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HomeMy WebLinkAboutMetromotion Productionsr CKLIST rvr• • . CLERK S CHE cash or certified check ► TOWN All paYn1ents must be r n NOTE- Al Completed application lication fee insurance policy o $100 nonrefundable app ublic liability ° f $1 000,000 sured in the amount or still ce that evidences a p of the filming town as an additional e for he duration Certi . ttl°e insurance ✓� covering, dollars) per occurrence (one million e all ' applicant agrees to assum d free photographythe app less of an ent stating old the town h s by reason of �nification agree and h em for and will indemnify ersons or property liability es that occur to p from any and all damages tat . royal or said filming °r still p olice for app Chief Co Control Fee is required / completed application t Traffic Forward comp ination if disapprO`'al nd determ ,� Approved Disapproved.required No Fee Requred of Fee in the amount agreement own Town d indemnification agr Forward certificate of insurance an oval Attorney for Approved Disapproved p'VVS: COLLECT FEES AS FTI' prior to issuance of permit): covered by the Pelt permit of ( coVered Zorn Fee _ $100 per day of each daycertified check for $250 for each day /osit: Separate cert Cleanup deP if required by the permit' covered by the Permit aired by $1000 for each day funds may be req Additional fee will be expended prior AXTraffic control fee lice. NO'f E • er day by the Chief of P ined that $1000 P the te�lnationt is det0 the Permit period the t ! /Beach Parking fee - $10 per vehicle, per day between May 1 and 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 ,ZChief Building Inspector 7Fir Marshal Code Enforcement Officer ' Superintendent of Highways Superintendent of Parks and Recreation RE VEST 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 August 8, 2001 CERTIFIED MAIL RETURN RECEIPT REQUESTED Yuray Valdivia Metromotion Productions, Inc. 27 W 20' St #400A New York, NY 10011 Dear Mr. Valdivia: Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 Returned herewith is certified check No. 5802 in the amount of $500 that was being held for cleanup fees as required by the Southold Town Code, Chapter 44A. An inspection of the permit site was made and no cleanup was necessary. 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. CVery truly yours, Linda J. Cooper 580.1 WTROMOTION, .INC. O 27 W. 20TH ST, STE. 400A. NEW YORK, NY 10011 1=37/210/ n DATE. `� -. 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: Raymond Jacobs, Superintendent of Highways From: Linda J. Cooper, Deputy Town Clerk Dated: August 7, 2001 Re: Film Permit No. 007 Cleanup Deposit Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 ?• � s:4VFrW AUG 8 2001 '""010 #Own Clerk In accordance with §44A-5 of the Southold Town Code, please advise if the $250.00 daily Cleanup deposit may be returned to the applicant; if not, please provide a statement setting forth the actual cost to the town of providing said cleanu"se 'ce. Cleanup was not required at the location(s) identified on the permit. The deposit may be returned. Cleanup was required. Actual cost statement is attached. R- 7-a Date 25/06 '01 MON 08:42 FAX 516 765 6145 SOUTHOLD CLERIC @]003 TOWN OF SOUTHOLD APPLICATION FOR FILMING/STILL PHOTOGRAPHY 7 V448:7 VRxNT O±t TYPE APPLICATIODT DATE: / PBRbaT =3 19AME OF APPLICANT: / e b(AILZNG ADDRESS .- )OHONR: Bu'snmS3 J1/9 , X0, Z:5"'" -;3 3 1:1- 'iT4lYC g -:� NAS OF ORCr]f=ZATx0V . 