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Home My WebLink AboutTown Beach/Rocky Point - Freebird Productions w` a b 4 APPLICATION FOR FILMING/STILL PHOTOGRAPHY PERMIT NO: Please Print or Type Z APPLICATION DATE; LJd c'S F,. NAME OF APPLICANT: -TA Ll Al ik&-A--C-- MAILING ADDRESS: I AA Pn f`J S T ,S jAI-TL J 2"`Q PHONE: BUSINESS: $ HOME: NAME OF ORGANIZATION/COMPANY: MAILING ADDRESS: �1�211 PHONE: FAX: DESCRIBE TYPE OF AC'T'IVITY(e.g. Motion Picture, Commercial, Television. Catalog, Magazine, etc.): M m5wu , �-T c LLQ f ro :S M 0-r DATE(S) AND TIME(S) OF PROPOSED FILMING/PHOTOGRAPHY; 0 CC- - ti -Lol c ^ afz. c)crq (:)TO 201 PROPOSED LOCATION(S) OF FILMING/PHOTOGRAPHY: (attach additional sheet, if necessary) NAME OF PERSON IN CHARGE AT SITE: 7A-U fh fT-bVt, NUMBER OF PERSONS AT LOCATION (cast &crew included): NUMBER AND TYPE OF VECHILES AT LOCATION: Ly N f 1/ NJ ,, TYPE OF SPECIAL EQUIPMENT: C- ST ANY SPECIAL REQUIREMENTS: J i.1'l 1 QT CN nT r (7e i1V Signature Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P.O. Box 1179 Southold,NY 11971 b \tj INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT The Applicant shall indemnify and hold harmless the Town from and against all suits, claims,demands or actions for any damage and/or injury sustained or alleged to be sustained by any party or parties in connection with the performance of filming or still photography by the Applicant,his employees or agents or any subcontractor and in case of any such action brought against the Town,the applicant shall immediately take charge of and defend the same at his own cost and expense. In addition,the Applicant will name the Town as an additional insured on any applicable policies. Signature Date 5� --f/7 Printed.name Title ELIZABETH A. NEVILLE, MMC ®%N'3 � �®G Town Hall,53095 Main Road TOWN CLERK �� P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS � 'g Fax(631)765-6145 MARRIAGE OFFICER ,j. ® Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ®�( �`j► www.southoldtowuny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT Issued to: Freebird Productions. Date(s),Time(s) and Location: 10/7/18 7:00 am—7:00 pm Rocky Point Road Beach, East Marion Permit No. 58 Issue Date: •10/3/18 Elizabeth A. Neville Southold Town Clerk (Town Seal) guFFoc� ELIZABETH A.NEVILLE,MMC 0� C® Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS g Fax(631)765-6145 MARRIAGE OFFICER ,f, ��. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �Ol �`1 www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PARKING PERMIT of 4 Freebird Productions DATE: October 7, 2018 TIME: 7:00 AM — 7:00 PM LOCATION: Rocky Point Road Beach, East Marion Filming/Still Photography Permit # 058 Place this Permit on the Dashboard, Passenger side of Vehicle Issue Date: October 3, 2018 RECEIVED S ' thold T ' �- o�irn Clerk w Y APPLICATION FOR FILMING/STILL PHOTOGRAPHY x, PERMITNO:r Please Print or Type L APPLICATION DATE; + NAME OF APPLICANT: -TA L( �--MAILING ADDRESS: I MSN o(T .SLL[7 �' [ �' ' , PHONE: BUSINESS: 1 �j�t� � HOME: 4 NAME OF ORGANIZATION!COMPANY: r -aG�'IJl MAILING ADDRESS: PHONE: FAX:: DESCRIBE TYPE OF ACTIVITY(e.g.Motion Picture,Commercial;Television. Catalog,Magazine,etc.); DATE(S)AND TIMES) OF PROPOSED FILMING/.PHOTOGRAPHY: 0 C--T -7-�� 2�l PROPOSED LOCATIONS)OF FILMING/PHOTOGRAPHY: (attach additional sheet,if necessary). f?DAC•I omatl�T NAME OF PERSON IN CHARGE AT SITE: NUMBER OF PERSONS AT LOCATION(cast&crew included): ,Lj [ g [YC NUMBER AND TYPE OF VECHILES AT-LOCATION: TYPE OF'SPECIAL EQUIPMENT: ANY SPECIAL REQUIREMENTS: . S 6T ( _TEny, it � ,—signature �\ Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P.O.Box 1,179 Southold,NY 11971 1 INDEMNIFICATION AGREEIVIENT i TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT r ' The Applicant'shall indemnify and hold harmless the Townfrom and against all' s 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 - r, 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. 't<. • 1 Signature Date ' 3 Printed name Title Rudder, Lynda From: Flatley, Martin Sent: Tuesday, September 25, 2018 3:23 PM To: Rudder, Lynda; Blasko, Regina; Doroski, Melanie; Foote, Nancy; Kruszeski, Frank; Norklun, Stacey; Sepenoski,John; Spiro, Melissa; Standish,Jeff; Duffy, Bill; Hagan, Damon; Silleck, Mary Subject: RE: Photo shoot- Rocky Pt Rd I have no objection to this permit being issued with Special Parking placards being displayed by the vehicles involved. Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 From: Rudder, Lynda Sent:Tuesday, September 25, 2018 10:19 AM To: Blasko, Regina <rblasko@town.southold.nv.us>; Doroski, Melanie<Melanie.Doroski@town.southold.nv.us>; Flatley, Martin <mflatlev@town.southold.nv.us>; Foote, Nancy<nancy.foote@town.southold.nv.us>; Kruszeski, Frank <fkruszeski@town.southold.nv.us>; Norklun, Stacey<Stacey.Norklun @town.southold.ny.us>; Sepenoski,John <iohnsep@town.southold.nv.us>; Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>;Standish,Jeff <ieffs@town.southold.nv.us>; Duffy, Bill<billd@southoldtownny.gov>; Hagan, Damon <damonh@southoldtownny.gov>;Silleck, Mary<marvs@town.southold.ny.us> Subject: Photo shoot- Rocky Pt Rd Insurance to follow 1 Rudder, Lynda From: Spiro, Melissa Sent: Tuesday, September 25, 2018 10:25 AM To: Rudder, Lynda; Blasko, Regina; Doroski, Melanie; Flatley, Martin; Foote, Nancy; Kruszeski, Frank; Norklun, Stacey; Sepenoski,John; Standish,Jeff, Duffy, Bill; Hagan, Damon; Silleck, Mary Subject: RE: Photo shoot - Rocky Pt Rd These are not considered preserved properties. Melissa Spiro From: Rudder, Lynda Sent:Tuesday, September 25, 2018 10:19 AM To: Blasko, Regina <rblasko@town.southold.nv.us>; Doroski, Melanie<Melanie.Doroski@town.southold.ny.us>; Flatley, Martin <mflatlev@town.southold.nv.us>; Foote, Nancy<nancy.foote@town.southold.ny.us>; Kruszeski, Frank <fkruszeski@town.southold.ny.us>; Norklun,Stacey<Stacey.Norklun @town.southold.nv.us>; Sepenoski,John <iohnsep@town.southold.nv.us>; Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Standish,Jeff <ieffs@town.southold.ny.us>; Duffy, Bill<billd@southoldtownny.gov>; Hagan, Damon <damonh@southoldtownny.gov>;5illeck, Mary<marvs@town.southold.ny.us> Subject: Photo shoot- Rocky Pt Rd Insurance to follow 1 Rudder, Lynda From: Duffy, Bill Sent Wednesday, September 26' J018I2:37PM To: Rudder, Lynda Subject: RE: Photoshoot - RockvPtRd Noobjection pending review ofinsurance William M. Duffy, Esq. Town Attorney Town ofSouthold Southold Town Annex S4I75Route 25 (Main Road) P.O. Box 1179 Southold, New York 11971-0959 Office: 631.765-1939 Fax: 631.765.6639 Email: 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 oflegal documents isnot permitted via electronic mail orfax. 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 orany 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 isstrictly prohibited. |fyou have received this communication inerror, please U\ 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, nrother storage device or media. From: Rudder, Lynda Sent: Tuesday, September 25, 2018 10:19 AM To: B|aykn, Regina; Donosk/, Melanie; F|ot|ey, Martin; Foote, Nancy; Kruszeski, Frank; Nork|un, Stacey; Sapenosk|, ]ohn; Spiro, Melissa; Standish, Jeff; Duffy, Bill; Hagan, Damon; SiUeck' Mary Subject: Photoshoot - Rocky Pt Rd Insurance tofollow 1 AC40 ® DATE(MM/DD/YYYY) 16. � CERTIFICATE OF LIABILITY INSURANCE 9/28/2018 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(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 Shamaila Awan NAME. Taylor & Taylor Ltd. PA/C o Ext): (212)490-8511 IA/c No (212)490-7236 271 Madison Avenue E-MAADDRESS sawan@taylorinsurance.com 5th Floor INSURERS AFFORDING COVERAGE NAIC# New York NY 10016-1001 INSURERA American Insurance Company 21857 INSURED INSURER B.Fireman Is Fund Insurance Company 21873 Tali Magal Inc., DBA: Freebird Productions INSURERC. 