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Home My WebLink AboutHiro Enterprisesj CHECKLIST FOR FILMING PEI TOWN CLERK'S NOTE: All payor ents must be cash or certified check ' Aj 7'L K PRl -5, F 5 �c.ce �< 9.01 _L/ Completed application $100 nonrefundable application fee ublic liability insurance policy of $1,000,000 Certificate of insurance that evidences a p filming or still the town as an additional eanl for the duration of the -- covering (one million dollars) per occur' photography agrees to assume all agreement stating the applicant less of and free Indemnification agr and hold the town harmless by reason of liability for and will indeemha occur to persons or property from any and all damages tt said filming or still Photography royal or Police Forward completed application to Ca f c Cpontrol Fee srequired disapproval and determination if Traffic r Approved Disapproved ,.,,No Fee Required required Fee in the amount of $ agreement to Forward rtceCe ificTown ate of insurance and indemnification Attorney for approval Approved Disapproved COLLE Cr FEES AS FOLLOWS: prior to issuance of pennit): permit Fees ( vered by the Permit Film Fee - $100 per day of each day co de osit. Separate certified check for $250 for each day covered Cleanup P by the permit. en -nit if required covered by the p 1000 for each day be required by Traffic control fee - $ OTE: Additional funds may by the Chief of police. N per day fee will be expended prior to police if it is determined that $10 0 the termination of the pennit period. Beach Parking fee - $10 per vehicle, per day between May 1 and September 30. ISSUED PERMIT Countersign application of applicant, locations(s), date(s), and times) Issue permit with name NOTIFICATION of ISSUED PERMIT Chief of police Chief Building Inspector Fire Marshal ✓ Code Enforcement Officer ✓Superintendent of Highways Superintendent of parks and Recreation RE WEST 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 providing Chief of police to provide applicant with statement of cost for Traffic Control and police coverage. (Refund overpayment or collect for additional costs within 30 days of termination of pen -nit) Highways inspections locations listed on permit and ✓ superintendent of High Y sonnei is required. p determine if cleanup efforts by town personnel will provide Town Clerk ��'� *If cleanup is required, Sup verpa ent or collect �? with a statement of actual costs. s of terdin. a on o permit) G for additional costs within 30 day *If not cleanup is required, Superintendent of Highways will notify Town Clerk and Town Clerk will remit the $250 certified check to applicant. /�/O T Town Of Southold P.O Box 1179 F Southold, NY 11971 ***RECEIPT*** s Date: 04/23/01 Receipt#: 26265 Transaction(s): Subtotal 1 Application Fee - Non -Refund $100.00 1 Daily Filming Permit $100.00 Check#: 244026265 Total Paid: $200.00 Name: Hiro, Enterprises Inc. 107 East 31 st St New York, NY 10016 Clerk ID: LINDAC Internal ID: 30596 J • 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 April 17, 2001 CERTIFIED MAIL RETURN RECEIPT REQUESTED Haruko Hashimoto Hiro Enterprises, Inc. 107 E. 31 st St — 4' Floor New York, NY 10016 Dear Ms. Hashimoto: Returned herewith is your certified check No. 021-244026266 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, 4t-�-9- et9-1-1� Linda J. Cooper Deputy Town Clerk Enc. r gxofFO1,��o Town Hall, 53095 Main Road co P.O. Box 1179 Southold, New York 11971 • Fax (631) 765-6145 