2COMPAffy, ,e) MAILLNC ADDRE'$S, v (/tom . �/ �+ ` - e4- - 11'f��aci001. ! ti`s 10 o i / a�.rya,s+anrr�a.rry.yyy,fr�►y it iiJrr irrrf ssf rrJrrrr mfr rsrf srrfrrr rrsrr DESCRIBE rXPB OF ACTIVITY (e.g. Xotion picture, Conmercial, Televtsion, Catalog, 74agaziao, DATES) )DTD TIlE(S) OF PROPOSED srraa3:nT6/PBOTOGRABSY: (provide rain date) sy-r PROPOM LOCATSObi(S) OF MHUG/PHOTOGRAPHY: attache additional sheet, if necedeary. "7- 5f& - Azo. c, 5owk,6 ,wa F G'Kt F,cl�'ota-. XMIS OF PERSON IN C LXRGE AT SITE: NUIMAP OF PUSONS AT LOCATION (CAST E. CRM INCLUDED) XtbMIM AND TYPE OS QSAICLES AT LOCATION:, TnE OF SPECIAL SQUxPusirT: ANY SPECIAL RE4VI&.ZH=TB: ,� Oyk) (L' Return to: Southold Town Clerk S.OUthold Town Hall 53095 Main Road P. O. Box 1179 Southold, NY 11971 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER �o�OS�fFO�,�co� C* y� C* = 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 To: Raymond Jacobs, Superintendent of Highways From: Linda J. Cooper, Deputy Town Clerk Dated: August 7, 2001 Re: Film Permit No. 007 Cleanup Deposit 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. Cleanup was not required at the location(s) identified on the permit. The deposit may be returned. Cleanup was required. Actual cost statement is attached. Signature Date 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: Yuray —Metromotion Productions Inc. From: Linda Cooper, Deputy Town Clerk Dated: July 26, 2001 Re: FILMING PERMIT FOR SOUTHOLD TOWN Number of Pages (including cover): If total transmittal is not received, please call 765-1800. COMMENTS: Here are your Filming and Parking Permits. The originals were placed in today's mail. (Sorry for the delay, I was unable to issue the permit without approval from the Southold Town Police. I received the approval this morning.) You should receive the permits in the mail either Friday or Saturday. If, for some reason you do not receive them, use the faxed copies. I'll alert the Police Department that you may be displaying a faxed version of the permit. I will be on vacation next week (7/30 — 8/3). If you have any questions or problems you may either call me at home (631-765-5132) or speak to Lynda.Bohn at the Town Clerk's Office. I will be sure she is familiar with all the information about your permit. Good luck with your fashion shoot. 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 FILMING/STILL PHOTOGRAPHY Issued to: PERMIT METROMOTION PRODUTIONS, INC. Date(s), Time(s), and Location(s) Wednesday, August 1, 2001 Thursday, August 2, 2001 6:00 A.M. to 9:00 P.M. 67 STEPS, END OF SOUND DRIVE EAST, GREENPORT Permit No. 007 Issue Date: July 25, 2001 Elizabeth A. Neville Southold Town Clerk (Town Seal) ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o��S�fFO�,�cOG y 2 oy� • o�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING PERMIT NO 007 OF 2001 METROMOTION PRODUTIONS, INC. PARKING PERMIT Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 DATE: WEDNESDAY, AUGUST 1, 2001 THURSDAY, AUGUST 2, 2001 TIME: 6:00 A. M. to 9:00 P.M. LOCATION: 67 STEPS, SOUND DRIVE EAST, GREENPORT Place this permit on the dashboard, passenger side of the vehicle 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: Chief Cochran, Southold Town Police Mike Verity, Senior Building Inspector Fire Marshal Ed Forrester, Code Enforcement Officer Raymond Jacobs, Superintendent of Highways Ken Reeves, Recreation Dept. From: Linda J. Cooper, Deputy Town Clerk Dated: July 26, 2001 Re: Filming Permit No. 007 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 In accordance with Town Code 44A-9 you are being notified that a Film Permit was issued to METROMOTION PRODUCTIONS, INC. See following pages for a copy of the permit and application. 