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HomeMy WebLinkAboutBlow the Man Down/Rocky Point Beach ELIZABETH A.NEVILLE,MMC o00�11FEOL�`�� Town Hall,53095 Main Road TOWN CLERK �� y� P.O.Box 1179 Southold,New York 11971 ce REGISTRAR OF VITAL STATISTICS ® Fax(631)765-6145 MARRIAGE OFFICER ,y off. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD INVOICE Blow the Man Down Easter Cove LLC c/o Secret Engine 49 8th Avenue, Ground Floor New York, NY 10014 Pricing for filming on August 22, 23 and 24, 2018, Rocky Point Road in Greenport $ 100.00 Filming Permit Application(non-refundable) 300.00 Filming Fee ($100 per day) 750.00 Clean-up Fee ($250 per day) 90.00 Parking Permit (3 vehicles @ $10.00 ea/day) $ 1,240.00 TOTAL DUE (before permit can be issued) Vendor No. Check No. Town of Southold, New York - Payment Voucher Vendor Name Vendor Address Entered by .—Eas+ev- roQe- L LC- _��_ ��e,- \��hVe_-- - Audit Date Vendor Telephone Number (l`'A- L� P a LI O(a S u'` a a� Town Clerk Ve dor Contact ------- - ------------ ------ - ---- - -- - -- PV 06 dQr Sc�n�r�rn flY) Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 00 TWO Uea-yl,uz Aucoo -(' 1 . c) Total 1159.00 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 ayment is approved Sign&4 -4ULL Title �C.� L Si natu Cl G � �/ Company Name Date _l ��3 '� D Title-yi4�Jt� Date 3"1 O Town of Southold P O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 08/20/18 Receipt#: 247595 Quantity Transactions Reference Subtotal 1 Application Fee- Non-Refund 57 $100.00 3 Clean-Up Deposit 57b $750.00 3 Daily Filming Permit 57c $300.00 9 Beach Permits 57a $90.00 Total Paid: $1,240.00 Notes: Payment Type Amount Paid By CK#1062 $1,240.00 Easter, Cove Llc Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Easter, Cove Llc 2711 N Haskell Ave, Ste 2800 Dallas, TX 75204-2940 Clerk ID: LYNDAR Internal ID 57 �VFF®L� ELIZABETH A.NE ILLE,MMC ® ®��� Town Hall,53095 Main Road TOWN CLE P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER ,� ®�. Telephone(631)765-1800, RECORDS MANAGEMENT OFFICER ® �,`8 www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT of 5 Blow the Man Down — Easter Cove LLC DATE: , August 22, 2018 August 23, 2018 August 24, 2018 TIME: 2:00 PM — 8:30 PM LOCATION: Rocky Point Road Beach, East Marion Filming/Still Photography Permit # 057 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: August 16, 2018 �SgRat� ELIZABETH A.NEVILLE, MMC ® ��� Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 CIO REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER ,� ®d. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ®� �a www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING/STILL- PHOTOGRAPHY PERMIT Issued to: Blow the Man Down—Easter Cove LLC Date(s),Time(s) and Location: 8/22/18 4: dim pm Rocky Point Road Beach, East Marion 8/23/18 4:3 in—,S-Wpm Rocky Point Road Beach,East Marion 8/24/18 in—8:00 pm Rocky Point Road Beach, East Marion Permit No. 57 Issue Date: 8/16/18 Elizabeth A..Neville Southold Town Clerk (Town Seal) ELIZABETH A. NEVILLE, MMCs Town Hall,53095 Main Road TOWN CLERK �� P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 9 Fax(631)765-6145 MARRIAGE OFFICER ,!, ��. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT of 5 Blow the Man Down — Easter Cove LLC DATE: August 22, 2018 August 23, 2018 August 24, 2018 TIME: 4:30 PM — 8:00 PM LOCATION: Rocky Point Road Beach, East Marion Filming/Still Photography Permit # 057 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: August 16, 2018 �Og�1FFOL��O ELIZABETH A. NEVILLE,MMC ® G� Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS coo Fax(631)765-6145 MARRIAGE OFFICER ,y. ��. