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Nonstop Pictures, Inc
TOWN CLERK'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check Applicant: r -"j 4 Date Received: a D /b / 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 $ ,,�ov - 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. aDo 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. each 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 Chief Building Inspector /Fire Marshal /Code Enforcement Officer I/ 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. N Check # Town of Southold BILL OF ...Nonstop Pictures Inc.... . Vendor No. . . . . . . . . .. . . . . Invoice No. . . . . . . . . . . . . Invoice Date . July. 27.,. 200.1. . . .I Amount Claimed $ . 50.0.0.. . . . Y Purchase Order No. . . . .... . . = For Services and Disbursements as Refund for. T.raffic Control . . Filming Permit No. 6-2001 Fund and Account ......... . Entered by .............. . Allowed, $ .............. . • 14 2001. Audited .. August. �' yqc ....................... Town Clerk 0 Town of Southold, New York - Standard Voucher PAY TO: Payee Name: I L Address: 6 0 Invoice Number _ Invoice Date Purchase Order Number P.O. Date Payee Tax Identification Number or Social Security Number: Payee Reference Phone No. 5271�) 47— - Ce!; Vendor Contact l /� �n V n Cash Discount 1 %C. Days Item NumberQuantity Description of Materials / Services Unit Price Amount Refund of Police Detail fee in regard 1 50.00 50.00 To Town Code Section 44A paragraph D. Filimg Permit No. 6-2001 Total 50.00 Net 50.00 Payee Certification The undersigned (Clai ant) (Acting on behAf 4 the above named claimant) does hereby certify that the foregoing claim is true and correct and that n art has been paid x t atherein stat , an that to balance therein stated is ac:tua It due and owing. Signat Title AW O Dat Ito Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution, the services properly performed and that the quantities ereo ave beU rifted with the exceptions or discrepancies noted, and payment is approved Sig le Town Clerk Dated 8/7/01 Town Of Southold P.O Box 1179-0- Southold, NY 11971 * * * RECEIPT* * * Date: 06/22/01 Receipt#: 4429 Transaction(s): Subtotal 16 Beach Permits $160.00 1 Daily Filming Permit $100.00 1 Traffic Control Fee $200.00 Check#: 4429 Total Paid: $460.00 Name: Nonstop,, Pictures Inc 27 W 20th St, Ste 700 New York, NY 10011 Clerk ID: LINDAC Internal ID: 34772 0 POLICE DEPARTMENT TOWN OF SOUTt101D Telephone Emergency Dial 911 RECEIVED JUL. 3 0 2001 Southold Town Clerk . MEMORANDUM TO: Linda Cooper, Deputy Town Clerk FROM: Chief Carlisle E. Cochran, Jr. a c/ DATE: July 27, 2001 RE: Filming Permit No. 6-2001 - Nonstop Pictures, Inc. CARLISLE E. COCHRAN, JR. Chief of Police As per Town Code Section 44A paragraph D, the actual cost for the police detail with reference to Permit No. 6-2001 is S1S0.00. 41405 Route 25 • P.O. Box 911 • Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 • Fax (631) 765-2715 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o�gOFfO(,�coG o� y� e� Z �oy�p♦ O�� • OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD July 30, 2001 Attn: John Maher Nonstop Pictures, Inc. 27 W. 20th Street, Suite 700 New York, NY 10011 Dear Mr. Mather: Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 On July 27"', 2001, I received a notice from Police Chief Carlisle E. Cochran, Jr. that the actual fee for police detail was $150.00 with reference to filming permit no. 6-2001. Please sign the enclosed voucher and return it to this office, so that we may refund you $50.00 of the $200.00 the you originally sent in. Sincerely, Lynd M. Bohn rR Deputy Town Clerk Enc. • POLICE DEPA MENT TOWN OF 6OUTKO,D Telephone Emergency Dial 911 RECEIVED JUL 3 0 2001 Southold Town Clerk MEMORANDUM TO: Linda Cooper, Deputy Town Clerk FROM: Chief Carlisle E. Cochran, Jr. DATE: July 27, 2001 RE: Filming Permit No. 6-2001 - Nonstop Pictures, Inc. CARLISLE E. COCHRAN, JR. Chief of Police As per Town Code Section 44A paragraph D, the actual cost for the police detail with reference to Permit No. 6-2001 is $150.00. 