Telephone (631) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD April 17, 2001 CERTIFIED MAIL RETURN RECEIPT REQUESTED Haruko Hashimoto Hiro Enterprises, Inc. 107 E. 31 st St — 4' Floor New York, NY 10016 Dear Ms. Hashimoto: Returned herewith is your certified check No. 021-244026266 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, 4t-�-9- et9-1-1� Linda J. Cooper Deputy Town Clerk Enc. f ■ ■ ■ ■ ■ ■ THE MIDDLE. THE VARIABLE TONE BACKGROUND AREA OF THIS DOCUMENT CHANGES COLOR GRADUALLY AND SMOOTHLY FROM DARKER TONES AT BOTH TOP AND BOTTOM TO THE LIGHTEST TONE IN c 0 �IUNI�f{EI�-- �o OER tt*TOWN OF OF NAME.OF REMff TER A1DDMSS — bawaHS�D�dPiil+rer#SY�4tMa _ todbielcp:{ewYmk'EYN�B�llelo,•li,Y` = • -i U 0 E 1:0 2 2000868: 28ii' 7905 55 i 4 0 APR 17 2001 9.,oinvaa town clerk RAYMOND L. JACOBS Superintendent Highway Department Town of Southold Peconic Lane Peconic, N.Y. 11958 MEMORANDUM TO: Linda J. Cooper Deputy Town Clerk FROM: Raymond L. Jacobs, Superintendent Wj/ Southold Town Highway Department DATE: April 16, 2001 RE: PERMIT # 001 Please be advised that there was no cleanup necessary in the beach area located at the end of Youngs Road, Orient. RLJ: Jes Tel. 765-3140 734-5211 Fax 765-1750 • ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR, OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER co Z oy� • o�� • 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 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 From: Linda J. Cooper, Deputy Town Clerk Dated: April 13, 2001 Re: Filming Permit No. 001 In accordance with Town Code 44A-9 you are being notified that a Film Permit was issued to Hiro Enterprises. See following page for a copy of the permit. ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o�oSUFFot,��oG a� y� N Z 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 PERMIT Issued to: HIRO ENTERPRISES, INC Date(s), Time(s) and Location Saturday, April 14, 2001 10:00 AM to 7:00 PM ( Rain Date 4/15/01) Beach at end of Youngs Road, Orient Permit No. 001 Issue Date: April 13, 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�f FO�,�coG o� y� C#3 ae oy� • o�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Southold Town Attorney's Office From: Linda J. Cooper Dated: 4/12/01 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 Hiro Enterprises, 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: Signat e 4 -13 -OI Date p ECEPWE APR 12 2001 TOWN ATTORNEY'S OFFICE TOWN OF SOUTHOLD FK. 11 . �LI�1— 1' d1FM 1KU EN I LKFK1bLb, 11`Il.- HU. r. C,TE(MMIDom) ACOff vEm i irIi c yr wpim,. ITY INSURANCE 10/04/2000 PRODUCXR (212-)227-8800 (2 571-2719 Haskell Brokerage Corp Ill ) o h n Street ' New York, NY 10038 ONLY AND CONFERS IWIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR !� ALTER THE COVORAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED Hiro Enterprises, Inc. 107 East 31st Street (4th Floor) New York, NY 10016 INSURER Travelers Insurance CompahY INSURER 0: INSUPERC: INSURER D; INSURER E: �Wvv.rVIV GJ 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, LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM87D ) DATE (MMIDDIYT) LIMITS GENERAL LIABILITY -660-543X6251 09/25/2000 09/25/2001 EACH OCCURRENCE 3 1.D00,000 FIRE DPMAGE (Any ane 1ko) s 50,000 X COMMERCIAL GENERAL LIABILITY MED CXP (Any one perBon) S 5,000 CLAIMS MADE Q OCCUR PERSQNAL a ADV INJURY $ 1,000,000 A GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO s 2.000.000 POLICY r7jgC ED LOC AUTOMOBILE