REGISTRANT Patchogue, NY 11772 REM CLASS: ITEM: REM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE i LOAN #: INTEREST END DATE: LIENHOLOER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL INSURED LOSS PAYEE Pugliese Vineyards LOCATION: BUILDING: VEHICLE: BOAT: BEACH MORTGAGEE 34515 Main Rd AIRPORT: AIRCRAFT: GO -OWNER OWNER Cutchogue, NY 11935 EMPLOYEE AS LESSOR AS REGISTRANT (631) 734-4057 CLASS: ITEM: REM DESCRIPTION LEASEBACK OWNER TRUSTEE REFERENCE / LOAN #: INTEREST END DATE: UENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL INSURED LOSS PAYEE Town of Southold LOCATION: BUILDING: VEHICLE: BOAT: BEACH OF WARRANTY MORTGAGEE Town Hall Annex AIRPORT: AIRCRAFT: CO-OWNER OWNER 54375 Route 25 / PO Box 1179 EMPLOYEE AS LESSOR REGISTRANT Southold, NY 11971-0959 ITEM CLASS: CL ITEM: OWNERLEASE TRUSTEE 631-765-1809 ITEM DESCRIPTION REFERENCE/ LOAN #: INTEREST END DATE: UENHOLDER I LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: The above are added as additional insured but only with respect to liability arising out of operations of the named insured during the policy period. ACORD 45 (2009104) © 1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACc>REY DATE(MMIDDIYYYY) ADDITIONAL INTEREST SCHEDULE 5/16/2013 AGENCY CARRIER NAIL CODE United States Fire Insurance Company 21113 POLICY NUMBER EFFECTIVE DATE NAMED INSURED(S) SRPGP-101-0413/USP116228 5/15/2013 Land and Sea Sports Club, Inc. ..A- my #1 .......n" d2*21 ACORD 45 (2009/04) lel T`J7J3-LVUV A%IUKLJ L.Urcrvrcr+uUn. wnyuw �ac..c.+. The ACORD name and logo are registered marks of ACORD In INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: XINSURED�L LOSS PAYEE Suffolk County Department of Parks VEHICLE: BOAT: BEACH OF WARRANTY MORTGAGEE 200 Main Street West Sayville, NY 11796 AIRPORT: AIRCRAFT: IREGIADDITIO CO.OWNER OWNER ITEM CLASS: ITEM: EMPLOYEE AS LESSOR STRANT REM DESCRIPTION LEASEBACK OWNER TRUSTEE REFERENCE I LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE BEACH OF WARRANTY MORTGAGEE VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER REM CLASS: REM: EMPLOYEE AS LESSOR REGISTRANT ITEM DESCRIPTION LEASEBACK OWNER TRUSTEE REFERENCE / LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE BEACH OF WARRANTY MORTGAGEE VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER REM CLASS: ITEM: EMPLOYEE AS LESSOR REGISTRANT ITEM DESCRIPTION LEASEBACK OWNER TRUSTEE REFERENCE /LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MML ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL INSURED LOSS PAYEE BEACH OF WARRANTY MORTGAGEE VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER REM REM: CUSS: EMPLOYEE E AS LESSOR REGISTRANT ITEM DESCRIPTION LEASEBACK OWNER TRUSTEE REFERENCE / LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A1C, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER LOCATION: BUILDING: X ADDITIONAL LOSS PAYEE INSURED BEACH OF MORTGAGEE WARRANTY VEHICLE: BOAT: AIRPORT: AIRCRAFT: CO-OWNER OWNER CLASS: ITEM: EMPLOYEE REGISTRANT AS LESSOR ITEM DESCRIPTION LEASEBACK TRUSTEE OWNER REFERENCE / LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (A/C, No, Ex): FAX (A/C, No): REASON FOR INTEREST: E-MAIL ADDRESS: The above are added as additional insured but only with respect to liability arising out of operations of the named insured during the policy period. ACORD 45 (2009/04) lel T`J7J3-LVUV A%IUKLJ L.Urcrvrcr+uUn. wnyuw �ac..c.