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HomeMy WebLinkAboutStarfish ProductionsTOWN CLERK'S CHECKLIST FOR FILMING PEI NOTE: All payments must be cash or certified check Applicant 5-rfi/e res H �� '� g Completed application $100 nonrefundable application fee ::�h Certificate of insurance that evidences a public liability insurance ePolicyo covering the town as an additional insured in the amount of $1, (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 Approve k balt� Disapproved No Fee Required Fee in the amount of $ required OForward certificate of insurance and indemnification agreement to Town r- Attorney for approval Approved .573 Disapproved COLLECT FEES AS FOLLOWS: Permit Fees (Prior to issuance of permit): _2ZFilm Fee - $100 per day of each day covered by the permit r/ 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. f 4 f„ _4(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) NOTIF ATION of ISSUED PERMIT Ch' f 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 T/' 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) N ° F14 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. • t 1 V %.v r v_nn� 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 DATE (MM/DD/YY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE I 5/3/01ns PRODUCER Taylor & Taylor, Ltd. 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 Taylor & Taylor Associates, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 90 Park Avenue New York New York 10016 Phone: (212)490-8511 INSURERS AFFORDING COVERAGE INSURED INSURER A: GULF INSURANCE COMPANY INSURER B: STARFISH PRODUCTIONS NEW YORK INC. INSURERC: 480 BROADWAY - SUITE 404E INSURERD: NEW YORK, NY 10013 **REVISED** INSURER E: %.v r v_nn� 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. INS TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM DD YY POLICY EXPIRATION DATE MM D Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Any One Fire $ 50,000 A X COMMERCIAL GENERAL LIABILITY MED EXP (Any One Person $ 5,000 CLAIMS MADE X❑ OCCUR CLP00626970 4/26/01 4/26/02 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE s 2,000,000 PRODUCTS - COMP/OP AGG $ 1.000.000 GEN -L AGGREGATE LIMIT APPLIES PER: PRO• POLICY JE LOC A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS CLP000626970 4/26/01 4/26/02 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) X X HIRED AUTOS NON•OWNEDAUTOS PROPERTY DAMAGE $ (Per accident) X HIRED AUTO VIRVATrAT, nAMAGIM $125,000 PER AUTO/$5(0,000 AGGGATE &-s1mw.1-pin GARAGE LIABILITY $1,000 MIZIMUM/$7,50C MAXIMUM AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG ANY AUTO VEHICLES ARE VALUED JT ACTUAL CJILSH VALUE EXCESS LIABILITY OCCUR El CLAIMS MADE EACH OCCURRENCE $ AGGREGATE DEDUCTIBLE RETENTION WC STATU• OTH- WORKERS COMPENSATION AND TORY LIMITS I IER EMPLOYERS LIABILITY E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE • POLICY LIMIT OTHER A MISCELLANEOUS EQUIPMENT - SPECIAL FORM, REPLACE NT COST $100,000 LIMIT, $ 750 DED. PROPS/SETS/WARDROBE CLP000626970 4/26/01 4/26/02 $100,000 LIMIT, $ 750 DED. THIRD PARTY PROPERTY DAMAGE $250,000 LIMIT, $1,000 DED. