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Home My WebLink AboutOn the Mark Locations (2)ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Peter Harris, Superintendent of Highways From: Linda J. Cooper, Deputy Town Clerk Dated: May 28, 2003 Re: Film Permit No. 011 Cleanup Deposit Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net In accordance with §44A-5 of the Southold Town Code, please advise if the $250.00 daily Cleanup deposit may be returned to the applicant; if not, please provide a statement setting forth the actual cost to the town of providing said cleanup service. L Cleanup was not required at the location(s) identified on the permit. The deposit may be returned. Cleapn� sas required. Actual cost statement is attached. Signature D; ELIZABETH A. NEVII.LE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD June 3, 2003 CERTIFIED MAIL RETURN RECEIPT REQUESTED Attn: Dena Zemsky On the Mark Locations Ltd. 310 Greenwich St, Suite 38G New York NY 10013 Dear Ms. Zemsky: Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown. northfork. net Returned herewith is check No. 2430 in the amount of $250 that was being held for cleanup fees as required by the Southold Town Code, Chapter 44A. I hope everything went well with the shoot. If I can be of any assistance in the future, please do not hesitate to contact me. ON THE MARK LOCATIONS, LTD. 310 GREENWICH STREET #38G NEW YORK, NY 10013 PAY TO THE ORDER OF. VL - Very truly yours, Linda J. Cooper Deputy Town Clerk 2430 50-791/214 DATE I $ 2 DOLLARS u N w mw�c.�M I W ---- ------------------ IIT FOR n'00 24 3011' i:0 2 140 79 1 21:11'96 ILo-00 29 2n, IOU s ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse SO that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: o97-rI, Jetllq zt "1s<cY 0" 7H Int9kk 40C,i;, 310 6Re� C'4 2- tiY ,�,Y loD<3 2. Article Number (Copy from service label) -------------- 70Dp PS Form.$$11 July 1999 A. Received by (Please Print Clear/Y) B. Date of Delivery C. Signature X ❑ Agent D. Is delive add 0 Addressee tY address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (bra Fee) ❑ Yes D0 d- 3x,57 Domestic Return Receipt 102595.00-M-0952 M m ti ti 0 — — -a 0 -° 7 &-w CLf�l� L171 Lrf Postage $ 3-7 O M m M Certified Fee 36 Postmark Er rU Q- n.l Return Receipt Fee (Endorsement Required) '7 Here C3 � Restricted Delivery Fee (Endorsement Required) O C3 C3 C3 Total Postage & Fees U $ y • / —0 �+ 0 ..A C3Recipiant's Name (Please Print Clearly) (to a completed by Mailer) O C3 C3 C-3 Street, Apt. No.; or PO Box No. --------------------- I v C3 C3 Crty, te, ZIP+4 --�---�-------- - __�i� 6PS I �Q I orm 1 -FOO, February 2.Q0 See Rove[so fol 111stnictions ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR. OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Peter Harris Superintendent of Highways FROM: Lynda Bohn � Deputy Town Clerk r RE: Filming permit DATE: May 27, 2003 Town Hall, 53095 Main Road - P.0 * oadP.O: Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net There was a filming permit issued to On The Mark Locations for use of "67 steps beach at the end of Sound Road in Greenport. They have currently finished shooting and are requesting the return of their Clean-up deposit. We can not return the deposit until the location has been inspected by the Highway Department and it is determined whether clean up efforts by Town personnel are necessary due to this project. Please notify me as soon as this inspection is done. Thank You. Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT*** Date: 05/13/03 Receipt#: 2432 Transaction(s): Subtotal 2 Beach Permits $20.00 Check#: 2432 Total Paid: $20.00 Name: On, The Mark Locations Ltd 310 Greenwich St., Ste 38 G New York, NY 10013 Clerk ID: LINDAC Internal ID: 74848 Town Of Southold P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 05/13/03 Receipt#: 2432 Transaction(s): Name: 2 Beach Permits Check#: 2432 On, The Mark Locations Ltd 310 Greenwich St., Ste 38 G New York, NY 10013 Subtotal $20.00 Total Paid: $20.00 Clerk ID: LINDAC Internal ID: 74848 TOWN CLERK'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check Applicant: JN 72� ll�� Date Received: Completed application $100 nonrefundable application fee Certificate of insurance that evidences a public liability insurance policy covering the town as an additional insured in the amount of $1,000,000 (one million dollars) per occurrence for the duration of the filming or still photography. Indemnification agreement stating the applicant agrees to assume all liability for and will indemnify and hold the town harmless of and free from any and all damages that occur to persons or property by reason of said filming or still photography. / Forward completed application to Chief of Police for approval or disapproval and determination if Traffic Control Fee is required Approved Disapproved ___,,,--'No Fee Required Fee in the amount of $ required Forward certificate of insurance and indemnification agreement to Town Attorney for approval Approved Disapproved COLLECT FEES AS FOLLOWS: Permit Fees (Prior to issuance of permit): Film Fee - $100 per day of each day covered by the permit Cleanup deposit: Separate certified check for $250 for each day covered by the permit. Traffic control fee - $1000 for each day covered by the permit if required by the Chief of Police. NOTE: Additional funds may be required by Police if it is determined that $1000 per day fee will be expended prior to the termination of the permit period. Beach Parking fee - $10 per vehicle, per day between May 1 and l`J September 30. ISSUED PERMIT _ Countersign application Issue permit with name of applicant, locations(s), date(s), and time(s) NOTIFICATION of ISSUED PERMIT Chief of Police Chief Building Inspector Fire Marshal Code Enforcement Officer Superintendent of Highways Superintendent of Parks and Recreation REQUEST FOR EXTENSION OF PERMIT Forward extension permit request to Chief of Police If granted, collect additional $100 per day filming fee Amend permit to indicate granted extension period COMPLETION OF PERMIT PERIOD Chief of Police to provide applicant with statement of cost for providing Traffic Control and police coverage. (Refund overpayment or collect for additional costs within 30 days of termination of permit) Superintendent of Highways inspections locations listed on permit and determine if cleanup efforts by town personnel is required. *If cleanup is required, Superintendent will provide Town Clerk: with a statement of actual costs. (Refund overpayment or collect for additional costs within 30 days of termination of permit) *If not cleanup is required, Superintendent of Highways will notify Town Clerk and Town Clerk will remit the $250 certified check to applicant. ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net FILMING/STILL PHOTOGRAPHY PERMIT Issued to: ON THE MARK LOCATIONS Location(s), Time(s) and Date(s) 67 STEPS BEACH, END OF SOUND ROAD, GREENPORT FRIDAY, APRIL 9, 2003 9:00 AM to 7:00 PM Permit No. 011 Issue Date: April 7, 2003 0�as*?' 040-;Z& Elizabeth A. Neville Southold Town Clerk (Town Seal) 05,/05/2003 03:21 2125711522 ON THE MARK LOCATION V.6/V6 '00 MON 14:27 FAX dla 765i8144SO[►THOLD CLERK TOWN OF SD'UTNQLO APPLICATION FOR FILMING/STILL PHOTOGRAPHY 7?LelAo# FliiXj 04 "VE AFP4:Q^TX0X IMM WOMIT 140 a Namm or Ax1?t'xCAWr, r� MAILI1iQ ADDRimsE: -i +r/n C4 Y-Qp-h 01 CA AM<_ N>tiQ Ol OYOA1iILi1'iON. Q'a�rP/LliYf �� , �L-- My►tLSlIC A09q:%d: 12, jtk4 4j)jo (AP— FAX., ..-4..r•...r•air.W••rNAi��wa..r.a..�....*.i.....•►ararwrr r........•. PAGE 03 D2*C*=1R TY?Y OY ACVZVITY V9tiam Picture, Cvm^49cial, TPlovieLaa, aocolog. Pimpasr;Lac etc, I; nmaz � a f wqD za®c e 1 es .i<oaa:BD r3r.Mxero/o�{CzovlaAolt3! : ICi4 /D� y J PROPC86D Y,nGTIG�(lFl Or Px�+elx4�q/A{1orOGaAPi1Y: attach addit omol gUeet, it noccdea b? Stip � � C p tG�� a rz.i Aj � Sov ND MW Or Vmsom 781 amaift AT stTB, L24-1 Vitt- ERfiff UU10111 or vitipj s: rT r.ol:As=cW (cm? a quer 7XCUMNO) : VM021i AND TY?i Olt vxp[XVVm0 A& toC#H'TONe _ rirr' or BPBCTAL DQUxFx Wz': IC ,y,.�,, - a�e�li erIF ok� ANY 11PBCZAL 1xQ P: enuc r. Returm to: uthold 'Down Clerk S.e'Uthold Town Hall $3095 Main Road P. O, BOX 1179 Southold, NY 11971 1 kens e .# �r 0.ti '�;Vy d� C", i2 ✓��t IGI C , ®003 MIA Town Of Southold P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 05/08/03 Receipt#: 67674194 Transaction(s): Subtotal 1 Beach Permits $10.00 Check#: 67674194 Total Paid: $10.00 Name: On, The Mark Locations Ltd 310 Greenwich St., Ste 38 G New York, NY 10013 Clerk ID: LINDAC Internal ID: 74578 Town Of Southold P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 05/08/03 Receipt#: 67674194 Transaction(s): Subtotal 1 Beach Permits $10.00 Check#: 67674194 Total Paid: $10.00 Name: On, The Mark Locations Ltd 310 Greenwich St., Ste 38 G New York, NY 10013 Clerk ID: LINDAC Internal ID: 74578 Town Of Southold P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 05/08/03 Receipt#: 67674194 Transaction(s): Subtotal 1 Daily Filming Permit $100.00 Check#: 67674194 Total Paid: $100.00 Name: On, The Mark Locations Ltd 310 Greenwich St., Ste 38 G New York, NY 10013 Clerk ID: LINDAC Internal ID: 74577 Town Of Southold P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 05/08/03 Receipt#: 67674194 Transaction(s): Subtotal 1 Application Fee - Non -Refund $100.00 Check#: 67674194 Total Paid: $100.00 Name: On, The Mark Locations Ltd 310 Greenwich St., Ste 38 G New York, NY 10013 Clerk ID: LINDAC Internal ID: 74576 07/05 '03 WED 17:16 FAX 516 765 6145 SOUTHOLD CLERK �a TX REPORT x��c TRANSMISSION OK TX/RX NO 4486 CONNECTION TEL 12125712817 CONNECTION ID ST. TIME 07/05 17:14 USAGE T 01'23 PGS. SENT 4 RESULT OK IM 003 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL. To: Dena Zemsky or Susan Stokes On the Mark Locations From: Linda J. Cooper, Deputy Town Clerk Dated: April 18, 2003 Re: FilnVShoot Permit and Parking Permits Number of Pages (including cover): 4 If total transmittal is not received, please call 631-765-1800. COMMENTS: Here are your permits. Don't worry that they are just faxed copies and not the originals, the Police Department is aware of your plans. ` ELIZABETH A. NES LE .