+. The ACORD name and logo are registered marks of ACORD In (MMIDD ATE A�ORO� ADDITIONAL INTEREST SCHEDULE D5/16/2013 ) AGENCY CARRIER NAIL CODE United States Fire Insurance Company 21113 POLICY NUMBER EFFECTIVE DATE NAMED INSURED(S) SRPGP-1 01-0413/USP1 16228 5/15/2013 Land and Sea Sports Club, Inc. ADDITIONAL INTEREST (Not all fields annly to all scenarios — nrovide only the necessary datal INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL INSURED LOSS PAYEE LOCATION: BUILDING: VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY CO-OWNER OWNER AIRPORT: AIRCRAFT: EMPLOYEE AS LESSOR REGISTRANT REM CLASS: REM: LEASEBACK OWNER TRUSTEE ITEM DESCRIPTION REFERENCE J LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL INSURED LOSS PAYEE LOCATION: BUILDING: VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY CO-OWNER OWNER AIRPORT: AIRCRAFT: EMPLOYEE AS LESSOR REGISTRANT ITEM ITEM: CLASS: LEASEBACK OWNER TRUSTEE ITEM DESCRIPTION REFERENCE/ LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL INSURED LOSS PAYEE LOCATION: BUILDING: VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY CO-OWNER OWNER AIRPORT: AIRCRAFT: EMPLOYEE AS LESSOR REGISTRANT ITEM CLASS: ITEM: LEASEBACK OWNER TRUSTEE ITEM DESCRIPTION REFERENCE I LOAN M INTEREST END DATE: UENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL INSURED LOSS PAYEE LOCATION: BUILDING: VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY CO-OWNER OWNER AIRPORT: AIRCRAFT: EMPLOYEE AS LESSOR REGISTRANT REM CLASS: REM: LEASEBACK OWNER TRUSTEE ITEM DESCRIPTION REFERENCE / LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AJC, No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER X ADDITIONAL INSURED LOSS PAYEE LOCATION: BUILDING: VEHICLE: BOAT: BEACH OF MORTGAGEE WARRANTY CO-OWNER OWNER AIRPORT: AIRCRAFT: EMPLOYEE AS LESSOR REGISTRANT REM CLASS: ITEM: LEASEBACK OWNER II TRUSTEE I ITEM DESCRIPTION REFERENCE 1 LOAN #: INTEREST END DATE: LIENHOLDER LIEN AMOUNT: PHONE (AIC, No, Ex): FAX (AIC, No): REASON FOR INTEREST: EMAIL ADDRESS: The above are added as additional insured but only with respect to liability arising out of operations of the named insured during the policy period. ACORD 45 (2009/04) © 1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • ZONING BOARD OF APPEALS Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Fax (631) 765-9064 Telephone (631) 765-1809 lx-) TOWN OF SOUTHOLD APPLICATION FOR AN OUTDOOR SPECIAL EVENT AT A WINERY CHECKLIST Date: V ication is being returned as incomplete for the following reasons: ived less than 30 business days from the proposed event date (Requires written request for expedited review stating reasons) F e: pplication (3 pages): Detailed description of the event: F Insurance Certificate e (,/ Parking Event Plan: /I e'�JJ `vvc. The location(s) and width(s) of all ingress/egress to the winery property. Parking for the existing winery building(s) and proposed additional on site parking for the outdoor event, in uding the number of narking spaces and the square footages"of narking areas The location(s) of adequate on site sanitary facilities The proposed location(s) for any tents (s), vendors, or other temporary structure(s) and the size of each Traffic control plan if 300 or more people will attend event: Information on sale of Development Rights Vendor Information: ther: cle>AtAL 9 FAILURE TO SUBMIT THE INFORMATION NOTED HEREIN TO THE ZBA OFFICE WITHIN FIVE (5) BUSINESS DAYS OF THE ABOVE DATE WILL RESULT IN DELAYS IN PROCESSING YOUR APPLICATION AND MAY RESULT IN A DENIAL. Owner: Pugliese Vineyards LLC File M