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HomeMy WebLinkAboutBiljana Starcevic-Parrish for G-III Apparel Group LTD 111 OFF `�� ELIZABETH A.NEVILLE,MMC ; �® ®may Town Hall,53095 Main Road TOWN CLERK ; P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ��� Fax(631)765-6145 MARRIAGE OFFICER = �• ti Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER OA . #0. www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT Issued to: Biljana Starcevic-Parrish for G-III Apparel Group LTD Date(s), Time(s) and Location: October 22, 2015 9:00 AM—7:00 PM Southold Town Beach Route 48, Southold Permit No. 045 Issue Date: 10/19/15 • Elizabeth A. Neville Southold Town Clerk (Town Seal) Vendor No. Check No: . Town of Southold, New York - Payment Voucher Vendor Name Vendor Address Entered by BUJ&Ala_ \54-0.3.12ev1e - rrIS S Is COL - -re � Audit DAte Vendor Telephone Number �y 311"1" aba l 1B 2rck 1 t\iy- l`' I ( �f3 ` — — Town Clerk Vendor Contact • Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number Special Event Clean-up t(1oI..S 250.00 250.00 Deposit Refund T1.030 • ® Skat+ I 0 la a, • • • •Total 250.00 • Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and sayment is approved. Sig4�V • . ��° Titl (`�`�'�-i— Signatu e f +/. - ✓:I�`i '411111111-110,_, 111-z Company Name Date (16)b• Tit: ��: �!'�.j': 1i!._3 Date 1ti U Southold Town Board - Letter Board Meeting of November 4, 2015 g°FODOC RESOLUTION 2015-898 ADOPTEDItem # 5.14 F ID: 11260 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2015-898 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NOVEMBER 4, 2015: WHEREAS the following groups have supplied the Town of Southold with a Clean-up Deposit fee in the amount of$250.00, for their events and _WHEREAS the Southold Town Police Chief, Martin Flatley, has informed the Town Clerk's office that this fee may be refunded, now therefor be it RESOLVED that Town Board of the Town of Southold hereby authorizes a refund be issued in the amount of$250.00 to the following: Name Date Received Mattituck-Cutchogue Cub Scout Pack 39 10/2/15 PO Box 774 Cutchogue, NY 11935 Bijana Starcevic-Parrish 10/19/15 315 Court Street, #2 Brooklyn,NY 11231 Cystic Fibrosis Foundation 4/24/15 6931 Arlington Road Bethesda, MD 20814 Mattituck Presbyterian Church 9/3/15 PO Box 1411 Mattituck,NY 11952 Cutchogue, New Suffolk Historical Council 9/4/15 Po Box 714 Cutchogue, NY 11935 ai.,244..(2q.,f,pia. Elizabeth A. Neville Southold Town Clerk Generated November 5, 2015 Page 19 * * * RECEIPT * * * Date: 10/19/15 Receipt#: 194130 Quantity Transactions Reference Subtotal 1 Application Fee- Non-Refund G-III Apparel Gro $100.00 1 Clean-Up Deposit G-III Apparel Grp $250.00 1 Daily Filming Permit G-III App Grp $100.00 Total Paid: $450.00 Notes: Payment Type Amount Paid By CK#113671643 $450.00 Starcevic-Parrish, Biljana Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Starcevic-Parrish, Biljana 315 Court Street#2 Brooklyn, NY 11231 Clerk ID: BONNIED internal ID G-iii App Grp Rudder, Lynda From: Flatley, Martin Sent: Thursday, October 29, 2015 12.18 PM To: Rudder, Lynda u pec : RE ctear pusits Other than all the beer bottles left behind by the Cub Scouts at the Cubmobile race,yes. Obviously just kidding,yes,they can all be returned. Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 ;NA From: Rudder, Lynda Sent:Thursday, October 29, 2015 8:59 AM To: Flatley, Martin<mflatlev@town.southold.ny.us>; Blasko, Regina <rblasko@town.southold.ny.us> Subject:clean up deposits Can the following be returned? Cubmobile Race Filming permit for 10/22 Cystic Fibrosis cycle for life Emerging Artisan Fair Matt Pres CNS Historical Car Show Lynda M Rudder Deputy Town Clerk Principal Account Clerk Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold,NY 11971 631/765-1800 ext 210 631/765-6145 1 ELIZABETH A.NEVILLE,MMC ii it 0Town Hall,53095 Main Road • TOWNCLERK k C ' Z P.O.Box 1179 k co ; Southold,New York 11971 1 REGISTRAR OF VITAL STATISTICSt. ',,,,4„,•-, ® 2 f....;- • .. . Fax Fax(631)765-6145 MARRIAGE OFFICER �'� ,„-a„, '. @ �w RECORDS MANAGEMENT OFFICER ®� di..+a 0,i Telephonevwhoa±. 765-1800 x65 18ggg�b FREEDOM OF INFORMATION OFFICER '--.. ,,,,,.�'' ' �,C81,�tU I. OFFICE OF THE TOWN CLERK OCT - 9 2015 TOWN OF SOUTHOLD APPLICATION FOR FILMING/STILL PHOTOGRAPauuRY Town Clerk PERMIT NO: Please Print or Type ) APPLICATION DATE: 10/6(2_015- NAME OF APPLICANT: 511100N , frrcQ,y(c— Pcwrs1'v MAILING ADDRESS: 3)s Co 'T Sir", 42 t Era d k y 4 i toy I1231 PHONE: BUSINESS: HOME: 3 1 Z. 9-9 IS I . . NAME OF ORGANIZATION/COMPANY: 1 — 1!fA-19*1-1) rit cro II MAILING ADDRESS: 2 9A/ V% AYftriAZ )OoT PHONE: 2,I 2• (103 .OS..0 FAX: 2I 2 .`,o3 .®t-c f * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * DESCRIBE TYPE OF ACTIVITY(e.g. Motion Picture, Commercial, Television. Catalog,.Magazine,etc.): ' 6, H . % 6 Co. Sp ri wt f (Simmer-rn plicito dao+ . DATE(S)AND TIME(S) OF PROP&SED FILMING/PHOTOGRAPHY: I4/02 /ZOic PROPOSED LOCATION(S)OF FILMING/PHOTOGRAPHY: (attach additional sheet, if necessary) TOWN BR_Cf NAME OF PERSON IN CHARGE AT SITE: 3111-61116/ Si-Vic/WIC- l?r rl ' NUMBER OF PERSONS AT LOCATION(cast& crew included): 71 TQ .C i NUMBER AND TYPE OF VECHILES AT LOCATION: 2 t or Es pacs yolks 13 3 John TYPE OF SPECIAL EQUIPMENT: Cl Q Q I l� ,r i 1 ifeller CLvr • ANY SPECIAL REQUIREMENTS: kJQ w ill par lc .1 v I vi % coy olA, 1✓C of h a fp ,ll chi (v lilt j • D----- Signature Return to: Southold Town Clerk Southold Town Hall * t1k 1 a f I 1-0 560+ I0/a! 1 Z6 I S 53095 Main Road P.O. Box 1179 OS IACIP 011"k Wf'I) ld- 64LII UA,J GfSGe. Southold,NY 11971 NO.5.e M cdi l itr rn th address a+ S 1 S Cth+- SIrw ' ►#z f%:)i ( , bl 1 I f1-3 t or QIIVul[ 1 bti f at'bzrrrr 5nrci;I-cowl 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. ivii it 5- egniflu re Date C2kri Printed name / 77/7C_ Title ROAR `"p:COMP, NV' Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 New York, October 14, 2015 To Whom It May Concern: Re:Town Beach Photo Shoot Permit Application I, Roark Dunn, the owner of NY based production company Roark&Company, herby confirm that G-III Apparel Group, LTD has hired me as the executive producer for their upcoming G.H. Bass&Co. photo shoot in Southold, October 20-22, 2015. Biljana Starcevic-Parrish is a freelance producer and has been hired by me to produce the shoot. Please feel free to contact me or Biljana should you have any further questions. B- t-Re•ards, .41410 Roark Dunn Owner, Roark&Company ROARK COMPANY 56 Beaver St, St 702 New York, NY 10004 t.917.733.3572 Rudder, Lynda From: Biljana Starcevic-Parrish <biljanaparrish@gmail.com> Sent: Friday, October 16, 2015 10:37 AM To: Rudder, Lynda Subject: Re: Filming Chris Gbur, who signed the form, works for G-III. He is the creative director On Oct 16, 2015, at 10:28 AM, Rudder, Lynda<lynda.rudder@town.southold.ny.us>wrote: Can you take care of this? From: Duffy, Bill Sent: Friday, October 16, 2015 10:10 AM To: Rudder, Lynda Subject: RE: Filming Hi Lynda, The Indemnification needs to be signed by someone from G-III as they are the one that is providing the insurance and everyone else is hired through them. The person who signs must be an officer of the company who has the authority to bind G-III. I am not sure who signed the latest