41405 Route 25 • P.O. Box 911 • Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 • Fax (631) 765-2715 Town of :Southold PCICodebook for Windows § 44A-4. Traffic control fee. A. In the event that the Chief of Police or his designee determines that the police officers or traffic control officers will be necessary for the protection of the citizens or for the control of traffic during the filming or still photography, the applicant shall submit to the Town Clerk a fee of $1,000 for each day covered by the permit pursuant to Subsection F of § 44A-3. B. If the Chief of Police determines that the one -thousand -dollar -per -day traffic control fee will be fully expended prior to the termination of the permit period, the Chief of Police shall notify the Town Clerk. The Town Clerk shall contact the applicant in writing and require payment of additional sum of money, said specific amount to be determined by the Chief of Police based on the salaries and the number of hours to be worked by the town police and traffic control personnel. Said additional traffic control fee shall be paid within seven days of said notice. The applicant's failure to pay such additional fee within said seven-day period shall result in the Town Clerk's providing the applicant with written notice that the permit has been suspended and the date of such suspension. The applicant's receipt of the Town Clerk's suspension notice shall not be construed as altering the date of suspension set forth in said written notice, the effective date of the suspension being the day immediately following the completion of the seven-day notice period. C. The procedure set forth in Subsection B may be repeated as necessary to ensure that the applicant pays for all costs included by the town in providing traffic control services. D. After termination of the filming, the Chief of Police shall provide the applicant with a statement regarding the actual cost to the town of providing said police officers or traffic control officers. If the actual cost is less than the moneys that the town has collected pursuant to Subsection A, B or C, the town shall remit the balance to the applicant. If the actual cost is more than the moneys that the town has collected pursuant to Subsections A, B or C, the applicant shall be responsible for providing the balance to the town within 30 days of the termination of the filming or still photography. E. The Chief of Police shall forward a copy of the statement of actual cost to the Town Clerk who will file said statement with the original application form. ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR. OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o�g�FFO���o CIO a OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD July 9, 2001 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 1�i 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 July 9, 2001 CERTIFIED MAIL RETURN RECEIPT REQUESTED Attn: John Maher Nonstop Pictures, Inc. 27 W 20"' St., Ste 700 New York, NY 10011 Dear Mr. Maher 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. 4428 in the amount of $250 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. If I can be of any assistance in the future, please do not hesitate to contact me. Very truly yours, Linda J. Cooper Deputy Town Clerk Enc. • � Th NONSTOP PICTURES, INC. 27 WEST 20TH STREET, SUITE 700 D NEWYORK, NY 10011 i i PAY Two Hundred Fifty and No/100 Do11MrsCN,, TO THE t ORDER OF Town of Southhold _ Southhold Town Hall "' I" 53095 Main Road in W WV Southhold, NY 11971 E The Chase Manhattan Bank d �r New York, NY 10012 O LL N 1-2/210 r— NUMBER Vw Q r' C\ - DATE 6/21/01 ONSTOP PI( 1 w % Memo: Line 114 Security Deposit for Clean-up 118001,1, 28111 1:0 2 10000 2 0:0a60 L 4428 AMOUNT $250.00 IES, INC. 0 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o�,rg%3ff0(4,coG o� y� C#* Z oA olZr OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Raymond Jacobs, Superintendent of Highways From: Linda J. Cooper, Deputy Town Clerk Dated: June 28, 2001 Re: Film Permit No. 006 Cleanup Deposit Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 In accordance with §44A-5 of the Southold Town Code, please advise if the $250.00 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. /�' �-- --% ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR. OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o�osuFFot,��oG N Z 15 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Cochran, Southold Town Police From: Linda J. Cooper, Deputy Town Clerk Dated: June 28, 2001 Re: Traffic Control Cost Statement Film Permit No. 006 — Nonstop Pictures Inc. 