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 FILMING PERMIT NO 007 OF 2001 PARKING PERMIT Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 DATE: WEDNESDAY, AUGUST 1, 2001 THURSDAY, AUGUST 2, 2001 TIME: 6:00 A. M. to 9:00 P.M. LOCATION: 67 STEPS, SOUND DRIVE EAST, GREENPORT Place this permit on the dashboard, passenger side of the vehicle Town Of Southold P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 07/18/01 Receipt#: 5800 Transaction(s): Subtotal 1 Application Fee - Non -Refund $100.00 2 Beach Permits $20.00 2 Daily Filming Permit $200.00 Check#: 5800 Total Paid: $320.00 Name: Metromotion, Inc. Yuray Valdivia 27 W 20th St #400a New York, NY 10011 Clerk ID: LINDAC Internal ID: 37024 Town Of Southold P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 07/18/01 Receipt#: 5800 Subtotal Transaction(s): 1 Application Fee - Non -Refund $100.00 2 Beach Permits $20.00 2 Daily Filming Permit $200.00 Check#: 5800 Total Paid: $320.00 Name: Metromotion, Inc. Yuray Valdivia 27 W 20th St #400a New York, NY 10011 Clerk ID: LINDAC Internal ID: 37024 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 RECEIPT $100.00 Application Fee - Permit No. 007 $200.00 Daily fees — August 1 and 2, 2001 $20.)0 Parking Permits —1 Vehicle — 2 Days $320.00 Certified Check No. 5800 $500.00 Cleanup Deposit Certified Check No -5801 Film Permit No. 007 - METROMOTION, INC. Received by Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 �abel,��p1 Sti69 Ile 3��,G�iGaco u�2 FedEx I Ship Manager 1 Labe17901 0418 5269 From: MARC A. CHANTI (212)675-3377 METROMOTION, INC 27 WEST 20TH STREET, 400A 361 COLLINS AVENUE, MIA33139 NEW YORK, NY, 10011 To: Linda Cooper (631)765-1800 Town of Southold 53095 Route 25 (P.O. Box 1179) Southold, NY, 11971 1111111111111111111111111�BII � Ref: 1111111111111111111111111111111111 DELIVERY ADDRESS BARCODEP:EDEH-EDR) FedEX STANDARD OVERNIGHT TRK # 7901 0418 5269 6a% 11971—NY—US SHIP DATE: 16JUL01 WEIGHT: 1 LBS JFK Z5 WSHA I11I 11 1111111111 TUE AM Deliver by: 17JUL01 Page 1 of 2 Please fold this document in half and place it in the waybill pouch affixed to your shipment so that the barcode portion of the label can be read and scanned. ***WARNING: Use only the printed original label for shipping. Using a photocopy of this label for shipping purposes is fraudulent and could result in additional billing charges, along with the cancellation of your FedEx account number. Shipping Label Fin'Dro o Location I Shi` ffT: ghip nttot>?plete' Cancel Shipment l 1. Use the "Print" feature from your browser to send this page to your laser or inkjet printer. 2. Fold the printed page along the horizontal line. 3. Place label in shipping label pouch and affix it to your shipment so that the barcode portion of the label can be read and scanned. 4. To print a receipt of your shipment, please click on "Shipping History." Ship a New Package Shlp°InsidaV'.S ) Ship Outside U.S. Ship to SaMO� ft I Use of this system constitutes your agreement to the service conditions in the current FedEx service Guide, available upon request. FedEx will not be responsible for any claim in excess of $100 per package, whether the result of loss, damage, delay, non-delivery, misdelivery, or misinformation, unless you declare a higher value, pay an additional charge, document your actual loss and file a timely claim. Limitations found in the current FedEx Service Guide apply. Your right to recover from FedEx for any loss, including intrinsic value of the package, loss of sales, income interest, profit, attorney's fees, costs, and other forms of damage whether direct, incidental, consequential, or special is limited to the greater of $100 or the authorized declared value. Recovery cannot exceed actual documented loss. Maximum for items of extraordinary value is $500, e.g. jewelry, precious metals, negotiable instruments https://www.fedex.com/cgi-binlunity?www4l&gifs/6915217901_0418_5269S9QayTs.html 7/16/2001 New York Califomia Florida productions On Location. In Control. a4 Pyr awt CA,•✓ e Xu , d 27 West 20th Street 361 Collins Avenue 535 Red Rose Lane Suite 400A Suite 10 Suite D New York, NY 1001 Miami Beach, FL 33139 Santa Barbara, CA 93109 