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ��j �`1 www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT of 5 Blow the Man Down — Easter Cove LLC DATE: August 22, 2018 August 23, 2018 August 24, 2018 TIME: 4:30 PM — 8:00 PM LOCATION: Rocky Point Road Beach, East Marion Filming/Still Photography Permit # 057 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: August 16, 2018 ELIZABETH A.NEVILLE, MMC o�®S�Ff�c�COG Town Hall,53095 Main Road TOWN CLERK �� �� P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS C.0 Fax(631)765-6145 MARRIAGE OFFICER ,y ��. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT Aof 5 Blow the Man Down — Easter Cove LLC DATE: August 22, 2018 August 23, 2018 August 24, 2018 TIME: 4:30 PM — 8:00 PM LOCATION: Rocky Point Road Beach, East Marion Filming/Still Photography Permit # 057 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: August 16, 2018 i ELIZABETH A. NEVILLE,MMC O`Og11fFOL�►`,oG Town Hall,53095 Main Road TOWN CLERK �� y� P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS � Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �0,� �`� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT !A of 5 Blow the Man Down — Easter Cove LLC DATE: August 22, 2018 August 23, 2018 August 24, 2018 TIME: 4:30 PM — 8:00 PM LOCATION: Rocky Point Road Beach, East Marion Filming/Still Photography Permit # 057 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: August 16, 2018 �oguFFOe,�co ELIZABETH A.NEVILLE,MMC ay0 fid Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS f Fax(631)765-6145 MARRIAGE OFFICER ,fr ®�. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �o,( �`� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT of 5 Blow the Man Down — Easter Cove LLC DATE: August 22, 2018 August 23, 2018 August 24, 2018 TIME: 4:30 PM — 8:00 PM LOCATION: Rocky Point Road Beach, East Marion Filming/Still Photography Permit # 057 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: August 16, 2018 FROM:(®(PLEASE Town Clerk 3)1 765-1800 I-I�II�II IIIIII IIS IIIII��IIi IIID I�II�IIIII II��I IIIII II��I I��I������I�I�I��I r J Town of Southold EK 202962378 US � J PO Box 1179 5305N,; MaorRoad So `SldavV11971` PRIORITY UNITEDSTdE * MAIL *JaPOST/L �APRESSTM ]e eIA USPS-C0 SPS®Co19294 rporate Acct No Federal Agency Acct No or Postal Service 1 '"'Acct No ' , • , l0q!GIN tPOSTAL SERVICE USE ONLY) ❑SIGNATURE REQUIRED Note The mailer must check the'Signature Required"box if the mailer 1) \1-Day ❑2-Day ❑Military r ❑DPO J Requires the addressee's signature,OR 2)Purchases additional insurance,OR 3)Purchases COD service,OR 4) 00 ZIP Code Sc - PumhasesRetumReceipt service If the box is not checked,the Postal Service will leave the item in the addressee's Scheduled Date Postage Sc W ) 'mall receptacle or other secure location without attempting to obtain the addressee's signature on delivery /'{✓� •''B V Delivery Options ❑No Saturday Delivery(delivered next business day) $ ❑Sunday/Holiday Delivery Required(additional fee,where available') Date Ac c ted(MM DD/YY) Scheduled Delivery Time Insurance Fee COD Fee ❑10 30 AM Delivery Required(additional tee,where available') [1 10 30 AM ❑3 00 PM 'Refer to USPS come or local Post Office"for availability ,�12 NOON $ $ ITO:(PLEASE PRINT) PHONE� �� � � � r7_� Time A epted 1030 AM Delivery Fee Return Receipt Fee' Live Animal .�1�'.'/�y- cn (� (r1 y O M Transportation Fee Y I lc , U r I C) {v PM $ $ $ (�!1 , IE +e `� ' 0 Weight _ Elat-Rate Sunday/Holiday Premium Fee Total Postage&Fees 1 ,1 ++�n� P q $ rU C14- 1 W 00, `� �a('� lbs -ozs Accey an p as Initials g USE ONLY) ZIP+4®(LI S ADDRESSES ONL - DeliveryAttempt MMMD p( /1^/) Time Employee Signature lJ V �I 1 ❑AM 1 i ❑PM For pickup or USPS Tracking'",visit USPS.corn or call 800-222-1811. Delivery Attempt(MM/DD/YY)Time Employee Signature, $100.00 Insurance Included. ❑AM ❑PM LABEL 11-B,JANUARY 2014 PSN 7690-02-000-9996 2-CUSTOMER COPY Delivery Guarantee:If the mailer submits an iterp�at a designated USPS®_Priority