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 §44-A paragraph D., a statement regarding the actual cost to the town of providing traffic control and police officers must be provided by the Chief of Police. Please provide this information at your earliest convenience. Thank you. ACORDTM CERTI ATE OF LIABILITY IN RANCE DATE (MM/DD/YY) 6/19/01NS PRODUCER Taylor & Taylor, Ltd. Taylor & Taylor Associates, Inc. 90 Park Avenue New York New York 10016 Phone: (212)490-8511 THIS CERTIFICATETS 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 NONSTOP PICTURES, INC. 27 West 20th Street, No. 700 New York, NY 10011 INSURER A: GULF INSURANCE COMPANY INSURER B:Firemans Fund Insurance Co. INSURER C: INSURER D: INSURER E: 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. INSF RDATE TYPE OF INSURANCE POLICY NUMBER POLICY EFFDECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X❑ OCCUR CLP0627557 8/19/00 8/19/01 EACH OCCURRENCE 1,000,000 FIRE DAMAGE (Any One Fire 50,000 MED EXP (Any One Person 5 000 PERSONAL & ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: __1PRO- GENERAL AGGREGATE s 2,000,000 PRODUCTS -COMP/OP AGG 1 000,,_000 POLICY JECLOC A AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS CLP0627557 8/19/008/19/01 BODILY INJURY $ (Per person) X X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ X Hired Auto Physical Damage - $125,000 Per Auto/$50C,000 All PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY Actual Cash Value AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC ANY AUTO AUTO ONLY: AGG B EXCESS LIABILITY X I OCCUR E] CLAIMS MADE XYZ00096389564 8/19/00 8/19/01 EACH OCCURRENCE 5,000,000 AGGREGATE 5,000,000 DEDUCTIBLE RETENTION WORKERS COMPENSATION AND WC STATU- 0TH - EMPLOYERS LIABILITY TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE . EA EMPLOYEE E.L. DISEASE . POLICY LIMIT OTHER A Props/Sets/Wardrobe CLP0627557 8/19/00 8/19/01 $ 500,000 Limit,$1,000 Ded. Third Party Property Damage $1,000,000 Limit,$1,500 Ded. Misc. Rented Equipme I t -Special Form, Repla ement Cost Worldwide $ 750,000 Limit,$2,000 Ded. DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED BUT ONLY AS RESPECTS TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. ^MnVIElnATr ue.1 nom., _ ---_-- _ _ - THE TOWN OF SOUTHOLD SOUTHOLD TOWN CLERK SOUTHOLD TOWN HALL 53095 MAIN ROAD P.O. BOX 1179 SOUTHOLD, NY 11971 ACORD 25-S (7 VAI\VL.VVn 1 IVI\ HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATE, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN OTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IPOSE NO OBLIGATION OR LIA IT OF ANY KIND UPON THE INSURER, ITS AGENTS OR EPRESENTATIVES. n ACORD CORPAROTION 10RA • OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Raymond Jacobs, Superintendent of Highways From: Linda J. Cooper, Deputy Town Clerk Dated: June 28, 2001 Re: Film Permit No. 006 Cleanup Deposit • Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 In accordance with §44A-5 of the Southold Town Code, please advise if the $250.00 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 FOt,�cQG ELIZABETH A. NEVILLE TOWN CLERK H Z REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER S • �� 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: June 28, 2001 Re: Film Permit No. 006 Cleanup Deposit • Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 In accordance with §44A-5 of the Southold Town Code, please advise if the $250.00 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 o�os�FFot�.�oG o� y� W Z 15 OFFICE olZr • 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: June 22, 2001 Re: Filming Permit No. 006 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 NONSTOP PICTURES, 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 �o�osuFFo��.�oG U2 r oy� 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 NONSTOP PICTURES, INC. Date(s), Time(s), and Location(s) Wednesday, June 27, 2001 (Rain Date Friday, June 29, 2001) 2:30 P.M. through 8:00 P.M. Beach at Lighthouse Road, Southold Soundview Ave. and Lighthouse Rd, Southold (area by white bridge) Southold Town Beach, Southold Permit No. 006 Issue Date: June 22, 2001 Elizabeth A. Neville Southold Town Clerk (Town Seal) 0 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. 