Tel. 212 675 3377 Tel. 305 531 1700 Tel. 805 966 6484 Fax. 212 675 5388 Fax. 305 5314880 Fax. 805 966 4626 The Rollins A4encY Inc. 65 Main Street, 3rd Floor Tuckahoe, NY 10707 USA Town Clerk Linda Cooper Box 1179 Southold, NY 11971 Enclosed is a Certificate of Insurance requested by your company. If you have questions regarding the certificate, please contact the Producer/Agent at the phone number listed on the certificate. This certificate was made available to you using CertificatesNowTM, an Internet -based system that allows agents, brokers and their clients to send certificates of insurance. To learn more: • Visit our website at wwwxonfirmneLcom or • E-mail us at customercarefconfirmneLcom, or • Call us toll-free at 877.669.8600 Best Regards, The CertificatesNow Team at ConfirmNet R . CERTIFICATE OF LIABILITY INSURANCE MIDD/YY) 7/02AC 07/02/01 PRODUCER BR632437 1-914-337-1833 The Rollins Agency Inc. 65 main Street, 3rd Floord Tuckahoe, NY 10707 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED AGA Creative Two Park Avenue New York, NY 10016 INSURERA: Travelers Indemnity Company INSURER B: INSURER C: INSURER D: INSURER E: [:OVFRA[.FC THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS Southold, NY 11971 GENERAL LIABILITY 680335D7191PHX01 02/01/01 02/01/02 EACH OCCURRENCE $1,000,000 FIRE DAMAGE An one fire $ 300,000 r X COMMERCIALGENERALLIABILITY CLAIMS MADE aX OCCUR MED EXP An one person)$5,000 PERSONAL BADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 PRO POLICY" LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO 1 AUTO ONLY: AGG $ A EXCESS LIABILITY CUP60111833A 02/01/01 02/01/02 EACH OCCURRENCE $20,000,000 7 OCCUR FICLAIMS MADE AGGREGATE $ 20,000,000 $ DEDUCTIBLE $ X RETENTION $10,000 A WORKERS COMPENSATION AND UB335D728301 02/01/01 02/01/02 X I H - TORY LIMITS LIABILITY E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYE9 $ 100 , 000 E.L. DISEASE -POLICY LIMIT 1 $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder is included as additional insured only with respect to a photo shoot: at 67 Steps Beach, Rt. 48, Southold, NY on August 1-2, 2001. CERTIFICATE HOLDER I I AnnITInNAL INRIIRFn- INRIIRFR 1 FTTFR• CANCFI I ATION AGORD Z5-5 (7/97) Silvia 519282 m ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town Clerk DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO Linda Cooper OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Box 1179 REPRESENTATIVES. Southold, NY 11971 AUTHORIZED REPRESENTATIVE Markham F. Rollins III AGORD Z5-5 (7/97) Silvia 519282 m ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 25-S(7/971 A 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: Southold Town Attorney's Office From: Linda J. Cooper Dated: 7/12/01 Re: Filming Permit Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 In accordance with the Southold Town Code, Chapter 44A, Section 3, Subsection D, the Certificate of Insurance and Indemnification Agreement for Metromotion Productions Inc. are attached hereto. Please review and advise whether these documents meet with your approval. Thank you. Approved as submitted Disapprove for the following reasons: Sign e �-l3-OI Date ^3-2001 TUE 11:45 AM05 1 FAX N0, P. 02 d 0 (14utiL.tCLr1� • ,_ a t' L i r Ik�3 DAT MrDDrYY) (J^yQ �■N. Jj��J �y _ �_ IGATE OF LIABILITY INSURANCEIR 03/01_ — THIS ER IS ISSUED AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YHE CERTIFICATE I'1]C Iic)l I 1 I'1:'.I F,tJF?11C'y, Lrl('- HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER TH1= COVCRAGE AFFORDED BY ,THE POLICIES 13EL�OW_ 111.1(;:I.:II)r1t , Ply IOU,/. I INSURERS AFFORDING COVERAGE 914 Jr INSUKKA.. Travelers i.delT!