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HomeMy WebLinkAboutTracey Breese/The New School I ELIZABETH A.NEVILLE,MMC ��®� ® Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Cie Fax(631)765-6145 MARRIAGE OFFICER ,f. ®`. 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 Z PERMIT Issued to: Tracey Breese/The New School Date(s), Time(s) and Location: 11/18/17 5:OOAM-4:OOPM McCabes Beach, North Sea Drive Southold,NY Permit No. 054 Issue Date: 11/16/2'017 Elizabeth A. Neville Southold Town Clerk (Town Seal) t Vendor No. 'Clidck'No: Town of Southold,; New York - Payment Voucher Vendor Name Vendor Address Entered•by' r 0.� Y e eSC 12 Cen+ra_1 v Audit j)I te.• Vendor Telephone D U umb r(� r\ I 1 r "1 — '.1'� U �'e.2.Y1 ` L '1 ---- Town Clerk Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services Gexteral I ed dr Puitd•and Account Number Special Event Clean-up f� 250.00 250.00 Deposit Refund "TL030 Fz 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 payment is approved Signat e r Title �LJ1 )v . Cz Si atur Company Name Date 12 / / Title Date 1.Z a15— Southold Town Board - Letter Board Meeting of December 5, 2017 aurrntr RESOLUTION 2017-985 Item # 6.3 ADOPTED DOC ID: 13562 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2017-985 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON DECEMBER 5, 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 Tracey Breese 11/14/17 250.00 1343 Central Avenue Greenport,NY 11944 Mattituck Cutchogue Teachers Association 10/3/17 1500.00 c/o Ilana Finnegan 775 Farmveu Road Mattituck NY 11952 Michael McCaffery 9/19/17 1500.00 PO Box 245 Cutchogue, NY 11935 Southold Athletic Association 9/19/17 1500.00 c/o Peter Salerno 420 Oaklawn Avenue Southold, NY 11971 Elizabeth A. Neville Southold Town Clerk Generated December 7, 2017 Page 11 Southold Town Board - Letter Board Meeting of December 5, 2017 RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER:William P. Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Russell ABSENT: Louisa P. Evans Generated December 7, 2017 Page 12 adder, Lynda From: Flatley, Martin Sent: Monday, November 27, 2017 1:17 PM To: Rudder, Lynda Subject: RE: Clean up deposits They certainly can Martin Flatley, Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 From: Rudder, Lynda Sent: Monday, November 27, 2017 12:39 PM To: Flatley, Martin <mflatley town.southold ny us>; Blasko, Regina <rblaskoCa�town.southold.nv.us> Subject: Clean up deposits Can the following be returned? Mattituck Cutchogue Teachers Assoc.Turkey Trot Drew McCaffery Memorial 7K Southold Athletic Assoc 5K Filming permit for McCabes 4,� //y/. Rz� Lynda M Rudder Deputy Town Clerk Principal Account Clerk Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold,NY 11971 6_31/765-1800 ext 210 I 1 RECEIPT Date: 11/14/17 Receipt#: 229655 Quantity Transactions Reference Subtotal 1 Application Fee- Non-Refund 11.18.17 $100.00 1 Clean-Up Deposit 11 18.17cleanup $250.00 1 Daily Filming Permit 11.18.17filming fe $100.00 Total Paid: $450.00 Notes: Payment Type Amount Paid By CK#122.123.125 $450.00 Breese, Tracey Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Breese, Tracey 1343 Central Avenue Greenport, NY 11944 Clerk ID: BONNIED Internal ID: 11 18 17filming fee ELIZABETH A.NEVILLE,MMC � Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 COD Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER �'� ®�' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www southc yJ;4 FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK NOV - 6 2017 j TOWN OF SOUTHOLD APPLICATION FOR FILMING/STILL PHOTOGRAPthold Town Clerk PERMIT NO: Please Print or Type /17 APPLICATION DATE: NAME OF APPLICANT: MAILING ADDRESS: f c PHONE: BUSINESS: `G�- "'�i4� HOME: NAME OF ORGANIZATION /COMPANY: Tv d,1ei MAILING ADDRESS: 5m . A INJ PHONE: Z- - �j 60 _ FAX: DESCRIBE TYPE OF ACTIVITY(e.g. Motion Picture, Commercial, Television, Catalog, Magazine, etc.): %v,,rA�vt� <aW AWL,, DATE(S) AND TIME(S) OF PROPOSED FILMING/PHOTOGRAPHY: W 6 v�m l"6' (qa� ` e "A PROPOSED LOCATION(S) OF FILMING/PHOTOGRAPHY: (attach additional sheet, if necessary) NAME OF PERSON IN CHARGE AT SITE: Tc-a- NUMBER OF