005 $100.00 Daily fee — June 27, 2001 $160.00 Parking Permits (16 vehicles) $200.00 Traffic Control Fee $460.00 Certified check no. 4429 $250.00 Cleanup Deposit Certified Check no. 4428 Film Permit No. 006 - NONSTOP PICTURES, INC. Received by Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 • Town Of Southold P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 06/22/01 0 Receipt#: 4429 Transaction(s): Subtotal 16 Beach Permits $160.00 1 Daily Filming Permit $100.00 1 Traffic Control Fee $200.00 Check#: 4429 Total Paid: $460.00 Name: Nonstop, Pictures Inc 27 W 20th St, Ste 700 New York, NY 10011 Clerk ID: LINDAC Intemal ID: 34772 06/20/2001 WED 15:02 FAX 631 734 2315 • SOUTHOLD P.D. CHIEF a 001 POLICE DET)AQTMF4N'f TOWN Of c Ol7RIOLD CARLISLE, r.,, C,0Ct.JMN, JR. Chief of Police Telephone. Fmergency Dial 911 Memorandum To: Elizabeth Neville, Southold Town Clerk From: Lieutenant Martin Flatley Date: June 20, 2001 Re: Nonstop Pictures, Inc_ Filming Permit Request Please be advised that the above request for a filming permit on Wednesday, June 27, 2001 is approved. We will be using Traffic Control Officers for this event and their cost will be $200.00 for the time period requested with any additional amount to be adjusted at the conclusion of the filming. Please have the applicant, Mr. Maher contact me at 765-3115 to arrange the traffic control_ 41405 koure 25 • P.O. Box 911 • Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 • Fax (631) 765-2715 • ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o�OS�ffO�,�coG N Z OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Southold Town Attorney's Office From: Linda J. Cooper Dated: 6/20/01 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 Nonstop Pictures, 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: qSignt e [0 Date 0 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: 6/20/01 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 Nonsto Pictures. 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: Signature Date • ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER 0 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Cochran, Southold Town Police From: Linda J. Cooper Dated: 6/20/01 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 Nonstop Pictures, 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. 20/06 '01 WED 10:23 FAX 516 765 6145 SOUTHOLD CLERK TRANSMISSION OK TX/RX NO CONNECTION TEL CONNECTION ID ST. TIME USAGE T PGS. SENT RESULT ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER TX REPORT 2611 7342315 Police Administ 20/06 10:22 01'11 4 OK OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Cochran, Southold Town Police From: Linda I Cooper Dated: 6/20/01 Re: Filming Pennit a ool 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 Nonstop Pictures, Inc for a Fihning 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. Town Of Southold • P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 06/20/01 Receipt#: 0 Transaction(s): Subtotal 1 Application Fee - Non -Refund $100.00 Total Paid: $100.00 Name: Nonstop, Pictures Inc 27 W 20th St, Ste 700 New York, NY 10011 Clerk ID: LINDAC Internal ID: 34574 JUN. 19. 200 To: 44PM eylor & Taylor Associates, Ire Taylor S Taylor, Ltd. 90 Park Avenue New York, NY 10016 Tel (212) 490-8511 Fax (212) 490-7236 From --�j Date: la Fax Number of pages including cover sheet: omments: N0.224 P. 112 ACORUM CERTIFIC PPODULIP Taylor & Taylor, Ltd. Taylor a Taylor ANSOCiateA, Inc. Park Avenue ,�� York NOW York 10016 PhonE AEU REU NONSTOP PICTURES, INC. 27 Weat 20th Street, No. 700 Now York, NY 10011 :OVERAGES TME POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I61SUE0 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. EFFECTIVE POLICY EXPIRATION tG2NERAL LIMITS TTP' OF INSURANCE POLICY NUMBER EACH OCCURRENCE R 1 000 ,1100 LIABILITY NMERCIAL GENERAL LIABILITY nn Ona Fre S SO,OOO (� MED XP One Parson S 5,00c) CLAWSMADE K OCCUR CLP0627557 8/19700 8/19/01 PE ONA 6AOvl JURY 000 000 TE OF LIABILITY INSURANCE 611910INS TMIS CERTIFICATE 1 ED AS A MATTER OF INFORMATION ONLY AND CONFER RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 7I A0A_PF1 I I INSURERS AFFORDING COVERAGE INSURER A: INSURER B: INSURER C: INSURER INSURER E: GEN'L AGGREGATE LIMIT APPLIES PER r PRO- P LICY F LOC tX OMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUT06 F11RED AUTOS NON -OWNED AUTOG AGE LIABILITY Actual } ANY AUTO 1 EXCE66 LIABILITY H X OCCUR ❑ CLAIMS MADE D EDU CTIELE WORKERS COMPENSATION AND EMPLOYERS LIABILITY CLP0627557 I Damage - $125,000 Value XYZ00096389564 8/19/00 1 8/19/01 Auto/$500,000 All 8/19/00 