>iit'y .company .. .... _. IN'-�uieU f11,C' I'11arnlac9 �t� 1'111,1.;11:�lh/PP1;.P INS UnEnC .. Two P"'I r k 1\v (--1141 F'- INSURCFI l): 1�7 E:IN CJ )" 1'-, Irl YI- 001INSURER F; RIOD I}1C= PI"11,11 E )c)FIN`�tIr1A'C LI1,,1 fil-L& HAVII BEEN ISSUED 019 T .jr!1 DOCUMENT WITHRESPE T TO WHICH TFOR TI Ir.- POLICY ES CENTIFICATE MAY [BE ISSUED NY f IF_(.IUII1• MCNi , TE I A tNY I'f R 1'11117, 1111' I I'Ll llrlA0171 C f l I)IT"I I'J 13Y '(IJE F O NTT DE5(.�, 0T1 HCRCIN IS SUBJECT TO ALL THE TEAMS. EXCLU01ONS AND CONDITIONS OF S UCH F't'l1.IGIL`a A i(il it<3Al l: L11+11 I $111)4VN MAY HAVE. BEEN REDUCED BY PAID CLAP 61 10 EFhFI iIVE IPOLIIyY EXPIRATION LIMITS NLfI', T Y1'l: UI' IIJ^UI;Al1Cc I POLICY NUMI9F,q_,^ _DATF. LMM/OrYYY I -PATE ,ter.. _ _ �. Fncn IJrrunRFNcr_ Tl , 0 0 0 , 0 0 0 1 (,r.NLIIAI.LIAI'IIIATY—168033SIP193,P1IX01 ~ 02/�1/0� 102/0 ./0?, FIRCUAMAGE(Ar,yonelinq Is 300, 00.0 IYj(IC(1MIujIr1U4AICl'Irlll,LurRtInYI MrDEXP (Any ono pmcon) �,Q00 _.... 1)t AIIAS MAUI! Grr:url i I PLRGONAL 6 ADV INJUnY 5 1 , 000,000 1 i GtNpR_AL AGrGRCGATC S2 , 0.00., 000. y PRODUCT:, :COMP/OI' AGG I 12_, 000, 000 I WITA,Y' W!1 11 R: I _ • • - i COMBINED SINGLE LIMIT � Allrl)M1»III; (IAC:III'1Y (Cancciijunt) Ar1Y AIITUI - •1 DODILY INJURY 1 � AH QW.a.UAtIl0'� ( I (Purpr+ron) 1 1 , sl;Iu',xn t o Autltis I I .__- ... ..... BODILY INJUnY I $ 1111II-.0 AU 10!1, � l (Per DCclJurd) 1 N014 Gl0f D AU i 0� 1 I I ... PR( IIr- RTY DAMAGE y i i I Iv � (Pjrnr��,lenl) ,•�� AU 1`0 ONLY :GA ACf;IDCN.. I S • C'Ai1Ar,CLIAI:1101Y 1 I OTIICAACr; S CR h1AN ' ANY AIJ r!) I AUTO ONLY: AGO F 01.11833A I XI I CLAIM,; MADE I ; lV)I�UI'i I I I f I i i ld I'�1)1, 111'11; ?{ t14 INI)Q14 _5;1.0000 I - wnlu.rrl:;c:LmarhNAnuNAHD IULi335p72830 L I:MI�1 rrYl-n'�� t Ir+hl! ITv II I 02/01/01. 02/01/02 EACHOgWnnlNCF-_ AGGl r.ATE 02/01/01 02/0i/02 14W.,N11111cm or or'EnAnoi.,'-/10(;A1IUI IWVk'111CLESlL""-XCLUSION.' AD01d0 DY ENDOnSFMCNT/SPGCIAL PROVISIONS y11 }1<,;l.c��.x' !.t3 inclt1dod as additional insured from Aurlur,i: 1-2, ;�00,L at; 57 Steps Leach, Route L,.....__..... ._, m. ._...__.... ,...r.....,.._,—....._— - CI:Pi'iiil(�A'1'1 1((ll.fyl;f?�T 1,nDDITONALIN:IINCD;IN:%URF.RLE17E1' ^Citli' 1'111 l.(l QWI) 4 ,e .1k Pox 11,19 ;.-i(,)1.II-4101d. NY 11.7"/1 ltCt: <:11t ;i cats : Lillda (.100Per AG(7/171)]. J:� 2,—"ItS23245/'M21342 $2.0, 000, 0 x20,_000,, 0 S I7onZilMlrs I_. I E13..' r.L. EACI I ACcir.L, T_ s 1.0 0, 0 0 0._ E.LUISFAW,FACMI!LOYCC $100, 000 11.1- DISCASE ;POLICY I-IMIr with ro,pect to a phoL,a 48, Southold, NY - SHOULD ANY OFTHE ADOVE DESCRINkD pOI.IGICS gE (",ANCEI,LCD La f: Fon i'H C•. minA1 DATE IIJCnEOr, THE ISSUING INSURER WILL CNDEpVOn TOMAIL3 0 . DAYSmW NOTICETOTHE rERTIFIOATD HOLDERNAMCO TOTIIE LPFT. SU'rFAILUIIF TOOO SOSIi/ IM POSE NO OD LIGATION OR LIAR II,ITY OP ANY KIND Ur'ON WE E INSuml,ITS A, �CNT-, nEI+RCSENTATIVLS,� AUTHMIZED RCPnESCNTATIVE I:1IIG o ACORD CORPORATIOr 25/06 '01 MON 08:42 FAX 516 765 6145 SOUTHOLD CLERK N3i 14 1 INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMING/STILI, PHOTOGRAPHY PERMIT The Applicant shall indemnify and hold harmless the Town from and against all suits, claims, demands or actions for any damage and/or injury sustained or alleged to be sustained by any party or parties in connection with the performance of filming or still photography by the Applicant, his employees or agents or any subcontractor and in case of any such action brought against the Town, the applicant shall immediately take charge of and defend the same at his -own cost and expense. In addition, the Applicant will name the Town as an additional insured on any applicable policies. 