�''! M 1� "; Town Hall, 53095 Main Road TOWN CLERK �i ^' lyse P.O. Box 1179 RSGISI-RAROrVITAL STATISTICS :;,' `ldlps Southold, New York 11971 MARItIACI; OFF'ICSR ,��L �' I „��, ;+: " =h = Fax (631) 765-6145 telephone (631) 765-1800 RECORDS MANAGEMENTOFFICFR FREEDOM OF INFORMATION OFFICEk2-- OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL. To: Dena Zemsky or Susan Stokes On the Mark Locations From: Linda J. Cooper, Deputy Town Clerk Dated: April 18, 2003 Re: FilnVShoot Permit and Parking Permits Number of Pages (including cover): 4 If total transmittal is not received, please call 631-765-1800. COMMENTS: Here are your permits. Don't worry that they are just faxed copies and not the originals, the Police Department is aware of your plans. ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER E Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax(631)765-6145 Telephone (631) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL To: Dena Zemsky or Susan Stokes On the Mark Locations From: Linda J. Cooper, Deputy Town Clerk Dated: April 18, 2003 Re: Film/Shoot Permit and Parking Permits Number of Pages (including cover): 4 If total transmittal is not received, please call 631-765-1800. COMMENTS: Here are your permits. Don't worry that they are just faxed copies and not the originals, the Police Department is aware of your plans. Good luck with the shoot. If you need anything else don't hesitate to give me a call. 1 ti 0 TF - 1019,ek'1v Cr /069M 1-7-5 -- 0,V/ l�-0 2 4 19e-# vtiWC t - e Town Of Southold P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 05/08/03 Receipt#: 67674194 Transaction(s): Subtotal 1 Daily Filming Permit $100.00 Check#: 67674194 Total Paid: $100.00 Name: On, The Mark Locations Ltd 310 Greenwich St., Ste 38 G New York, NY 10013 Clerk ID: LINDAC Internal ID: 74577 Town Of Southold P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 05/08/03 Receipt#: 67674194 Transaction(s): Subtotal 1 Application Fee - Non -Refund $100.00 Check#: 67674194 Total Paid: $100.00 Name: On, The Mark Locations Ltd 310 Greenwich St., Ste 38 G New York, NY 10013 Clerk ID: LINDAC Internal ID: 74576 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net FILMING PERMIT NO 011 OF 2003 PARKING PERMIT DATE: FRIDAY, MAY 9, 2003 TIME: 9:00 AM to 7:00 PM LOCATION: "67 Steps" Beach at Sound Road, Greenport M498LH 558167M ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net FILMING PERMIT NO 011 OF 2003 PARKING PERMIT DATE: FRIDAY, MAY 9, 2003 TIME: 9:00 AM to 7:00 PM LOCATION: "67 Steps" Beach at Sound Road, Greenport M498LH 558167M n the Marl. LOCATION S, L T D. www.onthemarklocations.com 310 Greenwich Street • Suite 38G New York, New York 10013 RECEIVED 212.571.1522 fax: 212.571.2817 MAY 6 Southold Tom flQrk LZ A 76l�a 0 S- �� JY ,S 05/07/2003 00:58 2125711522 ON THE MARK LOCATION n the Mark L 0 C A T 1 O N S 310 Greenwich Street, Suites 38G New York, Now York 10013 phone 212- 571-1522 fax 212-571-2817 www.onthemarldocations.gom Fo Tr '10 , Date: 1/x/0 3 To: �►`na C,00� Attn: �l,,0V, Ckrk.�s Fax number: 631-,76s-- Wq s From: Dena Zemsky/Susan Stokes #E of pages Including cover page: Z - I ,�+Gt/l �r i► da , - A, "fol, koov � �.d d A47 9 9! 