The URL can be used to link to this page

Home My WebLink AboutS3 Creative LLC ® FO`/-�®G ELIZABETH A.NEVILLE,MMC ��. y Town Hall,53095 Main Road TOWN CLERKc P.O.Box 1179 CA Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ® Fax(631)765-6145 MARRIAGE OFFICER ®� �a®�' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT Issued to: S 3 Creative, LLC Date(s), Time(s) and Location: 7/22/17 9:00 am—7:00 pm Rocky Point Road Beach,East Marion Permit No. 52 Issue Date: 7/20/17 Elizabeth A.Neville Southold Town Clerk (Town Seal) RECEIVE® JUL 1 8 2017 �oso� oc�-�o Southold Town Clerk ELIZABETH A.NEVILLE,MMC ar® l/y lbwn Hall,53095 Main Road TOWN CLERK p PO.Box 1179 H Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O ® Fax(631)765-6145 MARRIAGE OFFICER '�� Q' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www southoldtownny gov FREEDOM OF INFORMATION OFFICER j E OFFICE OF THE TOWN CLERK I TOWN OF SOUTHOLD APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT NO: Please Print or Type APPLICATION DATE: 07-17-2017 NAME OF APPLICANT: Siobhan Roso MAILING ADDRESS: 49N 8th St unit 5C,Brooklyn,NY 11249 PHONE:BUSINESS: 929-435-6344 HOME: 9294654646 NAME OF ORGANIZATION/COMPANY: S3 Creative,LLC MAILING ADDRESS: 337 Kent,Apt 11,Brooklyn,NY 11249 1 PHONE: 929-435-6344 FAX: N/A DESCRIBE TYPE OF ACTIVITY(e.g.Motion Picture,Commercial,Television. Catalog,Magazine,etc.): Magazine Editorial Photo Shoot DATE(S)AND TIME(S)OF PROPOSED FILMING/PHOTOGRAPHY: I ' July 22,2017 9 am-7 pm PROPOSED LOCATION(S)OF FILMING/PHOTOGRAPHY: (attach additional sheet,if necessary) l ROCKY POINT BEACH- 5502-5798 Rocky Point Rd @ Aquaview Ave East Marion,NY 11939 NAME OF PERSON IN CHARGE AT SITE: Matthew Easton NUMBER OF PERSONS AT LOCATION(cast&crew included): 10-15 people NUMBER AND TYPE OF VECHILES AT LOCATION:3 vehicles-15 person van,ford transit 250 cargo van,bmw suv TYPE OF SPECIAL EQUIPMENT: 2 battery pack flash lights,one 12 foot frame to keep sun off model,one camera tripod ANY SPECIAL REQUIREMENTS: not to my knowledge I r Signature Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P.O.Box 1179 Southold,NY 11971 i 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 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 I any applicable policies. i 07/07/17 S' re Date Siobhan Roso Printed name I, CEO I Title I Vendor No. —� Check No: Town of Southold, New York - Payment Voucher Vendor Name Vendor Address Entered by t IV FHJC`C'Q un"ti5c_ _ .Audit 1?�te . Vendor Telepl one Number ( � (� qaq U.. S "' �`"l r �� ` Town-Clerk.' Vendor Conti t 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 250.00 250.00 Deposit Refund T1.00 i i I • Total i 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 ment is approved. Sign ATitl Si atu e Y_1 Company Name Date $ Tit Date Southold Town Board - Letter Board Meeting of August 1, 2017 �urra�i�- `°s RESOLUTION 2017-673 Item # 5.18 ADOPTED DOC ID: 13257 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2017-673 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON AUGUST 1, 2017: WHEREAS the following groups have supplied the Town of Southold with a refundable Clean- up Deposit fee, 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 the deposit made to the following Name Date Received Amount of Deposit North Fork Country Club 4/27/17 $250.00 PO Box 725 Cutchogue,NY 11935 Siobhan Roso 7/20/17 $250.00 49N 8th Street, Unit 5C Brooklyn,NY 11249 Blush Group New York, LLC 7/12/17 $500.00 1385 Seabury Avenue Bronx, NY 11354 all, 67 Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Robert Ghosio, Councilman SECONDER:William P. Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Russell ABSENT: Louisa P. Evans Generated August 2, 2017 Page 27 Rudder, Lynda From: Flatley, Martin Sent: Friday,July 28, 2017 12:29 PM To: Rudder, Lynda Subject: Re: clean up Yes Sent from my Verizon, Samsung Galaxy smartphone -------- Original message -------- From: "Rudder, Lynda" <lynda.rudder@town.southold.n y�us> Date: 7/28/17 8:27 AM (GMT-05:00) To: "Flatley, Martin" <mflatley@town.southold.ny.us>, "Blasko, Regina" <rblaskoatown.southold.ny.us> Subject: cleanup Can the following be returned: 2 filming permits both at Rocky Point road North Fork Country Club 4� //W R� 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 ®��FEO(q ELIZABETH A.NEVILLE,MMC may® l/� Town Hall,53095 Main Road TOWN CLERK o :� P.O.Box 1179 N Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p Fax(631)765-6145 MARRIAGE OFFICER �� ®�' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE `]SOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT I of 4 DATE: July 22, 2017 TIME: 9:00 AM — 7:00 PM LOCATION: Beach at end of Rocky Point Road, East Marion Filming/Still Photography Permit # 52 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: July 20, 2017 ELIZABETH A. NEVILLE,MMC hyo l/y Town Hall,53095 Main Road TOWN CLERK o P.O.Box 1179 CA Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS • Fax(631)765-6145 MARRIAGE OFFICERy�01 ��®! Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT 2 of 4 DATE: July 22, 2017 TIME: 9:00 AM — 7:00 PM LOCATION: Beach at end of Rocky Point Road, East Marion Filming/Still Photography Permit # 52 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: July 20, 2017 gjjFFO4�o ELIZABETH A.NEVILLE,MMC �y� �y Town Hall,53095 Main Road TOWN CLERKc P.O. Box 1179 CA a Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ` .� Fax(631)765-6145 MARRIAGE OFFICERO1 ��! Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT 3 of 4 DATE: July 22, 2017 TIME: 9:00 AM — 7:00 PM LOCATION: Beach at end of Rocky Point Road, East Marion Filming/Still Photography Permit # 52 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: July 20, 2017 00i1FF0��-�O ELIZABETH A. NEVILLE,MMC �y0 �/y Town Hall,53095 Main Road TOWN CLERKo '-� P.O. Box 1179 vs = Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 96 • . Fax(631)765-6145 MARRIAGE OFFICER y� ate! Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT 4 of 4 DATE: July 22, 2017 TIME: 9:00 AM — 7:00 PM LOCATION: Beach at end of Rocky Point Road, East Marion Filming/Still Photography Permit # 52 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: July 20, 2017 Doroski, Bonnie From: Doroski, Bonnie Sent: Thursday, July 20, 2017 10:08 AM To: Siobhan Roso (siobhanroso@gmail.com) Subject: Emailing: film permit-52_20170720080401 Attachments: film permit-52_20170720080401.pdf Hi Siobhan, Here are the parking permits and the filming permit. Please make sure that you print the parking permits out on colored paper and that you have the filming permit available in case you are questioned. Good luck on your photo shoot! Regards, Bonnie Your message is ready to be sent with the following file or link attachments: film permit-52_20170720080401 Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 1 * * * RECEIPT * * * Date: 07/20/17 Receipt#: 226082 Quantity Transactions Reference Subtotal 1 Application Fee- Non-Refund 052 $100.00 3 Beach Permits 052. $30.00 1 Clean-Up Deposit 052cleanup $25000 1 Daily Filming Permit 052filmfee $100.00 Total Paid: $480.00 Notes: Payment Type Amount Paid By Credit Card-Ref# $480.00 S 3, Creative LLC Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: S 3, Creative LLC Siobhan Roso 49 N 8th Street Unit 5 C Brooklvn, NY 11249 Clerk ID: BONNIED Internal ID. 052filmfee ACC?RbP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 111.1 1 07/19/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME Hi$coX Inc. PHCNNo Ex (888)202-3007 AIC No 520 Madison Avenue ADDRESS 32nd Floor DDRcontact@hlscox.com New York,NY 10022 INSURERS AFFORDING COVERAGE NAIC# INSURER A• Hlscox Insurance Company Inc 10200 INSURED INSURER B Noir Productions INSURER C 337 Kent Ave Apt 11 INSURER D Brooklyn,NY 11249 INSURER E INSURER F• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 SUBR POLICY EFF POLICY EXP LIMITS LTR IN$D D POLICY NUMBER MMIDDIYYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO CLAIMS-MADE �OCCUR PREMISES(Ea occurrence) $ 50,000 X CGL is on BOP Form MED EXP(Any one person) $ 5,000 A Y UDC-1845054-BOP-16 10/31/2016 10/31/2017 PERSONAL&ADV INJURY s S/TEach Occ. GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT F—]LOCPRODUCTS-COMP/OPAGG $ SIT Gen.Agg. OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE I OR ANYPROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑ N/A (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AC ORD 101,Additional Remarks Schedule,maybe attached if more space is required) Town of Southold Suffolk County New York is an additional Insured,subject to policy terms and conditions CERTIFICATE HOLDER CANCELLATION Town of Southold Suffolk County New York SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Hall 53095 Main Rd POBOX 1179 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /{ @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Doroski, Bonnie From: Siobhan Roso <siobhanroso@gmail.com> Sent: Monday, July 17, 2017 4:58 PM To: Doroski, Bonnie Cc: Matt Easton Subject: Photoshoot Rocky Point Beach, July 22 Attachments: 1845054_BOP_ACORD25_1_1707171628C.pdf Hi Bonnie, How are you? Matt forward me your e-mail and I've filled out the application and got the COI from our insurance. I've attached the paperwork below. The location scout John mentioned there is a parking lot right on the beach we can park, so hopefully there will not be any need for traffic control. My only question is regarding the payment. Can you please let us know exactly how much we owe and if there is anyway to pay via creditcard or debit card on the phone? If certified check/cash is a requirement please let us and we can overnight a certified check tomorrow morning. Can you confirm this is the address of the Town Clerk to mail the certified check? Town Hall, 53095 Main Road P.O. Box 1179 Southold,New York 11971 Thanks so much and please let me know if I missed anything or you need anything else. xx Siobhan Roso +1 929-465-4646 www eastonandroso com c@siobhanroso 1 Doroski, Bonnie From: Flatley, Martin Sent: Tuesday,July 18, 2017 9:50 AM To: Doroski, Bonnie; Kruszeski, Frank; Duffy, Bill; Hagan, Damon Cc: Silleck, Mary; Blasko, Regina Subject: RE: Emailing: photo shoot_20170718074850 I have no objections to this permit being issued. Please have the vehicles display a Special Parking permit placard issued by the town for this location. Martin Flatley, Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Doroski, Bonnie Sent:Tuesday,July 18, 2017 8:52 AM To: Flatley, Martin<mflatlev@town.southold.nv.us>; Kruszeski, Frank<fkruszeski@town.southold.nv.us>; Duffy, Bill <billd@southoldtownnv.gov>; Hagan, Damon <damonh@southoldtownny.gov> Cc: Silleck, Mary<marys@southoldtownny.gov>; Blasko, Regina <rblasko@town.southold.nv.us> Subject: Emailing: photo shoot_20170718074850 Please review the attached request for a photo shoot at the end of Rocky Point Road,July 22, and let me know if there will be any additional fees involved (traffic control, etc). Thank you, Bonnie J. Doroski Deputy Town Clerk Your message is ready to be sent with the following file or link attachments: photo shoot_20170718074850 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. Doroski, Bonnie From: Duffy, Bill Sent: Wednesday,July 19, 2017 11:03 AM To: Doroski, Bonnie Subject: RE: Emailing: photo shoot_20170718074850 Town is not listed as additional insured. Once that is corrected, no objection William M. Duffy, Esq. Town Attorney Town of Southold Southold Town Annex 54375 Route 25 (Main Road) P.O. Box 1179 Southold, Nww York 11971-0959 Office: 631.765-1939 Fax: 631.765.6639 Email: bill.duffv@town.southold.nv.us ATTORNEY-CLIENT COMMUNICATION; ATTORNEY WORK PRODUCT; INTER/INTRA AGENCY COMMUNICATION; NOT SUBJECT TO FREEDOM OF INFORMATION LAW DISCLOSURE; DO NOT FORWARD WITHOUT PERMISSION Note: Service of legal documents is not permitted via electronic mail or fax. The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain information that is privileged, confidential and exempt from disclosure under applicable law. Unintended transmission shall not constitute a waiver of the attorney/client privilege or any other privilege. If the reader of this message is not the intended recipient,you are hereby notified that any review, retransmission, conversion to hard copy, copying, reproduction, circulation, publication, dissemination or other use of, or taking of any action, or omission to take action, in reliance upon this communication by persons or entities other than the intended recipient is strictly prohibited. If you have received this communication in error, please (i) notify us immediately by telephone at 631.765.1939, (ii) return the original message and all copies to us at the address above via the U.S. Postal Service, and (iii) delete the message and any material attached thereto from any computer, disk drive, diskette, or other storage device or media. -----Original Message----- From: Doroski, Bonnie Sent: Tuesday,July 18, 2017 8:52 AM To: Flatley, Martin; Kruszeski, Frank; Duffy, Bill; Hagan, Damon Cc: Silleck, Mary; Blasko, Regina Subject: Emailing: photo shoot_20170718074850 Please review the attached request for a photo shoot at the end of Rocky Point Road,July 22, and let me know if there will be any additional fees involved (traffic control, etc). Thank you, Bonnie J. Doroski Deputy Town Clerk 1