4-/�-- Id i Prino name ee- Title Z 004 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: Chief Cochran, Southold Town Police From: Linda J. Cooper Dated: 7/12/01 Re: Filming Permit Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 Transmitted herewith is the application of Metromotion Productions, Inc. for a Filming Permit. In accordance with Section 44A.3 of the Town Code please review the application and advise of approval or disapproval of the application and whether a traffic control fee is required and the amount needed. POLICE DEPA MENT TOWN Of &)UTHOLD Telephone Emergency Dial 911 CARLISLE E. COCHRAN, JR. Chief of Police �IEC FI�IEQ MEMORANDUM JUL 2 6 2001 ,,,o4 naaa 40wrt Clerk TO: Linda Cooper, Deputy Town Clerk FROM: Chief Carlisle E. Cochran, Jr. e- C— DATE: July 25, 2001 RE: Application for Filming/Still Photography As per Local Law No. 6-2001, Section 44A.3, it is the recommendation of the Chief of Police that application dated July 2, 2001, by Metromotion Productions, Inc., be APPROVED. As per Section 44A.4, Traffic Control Fee, there is NO FEE recommended at this time. 41405 Route 25 • P.O. Box 911 • Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 • Fax (631) 765-2715 JUL-03-2001 TUE 11:45 AM I FAX N0, P. 02 :I _.3 -3 �nU y INSURANCE nATEfMMrD/0 AC,OP►,M C,NTI��' O LIA�3tLIT 07/03/01 or NFORIVIA ~ - --- - — RI THIS ISSUED UPON YHE CERTFICAToNYNo CONFER RIGHTS ~ �'}li Pi) l 1 Ella F�yt?LlC'�%, Ll'1C' - HOLDE,R. THIS GERTI�rICATE DbES NOT AMENI?, EXTEND OB — gLTER THE COVERAGE AFFORDED 6Y TI'lt- POLICIES BELOW. NY 7 0'J 0'/ I INSURERS AFFORDING COVERAGE j-) 1.4 3 � `7 :1833 � �.,;• 7'ravelers Ir�delTlnity ..ComPa>iy - l:�l{}_,a.:i.f: pPhD IN,unertc .• .. ... INSURCRD: .- TV Y 1. i� 0 INSURER F; _.. RUED OR TO ^I ]ITIUN OF ANY CONTRACT ON fiT11Ff1 DOCUMENT' SWITH UBJECT TO IALLTTHE TEI IMS, E=XGLU^IONS ANO CONDI IONS OF SUCH j } II; I `I"q.It"If •) t)I° IN' t Ir1ANGE LI;+I E NIFi{;LOW HAVr. BELr4 I SUL'D TO THE IN,,URC'l') NAM4iD ABOVE I^OR TI I(i POLIC;y THIS PERIOD TF,'MAY NO TWl1 I ISI'ANUIN ,r rNv IIF,(.uJsl1! MCN1, '1'4IIM vf! MAY I'f•Fif�UN, 1111 l�i•�(ifir\*JC;Ic Atf�l�CiU['(1 BY -fNE f'OUG1L•S UESC(tIBED HCRC.IN IS - LIMITS F'l'II.IGI `a A'''Cil il-(3,111. (11.111:; al I()tVN AAliY F(AVr BEEN REDUCED C3Y PAID CLAIMS, lJtrY MM/DfU YS IP DATE j XPIR Y(ON l V' ^_LL �PoUCY NVMBF,R _DATE L— i T Yf'ti Ul' (l�'SUI;Ar10E 0 2 0 1 O 10 2� 0 �. � 0 2 FACT r t)CCt1t1F!F.NCG I �l , 000 , O J> II t,r.Nl; rine. Llnnu.lry V _ — ;'h H 0 3 3 SD 719 3, PllX 01 ~ / / FInE DAMAGE (Any ons lin) I s 3 0 0 , 0 0.0 Irr1MI.lrnclN C,t'�IrHALunRHIly MCDEXP(Anyono;.;.n) $ , X00 Qt AI1+I:; MALW ; X I or"mm �� I rt p'QNAL & ADV INJunY S 1 , O 00 , O 00 j GIENEnAL AGGRCGATC S2, 0.00., .0-00. NRODUCT:, :COMP/Ol' At)C, EJ,, 0()0, 0 0.0 ,I.A,f.,aru"„rn IIrAITAI'PlIl':rlh;-- 1 UC '. —�—• POL Ic;Y I .II't• -- —• COMr1INED SINGLE LIMIT Arlf(1MOD10 IlAC1111Y I (Caucrnlunt) ... ...... ANY AIIIU DUDII.Y INJURY 1 ALI OWN1.VAtIIO`i I I ( .cirPrron) 1 staICptnL1)nuf0S I BODILYINJUnY $ U:I a )I Au I(".V I (PeI gcaJi4d) Nf)IJ otvNCD nUi17:; I PROI>CRTY DAMAGE y I. I � {I _._�„- ,_ (Por ir•CitlC`IQ — _ ---...,---- _ U r0 ONLY • CA ACC.IDCNT S CAiiArif LIAD101Y ANY AU M ,.__.1,,...__....,.^_,,,,_—. •--�-” I�C"UP<U1.TfI833� �.. I I OLAIKI,; MADE I K: l'irf,Ul'I I { Ij I 1 I i Thr l''UI�111'I ,: 'U —"IL3335p728301 wrnll.rrr!; c:urarh�r;ATIuN AND I rum oyms'iowiITY CA ACC, UTII�R IhIAN Au TQ ONLY: ACG 6 _—., -- 0 2 / 0 'L / 01, 0 2 / 01 / 0 2 EAGH OCCURRI NCG w I s� 0 , 000 00 , •0 _nc(Znnrr s2Q,_000., 0 FEAO�Cl Tu, ol•H• 0201/01 02/0102MIIS CCIDENTL" EFACM{'LOVCI E • POLICY uMn' I I Gr.vtl:flll�'IIUIJ or fiT'L•.I':Al'IOt.2JI f)C;A1 1,0-f 1 4 C 1Vk'11ICI.SICXCLUSI ONG ADDED DYENDOnSSMCNT/SPGCIAL PROVISIONS a,13 i11C1L1,dcd as additioxial. insured :alil�rx(:. Lx:c�ut fur}u�li; 1-2, 2001 at h7 Steps 13each, Roiitc l(;,iji;firlc�/1'1^l lift►•fll':i�^ -.YT �,noamr�NAl�In Smit i'lol(1 'PL)W11 C'Lc.,x lk NY I �I't'< T,Jill("-L (Ovper if ;;'1.32�5/M2134:), 51.001 000_ 3100,.000 15210 1,9_0 _0 with rospOct to a phoLo 48, Southold, NY- CANCE,LLA"IION -- -- F,HOULID ANY OFTIIE A13OVE DcSCRIRED POLli;irsBE GANCEt,LCf) BF.1'ORC.THr WMAt DATE IIJCREOF, THE ISSUING INSURhR W11,1. CNDEPVOn TOMAIL 3 () . DAYDWfill' NOTICE10T1iE GkRRrIOATE HOLDER NAM CD 1.0 TI IF: LEFT, BurFAILUI IF TOOO SOSIi/ IM POS F NO OD LIGATION OR I._IABII.ITY OF ANY KIND UPON TI I E IN+UnER,ITS At3GNT`. nENRCSENTATIVES,— --- — AUTHORIZED RCPnE$ENTAYIVr- /� IJI IG o-t:e•.