items(with-°merchandise"defined by postal regulations)against loss,damage, MadiExppressj;�acceptance!locatlon'on''o j bef0�e the spepified deposiftime;th'e 1 or missing contents The Postal Service includes coverage up to$too per item Postal;Seryice;;will del'iveF or attercipt'delivery�fo the addressee„or argent betore the at no additional charge.The'mader may purchase additional merchandise applicable time:'The signature of the,addressee of;tfia addressde agept,i§!!',I I insurance up to$5,000 per item Additional insurance for Priority Mail Express required upon delivery','when regiiested by fire mailer.=lf;the PostaLService does not items is not available unless a signature is required., deliver or attempt delivery by the specified time avid the mailer files a claim for a 3. The Postal Service insures"nonnegotiable documents"(as defined by postal refund,the Postal Service may refund the postage,unless the delay was caused by indemnity regulations)against loss,damage,or missing contentg up to$100 per reasons including but not limited to the following:proper detention for law item for document reconstruction,subject to additional limitations f multiple enforcement purposes;strike or work stoppage;forwarding or return after the item pieces lost or damaged in a single,catastrophic occurrence.Docut was available for claim;incorrect ZIP Code'or address;governmental action reconstruction insurance provides reimbursement for the reasonable asis beyond the control of the Postal Service or air carriers;'war,insurrection,-or civil incurred in reconstructing duplicates of nonnegotiable documents mailed. disturbance;delay or cancellation of flights;projected or'scheduled transportation Document reconstruction insurance coverage above$100 per,item is not delays;breakdown of a substantial portion of the USPS transportation'network available.The mailer should not attempt to purchase additional document - resulting from events or factors outside the control of the Postal Service;or acts of insurance,because additional document insurance is void. God.See Mailing Standards of the United States Postal Service,Domestic Mad 4. The Postal Service insures"negotiable Items"(defined by postal regulations as Manual(DMM 114.2.0,214.3.0,314.3.0,or 414.3.0.(The DMM is available at ; items that can be converted to cash without fore currency,or bullion u to a' pe.usps.com) - - - forgery), S p +'`• maximum of$15 per item. When a mailer submits a Priority Mail Express item requiring a signature and the 5. The Postal Service does not provide coverage for consequential,losses due to Postal Service cannot deliver the item on the first attempt,the Postal Service leaves loss,damage,or delay of Priority Mail Express items or for concealed damage, a notice for the addressee.If fire addressee he it6 otb thii the item no laddi + spoilage of perishable items,and articles improperly packaged or too fragile to 5 calendar days,the Postal-Service returns the item to the sender at no additional , charge, withstand normal handling in the mad. Note:The Postal Service does not offer a guarantee for military or DPO'shipments '� and terms Coverofrcoverage,d limitations consulthe DMM which s aect to ge,For atpeonal limitations delayed due to customs inspections.Consult USPS.com or your local Post Officer, r for information on delivery commitments and Priority Mail Express Military,"'or i Refund Claims:If de0eryjof a Priohi ,,Mail Express item does not meet the Priority Mail Express DPO'°services.For details,see the DMM,which is available at, scheduled delivery commitment,the'mailer may apply for a postage refund within- pe.usps.com 30 days after the date of mailing Insurance Coverage:The Postal Service provides insurance only in accordance Indemnity Claims:Either the mailer or the addressee may file an indemnity claim with