1 8/19101 GOMBINEO SINGLE LIMIT S 1, 000, 00 D IEa aceloonl) BODILY INJURY 6 (Per pereorl BODILY INJURY $ (par eccldaln) PROPERTY DAMAGE 6 (Per oceldenl) AUTO ONLY • FA ACCIDENT OTHER THAN FAAC" AUTO ONLY: AGG EACH OCCU E CE 5 1 000 1 Ono A GREGIs 5.000,000 OTHER A Prope/Sete/Womdrobs CLP0627557 9/7.9/00 8/19/01 $ 500,000 Limit,$1,000 Ds Third Party Property Damage $1,000,000 Limit,$1,500 Dad MiAc. Ranted Eguipme t -Special Form, Repla I ement Cost Worldwide $ 750,000 Limit, $2,000 Dad DESCRIPTIONO F OPERATIONSILO CATIONSNEMICLESIEXCLU610N5 ADDED BY RNDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER 7:S INCLUDED AS ADDXTIONAL INSURED BUT ONLY A5 RESPECTS TO LIABILITY ARISIN OUT OF THE OPERATIONS Or THE NAI>MD INS'tT MD - THE TOWN OF SOTJTHOL13 SOUTHOLD TOWN C&MRS SOUTHOLD TOWN HALL 53095 ¢AIN ROAD P.O. BOX 1179 SOUTHOLD, NY 11971 3ULD ANY OF THE ABOVE DESCRIBED POLIGIeS eC GAr3NeLL.Fv ac" , nG , rE, THE ISSUING INSURER WILL ENDEAVOR TO MAIL1_�0 DAYS WRITT TIMETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO 6H1 306E NO OBLIGATION OR LIAIAITXOF ANY KIND UPON THE INSURER, ITS AGENTS ACORD 25-S (7197) © ACORD CORPORATION 19 15/06 '01 FRI 10:25 FAX 516 765 6145 • SOUTHOLD CLERK • INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERNUT 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. Si LIMA) Mum Printed name Title 6 IR o I Date Z002 TI IN 1 Q '-)MM1 '-�- AA 0M ACORDTM CERTIIWATE OF LIABILITY ININRANCE �yw i E (MMIDDIYY) 6/19/0IN'S PRODUCER THIS CERTIFICATE75 ISSUED AS A MATTER OF INFORMATION Taylor a Taylor, Ltd. Tailor k Taylor Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW _ 90 parks Avenue view York New 'York 10016 Phone: (212)490-6511 INSURERS AFFORDING COVERAGE INSURED NONSTOP $ICTm=S, XNC. 27 West 20th Street, No. 700 INSURER A: GULS impgA=m COMPimy INSURER B: rirema Fund Xneurance Co. INSURER C: INSURER D: Now York, NY 10011 INSURER E: 8/19/00 GOVFRAGFS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR ThE POLICY PERIOD INDICATED. NOTIA11THSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 13Y THE P041CIIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCI!O BY PAID CLAIMS, INS TYPE OP INSURANCE POLICY NUMBER POLICY RFPECTIVE POWCY EXPIRATION LIMAS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE 57 occuR CLP0627557 8/19/00 8/19/01 EACH CE S 1,000,000 ANAOE An One F� S01000 MED EXP (Ally Ono Parml 5 5 000 PERSONAL& ADV INJURY I �1000.000 GENERAL AGGREGATE 000 GE l- AOGREOATE LIMIT APPLIES PER: PRO•1,000,000 PRODUCTS - COMPIOP A LOC A OMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea eeeldepl) S 1,o00,000 POP1eYe JURY ( P ALL OWNED AUTOS SCHEDULED AUTOS CLP0627557 8/19/00 8/19/01 BODILY INJURY ; (Perao0ltl0111) X HIRED AUTOS NON•OWNED AUTOS FX X Hired Auto Pkiveic 1, Damage - 7125, 000 Per Auto/$30C,000 All PROPERTY DAMAGE S (Par 6001dapq GARAGE LIABILITY Actual Cash Valve AUTO ONLY . EA ACCIDENT OTHER THAN ACC ANY AUTO AUTO ONLY; AAQ S EXCESS LIABILITY OCCUR CLAIMS MADE XYZ00096389564 8/19/00 8/18/01 EACM OCCURRENCE s 5,900,000 AGGREGATE k 5,000,000 DEDUCTIBLE RFTPNTION WORKERS COMPENSATION AND w A T U. OT - EMPLOYERS LIABILITYIFIR E.L. EACH ACCIDENT E.L. DISEASE • E DISEASE . POLICY LIMIT OTHER A Props/Sete/Wardrobe crAP0627557 8/19/00 8/19/01 $ 500,000 Limit,$1,000 Dad. Third Party Property nama.Qe $1,000,000 Lftit,$1,500 Ded. Mind. Rented Eguipme f t -Special Form, Repla ament Cost Worldwide $ 750,000 Limit,$3,000 Dad. DESCRIPTION OF OPERATIC NSILOCATIONSNEHICLESIEYCLUSIONS ADDED BY ENDORSEMENT/6PECIAL PROVISIONS CERTIFICATE B014DIER 10 INCLUDED AS ADDZTTONAL INSURHD BUT ONLY AS RESPECTS TO x,YA331LITY ARISING OUT OF THE OPERATIONS OF THE XaNED INSURED. THE TOWN OF SOUTHOLD SOUTHOLD TOWN CLERK SOMHOLD TOWN HALL 53095 MAIN ROAD P.O. BOX 1179 SOUTHOLD, NY 11971 ACOHD 25-S (7/97) E ULD ANY OF THE ABOVE DESCRIBED POLICIES BI: CANCELLED BEFORE THE EXPIRATION E, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN ICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, OUT FAILURE YO DO 50 SHALL ISE NO OBLIGATION OR WAQf.ITYOF ANY KIND UPON THE INSURER, ITS AQENTS OR Dn ACORD CORPORATION 1988 TOWN OF SOUTHOLD JUN 2 U 2UU1 &PPLICATION FOR FILMING/STILL P140TOGRAPHY 30urhalu s riw b, ti erlk , r PLEASE PRINT OR TYPE I►PPLICATION DATE: Jump, I l 0 PERMIT NO: NAME OF APPLICANT : i%�gj�L 9/�So 6�y2 7P RONR I pluall s e, HOME sA, tm vP oRciANI ATION, CohlPANY: /VoN S"p pic-rur2S XAILXNC AbbRIM.9 i lK -T Tw pietyyvry N� IUUiI FAX= .