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS RESPECT TO CLAIMS ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. t;Ctl 1 Irlt�A I G PIULUC1f I I ADDITIONAL INSURED; INSURER LETTER: VAI\VGLLN r 1%j 11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF SOUTHOLD DATE, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN SOUTHOLD TOWN CLERK NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL SOUTHOLD TOWN HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 53095 MAIN ROAD P.O. BOX 1179 REPRESENTATIVES. AUTHORIZED REPRESENTAT E SOUTHOLD, NY 11971 ACORD 25-S (7/97) © ACORD CORPORATION 1988 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 May 9, 2001 CERTIFIED MAIL RETURN RECEIPT REQUESTED Starfish Productions New York, Inc. 480 Broadway, Suite 404B New York, NY 10013 _ Dear Sirs: Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 Returned herewith is your certified check No. 0747102022 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. I hope all went well with your shoot. 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. 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: May 4, 2001 Re: Film Permit No. 003 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 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Raymond Jacobs, Superintendent of Highways From: Linda J. Cooper, Deputy Town Clerk Dated: May 4, 2001 Re: Film Permit No. 003 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 POLICE DEPAMMENT TOWN Of cSOUTKO,D Telephone Emergency Dial 911 r-CFIVE[) MAY 4 2001 MEMORANDUM —o'noic $own Clerk TO: Linda Cooper, Deputy Town Clerk FROM: Chief Carlisle E. Cochran, Jr. AA— DATE: May 3, 2001 RE: Application for Filming/Still Photography Starfish Productions NY, Inc - 3/2001 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 application dated May 2, 2001, by Starfish Productions NY, Inc., be APPROVED. As per Section 44.A4, 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 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) I 5/2/01NS PRODUCER Taylor & Taylor, Ltd. Taylor & Taylor Associates, Inc. 90 Park Avenue New York New York 10016 Phone: (212)490-8511 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 STARFISH PRODUCTIONS NEW YORK INC. 480 BROADWAY - SUITE 404B NEW YORK, NY 10013 INSURER A: GULF INSURANCE COMPANY INSURER B: INSURER C: INSURER D: INSURER E: VVVCI'Imuca 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. INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM YY POLICY EXPIRATION DATE (MM/DD/YY) LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Any One Fire $ 50,000 A X COMMERCIAL GENERAL LIABILITY MED EXP (Any One Person $ 5,000 CLAIMS MADE X❑ OCCUR PERSONAL & ADV INJURY 1,000,000 CLP00626970 4/26/01 4/26/02 GENERAL AGGREGATE s 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 GEN -L AGGREGATE LIMIT APPLIES PER: PRO - POLICY T 7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 A ANY AUTO CLP000626970 (Ea accident) ALL OWNED AUTOS 4/26/01 4/26/02 BODILY INJURY $ (Per person) SCHEDULED AUTOS BODILY INJURY $ X HIRED AUTOS (Per accident) X NON -OWNED AUTOS PROPERTY DAMAGE $ X HIRED AUTO $125,000 PER AUTO/W0,000 AGGGATE (Per accident) GARAGE LIABILITY $1,000 MI1IK=/$7,50C MAXIMUM AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG ANY AUTO VEHICLES ARE VALUED J T ACTUAL CASH VALUE EXCESS LIABILITY EACH OCCURRENCE AGGREGATE $ OCCUR CLAIMS MADE $ $ DEDUCTIBLE RETENTION WC STATU. OTH- WORKERS COMPENSATION AND TORY LIMITS ER E.L. EACH ACCIDENT $ EMPLOYERS LIABILITY E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT OTHER A MISCELLANEOUS EQUIPMENT - SPECIAL FORM, RE LACEMENT COST $100,000 LIMIT, $ 750 DED. PROPS/SETS/WARDROBE CLP000626970 4/26/01 4/26/02 $100,000 LIMIT, $ 750 DED. THIRD PARTY PROPERTY DAMAGE $250,000 LIMIT, $1,000 DED. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS RESPECT TO CLAIMS ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. %,crti I IPIVA 1 C IIVLL/Cll ADDITIONAL INSURED' INSURtR LtI ItR: ve+n­­ . w . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN SOUTHOLD TOWN CLERK NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL SOUTHOLD TOWN HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE I RE ,ITS AGENTS OR 53095 MAIN ROAD P.O. BOX 1179 REPRESENTATIVES. AUTHORIZED REPRESE IVE SOUTHOLD, NY 11971 ACORD 25-S (7/97) © ACaDRORPORATION 1988 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 STARFISH PRODUCTIONS N.Y., INC. Location(s), Time(s) and Date(s) Narrow River Road Orient (at bend south of Main Road) Thursday, May 3, 2001 11:00 A.M. to 8:00 P. Permit No. 003 Issue Date: May 3, 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�OS%3FFOLco �coG s� H Z oy� • o�� 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 STARFISH PRODUCTIONS N.Y., INC_ Location(s), Time(s) and Date(s) Narrow River Road, Orient (at bend south of Main Road) Thursday, May 3, 2001 11:00 A.M. to 8:00 P. Permit No. 003 Issue Date: May 3, 2001 Elizabeth A. Neville Southold Town Clerk (Town Seal) Town Of Southold P.O Box 1179 Southold, NY 11971 ***RECEIPT*** Date: 05/03/01 Receipt#: 1151 Transaction(s): Subtotal 1 Application Fee - Non -Refund $100.00 1 Daily Filming Permit $100.00 Check#: 1151 Total Paid: $200.00 Name: Starfish, Productions N Y Inc. 480 Boardway Suite 404b New York, NY 10013 Clerk ID: LINDAC Internal ID: 31209 05/02/01 10:53 $ 5897343 Auarbach&Simaons 02 INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMINWSTJ11, PHOTOGRAPHY PERMIT The Applicant shall indemnify and hold harmless the Town from and against all I sluts, chums, 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 %till 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 Bali expense. In addition, the Applicant will name the Town as an additional insured any applicable policies. I'! IllitAj 11dI11C� I'itic 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: 5/2/01 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 Starfish Productions N.Y., Inc. is attached hereto. Please review and advise whether these documents meet with your approval. Thank you. JApproved as submitted Disapprove for the following reasons: Date FROM : starfish?productions new york FAX NO. : 212 3310051 J �)Ign May. 02 2001 11:41PM P2 n{etl�r� 'Ralallod olgsallddts Aug pa.tnsul lsuoltlppg ue Ott uMo,L all; auttau Ipm juealiddy nl;'uoillppa ui •asitadxa ijoru isoa uma sill ;e awns aq; p11app Poe to a3j6q;t aja; AIajvjpatut([1 t1e11s 111willddt: iatil 4tmoj atp 1sul83vt;gSnaAq uopae gans Xuujo ase.) al putt Jolats�llto-jyIty j , uv jo spaos jo saaAoldtuo +cig -jusaiiddd atp A<144dejgdjdtld 1111`4.jo Au4ual!j jo aauvtuso .Aa4 oq; t111m uolpauuoa ul 93psud ao,(tjud Cuts Sq paala;r;ns aq ui Sa11e ,to paula;ails AAn{ul Jo/pus 32ttuep pies JO) suolpan so spusurap'stump `s4111s Ite;snleIltt pus 1110.41 wAn,l, aqi saaµu,tetl ploy pus Ailutuapul 11ugx iUeJdlddV')4.1, 1.iW21�d �,Hd`4+21©03.OHd'1'll,f,S/7N1W"lld Q'ICIRMOS'40 Nm0.1. 