postal regulations in the DMM,which is available at pe.usps.mm.The DMM for loss,delay,damage,or missing contents The claimant may submit the claim'' sets forth the specific types of losses that are covered,the limitations on coverage, online at usps.mm ;Do ,or'by'using PS Form,1000mestic of International Claim— 'terms of insurance,conditions of payment,and"adjudication procedures.The DMM for more information,see Publication 122;Customer,Guide to,Filing Domestic consists of federal regulations,and USPS personnel are not authorized to change or Insurance Claims,or Registered Mail Inquiries.The tirnefinei for claims are as , waive these regulations or grant exceptions.A mailer who requires information on follows:claims for loss or;delay, ,—no sooner than 7 days but no later than 60 days Priority Mail Express insurance may contact the Postal Service before submitting an after the date of mailing;claims for damage or`missing contents—immediately item.Limitations prescribed in the DMM provide,in part,that: but no later than 60 days from the date of mailing.Retain the original customer 1. Insurance coverage extends to the actual value of the contents at the time of copy of the Priority Mail Express label for claims purposes.Fo"r claims involvingg , mailing or the cost of repairs,not to exceed the insured limit for the item. damage or missing contents,also retain the article,container,and packaging for 2. The Postal Service insures the contents of Priority Mail Express"merchandise" Postal Service inspection when requested - - Please do not remail.Thank you for choosing Priority Mail Express service. r_ LABEL 11-B,JANUARY 2014 PSN 7690-02-000-9996 2-CUSTOMER COPY(REVERS RECEIVED AUG 1 0 2018 Southold Town Clerk APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT NO: Please Print or Type APPLICATION DATE: August 8, 2018 NAME OF APPLICANT: Blow the Man Down MAILING ADDRESS: _Easter Cove LLC, c/o Secret Engine, 49 8th Ave, Ground Floor,New York,NY 10014 PHONE: BUSINESS: _(914) 924 2406 HOME: : _(914) 924 2406 NAME OF ORGANIZATION/COMPANY: Easter Cove LLC MAILING ADDRESS: PHONE: FAX: as@secretengine.film DESCRIBE TYPE OF ACTIVITY(e.g. Motion Picture, Commercial, Television. Catalog,Magazine, etc.): Motion Picture DATE(S)AND TIMES) OF PROPOSED FILMING/PHOTOGRAPHY: 8/23 from 4:30pm to 8:00pm and 8/24 from 4:30 to 8:00pm PROPOSED LOCATION(S) OF FILMING/PHOTOGRAPHY: (attach additional sheet, if necessary) Rocky Point Beach NAME OF PERSON IN CHARGE AT SITE: Drew Houpt NUMBER OF PERSONS AT LOCATION (cast& crew included): 10-15 NUMBER AND TYPE OF VEHICLES AT LOCATION: 3 Mini Vans TYPE OF SPECIAL EQUIPMENT: n/a ANY SPECIAL REQUIREMENTS: n/a Signature Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P.O. Box 1179 1 ® DATE(MMIDD/YYYY) ,ate CERTIFICATE OF LIABILITY INSURANCE 8/9/2018 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. Rona Lind Dewitt Stern Group, Inc. PHONE FAX 420 Lexington Avenue, Ste 2700 JaIC,E-MAINo.L xt 212-297-1454 (AIC,No): New York NY 10170 ADDRESS' INSURERS AFFORDING COVERAGE NAIC# INSURER A:AMERICAN INS CO 21857 INSURED 00159595 INSURER B:Fireman's Fund Insurance Company 22810 Easter Cove LLC 49 8th Avenue INSURER C: Ground Floor INSURERD: New York NY 10014 INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER:637439092 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 ADDLTYPE OF INSURANCE IVSD SUER POLICY NUMBER MMIDDYIYYYY MMIDEFF D EXP LTR LIMITS A X COMMERCIAL GENERAL LIABILITY Y XXC80509150 1/31/2018 1/31/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE �OCCUR PREMISES Ea occurrence $100, 100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 M'OTHER L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 JECTPOLICY❑PRO- ❑ LOC PRODUCTS-COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY Y XXC80509150 1/31/2018 1/31/2019 COMBINED