��..�...�♦+a�s.4Aa IINJ�J,y.+6ilaaL.r.:.art.yr a..rrYMtaa. a............ DESCRIER TTPS OP ACTIVITY (a.g. )Odic P±ctuve, CoMmercial, Television, Catalog, Magazine, etc_): -4"- DATE(5) xmn Tlmzcg) oi► Plt07i'oss'n 5 rita�bt0/piiogoQrtAP y(; L✓e�r7etg(��' Wye ,� �� ',3�- �t�? .�r�in d�` 6�9 PROPOSED LOCATYO.N(S) OF FILMING/PHOT0dRAPHY: attach additional sheet, if neceeeaxy. dee G ,dunk/ S'�ec�' or VERCON =rr cahRam AT sma NIIE�EX of PfiRSOHS AT LOCATION (CM? & CREW TNCLTjhJM) NIINIDBR AND iYPL' OS vFaFiICLES AT LOCA'1'ZO�Iq Clei f s5��c,Pr tkin s - Cwi, (Qrf TYPE OF SPECTAT" HQUIPYMNT : /M %%ii%� � /il�lCt Add lr jW - ANY 5PZ=AL RE0CIF=4ENT9: Slgriat e Return to: Southold Town Clerk JJ40 ahw tuc,"on m nam Southold Town Hall 53095 Main Road P. O. Box 1179 Southold, NY 11971 JUN 2 0 2001 -0iAQ10 gown Clerk Southold Town Clerk Southold Town Hall 53095 Main Rd P.O. Box 1179 Southold N.Y. 11917 6/19/01 Attn: Lynda Bohn It is the purpose of this letter to express the intentions of Nonstop Pictures, Inc. with the concept of filming a television commercial for Playtex Tampons on Wednesday, June 27"', 2001 with a rain date scheduled for Friday (6/29) in the community of Southold. Our cast and crew consists of 40 people, 3 trucks, 2 campers, 3 passenger vans and 5-6 crew cars. The locations and actions are as follows: Southold Town Beach at Lighthouse Rd -Travel from NY stage arrive between 2:30-3:30 Park production vehicles at beach parking lot, Vehicles will remain in parking lot as staging area. Sound View Ave at Lighthouse Rd. Road with white bridge Scene of teens riding bicycle down the road. Hand held camera —no lighting or sound Approximately 1 hour starting at approximately 3-3:30 Return to Southold Town Beach parking lot Shoot scene of Skateboarder "Pushing off' close up of foot/ leg No "stunt" Shoot in parking lot, Minimal or no lighting, No sound. Approximately 4:30-5pm 1 hour NONSTOP PICTURES INC. 27 WEST 20TH STREET #700 NEW YORK NY 10011 PHONE 212 675 6070 FAX 212 675 6071 i 1 0 Shoot Beach scene Scenes of active teens 4 or 5, 16-18 years old engaged in beach play, running along beach in water etc. No lighting or sound Approximately 2 hours starting sometime between 5 and bpm Police assistance at their discretion In review our total hours of operation would be from as early as 2:30 PM but more than likely 3pm to 7:30 or 8:00 Please review and advise me of the total amount for fees parking and Police assistance if they so require Th- nk ou forAy�our as s ance, /1� J n Maher Location Manager NONSTOP PICTURES INC. 27 WEST 20TH STREET #700 NEW YORK NY 10011 PHONE 212 675 6070 FAX 212 675 6071 15/06 '01 FRI 09:29 FAX 516. 7145 SOUTHOLD CLERK . APPLICANT'S CHECKLIST FOR FILMING PERMIT NOTE. All payments must be cash or certified check. ✓ Completed application ✓ _ $100 nonrefundable application fee Certificate of ilasurance 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_ Lndemui.ficati.on agreement stating the applicant agrees to assume all Iiability for and will indemnify and hold the town harmless of and free from any and all damages that occur to persons or property by reason of said filming or still photography. Permit Fees (Prior to issuance of permit): Film Fee - S 100 per day of each day covered by the permit Cleanup deposit: Separate certified check for $250 for each day covered by the pen -nit. Traffi e control fee - $1.000 for each day covered by the permit if required by the Chief of Police. Beach Parking fee - $10 per vehicle, per day between May 1 and September 30. NOTE: Additional fees for Cleanup and Traffic Control may be required at the direction of the Chief of Police and Superintendent of Highways [a 00 1 52 uriwuiimuimi�nueuiuniwra�uionuuuuiii .�.._.:_:ve mut �_:::_:_. FeCEX® USAAirbillTrakA 8271 5492 7182 Express Number 1 From PliesePdntandiaressnam. 6 / 2 2 / 01 Sender's FedEx Data Account Number 1067-7029-8 Linda Cooper N, Town Clerk's Office Phone( 631 ) 765-1800 Company TOWN OF SOUTHOLD 53095 ROUTE 25- Deptfloor/Sutra/Room SOUTHOLD stain NY 7Ip 11971 2 Your Internal Billing Reference First 24 characters Wit appear on imome. 