� . _.� -tel_` ,_�- 0 ACO RD cor•(PbRATIOr 25/06 '01 MON 08:42 FAX 516 765 6145 SOUTHOLD CLERK INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMING/STILI, PHOTOGRAPHY PERMIT The Applicant shall indemnify and hold harmless the Town from and against all suits, claims, demands or actions for any damage and/or injury sustained or alleged to be sustained by any party or parties in connection with the performance of filming or still photography by the Applicant, his employees or agents or any subcontractor and in ease of any such action brought against the Town, the applicant shall immediately take charge of and defend the same at his 'own cost and expense. In addition, the Applicant will name the Town as an additional insured on any applicable policies. Print name Title 0004 7C ® SSA AirbillTracking 8271 5492 71171, Express Number 1 From Plaesepnman ssne d. 4a Express Package S Sender's FedEx Date 7 1 01 Account Number 2 Dt57 7029-5 ❑ FedEx Priority Overnight Next business morning Sande Namers Linda Cooper Phone) 631)765-1800 Company TOWN OF SOUTHOLD Address 53095 ROUTE 25 Dept/FlopoSaid0oom SOU T HOLD qt. NY zip 1 197 I 2 Your Internal Billing Reference First 24 characterswillappear on meddice. To Recipients Name Yuray Valdivia Phone( 212)675-3377 Metromotion Productions Inc. Address 27 IN 20th St #400A To "HOLD" atFeclEz location, prim Fei address. We cannot degverto P.O. boxes or P.O. ZIP codes. New York State NY ZIP 10011 Peel r Stick Fil USA Airbill See back for application instructions. Questions? Visit our Web site at fedex.com or call 1.800•Go•FedFx® (800)463-3339. By using this Airbill you agree to the service conditions on the back of this Airbill and in our current Service Guide, including terms that limit Our liability. Packages up ro DelNarycommitment may be later xt s ­1500.t Overnight ❑ FedEx First Overnight I Esdiestnext business morning delivery to select loca fans ❑ FedEx 2Day ❑ FedEx Express Saver ❑ NEW FedEx Extra Hours secondbaainasaday Third business day laoindimpdfeeidlnedbuureas FedEx Envelope rate not available. Minimum charge: One -pound rate afternoon def ryforselectlocatans 4b Express Freight Service Packages over 1591bli Deliveryeommitinem maybe later in some areas. ❑ FedEx I Day Freight" ❑ FedEx Way Freight ❑FedEx3DayFreight Next business y Second business day Third business ay -Cell for Confirmation: Pa kaging Declared value limit elm dEx Envelope* ❑ Fei Pak* ❑ Other Pkg. Includes FedEx Small Pak FedEx Includes FedEx Box, FedEx Large Pak and FedEx Sturdy Pak Tube, and customer pkg. 6 Special Handling F--- Include Fei address in Section 3. --- --- SATIIADAY Detiuely SUNDAY Delivery HOLD Weekday HOLD Saturday ❑ RESTRICTIONS ❑ RESTRICTIONS ❑ at FedEx Location ❑ at FedEx Location Ae.ilableonNforFedEx Priority Available only for FedEx Priority RESTRICTIONS flESTRICTIONS Overnight and FedEx 2Day Dvemightto select JP codes Net svailable with Available only for Fai Priority to select ZIP codes FedEx First Overnight Overnight and FedEx 2Day es this shipment contain dangerees goodsl m select locations box must bechecked. —� ❑Yes ❑ mfyice x ❑ Cargo As per attached Drylca, 9, ON 1945 kA Aircraft Shippers Declaration Only Dangerous Goods (incl. Dry Ice) cannot be shipped In FedEx packaging or with FedEx Extra Hours service. 7 Payment f% ��_-ipiendt -Biter FedEx Acct No. or Credit Card No. below. 