SINGLE LIMIT $1,000,000 Ea accident 1 000 000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROaccident) PERTY DAMAGE $ X HIRED AUTOS X AUTOS $ A X UMBRELLA LIAB X OCCUR XAE24667487 1/31/2018 1/31/2019 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED RETENTION$ $ PER OTH- WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E L DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ B Miscellaneous Equipment MPT07204686 1/31/2018 1131/2019 1,000,000 Ded 2,500 Third Party Property Damage 1,000,000 Ded 2,500 Props,Sets&Wardrobe 1,000,000 Ded 2,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Certificate Holder shall be named as additional Insured as respects to liability claims arising out of the negligence of the Named Insured and loss payee as their respective Interests may appear. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The Town of Southold AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 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. August 9, 2018 Signature Date _Alexander Scharfman Printed name Producer Title TOWN CLERK'S CHECKLIST FOR FILMING PERMIT NOTE: All payments( must be cash or certified check Applicant: �0� Date Received: 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 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 C t Zoo) Cleanup deposit: Separate certified check for$250 for each day covered C SU0� 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. Beach Parking fee - $10 per vehicle, per day between May 1 and September 30. X Z (1 60) ISSUED PERMIT Countersign application Issue permit with name of applicant, locations(s), date(s), and time(s) NOTIFICATION of ISSUED PERMIT Chief of Police Chief Building Inspector Fire Marshal Code Enforcement Officer Superintendent of Highways Superintendent of Parks and Recreation REQUEST FOR EXTENSION OF PERMIT Forward extension permit request to Chief of Police If granted, collect additional $100 per day filming fee Amend permit to indicate granted extension period COMPLETION OF PERMIT PERIOD 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. Doroski, Bonnie From: Doroski, Bonnie Sent: Friday,August 10, 2018 9:46 AM To: Duffy, Bill; Hagan, Damon Cc: Silleck, Mary Subject: FW: Filming Permit request Attachments: filming permit-blow the_20180810093419.pdf Please find attached the application of Blow the Man Down, requesting permission to film their motion picture at Rocky Point Beach, 8/23 and 24. Please review this application and let this office (Lynda Rudder or Bonnie Doroski) know whether we can issue the permit or not. Thank you. Bonnie J. Doroski Deputy Town Clerk Your message is ready to be sent with the following file or link attachments: filming permit-blow the_20180810093419 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 Doroski, Bonnie From: Doroski, Bonnie Sent: Friday, August 10, 2018 9:43 AM To: Blasko, Regina; Flatley, Martin; Kruszeski, Frank; Norklun, Stacey;Town Att Cc: Rudder, Lynda Subject: Filming Permit request Attachments: filming permit-blow the_20180810093419.pdf Please find attached the application of Blow the Man Down, requesting permission to film their motion picture at Rocky Point Beach, 8/23 and 24. Please review this application and let this office (Lynda Rudder or Bonnie Doroski) know whether we can issue the permit or not. Thank you. Bonnie J. Doroski Deputy Town Clerk Your message is ready to be sent with the following file or link attachments: filming permit-blow the_20180810093419 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 Doroski, Bonnie From: Flatley, Martin Sent: Friday,August 10, 2018 12:41 PM To: Doroski, Bonnie; Blasko, Regina; Kruszeski, Frank; Norklun, Stacey;Town Att Cc: Rudder, Lynda Subject: RE: Filming Permit request I have no objections to this permit being approved. Please have vehicles associated with the shoot display special parking placards on their dashboards for the dates required. 