indemnification or who that person works for. From: Rudder, Lynda Sent: Wednesday, October 14, 2015 3:51 PM To: Duffy, Bill; Kiely, Stephen; Silleck, Mary Subject: FW: Filming Importance: High Additional Information you requested for permit From: Biljana Starcevic-Parrish [mailto:biljanaparrish@gmail.com] Sent: Wednesday, October 14, 2015 3:33 PM To: Rudder, Lynda Subject: Re: Filming Hi Lynda, See attached and let me know if there's anything else you'd need from me. I will be traveling to Greenport on the 19th. Do you think it might be best to have the permit sent to the hotel in Greenport? I will be staying there during the shoot, until 10/23. Just don't want to miss getting it. Thanks! 1 Biljana On Oct 14, 2015, at 12:46 PM, Rudder, Lynda <lynda.rudder@town.southold.ny.us>wrote: If you could email or fax both to me that would be great. Biljana Starcevic-Parrish 347.282.7918 2 Doroski, Bonnie From: Biljana Starcevic-Parrish <biljanaparrish@gmail.com> Sent: Tuesday, October 13, 2015 2:47 PM To: Doroski, Bonnie Subject: Re: Hi Bonnie, I can confirm that we won't need any police presence for our shoot at Town Beach. Do you think the permit will be mailed to me this week? I am leaving for the shoot to North Fork on the 19th. Please let me know if you need anything else on my end. Thank you! Biljana On Oct 6, 2015, at 12:53 PM, Doroski, Bonnie <Bonnie.Doroski@town.southold.ny.us>wrote: Biljana, Actually,you can just make out one check, all the monies need to be deposited so separate checks are not required at this time. Bonnie From: Biljana Starcevic-Parrish [mailto:biljanaparrish@gmail.com] Sent: Tuesday, October 06, 2015 12:42 PM To: Doroski, Bonnie Subject: Re: Hi Bonnie, Just to make sure: do you need separate checks for the application fee and film fee, or can they be on one check? I know the cleaning fee is a separate check.. Thanks! Biljana On Oct 6, 2015, at 10:09 AM, Doroski, Bonnie <Bonnie.Doroski@town.southold.ny.us>wrote: Per your request, please find the filming permit application and related materials attached. 1 APPLICANT'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check. X Completed application X $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. I• Permit Fees(Prior to issuance of permit): XFilm Fee-$100 per day of each day covered by the permit Cleanup deposit: Separate 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. Beach Parking fee- $10 per vehicle,per day between May 1 and • September 30. ALL CHECKS MUST BE CERTIFIED NOTE: Additional fees for Cleanup and Traffic Control may be required at the direction of the Chief of Police and Superintendent of Highways { II I• 1 INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD r" 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 i 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. )0 /6/?DI Signature Date P 0) A A /� " GCVO 1 , Printer name • POOLk Tit e • 164690 ® DATE(MMIDDIYYYl7 A`� CERTIFICATE OF LIABILITY INSURANCE 10/62015' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Steve Julis NAME: Commercial Lines-(973),437-2300 PHONEFAX (A/c.No.Ext): 973-261-9066 (Am No):866-965-0591 Wells Fargo Insurance Services USA,Inc. E - MAIL Ess: BSU.NJ@wellsfargo.com 7 Giralda Farms,2nd Floor INSURER(S)AFFORDING COVERAGE NAIC# Madison,NJ 07940-1027 INSURER A: Liberty Insurance Corporation 42404 INSURED INSURER B: Liberty Mutual Insurance CO. 23043 G-III Apparel Group,LTD INSURER C: Attn:Mr.Mike Brady INSURER D: 512 Seventh Avenue INSURER E. New York NY 10018 INSURER F: COVERAGES CERTIFICATE NUMBER: 9655219 • REVISION NUMBER: See below THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP wLIMITS LTR INSD VD -POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY TB7 Z91 449715 015 07/012015 07/01/2016, DAMAGE TO EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000 X Blanket Add'I Insured where require MED EXP(Any one person) $ excluded X by written contract PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 - X POLICY JECT PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY AS2-Z91-449715-025 07/01/2015 07/01/2016 C(EaOMBINEDacadenfl SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ _ X HIRED AUTOS x, AUUT S ED (Per PERTYaccidentDAMAGE) $ $ B X UMBRELLA LIAB X OCCUR TH7-Z91-449715-045 07/01/2015 07/012016 EACH OCCURRENCE $ 26,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 25,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? n NIA (Mandatory in NH) EL DISEASE-BA EMPLOYEE $ - If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ Physical Damage AS7Z91449715025 • 07/01/2015 07/01/2016 $1,000 Camp Dad $1',000 Coil Ded I ' DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) With respect to the General Liability policy the"Town of Southhold"is Included as an additional insured subject to the terms and conditions of the policy CERTIFICATE HOLDER CANCELLATION Town of Southhold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 Route 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Southhold,NY 11971 AUTHORIZED REPRESENTATIVE 904,4L The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) Rudder, Lynda From: Flatley, Martin Sent: Tuesday, October 13, 2015 9:55 AM To: Rudder, Lynda Subject: RE:filming I have no objections to this shoot taking place. It is in an open,visible location, will they be controlling any spectators? I see they are not requesting any police assistance. Martin Flatley, Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 Original Message From: Rudder, Lynda Sent:Tuesday, October 13, 2015 9:43 AM To: Blasko, Regina <rblasko@town.southold.nv.us>; Flatley, Martin <mflatlev@town.southold.nv.us>; Kruszeski, Frank <fkruszeski@town.southold.nv.us>; Duffy, Bill <billd@southoldtownnv.gov>; Kiely, Stephen <stephen.kiely@town.southold.nv.us>; Silleck, Mary<marys@southoldtownnv.gov> Subject: filming Please approve/disapprove attached filming • 1 . CUSTOMER U$E,ONLY FROM.(PLEASE PRINT) PHONE(i I I 11111111111 1111111111111 ` �?i-� f� ll I J EL 039572145 US 30 Gd IAA- Vf62,1—� (�Q�t�v Skrcoic /iiii'ck' tap I Ny (1z, 1 a UNITED STATES PRIORITY POSTALSERVICE® * MAIL * TM PAYMENT BY ACCOUNT(if applicable): ���l i��� USPS®Corporate Acct ,o Federal Agency Acct No or Postal Service"Acct No DELIVERY OPTIONS(Customer Use Only) QRIGINY,?O$TAL��.< azM.,:T„,_vr•/ % r 0 SIGNATURE REQUIRED Note The mailer must check the'Signature Required”box if the mailer 1) 7 1-Day 102-Day ❑Military 0 DPO _ Requires the addressee's signature,OR 2)Purchases additional insurance,OR 3)Purchases COD service,OR 4) PC ZIP Code Scheduled Delivery Date Postage Purchases Return Receipt service If the box is not checked,the Postal Service will leave the Rem in the addressee's (MM/DD/YY) mail receptacle or other secure location without attempting to obtain the addressee's signature on delivery Delivery Options 0 No Saturday Delivery(delivered next business day) $ 0 Sunday/Holiday Delivery Required(additional fee,where available') Date Accepted(MM/DD/YY) Scheduled Delivery Time Insurance Fee COD Fee ❑1030 AM Delivery Required(additional fee,where available') 'Refer to USPS corn®or local Post Office"for availability 1=I 1030 AM CI 3 00 PM $ $ p ^ ❑12 NOON TO:(PLEASE PRINT) I_ /t 6 c �L U'0 �t��O ^ �o PHONE(�J�7crf Time Accepted ❑PM $130 AM Delivery