3 To Recipients Na John Maher Phone 1212 1 675-6070 NONSTOP PICTURES, INC. Address 27 W 20th St, Ste 700 To "HOLD" in FedEx location, print Fed& address, We cannot deliver to P.O. bones or P.O. ZIP codes. New York State ilY zip 10011 t Stick FedEx See back for application instructions. Questions? Visit our Web site at fedex.com or call 1.800•Go•FedEe (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. De"oor/Suite/Room 4a Express Package Service Packages u ro 150Ibs © FedEx Envelope* ❑ FedEx Pak* ❑ Other Pug. ,w�ii3..•, "���>.�i� � '. Delivery commionem may bra some areas. FedEx Standard Overnight ❑ FedEx Fust Overnight 6 Special Handling ---- Include Feiaddress inSection 3. ----- SATURDAYDelivery SUNDAY Delivery HOLD Weekday HOLDSaalyday Next business morning ❑ FedEx 2Day Next business afternoon ❑ FedEx Express Saver �,�::r!�� FSS RESTRICTIONS Available only for FedEx Priority Sec and business day Third business day Fed& Envelope rate not available. Minimum charge: One -pound rate �)7� AirbillTracking 8244 8000 0270 E, ❑ No❑Yep [I Dr lce As eratrached Packages over 150 lbs. NuedEx Exress rubber : . so commumem maybe later in me areas. 7 Payment si►Iro: ❑ FSI Dal Freight* ❑ FedEx 2Day Freight ❑FedEx3DayFreight < 1 From This portion can be removed for Recipient's records. Third business day Exp ss Package Service Packages up to 15016s W / [ Date ( § G C FedEx Tracking Number y p�7 �7 ! S $�NP y.a1+•- p ! DeliverycommN en[may be latera in. areas Ned sPSSomotyOvernight ❑ Neab .staadardOvernight .f FedFxFirst ine.dagh9 a `/—' tour liability is limited to $100 unless you declare a higher value. See back for details. FedEx Use Only b delivery to select locations 2 Sender's Name Phone 212 675-6070 FedEx 2Day*❑I FedEx Express Saver* J W Second business day - Third business day 'fed&Envelope/Letter Rate not availabia i Mnmumcharge:Onepoundrate - u d WNONSTOP PICTURES INC 4b Express Freight Service Packages over 150tbs. jr Company Oahvery commihnemmay be latera some areas f'❑ Z FEIMayFreight* ❑FedEx20ayFreight ❑ FedEx May Freight Neat business Second business day Third business l Address 27 W 20TH ST STE 700 y y ti Call for Ij v Dept/Floor/Sube/Room aekaging Declared value limit $500 1 W tY NEW YORK City State NY ZIP 1001 1 1Envelope/Letter* ❑ FedEx Pak* ❑ Other Pkg. Includes FedEx Bax, FedEx Tube, and customer pkg 2 Your Internal Billing Reference 6 Special Handling Include Fecliaddress inSection 3.� 3 To SATURDAYDelivery SUNDAYDelivery HOLD Weekday HOLD Saturday ❑ Avaitable norFea&Poorly ❑ for Fed&Prority❑ at Fed Ex Location ❑ Location Recipients p - jr % only Avalableonly at FedEx Overrght and FedEx 2Day Over gM to select ZIP codes Not avalable wm Available only for FedEx Frei Name Fl Phone is ( (",' j S k e(% to select ZlP codes Fed& First Overnight Ovemght and FedEx May to select locations Does this shipment contain dangerous goods? i One box must be checked. E ' "i'- Company �� .. , i 4( „f t. ; 1 7 j{ G�Er No Yes Yes D Ice ❑ ❑ AS ❑ snipperSDetlamtan ❑ ver aaatned Shippers Declaration nolrequired Dry ce, 9, UN 1845 kg ❑ Cargo Aircraft Only l r[ ) `I°� rS Dangerous Goods cannot be shipped in FedEx packaging. Recip. Address + yk Paymeln sill ro: ❑obtain Acct NO. To"HOLD"at Fed& located, punt Fed&address. We cannotdehverte P.O. boxes or P.O. ZIP codes Enter FedEz Acct No. or Credit Card No. below. 0 ender ❑Recipient ❑Third Party ❑Credit Card ❑ Cash/Check r cctI Na. in Section will be bAled. Dept/Roar/Suite/Room ' I Crry 1 r `"`s ! L / State 1 J ZIP T Total Packages Total Weight Total Char]8244 t(�y ►I�np 8000 0270 ered-ardA tour liabiluyis limited to$100 unless you declare a hlghervalue. Seethe FedEx Service Guidefordetaile. C"v 8 R I S" uriwuiimuimi�nueuiuniwra�uionuuuuiii .�.._.:_:ve mut �_:::_:_. FeCEX® USAAirbillTrakA 8271 5492 7182 Express Number 1 From PliesePdntandiaressnam. 6 / 2 2 / 01 Sender's FedEx Data Account Number 1067-7029-8 Linda Cooper N, Town Clerk's Office Phone( 631 ) 765-1800 Company TOWN OF SOUTHOLD 53095 ROUTE 25- Deptfloor/Sutra/Room SOUTHOLD stain NY 7Ip 11971 2 Your Internal Billing Reference First 24 characters Wit appear on imome. 