LIABILITY ANY AUTO -810-356K136A 08/10/2000 08/10/2001 COMBINED SINGLE LIMIT $ (EA mem) 1, 0 0 0, 0 0 0 BODILY INJURY $ (Per person) X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY 5 (Pa' accident) A X HIRED AUTOS X NON -OWNED AUTOS PeOa dankPERTY AGE 5 GARAGE LIABILITY AUTO ONLY • EA ACCIDENT S OTHER THAN EA ACC 3 AUTO ONLY AGG $ ANY AUTO EXCESS LIABILITY EACH OCCURRENCE S AGGREGATE $ OCCUR CLAIMS MADE S DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND —UB -354K7782 0$/10/2000 08/10/2001 X TORYLIMITS ER B.L EACH ACCIDENT & 100,000 EMPLOYERS' LIABILITY A E.L, DISEASE - EA qMPLOYR5 s 100,000 E.L.DISEASE- POLICY LIMIT S 500,000 A OTHER AMERA EI AUDIO QUrPMENT FLOATER -660-543X6251 09/2S/2000 09/25/2001 $150,000 LIMIT ALL RISK - WITH THEFT S250 DEOUCTISLE DES MPTION OF OP94ATIONSILOCATIOSS-VF-141CI-ESlraXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS LL OPERATIONS / ALL LOCATIONS USUAL TO A PRODUCTION COMPANY. ERTIFICATE HOLDER IS AN ADDITIONAL INSURED / LOSS PAYEE AS ITS INTEREST MAY APPEAR. GERTIFIGATE MOLDER ADDITIONAL INSURED: INSURER LETTER vf+vmvr-r-L.n I lvrs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES IRE CANCELLED BEFORE TME TOWIl Of Southold EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL R 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIAMIL17Y OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. aurice RPR.11.2001 6:26PM HIRO ENTERPRISES,INC. NU. yd4 F. G • 2 v INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT The Applicant shall indemnify and bold harmless the Town from and against all suits, claims, demands or actions for any damage andlor injury sustained or alleged to be sustained by any party'or parties in connection with the performance of filuung or still photography by the Applicant, his employees or agents or any subcontractor and in case of any such action broagght ag inst the Town, the applicant shall immediately take charge of and defend the same at lois own cost and expense. In addition, the Applicant will name the Town as an, additional insured on any applicable policies. 4/11/2001 Signature Date Hirokazu Otsubo Printed mune President Title 11/U4 'U1 WED U8:00 rAA 010 Ibb U145 buUIHULU tLIKA aaa route ACUlllfl_1bu�1O VVL IOWRPR.10.200115 6:55Pr9 516HIRO ENTERPRISES,rNc. MOLD CIEIM NU.yILj1 r.c u 2 TOWN OF SOUTHOLD APPLICATION FOR FILMING/STILL P OTOGRA.� Ry P&MIL -7 VVA-W oa T'YpL L1�8T�ICATxCbY' DATE: 4110-17.001 P Am7 ra►a�a e>a ,�prxc�ar: Hiro Enterprises, Tna. , Haruko Hashimoto 107 E. 31st St., 4th Floor Nevw York, NY 10016 p}iont�: ' BQBasS (212)684-6868 xaace. QF CRGAVm A=QN, COW.�.trrl Hl.ro Enterprises-, Inc. azrxA s►ab�sss. the same as above. PHQIM: _1 71 )U4•-6868 PAX: („212)68+-6$21 wVW*Va."--W-r.+-r.i•**MW Lrl.J+—.—.-WMWr—r"a*op*m W VWW.r W-1-1V.wA- nESC=mA %-mv OP drm'IVI'I"l (v.g. dLv+tira 8il=AZZ, COmmcre':LCL1' TcleVidion, chrmlag. 2Saga=6.ue' etc.) a Still Photo Shootinr for CD Cover L?►Tx (s) I= Tm gn (e l or MOVOM S�lf� f DS3oTd�riAPHY 4/14/2001 (Rain day: 4/15/2001); 10 am - 7 pm pA.4poaEA LOCATSONtSI of F3M&9=NQ/PUdTC43A0HY- attach addiLionRi dklcet, 1£ acer_ 8Kry. Beach at the end of Youngs St. or 67 -step -heath at the end of Sound Rd. xmm or ZVM ap Tia cHARou Ax !3r=z Ms. A&suko Satake Quirk HMMM OF PSRsoAqS AT Lo<►x=ani' (CAST a C23W TyCLVD=) : 10 kms' mm AAM Vxpli� or -:RXXC .'Zs AT L0QA=0x.' Sedan(1) . 1_5 Pass Van(1) , Mo torhome (1) zYFE aF s2mCIAI, 11QVxg7'2C3Srx; none AW E1P9d1 L UQ=R=C9=8 a none Return to . Southold Town Clerk Wothold Town Hall 53095 Main Road P. O. sox 1179 Southold, NY 11971 IaU L Lvvv.