1 Main Street INSURERD: Suite 7A INSURERE. Brooklyn NY 11201 INSURER F. COVERAGES CERTIFICATE NUMBER:18-19 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS POLICY NUMBER MM/DD/YYYY MMIDDNYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PREM SES a occu ante $ 100,000 AZC80921091 3/2/2018 3/2/2019 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ INCLUDED GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ INCLUDED JECT OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ INCLUDED Ea accident A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AZC80921091 3/2/2018 3/2/2019 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS ixx AUTOS Per accident) $ HIRED AUTO PD MPT07111297 LIMITS&DEDUCTIBLES $ INCLUDED X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED RETENTION$ 1 AZC80921091 3/2/2018 3/2/2019 1 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E L EACH ACCIDENT $ 11000,000 OFFICERA (Mandatory/ EIn NH)MBER EXCLUDED? WZC81043289 9/21/2017 9/21/2018 E L DISEASE-EA EMPLOYE $ 3_000,000 If yes,descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,000 B PRODUCTION PACKAGE MPT07111297 10/11/2017 10/11/2018 LIMITS SEE ATTACHED DEDUCTIBLES SEE ATTACHED DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as Additional Insured on the General Liability Policy with respect to claims arising out of the negligence of the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATIVE Shamaila Awan/MLONG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) COMMENTS/REMARKS INSURED: TALI MAGAL INC. dba FREEBIRD PRODUCTIONS PRODUCTION PACKAGE POLICY COMPANY: Fireman's Fund Insurance Company POLICY # MPT07111297 PERIOD: OCTOBER 11, 2017 - 2018 COVERAGE LIMIT DEDUCTIBLE Props/Sets/Wardrobe $ 100, 000 $1,500 Third Party Property Damage $ 500,000 $1,500 Miscellaneous Rented Equipment $1,000,000 $2,500 Coverage: Special Form Valuation: Legal Liability (per terms of Rental Agreement) Territory: Worldwide (including transit) Hired Auto Physical Damage: Limit: Included in Miscellaneous Equipment Deductible: 10% of Loss, $2,500 Minimum, $7,500 Maximum Valuation: Actual Cash Value OFREMARK COPYRIGHT 2000, AMS SERVICES INC. ' A CERTIFICATE OF LIABILITY INSURANCE ogrE(MN oorrvvY) 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 pollcy(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 confor rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTNAME Rona Rona Lind Dewitt Stern Group,Inc, PHONE 212-297-1454 A C o 420 Lexington Avenue,Ste 2700 E-MAIL New York NY 10170 ADDRESS' INSURER 5 AFFORDING COVERAGE NAIC d INSURER AMERICAN INS CO 21857 INSURED 00158595 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 TYPE OF INSURANCE AOD R POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY Y XXC80609150 1131/2018 1131!2019 EACH OCCURRENCE $1 'coo0 DAMAGE O RENTED CLAIMS-MADE 7 OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) S 5,1100 PERSONAL&ADV INJURY 51,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY❑PRO- JECT 0 LOC PRODUCTS-COMP/OPAGG $2,000000 OTHER $ A AUTOMOBILE LIABILITY Y XXC80509150 113112018 113112019 COMBINED SINGLE MIT $ Ea accident 000000 ANY AUTO BODILY INJURY(Perperson) S ALL OWNED SCHEDULED BODILY INJURY(Peracudent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ Ix HIRED AUTOS X AUTOS Per acudenl A X UMBRELLA LIAR X OCCUR XAE248874B7 11312018 1131!11119 EACH OCCURRENCE $100000D EXCESS LIAR CLAIMS-MADE AGGREGATE 81,000,000 DED I I RETENTIONS S WORKERS COMPENSATION STATUTE ERH AND EMPLOYERS'LIABILITY Y IN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑NIA EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-FA EMPLOYE $ II yes,desnnbe under DESCRIPTION OF OPERATIONS beta. EL DISEASE-POLICY LIMIT $ B Miscellaneous Equipment MPT072111 5 1/312018 1/312019 1,000,000 Dad 2,500 Third Party Properly Damage 1,D00,000 Ded 2,500 Props,Sets&Wardrobe 1,000,000 Ded 2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schadulo,may be attached If mare spacers 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(2014101) The ACORD name and logo are registered marks of ACORD On Oct 2, 2018, at 12:49 PM, Jessie Jobst<jess@freebirdprod.com>wrote: Hi Lynda, We are shooting on the 7th. Please see COI attached. How is the progress going on the permit? Can we make payment with you over the phone? Thanks! Jess jess jobst freebird productions 1 main street, suite 7a, brooklyn, ny 11201 2633 lincoln blvd, suite 158, santa monica, ca 90405 cell: +1917 385 0750 1 ofc: +1718 596 3074 1 fax: +1718 247 5595 jess@freebirdprod.com I www.freebirdprod.com <image002.png> On Sep 27, 2018, at 12:00 PM, Rudder, Lynda<lynda.rudder@town.southold.ny.us>wrote: Jessie, I need the insurance for the application and the definite date. Nothing will be approved until application is complete. 