1N3W33HOV N011V31d1NW3QN1 - MAY. 3.2001 9:05AM NO.751 A CORDTM CERTIFICATE OF LIABILITY INSURANCE S ISSUED AS A MATTEF . 2i an 1 5 / 3 / 01nD IS CERTI KATE 1 PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Taylor & Taylor, Ltd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Taylor & Taylor A980ciat6m, TUC' ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW . 90 Park AVG=U6 INSURERS AFFORDING COVERAGE INSURED 13TARFISH PRODUCTIONS .NEW yCO�ttC INC. INSURER 6. 480 aR0}IDVITAY - SUITE 404E INSURER C: �*RSV'TSED*�' INSURER D. NEW YORK, NY 10013 INSURER E: ;OVERAGES -""" " THE POLICIES OF INSURANCE LISTED 6EL.OW HAVE BEEN ISSLIEDTOTWE INSURED NAMED ENT WITH E F E ISSUeD OR ANY REQUIREMENT,IINSURANCE TERM OR E AFFORD DNOF ANY CONTRACT OR BY THE POLICIES DESCRIBED HER DO HEREIN ISMSUBJECT TOBALL. THE TERMS- EXCLUSIONSANDCONDITIONS OF SUCH MAY PER POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I IV EFFECTIVE POLICY EXPIRATION LIMITS IS TYPE OF INSURANCE POLICY NUMBER 000 000 ACH OCCUR CE 1 GENERAL LIABILITY PIRE AMAG An O o Fire 50.000— A O 0OA X COMMERCIAL GENERAL LIABILITY M EYP One ereo "00 0 CLAIMS MAGE © OCCUR CLrO0626910 4/26/01 4/26/Oa JpFRSON kL A APV INJU 1 00 000 n wAA AAA G N'L AGGREGATE LIMIT AFPLIES PER: DAO• OUC C TOMOBILE LIABILITY A ANY AUTO CLP000626970 ALL OWNED AUTOS 4/26/01 4/26/02 SCHEDULED AUTos X HIRED AUTOS NON•OWNEP AUTOS X R tEDyTo $225,000 P= AUTO/^x500,000 A= GATS GARAGE LIADILITY $1„ 000 MT MUM/$7, 50 MAXIMUM ANY AUTO VEHICLES ARE VW vM=W ACTUAT, C BH VAIrUL SS LIABILIT OCCUR CLAIMS MAPC OEDUCTIpLE WORKERS COMPENSATION AND EMPLOYERS LIABILITY iAUTOQNLy;: ED SINGLE LIMIT ¢ 1,000,000 Ski 40016ni) INJURY $ gon) INJURY $ ldenl) RTY DAMAGE S ldenr) NLY - A ACC ENT THAN EA AGCONLY: AGG 6 OTHER $100,000 LIMIT, S 750 DED. A IIIdISCELLANEOUS EQUIP NT - SPBCIAT+ FORM, RE ZACENSNT C BT $ 4/26/01 4/26/02 $100,00D �,I11CCT, $ 750 OLD. PROPS/9ET8/W"DRO9Z CLP000626970 $150,000 LIMIT, $1,000 DED. THIRD PARTY PROPERTY Di1GE DESCRIPTION of OPERATIONsILOCATIONGIYCHICLEslp%CLUSIONS APDP.D BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS RESPECT To CLAIMS ARISING OUT OF THE OPERATIONS OF THE NAMED INSUR39D . TOWN OF SOUTHOLD SOUTHOLD TOTIM CLARK SOUTHOLD TOWN UALL 53095 MAIN ROAD P.O. Box 1179 SOUTHOLD, NY 11971 ACORD 25•S (7/97) MOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATE, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _jp— DAYS WRITTEN OTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT, BUT fAILuRE TO DO 60 SHALL NpOSE No OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENYG OR IEPRESENTATNES, ftoQP-ORATION 1968 MAY. 2. 2001 12: 52PM NO. 724 P . 