+-- - i:0 2 200 1 V 04 '01 TUE 15:54 FAX 516 765 6145 SOUTHOLD CLERK TOWN OF SOUTHOLD APPLICATION FOR FILMING/STILL PHOTOGRAPHY PLEA88 PRINT OR TYL'a APPLICATION DATE: 4/10/2001 PEM&= NO: NAX2 OF APPLICANT: Hiro Enterprises, Inc., Haruko Hashimoto XAxLZNa A=R.23112. 107 E. 31st St., 4th Floor New York, NY 10016 PRONE: BUMMSS (212)684-6868 HOME Nal= OF ORGANIZATION, CODOAdY1 Hiro Enterprises, Inc. MAIL= A=XX9S, the same as above. •.--A-:r.-.-----r. W 4 * **-A* 4. * 4*.•.....s.... i.. i... a... I: w............ DESCRIES T"X OF ACTIVITY (c.g. Notion Picture, Commercial, Seleviaion, Catalog, 'Magazine, etc.) : Still Photo Shooting for CD Cover DATES) AND TINE(S) OF PROPOSED rXLXZVG/PHOTOGRAPHY: 4/14/2001 (Rain day: 4,/15/2001); 10 am - 7 pm PROPOSED LOCATIONS) OF F=MING/PHOTOGRAPHY: attach additional aheet, it nece6sary. Beach at the end of Youngs St. or 67 -step -beach at -the end of Sound Rd. NAMR OF $ERSON IN CHARGE AT SITE. 11s. Atsuko Satake Quirk VMMER OF MEWS AT LOCATION (CAST & CREW INCLIIDED) : 10 NuMBsR AMID TYPE OF 4sx=cL8s AT LocATioN: Sedan(1), 15 Pas's Van(1), Motorhome(1) TYPE of SBECSAL EQQIPX MT: AHY SPECIAL UQVZ7ZK=T9: none none Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P. 0. Box 1179 Southold, NY 11971 �'•c 11 Aho�� lj 002 22 was ACORD CERTIFICPW OF LIABILITY INSUOkNCE TM DATE(MM/DDIYY) 10/04/2000 iNt-UKmATr01U- PRODUCER (212)227-8800 (212)571-2719 Haskell Brokerage Corp 111 John Street New York, NY 10038 THIS CEIRI It-IUA I h 15 IbbUt:U AS A19151=11 OF 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 Hiro Enterprises, Inc. 107 East 31st Street (4th Floor) New York, NY 10016 INSURER A: Travelers Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: MV V CRN\7GJ 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. LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY -660-543X6251 09/25/2000 09/25/2001 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Any one fire) $ 50,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 11000,000 A GENERAL AGGREGATE $ 2,000,000 GEN -L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC AUTOMOBILE LIABILITY -810-356KI36A 08/10/2000 08/10/2001 COMBINED SINGLE LIMIT ANY AUTO $ (Ea accident) 1,000,000 BODILY INJURY X ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ A BODILY INJURY X HIRED AUTOS X NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND -UB -354K7782 08/10/2000 08/10/2001 X I TORYLIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 100,000 A E.L. DISEASE - EA EMPLOYE4 $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER AMERA & AUDIO -660-543X6251 09/25/2000 09/25/2001 $1SO,000 LIMIT A QUIPMENT FLOATER ALL RISK - WITH THEFT $250 DEDUCTIBLE DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS LL OPERATIONS / ALL LOCATIONS USUAL TO A PRODUCTION COMPANY. ERTIFICATE HOLDER IS AN ADDITIONAL INSURED / LOSS PAYEE AS ITS INTEREST MAY APPEAR. !