1 ❑ Sender ❑ Third Parry ❑ Credit Card ❑ Cash/Check Acct No. in Secti 1 will be billed. CreditFadECard No 01000121-8 oxta To", gee Trial Weight Total Declared Valuet tour liability is limbed to $100 unless you declare a higher value. See back for details. FedEx Use Only 8 Release Signature Sign be authorize delivery wfiheutobtaining signature By signing you authorize us to deliver this shipment without obtaining a signature and agree to indemnify and hold us harmless from any resulting claims. 0175304062 III -Is,, Date 12100- Part #155919S•©1994-2000 Fed, •PRINTED IN U.S A. LISA i NFadEx umbn9. 810070.720456 Address � C/`*' i a0 _S10"7 C- C 'T ^T Dept/Floor/Suite/Room city StateZIP /" /■ © Your Internal Billingeference Information To / Name 4 Phone 4Will, W Company /6K-VJr to �>(ho Vt ❑Check here K+� AOrly- 7 �'� /� �((/'(� If residence Address - �✓ 7J �/T / • w c \ �, �9 (Extra charge applies for FedEx Express Saver) (To "HOLD' at FedEx location, print FedEx address here) Dept/Floor/Surgelm City _VV ayIj e StatZIP 119-7 For HOLD at Fei Location check here For WEE END Delivery check here ExIra hatge;l loctahons, ❑Hold Weekday ❑ Hold Saturday (Not available at all locations) Seturda Delivery NEW SundaXDelivery (Not available with (Available far FedEx Priority Overnight El (Available or FedEx Priority (Available far Fe Fed Ex First Overnight) and FedEx 20sy only) Overnight and FedEx 2Day only) Priority Overnight only) 406 n Far, ecipients Copy I.O. No. EXpreSP keDelivery commitmentmay g � C P kagesunderl5g/bs. belalerinsomaareas. ❑Fed ExPrimry mig dEx Standard Overnight (Next bedurds i ) ext business afternoon) ❑Fed migh (Earliest next usiness morning delivery to select locations)(Higher rates apply) ❑FedEx 2Day ❑ FedEx Express Saver ISeccnd business day) (Third business day) L— FedEx Letter Rate not available. Minimum charge: One pound rate. Express ht Service Packaesovernoibs. DelrverycommOmentmay P 9 g be later. nsam�areas. ❑FedEx Overnight Freight ❑ FedEx 2Day Freight❑ FedEx Express Saver Freight (Next business day) (Second business day) (Up to 3 business days) (Call for delivery schedule. See back for detailed descriptions of freight services.) Ll Packaging Fe Ex FedEx FedEx FedEx ❑Other Letter ❑ Pak ❑ Box ❑Tube pill Glared value limit $500. —I Special Handling 10neon" maatbechecked) —� lk torhad pears Does this shipment contain dangerous goods ?* No ❑Yes shy ,a's ❑ Yes oerlameon osclaranaal nauxi ❑Dry Ice Dry Ice, 9, ON 1945 kg. ❑ Cargo Aircraft Only 'Dangerous Good scannot be shipped Fed xpackaging. PaymentObtain Recipient ❑ FedEx Account No. Bill El Sender ❑Recipient hind Parry ❑ Credit Card ❑ Cash/ to: Section(Iwiilbeelieal A���"n,N Check (Enter FedEx [No. ar Credit Card No. helow)� TPackaTotal g Total Declared Value' Total Charges $ .00 $ an$Too per shipment, you pay an additional charge. See SERVICE CONDITIONS, DECLARED VALUE, AND LIMIT OF LIABILITY section for further information. Credit Card Auth: U Release Signature Your signature authorizes Federal Express to deliver this ship- ment without obtaining a signature and agrees to indemnify and hold harmless Federal Express from any resulting claims. Questions? WCGL 1098 flev. Date 7/98 Call1'800'GO'FedEx (800)463-3339Fart8153D23 ©1994-98 FedEx PRINTED IN U.S A. UNITED STATES POSTALSERVIC First -Class Mei1e ,, riostWo& Fees.P d e rn1 N9. • Sender: Please print y'oUi J -6, address, affr1P_+T_1.M_�0X • Elizabeth A. Neville Southold Town Clerk P 0 Box 1179 Southold NY 11971 Ir ru M c3 C To�wnl( -0 postage Ln 0 certified Fee rn 17— Return Receipt Fee (Endorsement Required) ru C3 Restricted Delivery Fee Required) [_-3 (Endorsement C3 Total postage & Fees C3 Recipient's Name (Plea C-3 'V r Motlor --- 0 PO or P -- -- ----- Street,-- ��q c3 h 27 Vy 20th --- - ------- C3 CJ a + Y1�5+4 New York 'Postmark Here AUG 0 8 not