00a r*7 ' 0010""' y� PAGE 01 us4�-� Page I of I Cooper, Linda From: Garsik, Pat Sent: Wednesday, May 07, 2003 2:01 PM To: Cooper, Linda Subject: RE: On The Mark fashion shoot Taken care of as we speak!!! -----Original Message ----- From: Cooper, Linda Sent: Wednesday, May 07, 2003 1:41 PM To: Garsik, Pat Subject: On The Mark fashion shoot Heavy rains are predicted for tomorrow so On the Mark productions have requ( changed to Friday. I have spoken with the Chief and he has okayed the change and asked that I email you to put it in "the book". Thank you 5/7/03 05!05/2003 03:21 2125711522 ON THE MARK LOCATION us; u6 '03 MON 14:27 FAX 618 765:6146 SOLITHOLD CLERK INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMING; STILL PHOTOGRAPHY PERMIT The Applicant shall indemnify and hold harmless the Town from and against ail suits, claims, demands or actions for any damage and/or injury sustained or alleged to be sustained by any party or parties in connection with the performance of diming or still photography by the Applicant, his employees or agents or any subcontractor and in case of any such action brought against the Town, the applicant shall immediately take charge of and defend the same at his own cost and expense. In Addition, the Applicant will name the Town as an additional insured on troy applicable policies. Date Printed name Title S�1a3 PAGE 04 1 2004 i POLICE DEPA MENT TOWN Of 6OUTKOLD Telephone Emergency Dial 911 MEMORANDUM TO: Linda Cooper, Deputy Town Clerk FROM: Chief Carlisle E. Cochran, Jr." DATE: May 6, 2003 RE: Application for Filming/Still Photography On The Mark Locations CARLISLE E. COCHRAN, JR. Chief of Police As per Local Law No. 6-2001, Section 44A.3, it is the recommendation of the Chief of Police that the application dated May S, 2003, by On The Mark Locations, be APPROVED. As per Section 44A.4, Traffic Control Fee, there is NO FEE recommended at this time as no police assistance will be needed. 41405 Route 25 • P.O. Box 911 • Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 9 Fax (631) 765-2715 06/05 '03 TUE 07:49 FAX 516 765 6145 SOUTHOLD CLERK �cxcxc TX REPORT �k�c TRANSMISSION OK TX/RX NO 4479 CONNECTION TEL 7342315 CONNECTION ID Police Administ ST, TIME 06/05 07:48 USAGE T 01'02 PGS. SENT 3 RESULT OK ELILA.BET H A. NEVILLE TOWN CLERK RI.GISTRA.tk OF vrfAL STATISTIS MARRIAGE OFFICER RE.CORnB MANAGEMENT OFFICER FREEDOM Or INFORMATION OFFICER 2001 Town Hall,53095 Main Road P.0 - Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telepbone (631) 765-1800 OY+FICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL To: Cbief Cochran, STPD From; Linda J. Cooper, Deputy Town Clerk Dated: April 18, 2003 Re: Film/Shoot Permit Number of Pages (including cover): 3 If total transinittal is not received, please call 631-765-1800. COMMENTS: I received a call and fax late yesterday. On the Mark Locations would like to do a fashion shoot at 67 steps on Thursday. It appears to be a relatively simple event but 1 did advise the rep that it was short notice and that it does require your approval. Here is the application Please let me know if its will be okay, ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL To: Chief Cochran, STPD From: Linda J. Cooper, Deputy Town Clerk Dated: April 18, 2003 Re: Film/Shoot Permit Number of Pages (including cover): 3 If total transmittal is not received, please call 631-765-1800. COMMENTS: I received a call and fax late yesterday. On the Mark Locations would like to do a fashion shoot at 67 steps on Thursday. It appears to be a relatively simple event but I did advise the rep that it was short notice and that it does require your approval. Here is the application Please let me know if its will be okay. 05/05/2003 03:21 2125711522 n the Mork L 0 C A T 1 0 N S 310 Greenwich Street, Suite SG New York, New York 1003 phone 212- 571-152 fax 212-571-2817 www.onthemar*looations.00m ON THE MARK LOCATION Fox -TrA " Dote: S-A /03 Attn: Fax number. 3 From: Dons Zemsky/Susan stokes * of pages Including cover page:0�4 /4'u C-- '�dk- 6?-" '--� 'sa -r X-'� ?at, PAGE 01 05/07/2003 00:58 2125711522 ON THE MARK LOCATION PAGE 02 Uo; U;iUJ rr.L+ 11:09 NAA Z14 eaq 1:096 If UILYIA lnh A6EN;.Y I WL#Lpi CERTIFICATE , )F LIABILITY INSURANCE P w OATr,walLe/YT„► PRooUclq THIN! CMTICICATLI IS 11 Af A K I TON Suburbs! n cefteralll :nAuxance Agy ONLY AND COWMAk NO WORTS UPON T" GE CATE 393 rai, rt Str,,t LA DER. Tllls COWIFICAT; QORS NOT ♦■ENC, STEM OR Krcknns rck NJ 07 601 ERThE COVARA09 AFIRORDEO BY THE POI. BELOW,ERSAFFORDINGCoveRACE WAIL/ gA I"Xtfu InalvrunQ4CC As. T� NIC. +� ..r York, IMs1+a�AO �' COVCIUIO :f nouMell E TME POLIGII:i OC b^UFANQ4 LAM IIPLOH HAK 6C[N !EA+,Y To THE WLURQD MMeb AfOrE ror+Tf K MONvy ►18100 INDIC/,TCD. NOTy,AYwRTA.,eIr� w. nCnus�+,1. r -M *a CoNb-" Up ANY MNT+w I ,l 07ha!11 DOCIJM04T MTN Nl+itrl - 14 MMDN THIS OEM I IhK:ATO MAY N T UID &- MAY PENIA AI Till WPURANGt IT PGLICIEa OE GRoop N4gE1N III a1N1.IRf T Ib ALL INN 7GIMp, ezCWagNp ANIS cOI(Drt1DNt of auc11 oOLN lEp A �WI[Or1Yt Ii,QTe SHOW A,Ar IIAIAF SEEN N!tIUC! f aY pall) Caws. OI IQaL LM�I{ii1 yc,lc�wluloALaiNi%iELLIApILfrT 13SHOJA 5878 CLAIMS MAD! Q nrc11� , _ I DE.gt *30REOATt LOMT APPLIlp PER. � A+r rwa■rLt L+Awun ANr AUTO ALL O%WKO AUTO! 5CNEWULlb Autos NMKh AUTO$ _ MON OyII�D AUTO■ 04iNIG[ NRMLIly ANY AU+u ;c pMYMMKL. u.Ir,Lm OCCUR CLNMO MAGE j V&DUCTISLK �cNcGGUMafNCi a 10001.009 05/23/02 05/25/01IICM1scl ■wwno�! p 300�D00 MI!D CUP (An, a% pr.en) p 0 00 NII■pCRW s �dVM11UgY a � , 000 +•000 UI/M AOkL 400MMA" $2,000,000 PFNCFU014. GGWAiP A011 a 2 000 000 (V." Lo INOLC Lru1r � IEE add�nl► f OLV "ry I Pq�I1lTY nMM4! a (vu �aad 1 AUTO ONLY .(AACCIO T a oT �q TH" EA ACS a ALWO OWLY. AW CA-' 4 ocCulmVelt 1 1190*116W—�— �pW'1'EiML1�iW TIeYAI 7�i l'r�LiiQ' I 1 �e H T- AMT..oPl�toplr 1157131 ! I 09/01/02 99/01/03 i,l SAC" ACCIDENT ! 140i0Q0 OFFIcEIu,AiMYFR u c+.EcR.,E,CRr OIfCN+! •-M �+LOYE a 100 000 ' IgD O'Is b'i"GL DiGrAGE Pout" Iun, 1570.000 beper,►hoMq`oPWlpr■ a/YiH10L■s/lECLUr01tADDlD T MO NIAaNtliP11C1.1.sRo�gloMs FROTO SPOOPM OKI 5/9/09 LOCATZ" Ojr SHOOT. Tow Or SOUTHC ren, 3qy ADDITIONAL jxWLT;e>e,'D: ON 'TI1E NAM IOCATXOlt® LTD, 310 IXI1ZZNWZCH ST, 11=12 31110, maw YORK, in 200.13, CElti�— TIfICAT : HOLDER CANCIlLAT10N • TOWN or BMTROLD :20NN HALL 15300B "Alm itOAp 30M= NY 11971 001/081 mov�3�HoT. ENO II LD AMT OF TNR A■ore O[■AIRao 100MAte Of DAMDaLLIM rPO■1 W RM =PI•10 DATE 11`11111111110F, TN■I■s1NDef 11R0 rRumizaWALL 11AroR TO, M+IIL 0 T _ DAVE WRITTEN SOME YO TMt COMM"TI] NOLpaA MANED To Tmit "Wr. ■ 1' UT LYRt To Do 20 !HALL IMr01a No 05LI04KT10M