2/ MIDDIYr AC.ORDTM CERTIFICATE OF LIABILITY INSURANCE ATT6ROFINF1210 SN ON pRopucER THIS CERTIFICATE Is ISS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Taylor is Taylors Ltd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Taylor & Taylor AsNoaiatoe, Inc- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW - 90 Park Avenue INSURERS AFFORDING COVERAGE p@w York Wow York 10016 Phone- 212 490-8511 INSURER "A: G17 8' IN $ CO PANT! INSURED STARS'16H PRODUCTIONS NNW YOM INC. INSURER B: 490 HRoADwAY - SUITE 4048 INSURER C:. MW YORK, NY 10013 INSURER D: INSURER F: COVERAGES ITHSTANDING THE POLICIES OFINSURANCE 1-ISTEO BELOW HAVE SEEN ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INVIITFCATE MAY BE ISSUED Oft DICATED. NOTW ANY REQUIRMENT, TIERM OR Rr-.SPF-CT TO wHicH THIS CIE MAY P RTA NE THE INSURANCE AFFORIDED BY THE POS CIES OBSCRIBED HEREIN 1S SUSJF TION OF ANY CONTRACT OR OTHER DOCUMENT WIT To ALL HE TIE Mg EXCLUSIONSIAIND COND TIONS OF SUCH EHN REDUCED BY PAID CLAIMS. POLICIES, AGGREGATE LIMITS SHOWN MAY HAV1= a POLICY EFFECTIVE POLICY EXPIRATION NS TYPE OF INSURANCE POLICY NUMBER 50 000 ED EX An One a eon GENERAL LIABILITY PER80 ALL ADV NJURY 1 00 000 G ERALA ELATE A COMMERCIAL OENEHAL LIABILITY P ODUC 9 • COMP/ AGG 1 000 000 COMBINED SINGLE LIMIT $ 1,000,000 CLAIMS MADE X� OCCUR CLp00626970 4/26/01 4/26/02 GEN'L AGGREQATE LIMIT APPLIES PER BODILY INJURY g PRO - PROPERTY DAMAGE OL C C AU '0 ONLY • A ACCIOB AUTOMONILE LIABILITY AUTO ONLY' AGO S F C OCCU ENCE CLP000626970 AGGRE TE EDAUTOS 4/26/01, 4/26/02 LED AUTOS T E UTOS E, DISEA6E - A 1;: EE LO NFD AUTO5D UTO $125,000 PER AUTO/$5 O,ODO A C;<A'�E BILITY $1,000 DMZ 7V=':rmzs IMU12/$7 r 5MAXITO $1,000 DLD• ARE V"AhUED T ACTUAL OR YALUE ;SS LIABILITY OCCUR Q CLAIMS MADE DEDUCTIBLE WORKERS COMPENSATION AND EMPLOYERS LIABILITY A tOTHER THERISCANE0U8 LQUIP NT ^ SPECIAL rORM, RN LACR�NT C ST PROPS/$RTS/WARDROBE CLP000626970 4/26!01 4/26/02 THIRD PARTY PROPERTY DAMAGE LIMITS E C OCCU NCE 1000,000 F AMAX An 0 Ire 50 000 ED EX An One a eon 5.000 PER80 ALL ADV NJURY 1 00 000 G ERALA ELATE 000-000 P ODUC 9 • COMP/ AGG 1 000 000 COMBINED SINGLE LIMIT $ 1,000,000 (Em APolAenl) BODILY INJURY B (Per pare0n) BODILY INJURY g (Per mccidem) PROPERTY DAMAGE (P,l eccldepl) AU '0 ONLY • A ACCIOB OTHER THAN ACC AUTO ONLY' AGO S F C OCCU ENCE AGGRE TE W 6TATU- OTH- T E E.L. cH ACCI T E, DISEA6E - A 1;: EE IS • POLIC I $100,000 LIMIT, $ 750 DED. $100,000 LIMIT, $ 750 ZED. $250,000 LIMIT, $1,000 DLD• DESCRIPTION OF OPBRATIONS/LOCATION9NEHICLEs/EXCLUSIO149 ADDED BY ENDORSEMENTISPECIAL PROvIsIONs CERTIFICATE $OLDER 16 IDICLUDND AS ADDITIONAL INSURED AS RESPECT TO CLAI>#S ARISING 09'1' OF THE OPERATIONS or THE NAMED INSURED, 90VTKQLD TOWN CLZRX 6OUTSOx.1) TOWN HALL 53095 MAIN ROAD P.O. BOX 1279 SOCJTUoLD, NY 1.971 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES OF CANCELLED BEFORE THE EXP14ATIO DATE, THE ISSUING INSURER WILT- ENDEAVOR TO MAIL :Lo^ DAYS WRITTRI NOTICE TO THE CERTIFICATE MOLDER NAMED TO TME LEFT, BUT FAILURE TO 00 SO 5HAL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THERE. ITS AGENTS 0 ACORD 25-S (7/97) Q A D),Bdh'PORATION 1 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 - Check No. 1151 $100.00 Daily fee — Check No. 1151 ' $250.00 Cleanup Deposit — Certified Check No. 0747102022 Starfish Productions N.Y., Inc. Film Permit No. 003 Received by Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 MAY. 3.2001 9:05AM 10 From, Taylor & Taylor Associates, Inc. Taylor & Taylor, Ltd. 90 Park Avenue New York, NY 10016 Tel (212) 4908511 Fax (212) 490-7236 L` o frnw IQ'R11 Date. 5-3--ol Fax No. Number of pages a includingcover sheet: 0 Comments: N0.751 P.1/2 MAY. 2.2001 12:52PM To: From: Taylor & Taylor Associates, Inc. Taylor & Taylor, Ltd. 90 Park Avenue New York, NY 10016 Tel (212) 490-8511 Fax (212) 490-7236 0 Vu v Date: S7—�k —D Fax No: 3 6 — � 6 S- 'Z Number of pages including cover sheet: Comments: N4.724 P.1/2 r. 