`CGTI Cif^ATC IJAI ACD ---""'"-"'"-••��•` /1vv111VK/1L IKJVRCV�IKJUKGK LCI ICK VAI\VGLL/111V1\ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Southold EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. urice Won 11/04 '01 WED 15:28 FAX -516 765 6145 r SOUTHOLD CLERK • INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMING/STILL 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. Signature Hirokazu Otsubo Printed mune President Title 4/11/2001 Date f� 002 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: 4/12/01 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 Hiro Enterprises, 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 APR.11.2001 6:25PM HIRO ENTERPRISES,INC. NO.994 P.1 H R • 2 HIRO ENTERPRISES. INC, A7� T NS SSiON 107 EAST 31ST STREET 4TH FLOOR NEW YORK, NY 10016 TEL; 212.684,6868 FAX: 212-684 6821 TO:?Ah 14� �.0�7 FROM: _ (y91�� OF: �� p(�'fj-t _ HIIRO ENTERPRISES, INC. TEL: FAX: E-MAIL: TEL: DATE: FAX: CA PAGES: RE: M 1�i(Y1� ['Tvt- 212-6846868 212.684-6821 hiroent@tiac.net (including this paper) ,�djan WRIA1 APR.11.2001 6:26PM HIRO ENTERPRISES,INC. N0.9e4 P.2 INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMING/STILL PHOTOGWHY PERMIT The Applicant shall indemnify and bold 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 defcnd the sane at h& own cost and expense_ In addition, the Applicant will name the Town as an additional insured on any applicable policies. r—~ 4/11/2001 Signature Date Hirokazu Otsubo Priiateci naanc President Title ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER sera d 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: Haruko Fax: 212-684-6821 From: Linda Cooper Dated: April 11, 2001 Number of Pages (including cover): 2 If total transmittal is not received, please call 765-1800. COMMENTS: Here is the Indemnification Agreement APR.11.2001 1:01PM HIRO ENTERPRISES,INC. H R F&Y TR NSNI SSTON • J.A NO.973 P.1 0 �2 HIRO ENTERPRISES, INC. 107 EAST 31 ST STREET 4TH FLOOR NEW YORK. NY 10016 TEL; 212,684.6868 FAX; 212.684,6821 FROM: 10 HIRO ENTERPRISES, INC. TEL: FAY: Da E-MAIL: TEL: � DATE: FAQ: f7 PAGES: P. E. S*y'kwwU-/ 212-684-6868 212-684.6821 hiroent@tiac,net U- 1/'100V (including this paper) 0 _ Zdo bciN e z5o 'ODA 1 �1P -C1j1111k -MV VhvYYaW�S ��ye LIM Z'�Av-- �eL6 Av- VAevwk— vv W- _ -10SWCVVV-e. c i cow; ACoRD 2eZoEm i ir—IC%110 %jr 1pic2iL..ITY INSURANCE 0.973 P.2T>cIINM,DWIY) 10/04/2000 PRODUCER (212)227-8800 (2171)1371-2 719 Haskell Brokerage Corp 111 ) o h n Street - New York, NY 10038 ONLY AND CONFERS N GHTS UPON THE CERTIFICATE q. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED Hiro Enterprises, Inc. 107 East 31sc Street (4th Floor) New York, NY 10016 INSURER A; Travelers Insurance CompahY INSURER 8: INSUPERC: INSURER 0: INSURER E: «*►-i m: r -1e1 W THE POLICIES OF INSURANCE LISTED BELOW IiAVE 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, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES PIR CANCELLED BEFORE THE TYPE OF INSURANCE POLICY NUMBER Gr'jATE (MNWDL rout, EAPIRAIRM DATE IMMlDpIYY) LIMITS BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO 015LIGATION OR LIABILITY GENERAL LIABILITY -660-543X6251 09/25/2000 09/25/2001 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Any one firs) S 50,000 7AAR X COMMERCIAL GENERAL LIAQILITY MED MP (Any one peraon) s 5,000 CLAIMS MADE Q OCCUR PERSONAL A ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PGR; PRODUCTS -COMP/OP AGO s POLICY F7PgOT m LOC AUTOMOBILE LIABILITY ANY AUTO -810-35GK136A 08/10/2000 08/10/2001 COMBINED SINGLE LIMIT $ (Ee ecddantl 1.000,000 BODILY INJURY (Per parson) $ X ALL OWNED AUTOS SCHEDULED AUTOS A X k HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per awc dant S PROPERTY DAMAGE S (P•r accident) GARAGE LIABILITY AUTO ONLY - IA ACCIDENT $ OTHER THAN EA ACC 5 ANY AUTO AUTO ONLY; AGO $ EXCESS LIABILITY EACH OCCURRENCE 8 OCCUR CLAIMS MADE AGGREGATE $ 4 DEDUCTIDLC S RETENTION ; $ WORKERS COMPENSATION AND -UB-354K7782 