40zz //Y/ RW40,-� Lynda M Rudder Principal Account Clerk Southold Town Clerk's Office 53095 Main Road,PO Box 1179 Southold,NY 11971 631/765-1800 ext 210 631/765-6145 3 Doroski, Bonnie From: Jessie Jobst <jess@freebirdprod.com> Sent: Tuesday, October 02, 2018 12:58 PM To: Doroski, Bonnie Cc: Tali Magal; Rudder, Lynda Subject: Re:filming permit Importance: High Hi Bonnie, Following up on the below permit request for this Sunday October 7th. Please let me know how the progress is and when we can make payment. I have attached COI here. Thanks! Jess jess jobst freebird productions 1 main street, suite 7a, brooklyn, ny 11201 2633 lincoln blvd, suite 158, santa monica, ca 90405 cell: +1917 385 0750 1 ofc: +1718 596 3074 1 fax: +1718 247 5595 jessgfreebirdprod.com I www.freebirdprod.com ( n �sD CIO K J� i � � a Rudder, Lynda From: Duffy, Bill Sent: Monday, October 01, 2018 10:52 AM To: Rudder, Lynda; Silleck, Mary Subject: RE: insurance for photo shoot Rocky Point Ok. Looks good tome 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. 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: Rudder, Lynda Sent: Friday, September 28, 2018 10:23 AM To: Duffy, Bill; Silleck, Mary Subject: insurance for photo shoot Rocky Point Beach Parking fee - $10 per vehicle, per day between May 1 and September 30. ISSUED PERMIT Countersign application p ✓ 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. TOWN CLERIC'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check Applicant: FY-ce_� (f( ?Y-08UCLI� � Q1L� Date Received: � ' 2,S - I S- 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$1,000,000 (one million dollars) per occurrence for the duration of the filming or still photography. Indemnification agreement stating the applicant agrees to assume all liability for and will indemnify and hold the town harmless of and free from any and all damages that occur to persons or property by reason of �sai�d filming or still photography. Forward completed application to Chief of Police for approval or disapprova�d determination if Traffic Control Fee is required Approved Disapproved No Fee Required Fee in the amount of$ 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 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. Vendor No. •Check•No: :..: Town of Southold, New York - Payment Voucher Vendor Name Vendor Address 'tntared by . ........ . . r' ?r-0 u Sr Vendor Teleph ne Number 1 ` 31Q0Y'0 o K I♦ I 1 Town Clerk•'' Vendor Contact lobs- ' Invoice Invoice Invoice Net Purchase Order •' • Number Date Total Discount Amount Claimed Number Description of Goods or Services ;'Ge eFal'I ed et•'F,itild and A pdouAf Nurimber 9geccn-FAQ Clean-up 250.00 250.00 Deposit Refund 'x'1.030 ' it t .. 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 S n r �/l Title Si atu Company Name Date 16 'LS -17 Title -Q,(,JI_ Date 10 -Z5—I Sr Southold Town Board - Letter Board Meeting of October 23, 2018 RESOLUTION 2018-926 Item 4 5.32 3 oy� °f DOC ID: 14577 ADOPTED VTHIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2018-926 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 23, 2018: 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 Freebird Productions 10/3/18 250.00 Att: Jess Jobst 1 Main Street, 7A Brooklyn,NY 11201 Cutchogue New Suffolk Historical Society 8/13/18 250.00 Zeth Studenroth PO Box 714 Cutchogue,NY 11935 Mattituck Chamber of Commerce 2/28/18 250.00 David Perrin PO Box 1056 Mattituck,NY 11952 Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Robert Ghosio, Councilman SECONDER:Louisa P. Evans, Justice AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Evans, Russell Generated October 24, 2018 Page 47 Town of Southold P0Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 10/03/18 Receipt#: 248792 Quantity Transactions Reference Subtotal 1 Application Fee- Non-Refund 058 $100.00 1 Clean-Up Deposit 058a $25000 1 Daily Filming Permit 058b $100.00 4 Beach Permits 058c $4000 Total Paid: $490.00 Notes: Payment Type Amount Paid By Credit Card-Ref# $490.00 Freebird, Productions Southold Town Clerk's Office 53095 Main Road, PO'Box 1179 Southold, NY 11971 Name: Freebird, Productions 1 Main Street, Apt 7a Brooklyn, NY 11201 Clerk ID: LYNDAR Internal ID 058