OA LIA■ILn7 or Awr KIM* UPON TN! lot !w, 171 AOEMTE oR 20/20 908'ON ZL=LL CO, L0/50 '_� 14 nrox Ie►a31439 N Nn9n5 05;'05!2003 03:21 2125711522 ON THE MARK LOCATION PAGE 02 -v:' k,� lAWlr i 4 : s r FAA 610 765 6115 SOLrMOLD CLERK— � Oot APPLICANT -1 1:CKLIST FILMING EMT NOTt: All payments must be cash or certified chcck. Completed application -Z—g 100 nornrefAndable arplication lee Certificate of ingurdnce that cviden.ces a public liability insurance policy covering the town as an additional insured in the amcrwnt of$l,(1A0,000 (one million dollars) per occutTcnce for the duratiotl of the filming or still photography, Indemnification agreement Mating the applicant agrees to assume all liability for and will indenutify and ?sold the town harmless of arad free ftm any and all damages that occur to persons or property by reason of said filming or still photography. Permit ees (Prior to issuance ofpermit): F i Irn Fee - $100 per day of each day covered by the pen -nit (Cleanup deposit- Separate check for $250 for each day covered by tho permit. Traffic control 1c e - $1000 for each day coverod by the permit if repired by the Chief of Police. Bcach Parking feo - $10 per vehicle, per day between May 1 and September 30. ALL CHECKS MUST BE CFATiFIED NOTE: Additional fees for Cleanup and Traffic Control may be required at the direction of the Chief of Pollee land Superintendent of Highways 5/05 '03 MON 14:30 FAX 516 765 6145 SOUTHOLD CLERK �c TX REPORT TRANSMISSION OK TX/RX NO 4472 CONNECTION TEL 12125712817 CONNECTION ID ST. TIME 05/05 14:26 USAGE T 03'23 PGS. SENT 10 RESULT OK ELIZABETH A. NEVILLE TOWN CLERIC REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGENIF>VT 01-"FICER FRF..FDOM OF INFORMATION OFFICER Q001 Town Hall, 53095 Main !toad P.O. Box 1179 Southold, New York ] ] 971 Fax(631)765-6145 Telephone (631) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX '1 RANSMITTA.I, To: Dioa (Fax 212-571-2817) From: Linda J. Cooper, Deputy Town Clerk Dated: April 18, 2003 Re: Film/Shoot Permit Number of Pages (including cover): 9 If total transmittal is not received, please call 631-765-1800. COMMENTS: Here is the packet for the photo shoot as you rcquested 4 Wit Q001 Town Hall, 53095 Main !toad P.O. Box 1179 Southold, New York ] ] 971 Fax(631)765-6145 Telephone (631) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX '1 RANSMITTA.I, To: Dioa (Fax 212-571-2817) From: Linda J. Cooper, Deputy Town Clerk Dated: April 18, 2003 Re: Film/Shoot Permit Number of Pages (including cover): 9 If total transmittal is not received, please call 631-765-1800. COMMENTS: Here is the packet for the photo shoot as you rcquested ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL To: Dina (Fax 212-571-2817) From: Linda J. Cooper, Deputy Town Clerk Dated: April 18, 2003 Re: Film/Shoot Permit Number of Pages (including cover): 9 If total transmittal is not received, please call 631-765-1800. COMMENTS: Here is the packet for the photo shoot as you requested I ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL To: Dina (Fax 212-571-2817) From: Linda J. Cooper, Deputy Town Clerk Dated: April 18, 2003 Re: Film/Shoot Permit Number of Pages (including cover): 9 If total transmittal is not received, please call 631-765-1800. COMMENTS: Here is the packet for the photo shoot as you requested