PERSONS AT LOCATION(cast & crew inclu d): 5 NUMBER AND TYPE OF VECHILES AT LOCATION: I vm TYPE OF SPECIAL EQUIPMENT: , ANY SPECIAL REQUIREMENTS: avvp,- . i Signature Return to: Southold Town Clerk Southold Town Hall 53095 Main Road r P.O. Box 1179 Southold, NY 11971 DATE(MMIDD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 11/9/2017 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(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 NAME: Carmel Kretchmer Arthur J Gallagher Risk Management Services, Inc. PHONE 973-939-3631 FAX 973-299-1864 200 Jefferson Park E-MAIL @ �g Whippany NJ 07981 .Carmel_kretchmer a com INSURERS AFFORDING COVERAGE NAIC# INSURERA:United Educators Ins 10020 INSURED NEWSCHO-01 INSURERS. The New School INSURER C: Attn Mr Howard Bressler 80 Fifth Ave, Suite 800 INSURER D: New York NY 10011 1 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:2122916991 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 INSURANCEADDLISUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CGL201700337800 4/1/2017 4/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE ❑X OCCUR PREMISES Ea occurrence $1,000,000 X Al CGL 06-2008 MED EXP(Any one person) $5,000 PERSONAL BADV INJURY $INCLUDED GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $3,000,000 X POLICY F1 PRO JECT 71LOC PRODUCTS-COMP/OPAGG $1,000,000 OTHER $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY(Per person) $ AUTOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED F RETENTION$ $ WORKERS COMPENSATION PER ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Student Tracey Breese shooting, "Two women meet on the beach in search of a lost ring". Location: McCabe's Beach, Southold, NY Shooting date. November 18, 2017.Additional insured Town of Southold CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 Route 25,P 0 BOX ACCORDANCE WITH THE POLICY PROVISIONS, 1179 Southold NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I Doroski, Bonnie From: Flatley, Martin Sent: Thursday, November 16, 2017 1:25 PM To: Doroski, Bonnie; Blasko, Regina; Kruszeski, Frank; Norklun, Stacey;Town Att Cc: Rudder, Lynda Subject: RE: Emailing:film permit-11_20171116084529 I have no objections to this permit being approved. I see no expenses for the PD and there are no parking restrictions at this site at this time of the year. Martin Flatley, Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-7615-3115 i -----Original Message----- From: Doroski, Bonnie Sent:Thursday, November 16, 2017 8:53 AM To: Blasko; Regina <rblasko@town.southold.nv.us>; Flatley, Martin <mflatlev@town.southold.ny.us>; Kruszeski, Frank <fkruszeski@town.southold.nv.us>; Norklun,Stacey<Stacey.Norklun @town.southold.ny.us>;Town Att Cc: Rudder, Lynda <Iynda.rudder@town.southold.nv.us> Subject: Emailing:film permit-11_20171116084529 Importance: High Please review the attached filming permit request from Tracey Breese. Her request is for this Saturday 11/18/17 at McCabe's beach in Southold. If there are any comments or concerns, please notify this office. Thank you, Bonnie J. Doroski Your message is ready to be sent with the following file or link attachments: film permit-11_20171116084529 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. I 1 Doroski, Bonnie From: Duffy, Bill Sent: Friday, November 17, 2017 12:47 PM To: Doroski, Bonnie Subject: RE: Filming permit Ind.Agree. It is not ideal, but it will do. Ask them if they can provide a letter on the school's letterhead stating that he is authorized to sign the indemnification on behalf of the school. But if they can't it is okay to issue the permit. 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.ny.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. From: Doroski, Bonnie Sent: Thursday, November 16, 2017 2:17 PM To: Duffy, Bill Subject: Filming permit Ind. Agree. Will this work? 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 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. 444, 11/16/2017 Signature Date Howard Bessler I Printed name Director of Real Estate Title 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. i ol7 Signature Date k Printed name E Am- 0 o C C'.I/ � Title i