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: Friday,August 10, 2018 9:43 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.ny.us> Subject: Filming Permit request Please find attached the application of Blow the Man Down, requesting permission to film their motion picture at Rocky Point Beach, 8/23 and 24. Please review this application and let this office (Lynda Rudder or Bonnie Doroski) know whether we can issue the permit or not. Thank you. Bonnie J. Doroski Deputy Town Clerk Your message is ready to be sent with the following file or link attachments: filming permit-blow the_20180810093419 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 Rudder, Lynda From: Duffy, Bill Sent: Monday,August 13, 2018 10:39 AM To: Rudder, Lynda Subject: RE: FILM PERMIT No objection William M. Duffy, Esq. Town Attorney Town of Southold Southold Town Annex 54375 Route 25 (Main Road) P.O. Box 1179 Southold, New York 11971-0959 Office: 631.765-1939 Fax: 631.765.6639 Email: billd@southoldtownny.gov 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. 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From: Rudder, Lynda Sent: Monday, August 13, 2018 9:19 AM To: Duffy, Bill; Silleck, Mary Cc: Doroski, Bonnie Subject: FILM PERMIT Importance: High 2nd request for comments Blow the Man Down productions, 8/23-24 0*00zz 0 Rffalw Lynda M Rudder Principal Account Clerk Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold,NY 11971 631/765-1800 ext 210 1 Pr u� ' SOUTHOLD 710 TRAVELER ST SOUTHOLD NY , 11971-1000 3580000971 06/27/2018 (800)275-8777 ; 4:02 PM -------------------------------------- -------------------------------------- Product Sale Final Description Qty Price PM Exp 1-Day 1- $24.70 Flat Rate Env (Domestic) (NEW YORK, NY 10004) (Flat Rate) (Signature Waiver) (Scheduled Delivery Date) (Thursday 06/28/2018 12:00 PM) (Money Back Guarantee) (USPS Tracking #) (EK202962378US) PM Exp 1 $0.00 Insurance (Up to $100.00 included) USPSCA 1 ($24.70) (USPSCA Number:119294000000) (Name:TOWN OF SOUTHOLD) Total $0.00 Includes up to $100 insurance Save this receipt as evidence of insurance. For information on filing an insurance claim go to https://www.usps.com/help/claims htm. Preview your Mail- Track your Packages Sign up for FREE www.informeddelivery.com All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE Go to: https://Postalexperience.com/Pos 840-5117-0170-001-00019-06984-01 or scan this code with your mobile device: al N G 91 Flu n eb or call 1-800-410-7420. YOUR OPINION COUNTS r_ Bill #: 840-51170170-1-1906984-1 Clerk: 02 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. August 9, 2018 Signature Date _Alexander Scharfman Printed name Producer Title APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT NO: Please Print or Type APPLICATION DATE: August 8, 2018 NAME OF APPLICANT: Blow the Man Down MAILING ADDRESS: Easter Cove LLC, c/o Secret Engine, 49 81h Ave, Ground Floor, New York, NY 10014 PHONE: BUSINESS: (914) 924 2406 HOME: : (914) 924 2406 NAME OF ORGANIZATION/COMPANY: Easter Cove LLC MAILING ADDRESS: PHONE: FAX: as@ secretengine.film DESCRIBE TYPE OF ACTIVITY (e.g. Motion Picture, Commercial, Television. Catalog, Magazine, etc.): Motion Picture DATE(S) AND TIME(S) OF PROPOSED FILMING/PHOTOGRAPHY: 8/23 from 4:30pm to 8:OOpm and 8/24 from 4:30 to 8:OOpm PROPOSED LOCATION(S) OF FILMING/PHOTOGRAPHY: (attach additional sheet, if necessary) Rocky Point Beach NAME OF PERSON IN CHARGE AT SITE: Drew Houpt NUMBER OF PERSONS AT LOCATION (cast& crew included): 10-15 NUMBER AND TYPE OF VEHICLES AT LOCATION: 3 Mini Vans TYPE OF SPECIAL EQUIPMENT: n/a ANY SPECIAL REQUIREMENTS: n/a Signature Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P.O. Box 1179 Southold, NY 11971