3 To Recipients Na John Maher Phone 1212 1 675-6070 NONSTOP PICTURES, INC. Address 27 W 20th St, Ste 700 To "HOLD" in FedEx location, print Fed& address, We cannot deliver to P.O. bones or P.O. ZIP codes. New York State ilY zip 10011 t Stick FedEx See back for application instructions. Questions? Visit our Web site at fedex.com or call 1.800•Go•FedEe (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. De"oor/Suite/Room 4a Express Package Service Packages u ro 150Ibs © FedEx Envelope* ❑ FedEx Pak* ❑ Other Pug. ❑ FedEx Priority Overnight Delivery commionem may bra some areas. FedEx Standard Overnight ❑ FedEx Fust Overnight 6 Special Handling ---- Include Feiaddress inSection 3. ----- SATURDAYDelivery SUNDAY Delivery HOLD Weekday HOLDSaalyday Next business morning ❑ FedEx 2Day Next business afternoon ❑ FedEx Express Saver Each" nest business mommg delWeryto selectlocadons ❑ NEW FedEx Extra Hours RESTRICTIONS Available only for FedEx Priority Sec and business day Third business day Fed& Envelope rate not available. Minimum charge: One -pound rate larerdrop-offs thnaxtbuseaus iff—roelieryforsekctiocetaas -- One box must be checked. —1 4b Express Freight Service ❑ No❑Yep [I Dr lce As eratrached Packages over 150 lbs. ry ce,9,UN]945 x Shippers Declaration kg Aircraft Delivery so commumem maybe later in me areas. 7 Payment si►Iro: ❑ FSI Dal Freight* ❑ FedEx 2Day Freight ❑FedEx3DayFreight < Next business y Second business day Third business day Cred�aroNo 1632-2864-5 ;� 5 Packaging * Declared value limit= © FedEx Envelope* ❑ FedEx Pak* ❑ Other Pug. Includes Fed&Small Pak, FedExIncludes Fad&Box, Fed& Large Pak and FedEx Sturdy Pak Tube, and customer pkg. 6 Special Handling ---- Include Feiaddress inSection 3. ----- SATURDAYDelivery SUNDAY Delivery HOLD Weekday HOLDSaalyday ❑RESTRICTIONS ❑ RESTRICTIONS ❑ at FedEx Location ❑ at FedEx Location Available only for FedEx Poetry, Available only tar Fed& Priority RESTRICTIONS ght and FedEx Overnight codes Nmaveileblewhh RESTRICTIONS Available only for FedEx Priority to Set m select ZIP codes Fed&Fred Overnight Does this shipment conte in dangerous goods? 0vemi9le and Fed Ex 2Dsy to Salem locations -- One box must be checked. —1 ❑ RETURNED YOUR CALL ❑ No❑Yep [I Dr lce As eratrached ❑ Cargo ry ce,9,UN]945 x Shippers Declaration kg Aircraft Dangerous Goods Iincl. Dry Ice) cannot be shipped in FedEx packaging or with Fed& Extra Hours service. Only 7 Payment si►Iro: I Enter FedEx Acct No. or Credit Card No. below. --'I ❑ Sender ® Recipient ❑ Third Party ❑ Credit Card ❑ Cash/Check Acct No. in Section 1 will be billed. Cred�aroNo 1632-2864-5 ;� Total Packages Total Weight Total Declared Valust $ .00 tour liability is limited to $100 unless you declare a higher value. See back for details. FedEx Use Only 8 Release Signature Sign ad authorize delivery wvhautobrainingsignamre By signing you authorize us to deliver this shipmemwithout obtaining a signature 0175304062 and ,ran to indemnity and hold us harmless from any resulting claims. SRS•Rev. Date 12/00 -Part #155918S•©l 994-2000 Forl PRINTED IN U.S.A. A MESSAGE FOR; FROM DATE OF A• TIME � = .M. h PHONE o 7o El URGE AREA C013E NUMBER EXT. ❑ CAME TO SEE YOU ❑ RETURNED YOUR CALL MESSAGE: R-ALEASE CALL O WANTS TO SEEP U ❑ WILL CALLAGAIN SIGNED ■ 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: Attn: John Maher Nonstop Pictures Inc. 27 W 20th St, Ste 700 New York NY 10011 2. Article r06�Ofr0029c3055 9668 by (Fuse Prinf Clearly) I B. gate If Delivery 11 C. Sm4k�_� ❑ Agent ❑ Addressee D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type 8 Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes PS Form 3811, July 1999 Domestic Return Receipt 102595-00-M-0952 406 FedEx I Ship Manager 1 Labe17900 8466 2862 Fmrn:.JEANINEFARFA.LLA(212)675-6070 SHIPPER'S FEDEX ACCOUNT* PICTUBES Ir WEST 0TH STREET IIIIIII IIIIII I IIIIIIII I IIIIIIIII III III °NONSTOP UTE 700 NEW YORK, NV, 10011 To: Linda Cooper (631)765-1800 Town of Southhold SHIP DATE: 21JUN01 Southhold Town Hall WEIGHT: 1 LBS 53095 Main Road Southhold, NY, 11971 Ret: 0170 DELIVERY ADDRE558AMODE(FEDEM-EDR) FedEx PRIORITY OVERNIGHT FRI TRK # 7900 8466 2862 5sn JFK AM 11971 -NY -US IN 111 11111111111 Z5 111111111111111 WSHA 111111111111111 22JeUN01 6/21/:)l 4:44 PM 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 ,Schedule Courier Find a Dropoff Location: Shipping History; Shipment Complete Cancel Shipment 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 Ship Inside U.S. Ship Outside U.S. Ship to Same Recipient' 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 tFe current FedEx Service Guide apply. Your right to recover from FedEx for any loss, including intrinsic value of the package, loss of sales, income inte^est, 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 and other items listed in our Service Guide. 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