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: 5/2/01 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 Starfish Productions N.Y., Inc. is 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 . M INDEMNIFICATION AGREEMENT 'T'O'WN OF SOUTHOLD FILMING/STILL, PHOTOGRAPHY PERMIT The Applicant Miall indernnify and hold harmless the Town froin and against all stilts, claims, demands or actions for any damage and/or injury sustained or allege to be sustained by any party or parties in connection with the performance of filming or stili photography by the Applicant, his employees or agents or any subcontractor and in cuNe (,f tiny such action brought against the Town, the applicant shall intrnediatiely take charge of and defend the same at his own cost anii expense. In addition, the Applicant will name the Town as an udditional insured pay applicable policies. Signalli iia« 1'l•iniaci aaan'�c V � . _ �. C. . Ed Wdtib : TT TOOE EO 'FpW TSOOT22 ZTZ : 'ON Xdd JUOR mau suot-�Onpoid{ysjiup;s : WO�jd '-w- MRY . 2.2001 12: 52PM N0 . ?24 P . 2/ M/DDfTY ACOMDTM CERTIFICATE OF LIABILITY INSURANCE 5fx/o1Ns FMCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Taylor A Taylor, Ltd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Taylor & Taylor Associates, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 90 Park Avenue INSURERS AFFORDING COVERAGE DTom York Naw York 10 016 Phone; 212 4 9 0 - 8 511 I N S U R E R A: G17T,8' IMUPR" I cONMA Y STARrISH PRODUCTIONS NSW YORK INC. INSURER 13: 490 BROADWAY - SUITE 404E INSURER C: N= YORK, NY 10013 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TME INSURED NAMED ABOVE FOR THE PO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO H MAY PERTAIN, THC INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALE THE TEI POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ICY EFFECTIVE POLICY EXPIRATION IS TYPE OF INSURANCE POLICY NUMBER GENERAL 1IA8101Y A COMMERCIAL gENERAL LIABILITY CLAIMS MADE X� OCCUR CLP00626970 4/26/01. 4/26/02 FGpN"OLICYF7 L AGGRI BATE LIMITAPPLIES PEO, PRO - 17 0 AUTOMOBJU LIABILITY A ANY AUTO CLP000626970 ALL OWNED AUTOS 4/26/01 4/26/02 SCHEDULED AUTOS HIRED AUTOS R NON•OW NFD AUTOS E RED UTO $125,000 PER AUTO/S5 $1,000 IdI 0,000 A I11EUM/$7, 50 GATE MMIMUM ARAOE LIABILITY ANY AUTO VEEiTC11ES Alt$ VALUED AT ACTUAL CASH VALUE EXCESS LIABILITY OCCUR 71 CLAIMS MADE DEDUCTIBLE RF O WORKERS COMPENSATION AND EMPLOYERS LIABILITY OTHER A >MISCELIJLNEOUS EQUIP NT SPECIAL FORM, R11 LACEMLNT COST &BOPSISRTSMARDROB& CLP000626970 4/26/01 4/26/02 THIRD PARTY PROPERTY DAMAGE DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY BNDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER 18 INCT,UDSD 71S ADDITIONAL INSURED AS RESPECT ' OPERATIONS OF TIM NAMED INSURED. 