08/10/2000 08/10/2001 X I TORY LIMITS ER EMPLOYERS' LIABILITY 6.L EACH ACCIDENT S 100,000 A E.L. DISEASE -EI►EMPLOYE S 100.000 E.L. DISEASE - POLICY LIMIT S S00.000 A OTHER AMERA & AUDIO QUIPMENT FLOATER -660-543X6251 09/25/2000 09/25/2001 $150,000 LIMIT ALL RISK - WITH THEFT $250 DEDUCTIRLE DES RIPTION OF OP TIONSILOCATIONSrvEMICLEsIEXCLUs(ONS ADDED BY ENDOR EM N r L ROVISIONS LL OPERATIONS / ALL LOCATIONS USUAL TO A PRODUCTION COflPANY. ERTIFICATE HOLDER IS AN ADDITIONAL INSURED / LOSS PAYEE AS ITS INTEREST MAY APPEAR, CERTIFICATE HOLDER I I ADDITIONAL INSURED. INSURER LETTER CANCELLATION ... Wmjj4;3-a(rrzir) "'7rvrcnliury 1ya0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES PIR CANCELLED BEFORE THE Town of Southold EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRPREN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO 015LIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED SENTATIVE Maurice Won ... Wmjj4;3-a(rrzir) "'7rvrcnliury 1ya0 0 • DORIC DEPARTMENT TOWN Of cSOUTHOLD Telephone Emergency Dial 911 MEMORANDUM TO: Linda Cooper, Deputy Town Clerk FROM: Chief Carlisle E. Cochran, Jr. Zig DATE: April 11, 2001 RE: Application for Filming/Still Photography 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 April 10, 2001, by Hiro Enterprises, Inc., Haruko Hashimoto, be APPROVED. As per Section 44A.4, Traffic Control Fee, there is NO FEE recommended at this time. 41405 Routc 25 • P.O. Box 911 • Pcconic, N.Y. 11958 Administrative (631) 765-2600/2601 9 Fax (631) 765-2715 i ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL To: Chief Cochran From: Linda Cooper Dated: April 11, 2001 Number of Pages (including cover): 8 If total transmittal is not received, please call 765-1800. COMMENTS: Chief, Here is the application for the still photography that is to take place on Saturday (rain date Sunday). In accordance with the law, you have to determine if a fee would be required for traffic control. I have also faxed along a copy of the law. Hope to hear from you soon. Thank you. APR.10.2001 6'55PM HIRO ENTERPRISES,INC. H '' I R FAY TRANS SSION • V►�WIT 1sliop TEL: mo FAY: ( 6e 1Q FROM: Oa4o NO. 961 P.1 o HIRO ENTERPRISES, INC. 107 EAST 91ST STREET 4TH FLOOR NEW YORK. NY 10016 TEL: 212.684.6868 FAX! 212.684.6821 MRO ENTERPRISES, INC. TEL. 212-684-6868 FAY: 212.684-6821 E-MAIL: hiroent@tiac.n`et �d DATE_ 4 PAGES: (including this paper) k__ AfW011-1,017M 11161 L 10VAPR.10.200115 6:55PM S16HIRO ENTERPRISES, INC. MOLD CLERK NO. 961 P.2 9002 TOWN OF SO'UTHOLD APPLICATION FOR FjLMYIVG/STILL PHOTOGRAPHY PLEAaE PAZ= OR Typr!! ASPLXCATZON DAZTB: 4110'/2001 Bs1�t7 xn7 NXIOM OP APPLxcszva: Hiro Enterprises, Inc., Haruko Hashimoto 107 E. 31st St., 4th Floor- 7I�,i1ryx7O a�PDR�sA : _ New York, NY 10016 vxaN$: acan+zsss (212)684-6868 fic= WAAq OF ORGANIZATZON, cop0<vrnr, Hiro Enterprises', Inc. ' TM=Zgq the same as above. PRONXt -(212)694-6868 PAX: (21.2)684-6821 w��►i,wv��r��r r.+�Wiiy�NMW Lei►��.�.�.��ww*��.�w. �t��7Rw*�w.�.�w�+w� D$SCRZRA YYRg OF A�TSrIYTlt (q, g, �ekiaa 8iczt;rm, Co eYC1S7„ Te�evisiai►r ®Falag, Wa5am: ue, etc.) a Still Photo Sfiooting for CD Cover DATZ (S) zap (!31 OD pQoygB$D Szx.�cxaTQ f RxOTdGRAPXY 4/14/2001 (Rain day: 4/15/2001); 10 am - 7 pm PA.QPOSZD LOCATZCW(S) O8 additianetl gayaet, if neceggazy, Beach at the end of Youngs St, or 67 -step -beach at -the end of Sound Rd. xma or tzRzaig = eSAADA AT snz. MS. Agsuko Satake Quirk Asa. of PSR.Sa249 AT Lo[Awxox (Cas -Z a CRM INCLUDW) : 10 WMORR ?AM 'TTPA OF VzPl2CL$S AT LOCA7ZOLTs Sedan(1) . 