WP247 Address: Route 25 Code: Agent Info Andre McCallan 945 Smithtown Avenue Bohemia, NY 11716 Phone: 631 848-0402 Fax: Email: ZBA TO TOWN CLERK TRANSMITTAL SHEET (Filing of Application and Check for Processing) DATE: 4/18/14 I ZBA_# I NAME I CHECK # I AMOUNT I TC DATE STAMP Land & Sea Sports Club WP247 Motorcycle Run for 1217 Autism $150.00 t5 '...'N SO :SLATER MORICNSS, MY 41!34 , s. WW,.brtdgEnb.COrn gl4%lTown of South Annex 4/23/2014 ttJt,t 1., 54375 Main Road TY Southold, New York 11971 Zoning Application Information File Number: WP247 Master Parcel: 97.-1-12.10 Assignment Code: 06L Owner Name: Land & See Sports Club @ Pugliese Vineyards LLC Location: Route 25 Cutchogue Status: OPEN Description: Bike Run/Fundraiser for Autism at Pugliese Winery on 9/28/14 for approximately 300 people from 12:30 - 4:30 pm Notes: DATES Sent to Town Clerk: 4/23/2014 CoPL: LWRP: Sand W: PB: Trustees/DEC: Page 1 of 1 Decision Date: Sent to LF: e w • • ZBA TO TOWN CLERK TRANSMITTAL SHEET (Filing of Application and Check for Processing) DATE: 4/18/14 ZBA # NAME CHECK # AMOUNT TC DATE STAMP WP247 Land & Sea Sports Club Motorcycle Run for Autism 1217 $150.00 RECEIVED APR 4 Southold Town clerk $150.00 By _lc Thank you. Date: 04/25/14 Quantity 1 Transactions Public Events ***RECEIPT*** Ll Receipt#: 168232 Reference Subtotal WP247 $150.00 Total Paid: $150.00 Notes: Payment Type CK #1217 Amount Paid By $150.00 Land, And Sea Sports Club Name: Land, And Sea Sports Club Southold, NY 11971 Clerk ID: CAROLH Internal ID: WP247 Toth, Vicki From: Spiro, Melissa Sent: Wednesday, April 23, 2014 11:13 AM To: Toth, Vicki Subject: RE: Bike Run for Autism This is adjacent to preserved land; however the event is shown on the area that is not preserved. Therefore, I am not reviewing. From: Toth, Vicki Sent: Wednesday, April 23, 2014 9:51 AM To: Glew, Claire; Lanza, Heather; Webster, Kevin; Weisman, Leslie; Spiro, Melissa; Fisher, Robert; Flatley, Martin Subject: Bike Run for Autism Dear All — Under shared special event applications, for 2014 please review the Land & Sea application. Address comments back to me. Martin —This is the same event as last year, the event organizer is going to contact you for the same escort. How did the event go last year? Vicki Toth Zoning Board of Appeals Town of Southold 631-765-1809 631-765-9064 (fax) 1 1. 0 Toth, Vicki From: Fisher, Robert Sent: Thursday, April 24, 2014 10:53 AM To: Toth, Vicki Subject: RE: Bike Run for Autism Vicki I have no opposition to this permit. Robert Fisher Fire Marshall robert.fisherC«Dtown.southold.nv.us (631) 765-1802 office (631) 786-9180 cell • CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. It is solely for the use of the intended recipient(s). Unauthorized interception, review, use or disclosure is prohibited and may violate applicable laws including the Electronic Communications Privacy Act. If you are not the intended recipient, please contact the sender and destroy all copies of the communication From: Toth, Vicki Sent: Wednesday, April 23, 2014 9:51 AM To: Glew, Claire; Lanza, Heather; Webster, Kevin; Weisman, Leslie; Spiro, Melissa; Fisher, Robert; Flatley, Martin Subject: Bike Run for Autism Dear All — Under shared special event applications, for 2014 please review the Land & Sea application. Address comments back to me. Martin —This is the same event as last year, the event organizer is going to contact you for the same escort. How did the event go last year? Vicki Toth Zoning Board of Appeals Town of