90TITUOLD TOWN CI42.'RK SOUTHO,LD TOWN HALL 53095 MAIN ROAD P.O. BOX 1179 SOUTHOLD, NY 11.971 ACORD 25-S (7/97) .ICY PERIOD INDICATED. NOTWITHSTANDING HIC1i THIS CERTIFICATE MAYBE ISSUED OR ,MS, EXCLUSIONS AND CONDITIONS OF SUCH LIMITS E c OCCURRENCE 000 000 F AMAG- (Any Omp Fire)50,000 E❑ EK An Ono a eon 5,000 PERBO AL 6 ADV INJURY 1,000,000 G ERAL A EOATE2,000 000 PODIC S • COMPI ADO F. 1,000,000 COMBINED SINGLE LIMIT A 1� 000, 000 (Ea 0001aenl) BODILY INJURY 6 (Per pardon) BODILY INJURY S (P ar mldanr) PROPERTY DAMAGE $ (Parecc(lanl) AU70 ONLY • gA ACCIOE OTHER THAN RA ACC AUTO ONLY! AGO FAC14 OCCU ENCE ABBRE TE W a STATU DTH T E E.L. CH ACCT T E. DISEASE • A EMPL EE IS - POLICY LIMIT $100,000 LIMIT, $ 750 DSD. $100,000 LIMIT, $ 750 DED. $250,000 LIMIT, $1,000 DED. TO CLAIMS ARISING OUT OF THE CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13EFORF THE EXPIRATION DATE, THE ISSUING INSURER WILT- ENDEAVOR TO MAIL Io DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 So SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE,*u3p, ITS AGENTS OR = 0- Mo WRR�E:- N 1968 i I � I I II sta r h s h j/ productions FAX MESSAGE Flay 2 dy 2001 TO: Town of Southold Fax: 631 — 766 6145 Attn: Linda Cacp-R�r- From: Angelika Bussjaeger Fax: 212 — 331 0051 Starfish Productions New York Pages total 3 Dear Linda, Please find attached the application for the requested Permit for Still Photography Thru the Location Company " Where'bouts". My insurance Company "Taylor & Taylor" will fax you a Certificate of Insurance upfront and will mail the Hardcopy. The Location Manager"Sascha Pfaeging" will drop off the 2 cheques by tomorrow around 12.00 pm on there way to the location: If you have any questions please feel free to call me. Thank you very much ! Best, Angelika E I I I starfish prod ucLions npw york.'iric. 480 broadw;ay sui to # 404b new York, ny ,1.0013 rphornr 2. '1 i - 331. 0050 Fax 211 331 0051 r.rnarl >,tarf'i}hny(-)hotmaiI.com Td WdOV:TT Tooz ze -Rew i TS00T22 DTZ : 'ON Xdd 1.loF, mau Su01;0npo..id<4s i j Ap;S : WOJd ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR, OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o�oSUFFot�.�oG h Z OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Cochran, Southold Town Police From: Linda J. Cooper Dated: 5/2/01 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 Starfish Productions N.Y., 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. TOWN OF SOUTHOLD APPLICATXON FOR. FILMING/STILL PHOTOORAPHY PUT"s PAINT *A 7v0A AVPL10ATTMMvXAMIT No: Nazis 010 STAV, MAI L,,%I*Q Amxxss 4-80 .40t+ f pHosp; MAKr or QhQ&MxZAr10W=WM&1 MATLXMd AbDKxpGj . . . . . . . . . . . . i�_ N-0� VZUC7eXbt TVyR 07 ACTIVITY (o,g, 99biou ticturc, <ompeccial, TelayiStV4, Cgcalag M"Kaxlsw. ptc, I I MOL/ -*�M - (s. 00 )Mb T:vmla(125 or Marozzu r1:&M,11ic1 e pjI. Pilop how i ve-r .k5�Q-ot- t3PPM I-OCNTION(g) mUikel 4,1;4t3onal BL*4t, 49 M^" or Pkkam In camea AT arm: s s cl-I 0, 9- ch, e- Mft0flit OF PEILSOMS AT LQCATIrOM (CL49T & CMM IM=,XMcpj = `�. I � 7� IQS�! AM TYPIC 01, "HICLNg 9&SC14� Tguc cp4f cfro #' ... . ... .. . n to; Southold Town Clerk Southold Town Hall 53095 Main Road P. 0. Box 1179 Southold, NY 11971 f -x 431-76S--I/q�- 2d WcJTV:TT T007 EO 'ReW TSOOT22 ETE 'ON XUA jaoFi mau suoi�onpo,.Ld{4sijae�s LJOcId