Fee Return Receipt Fee Live Animal (((�� l�/�JY`nn// ID AM Transportation Fee V 0 4k0 I„u ¶0(My I Weight ❑Flat Rate Sunday/Holiday Premium Fee Total Postage&Fees $ 3 0 0 5 (HCIJ K) PO A Acceptance Employee Initials (/y� t��{��( A / lbs ozs $ E �n(Al� 1 Vv 'V , IDEL6vERN POSTAL SERVICE e fi< , ,yt ZIP+4®US ADDRESSES 0 V'1 d Delivery Attem ii Em loyee Signature I I `/ I _ PU6 f AM D PM �■ For icku or USPS Trackin Attempt(MM/DDM')Time Employee Signature pickup g'",visit USPS.com or call 800.222-1811 • $100.00 insurance included 1:1 AM ❑PM LABEL 11-B,JANUARY 2014 PSN 7690-02-000-9996 1-ORIGIN POST OFFICE COPY a ,..Ts . ._HOLD.DOCUMENTaUP-TO:THG,LIGHT TO.VIEW.TAUE WATERMARK.- 1:7''Ol'!. RECTAL .Cl1I3CK- j ' _ ;HOLD DOCUMENT_UP TO.THE LtGHT_TO_UIEW TRUE.WATERMARRK CI tib�nk° ' � _' �' 1136714.3 . Citibank,N.A. - :62•:26 _ FC# 00185 FA# 024 $10.00 ONL PIG' DATE 310/06/15 ' 311 '; 097-03 Ck, Ser. it ,'1 13671'643 „f „ , - PAY ****F.OUR' 'HUNDRED FIFTY DOLLARS****. - - ,, ' a ,.. ;- ' - , . ti, ,z.�n 1, _--.i To: `' *$450 :00* ;r „I .,:.:-?.;.,.. .,--,-. ,- ` . ;THE ** ? TOWN OF', SOUTHOLD ir- ; ORDER A J L!'' "i { NAMEbF, 1 ,-_REMITTER •\t - =DrawerG ,.A.‘--,--7,--?;;;;;;,--.---. ' ``, it B STARCEUIC-PARRISH. -.� i 'r.; y��, :;'; I ' iit” 'iiE %ADDRESS , . . }F .' l'- ,`• • }i,Cihtiank7N-A-One'Penn's`Way,, y ;BY �l /lam R --'rt `► Hrt� ,l I : New Castle;,DE 19720 � , ,� I ' AUTHORIZED IGNAIUR :`' -='-i'' "`I !`-- • aV n - .. "vlh,w'`. -.ti,��:-a . , ,r ., t ° - ty ii' LL367L643ii' 031L00209p: 38762924ii' ROJ RS ,''..CCM AN nr • Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 New York, October 14, 2015 To Whom it May Concern: Re:Town Beach Photo Shoot Permit Application I, Roark Dunn, the owner of NY based production company Roark&Company, herby confirm that G-111Apparel Group, LTD has hired me as the executive producer for their upcoming G.H. Bass&Co. photo shoot in Southold, October 20-22, 2015. Biljana Starcevic-Parrish is a freelance producer and has been hired by me to produce the shoot. Please feel free to contact me or Biljana should you have any further questions. B t- Bards, Roark Dunn Owner, Roark&Company ROARK-COi'v9PANY 56 Beaver St, St 702 New York, NY 10004 t.917.733.3572 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. Te• ID/ / Si-graft-nre Date %41-1 Printed name 4i 7/ /d 7%')/-(7 Title Rudder, Lynda From: Duffy, Bill Sent: Monday, October 19, 2015 1:39 PM To: Rudder, Lynda Subject: RE: Filming You can issue the permit. From: Rudder, Lynda Sent: Monday, October 19, 2015 1:14 PM To: Silleck, Mary; Duffy, Bill; Kiely, Stephen Subject: FW: Filming Importance: High New form attached From: Biljana Starcevic-Parrish [mailto:biljanaparrish©gmail.com] Sent: Monday, October 19, 2015 1:12 PM To: Rudder, Lynda Subject: Re: Filming Importance: High Hi Lynda, Can you please forward the attached indemnification form to Mr. Bill Duffy? It is now signed by Mike Brady, the VP and Corporate controller at G-III. Please let me know if there's anything else needed. Thank you! On Oct 19, 2015, at 10:50 AM, Rudder, Lynda<lynda.rudder@a town.southold.ny.us>wrote: Hi,Town Attorney would like you to give him a call please, 631/765-1939 Bill Duffy From: Biljana Starcevic-Parrish [mailto:biljanaparrish(a�gmail.com] Sent: Monday, October 19, 2015 9:17 AM To: Rudder, Lynda Subject: Re: Filming Ok, let me know if there's anything else I can do to push this through. Shoot is this Thursday.. Thanks! Biljana 1 On Oct 19, 2015, at 8:55 AM, Rudder, Lynda <lynda.rudder@town.southold.ny.us>wrote: Still waiting for an answer from TA From: Biljana Starcevic-Parrish [mailto:biljanaparrish@igmail.com] Sent: Friday, October 16, 2015 3:42 PM To: Rudder, Lynda Subject: Re: Filming Hi Lynda, Just checking in if you have any news? I hope there won't be any problem with the permit.. Let me know, thanks! Biljana On Oct 16, 2015, at 10:38 AM, Rudder, Lynda <lynda.rudder@town.southoid.ny.us> wrote: Ok will let TA know From: Biljana Starcevic-Parrish [mailto:biljanaparrish@ mail.com] Sent: Friday, October 16, 2015 10:37 AM To: Rudder, Lynda Subject: Re: Filming Chris Gbur, who signed the form, works for G-III. He is the creative director On Oct 16, 2015, at 10:28 AM, Rudder, Lynda <lynda.rudder@town.southold.ny.us> wrote: Can you take care of this? From: Duffy, Bill Sent: Friday, October 16, 2015 10:10 AM To: Rudder, Lynda Subject: RE: Filming Hi Lynda, The Indemnification needs to be signed by someone from G-III as they are the one that is providing the insurance and everyone else is hired through them. The 2 person who signs must be an officer of the company who has the authority to bind G-III. I am not sure who signed the latest indemnification or who that person works for. From: Rudder, Lynda Sent: Wednesday, October 14, 2015 3:51 PM To: Duffy, Bill; Kiely, Stephen; Silleck, Mary Subject: FW: Filming Importance: High Additional Information you requested for permit From: Biljana Starcevic-Parrish [mailto:biljanaparrishOgmail.com] Sent: Wednesday, October 14, 2015 3:33 PM To: Rudder, Lynda Subject: Re: Filming Hi Lynda, See attached and let me know if there's anything else you'd need from me. I will be traveling to Greenport on the 19th. Do you think it might be best to have the permit sent to the hotel in Greenport? I will be staying there during the shoot, until 10/23. Just don't want to miss getting it. Thanks! Biljana On Oct 14, 2015, at 12:46 PM, Rudder, Lynda <lynda.rudder@town.southold.ny.us > wrote: If you could email or fax both to me that would be great. Biljana Starcevic-Parrish 347.282.7918 Biljana Starcevic-Parrish 3 347.282.7918 Biljana Starcevic-Parrish 347.282.7918 Biljana Starcevic-Parrish 347.282.7918 4 Rudder, Lynda From: Duffy, Bill Sent: Monday, October 19, 2015 1:39 PM To: Rudder, Lynda Subject: RE: Filming You can issue the permit. From: Rudder, Lynda Sent: Monday, October 19, 2015 1:14 PM To: Silleck, Mary; Duffy, Bill; Kiely, Stephen Subject: FW: Filming Importance: High New form attached From: Biljana Starcevic-Parrish [mailto:biljanaparrish@gmail.com] Sent: Monday, October 19, 2015 1:12 PM To: Rudder, Lynda Subject: Re: Filming Importance: High Hi Lynda, Can you please forward the attached indemnification form to Mr. Bill Duffy? It is now signed by Mike Brady, the VP and Corporate controller at G-III. Please let me know if there's anything else needed. Thank you! On Oct 19, 2015, at 10:50 AM, Rudder, Lynda<lynda.rudder@town.southold.ny.us> wrote: Hi,Town Attorney would like you to give him a call please, 631/765-1939 Bill Duffy From: Biljana Starcevic-Parrish [mailto:biljanaparrish@gmail.com] Sent: Monday, October 19, 2015 9:17 AM To: Rudder, Lynda Subject: Re: Filming Ok, let me know if there's anything else I can do to push this through. Shoot is this Thursday.. Thanks! Biljana 1 On Oct 19, 2015, at 8:55 AM, Rudder, Lynda <Lynda.rudderna,town.southold.ny.us>wrote: Still waiting for an answer from TA From: Biljana Starcevic-Parrish [mailto:biljanaparrish@gmail.com] Sent: Friday, October 16, 2015 3:42 PM To: Rudder, Lynda Subject: Re: Filming Hi Lynda, Just checking in if you have any news? I hope there won't be any problem with the permit.. Let me know, thanks! • Biljana On Oct 16, 2015, at 10:38 AM, Rudder, Lynda <lynda.rudder@town.southold.ny.us> wrote: Ok will let TA know From: Biljana Starcevic-Parrish [mailto:biljanaparrish@gmail.com] Sent: Friday, October 16, 2015 10:37 AM To: Rudder, Lynda Subject: Re: Filming Chris Gbur, who signed the form, works for G-III. He is the creative director On Oct 16, 2015, at 10:28 AM, Rudder, Lynda <lynda.rudder@town.southold.ny.us>wrote: Can you take care of this? From: Duffy, Bill Sent: Friday, October 16, 2015 10:10 AM To: Rudder, Lynda Subject: RE: Filming Hi Lynda, The Indemnification needs to be signed by someone from G-III as they are the one that is providing the insurance and everyone else is hired through them. The 2 person who signs must be an officer of the company who has the authority to bind G-III. I am not sure who signed the latest indemnification or who that person works for. From: Rudder, Lynda Sent: Wednesday, October 14, 2015 3:51 PM To: Duffy, Bill; Kiely, Stephen; Silleck, Mary Subject: FW: Filming Importance: High Additional Information you requested for permit From: Biljana Starcevic-Parrish [mailto:biljanaparrish@gmail.com] Sent: Wednesday, October 14, 2015 3:33 PM To: Rudder, Lynda Subject: Re: Filming Hi Lynda, See attached and let me know if there's anything else you'd need from me. I will be traveling to Greenport on the 19th. Do you think it might be best to have the permit sent to the hotel in Greenport? I will be staying there during the shoot, until 10/23. Just don't want to miss getting it. Thanks! Biljana On Oct 14, 2015, at 12:46 PM, Rudder, Lynda <lynda.rudder@tovvn.southold.ny.us >wrote: If you could email or fax both to me that would be great. Biljana Starcevic-Parrish 347.282.7918 Biljana Starcevic-Parrish 3 347.282.7918 Biljana Starcevic-Parrish 347.282.7918 Biljana Starcevic-Parrish 347.282.7918 4 TOWN CLERK'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check Applicant: % in est- C.ev I C. r .S Date Received: 10 - S-- 1 S V Completed application $100 nonrefundable application fee Certificate of insurance that evidences a public liability insurance policy covering the town as an additional insured in the amount of$1,000,000 (one million dollars)per occurrence for the duration of the filming or still photography. Indemnification agreement stating the applicant agrees to assume all liability for and will indemnify and hold the town harmless of and free from any and all damages that occur to persons or property by reason of said filming or still photography. �✓ Forward completed application to Chief of Police for approval or disapproval and determination if Traffic Control Fee is required ✓ Approved Disapproved No Fee Required Fee in the amount of$ required f+ • Forward certificate of insurance and indemnification agreement to Town Attorney for approval Approved Disapproved COLLECT FEES AS FOLLOWS: Permit Fees (Prior to issuance of permit): ✓ Film Fee - $100 per day of each day covered by the permit Cleanup deposit: Separate certified check for$250 for each day covered by the permit. Traffic control fee - $1000 for each day covered by the permit if required by the Chief of Police. NOTE: Additional funds may be required by Police if it is determined that $1000 per day fee will be expended prior to the termination of the permit period. 0\ia- NIk Beach Parking fee - $10 per vehicle, per day between May 1 and September 30. ISSUED PERMIT Countersign application Issue permit with name of applicant, locations(s), date(s), and time(s) NOTIFICATION of ISSUED PERMIT Chief of Police I/ Chief Building Inspector IFire Marshal V Code Enforcement Officer V Superintendent of Highways V 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.