Southold 631-765-1809 631-765-9064 (fax) 1 40a • • Toth, Vicki From: Magee, Kathryn <Kathryn.Magee@suffolkcountyny.gov> Sent: Thursday, April 24, 2014 2:36 PM To: Toth, Vicki Cc: Fischer, Lauretta Subject: RE: Special Event Application Hello Vicki, Thank you for sending us this application, and for the opportunity to comment. Since the parcel is not in the County's program, and the event is not likely to impact the County PDR to the west, we do not have comments on this event. Thanks again, Katie Magee Kathryn Magee Environmental Planner DE VEI.top,6.'' F 0�`��,,. ........... AND vr.F��' Suffolk County Dept. of Economic Development and Planning 100 Veterans Memorial Highway.. 4th Floor Hauppauge, NY 11788 631-853-5201 Tel 631-853-4044 Fax web CONFI DENTIALI TY NOTI CE: This electronic mail transmission is intended solely for the use of the individual/entity to whom it is addressed and may contain confidential information belonging to the sender. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this transmission in error, please notify the sender immediately by e-mail and delete the original message. From: Toth, Vicki[mailto:vicki.toth@town.southold_.ny.us] Sent: Wednesday, April 23, 2014 9:47 AM To: Amakawa, Andrew; Magee, Kathryn; Fischer, Lauretta; Peconic Land Trust (nfsoCbpeconiclandtrust.org) Subject: Special Event Application Dear All — Attached is an application for a special event in the Town of Southold. Please review and address comments back to me. Thank you, Vicki Toth Zoning Board of Appeals Town of Southold 631-765-1809 631-765-9064 (fax) 1 A .J 9 Toth, Vicki From: Flatley, Martin Sent: Thursday, April 24, 2014 2:30 PM To: Toth, Vicki Subject: RE: Bike Run for Autism 0 Hi Vicki, I did come in for that event last year to check on since it was the first time that Pugliese hosted it and the check on the escort. Everything went fine on our end as it came into Town so I would have no problem with it being approved again. The only suggestion I would have for the group is to plan and discuss the escort route better this time so it is not a last minute surprise to our department. L76A _ - Chief of Police Southold Town Police Department 41405 State Rt. 25 Peconic, N.Y. 11958 631-765-3115 From: Toth, Vicki Sent: Wednesday, April 23, 2014 9:51 AM To: Glew, Claire; Lanza, Heather; Webster, Kevin; Weisman, Leslie; Spiro, Melissa; Fisher, Robert; Flatley, Martin Subject: Bike Run for Autism Dear All — Under shared special event applications, for 2014 please review the Land & Sea application. Address comments back to me. Martin —This is the same event as last year, the event organizer is going to contact you for the same escort. How did the event go last year? Vicki Toth Zoning Board of Appeals Town of Southold 631-765-1809 631-765-9064 (fax) 1 Toth, Vicki From: Sent: To: Subject: No comments from Planning Lanza, Heather Thursday, May 01, 2014 10:05 AM Toth, Vicki RE: Bike Run for Autism From: Toth, Vicki Sent: Wednesday, April 23, 2014 9:51 AM To: Glew, Claire; Lanza, Heather; Webster, Kevin; Weisman, Leslie; Spiro, Melissa; Fisher, Robert; Flatley, Martin Subject: Bike Run for Autism Dear All — Under shared special event applications, for 2014 please review the Land & Sea application. Address comments back to me. Martin —This is the same event as last year, the event organizer is going to contact you for the same escort. How did the event go last year? Vicki Toth Zoning Board of Appeals Town of Southold 631-765-1809 631-765-9064 (fax) 1