1_5 Pas's Van(1) , Motorhome(1) 2YF8 OF SDECMA,L 8Q=142Wr; none ANY ®PECUL UQCZa-UMiTS a none Return to: Southold Town Clerk Sduthold Town Hall 53095 Main Road P. 0_ Box 1179 Southold, NY 11971 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER e4 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: Haruko Fax: 212-684-6821 From: Linda Cooper Dated: April 10, 2001 Number of Pages (including cover): 2 If total transmittal is not received, please call 765-1800. COMMENTS: Here is the application for filming in Southold Town. Like I said, if you have questions just give me a call after 8:00am tomorrow. As soon as I get the information from the police I will contact you. 9.2001 1:20PM HIRO ENTERPRISES,INC. NO.950 P.1 R 0 HIRO ENTERPRISES, INC. FAX TRANSMISSION SIVI SSION 107 EAST 31ST STREET ATN FLOOR NEW YORK, NY 10016 /9/2001 TEL: 212.684,6868 FAX: 212.68A.6821 To: Ms, Linda Cooper From; Haruko Hashimoto Town of Southold Hlro Enterprises. Inc, t: (631)765-1800 t: (212)684-6868 f: (631)765-6145 f: (212)684-6821 Re; Still Photo Shooting Permission Page#: 2 (including this page) Dear Ms. Cooper, Thank you very much for your kind asslstance. As I mentioned, we would like to apply for photographing permission from town of Southold. Detail of our plan Is as follow, Date: Saturday, April 14, 2001 (In case of rain, we would like to do this on April 15, Instead,) Time: 10 am - 7 pm Location: Small Beach near Candyman. (* The beach we would like to use seems to be different from beach with 67 steps at the end of Sound Rd, ) Do you appen to know the beach we are talking here? It is a small beach. The way to reach to It is „, you go 25 (Sound Ave) from Greenport to Orient polnt turn left at Candvman,_ o straight until the end of the road where there are steps to go down the beach. Please note that there Is an another beach with trees near Candvman, but that Is not the b ch we woul like to use,. Format; Still Photography Cast & Crew: 10 people Memo; We will probably use the following types of vehicles for our production, Sedan (xl ) 15 -passenger van (xl ) Motorhome (xl ) That will be all as for now. �R. 9.2001 1:20PM HIRO ENTERPRISES,INC. NO.950 P.2 Please let me know whether the beach we would like to use really belongs to town of Southold, or not, As for your application form, please fax us at (212)684-6821. Thank you very much for your time and cooperation, I am looking forward to hearing from you soon, Sincerely, fV Vii&' 57�04 Haruko Hashimoto Hiro Enterprises, Inc, i 43 44 45 Rocky Pi RD y L � s 1 J� 1 S Q U N 1 D 1 1 E ISLANOS'EI T 601f m OUND STIR I N G COUNTRY .17det.P1 � o clue`s �ti ti JSp 2 =�a INl TPoNO RDZ T 7 \ TTN L a 5 48 46 INLF HDM 1 gyp" 9'�d oR y O co •` +r BENNET�T Z_ e KNAPP� F ST/RLt Gq Po 9 N CEM. p \ Brl� gH LA I AAA 2 P 1 A 1 O �,0a1 S r c E N!N T N OLL N T . 'v, CfM.I1'�SNO - P \ 9�S CZZ P 9 O 1 B £AS�LT' ` ' T.A6NE5 ° -1 d°_ N�61� 119 sLt7761 CT BROAD 57 1 1 N = y 2• x 'n'� XCANORTH L � OD� R4q, C \ K.,r i 1. [.. $L E� TRA/LER 2y�-N-11 RTH 5T= m . RY OCA PARK �%• �jr iS��IN r I110 WEST MTIRV'gfvvYyT/AC"'ER uST, M R�0E T A oun.gsPt NPL T®PCJ ��'�aNY � r fd Q SOUTH BAY AV `RDS°"Q OqN ST ® 0�° M GREENPORT f V 6 m 0. 1! ` aeyO� FRONT C7Q Q sr of \` 25 iLrdN 25 L.H. fl Nd LINT Chinesey oft, OR p P8 d,TW i C 6 I A. DY i I,•I � � CEM. LA n d g 11971 p,� ` Ro PIPES COVE � in.g Pt .•�a ��y h E T R 7C'L� N�aQ µr✓irr��``?, Am? 1 i ng Ft pt S ;:,:.. a ern. � ... _.. • YJ1' .AA .�,.. i f E a 193 P EAST ARION PSS n ----------------- as XEAST MARION Bf4Cy ORl£RT PABX P"� / 1 47 Terry Pt I r r 1 vCEM� �� Mrvue C14lv0Vm+A1 O R I E N T H A R 0 O R Cleves Pt SOUTHOLD N ° -s-- - SHELTER ISLA%�\, a / \ wf Hay Beac R W W W F 1 Ur u DI v Z P` % Long Be ch Pt. 0 o Cornelius P PZ 6A RD! IERS pO�Ni 0 RA DERING cou" v f�"•`°Fh ! ARB6R ccue \ /2 ORIF as. enf Y.C. \+N,.f cen. Peters Neck Pt d 4�<Z5 e ASN LONG � C ST ti Eagle Pt C ✓ C r Browns Pt :�:�OR/ENT E § 65-2 PARKING AT BEACHES § 65-2 Southold (east of Goose Creek Bridge), known as and referred to herein as "Goose Creek Beach." (6) Parking area located at the terminus of Mill Road, and both sides south on Mill Road to the intersection of Second Avenue, Peconic, known and referred to herein as "Goldsmith's Inlet Beach." [Amended 10-29-1996 by L.L. No. 19-19961 (7) Parking area adjacent to the bathing beach located at the terminus of First Street, Peconic Bay, New Suffolk, known as and referred to herein as "New Suffolk Beach." B. The following road end areas are hereby designated as Town of Southold "Parking by Southold Town Permit Only" areas: (1) Harbor River Road, Orient Harbor, Orient, along both sides from the terminus north to intersection with Skippers Lane. (2) Lands End Road, Orient, along both sides from the - terminus southerly for a distance of three hundred twenty-five (325) feet. [Added 6-11-1996 by L.L. No. 11-199611 1) Youngs Street, Long Island Sound, Orient, from the guardrail at the terminus south for a distance of five hundred (500) feet. (3) Aquaview Road from Rocky Point Road, Long Island Sound, East Marion, east for a distance of five hundred (500) feet, and Rocky Point Road from the terminus south for a distance of five hundred (500) feet. (4) East Gillette Drive, Orient Harbor, East Marion, from the terminus north to Cleves Point Road a distance of one hundred (100) feet. 1 Editor's Note: With the addition of L.L. No. 11-1996, former Subsection B(2) was renumbered as Subsection B(2.1) by the editor to maintain sequential numbering. 6503 11-25-96 § 65-2 SOUTHOLD CODE § 65-2 (5) Shipyard Lane, Orient Harbor, East Marion, along both sides from the terminus north for a distance of one hundred sixty (160) feet. (6) Island View Lane, Shelter Island Sound, Greenport, along both sides from the terminus west to intersection of Bayview. (7) Silvermere Road, Pipe's Cove, Greenport, along both sides of the parking area adjacent to the terminus. ((8) Sound Drive East, also known as "67 Steps," Long Island Sound, Greenport, from the guardrail at the terminus south for a distance of five hundred (500) feet. (9) Sound Drive, Long Island Sound, Greenport, both sides, between Sound Drive East and Sunset Lane. (10) Bay Home Road, Southold Bay, Southold, along both sides from the terminus north for a distance of three hundred (300) feet. (11) Bayview Avenue North, Hashamomuck Pond, Southold, along both sides from the terminus east for a distance of one hundred forty (140) feet. (12) Cedar Avenue, Goose Creek, Southold, along both sides from the terminus south to Oak Avenue. (13) Gilbert Street, Jockey Creek, Southold, along both sides from the terminus north to Jockey Creek Drive. (14) Glenn Road, Goose Creek, Southold, along both sides from the terminus north for a distance of two hundred (200) feet. (15) Kenney Road, Long Island Sound, Southold, west side only, from the terminus south to intersection of Lake Drive. 6504 11-25-96