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Home My WebLink About2019 ELIZABETH A.NEVILLE MMC °°� '.�; � � 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 ', :, Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLEC TOWN OF SOUTHOLD PERMIT#2-of 2019 PUBLIC DISPLAY OF FIREWORKS I, ELIZABETH A.NEVILLE,Town Clerk of the Town of Southold, Suffolk County,New York, being an officer duly designated by the Town Board of the Town of Southold for this purpose, do hereby GRANT TO: MATTITUCK LIONS CLUB-STRAWBERRY FESTIVAL PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York on-T%upstlay,,Juh6.JJ, 260011t 9:1St'A't;,: riday, �eiaie lt;.2019.at-y0:001'M ; Stitoaril:ay, June, 1S, 1610- at--- -10:15. -Y' ., .Rain :slates: 'None -,on the property known as `STRAWBERRY FIELDS",located at 1105 County Road 48,Mattituck,New York. ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feet from the nearest above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines;that all fireworks that fire a projectile shall be so set up that the projectile will go in the air as nearby as possible in a vertical direction unless such fireworks are to be fired from the shore or a lake or other large body of water, then they may be directed in such manner that the falling residue from the deflagration will fall into such lake or body of water; that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no.fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task,that there shall be at least two such operators constantly on duty during the discharge and that at last two soda acid or other approved type fire extinguishers of at least two and one-half gallons capacity t each shall be kept at such widely separated points as possible within the actual area of the display. (Town Seal) lizabeth A.Neville, Southold Town Clerk Town of Southold,New York Dated: June 4,2019 THIS PERMIT IS NOT TRANSFERABLE Chief Secretary TED WEBS BRIAN WELLIAM9 First Assistant Chief Treasurer ED RITTBERG THERESA WELLS Second Assistant Chief w Sergeant-at-Arms JAMES COX JR. ' RAYMOND F.NINE Chaplain TT JAMES L.MURPHY ' r t Elizabeth A. Neville, Southold Town Clerk, I have Reviewed The Application for the Fireworks Permit scheduled for r June 13, 14, 15, 2019 and approve the event.The Mattituck Fire Department will be on Stand By for the Strawberry Festival with coverage to include Fire if needed. i 3 t 'Ted Webb Chief, Mattituck Fire Department P.O.Box 136 • 1000 Pike Street•Mattituck,NY 11962.0666 Main(631)298-8833•Fax(631)298-1904 • Chiefs(631)298.8862•Fax(631)298-8868 www.mattitackfd.org ��8UFf0(* RESOLUTION 2019-516 yQ ADOPTED DOC ID: 15294 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2019-516 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 4,2019: RESOLVED that the Town Board of the Town of Southold hereby_approves the issuance of a Fireworks Permit#2 of 2019 by the Town Clerk to the Mattituck Lions Club for the Strawberry Festival fireworks displays on Thursday June 13, 2019 at 9:15 PM; Friday June 14, 2019 at 10:00PM ; and Saturday, June 15, 2019 at 10:15 PM on property located at 1105 County Road 48, Mattituck, New York (Strawberry Fields)upon the payment of a single fee of $100.00, and subject to the applicant's compliance with the requirements of the Town's policy regarding the issuance of fireworks permits and subject to the approval of the Town Attorney and the Chief of the Mattituck Fire Department. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER:Robert Ghosio, Councilman AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Evans, Russell Chief `- Secretary TED WEBB BRIAN WILLIAMS First Assistant Chief (. Treasurer ED RITTBERG THERESA WELLS Second Assistant Chief ,3' ,uy° Sergeant-at-Arms JAMES COX JR. `' RAYMOND F.NINE Chaplain jsV ; : JAMES L.MURPHY ,IWArTTITU CI II 3 DEI' , Elizabeth A. Neville, Southold Town Clerk, I have Reviewed The Application for the Fireworks Permit scheduled for June 13, 14, 15, 2019 and approve the event.The Mattituck Fire Department will be on Stand By for the Strawberry Festival with coverage to include Fire if needed. Ted Webb Chief, Mattituck Fire Department P.O.Box 136 • 1000 Pike Street • Mattituck,NY 11962-0666 Main(631)298-8833 • Fax(631)298-1904• Chiefs(631)298-8852 • Fax(631)298-8858 www.mattituckfd.org Neville, Elizabeth f From: Neville, Elizabeth (Cd UV�OlD Sent: Friday, May 31, 2019 1:53 PM u / To: 'ted@strongsmarine.com' 1 [ C 4 Subject: Fireworks Matt Lions Attachments: Fireworks,Matt Lions Str_20190514095215.pdf Good Afternoon Ted, Here is the fireworks application of the Mattituck Lions Club for the Strawberry Festival for three (3) events 6/13; 6/14; & 6/15. Please review and send me your written approval on the stationery of the Mattituck Fire Department with your signature. The letter should state that you are aware of the event, have reviewed the application, and approve of the new location and will provide fire trucks and firemen at the events. Thank you, Betty Neville Elizabeth A. Neville, MMC Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel.631765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 1 Neville, Elizabeth From: Neville, Elizabeth Sent: Monday,June 03, 2019 9:46 AM To: Fisher, Robert Subject: RE: Emailing: Fireworks Matt Lions Str 20190514095215 Thank you. The Chief of the Mattituck Fire Department Ted Webb will be bringing in a letter of approval today. -----Original Message----- From: Fisher, Robert Sent: Monday,June 03, 2019 9:43 AM To: Neville, Elizabeth Subject: RE: Emailing: Fireworks Matt Lions Str_20190514095215 Betty I agree with Chief Flatley.As long as MFD is aboard I have no problem with this event taking place. Bob -----Original Message----- From: Neville, Elizabeth Sent: Friday, May 31, 2019 7:15 AM To: Fisher, Robert<Robert.Fish er@town.southoId.nv.us> Subject: FW: Emailing: Fireworks Matt Lions Str_20190514095215 Importance: High Good Morning Bob, On May 16th I sent out the application of the Mattituck Lions Club for the Strawberry Festival taking place June 13, 14, & 15. 1 have not heard back from you on this one. Chief Flatley made the comment below. I must put this on the agenda for next Tuesday's meeting 6/4 as it is the last meeting before the event. Please review it and respond to me as your very earliest convenience. Thank you. Betty -----Original Message----- From: Flatley, Martin Sent:Thursday, May 16, 2019 3:14 PM To: Neville, Elizabeth; Duffy, Bill; Fisher, Robert;Spiro, Melissa; 'ted@strongsmarine.com'; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland, William; Russell,Scott Cc: Norklun,Stacey Subject: RE: Emailing: Fireworks Matt Lions Str_20190514095215 I have no objections to this permit being approved as long as the Mattituck Fire Department has signed off on it.This is a new location for their shoot this year in an area which was formerly a horse corral surrounded by trees. We will still be closing down Rt.48 while the display is being fired because of its proximity to the roadway.Just want to make sure any local properties will be safe from falling embers and fire potential. i Martin Flatley, Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Neville, Elizabeth Sent:Wednesday, May 15, 2019 2:50 PM To: Duffy, Bill<billd@southoldtownnv.gov>; Fisher, Robert<Robert.Fisher@town.southo Id.ny.us>; Flatley, Martin <mflatlev@town.southold.ny.us>; Spiro, Melissa<Melissa.Spiro@town.southold.nv.us>; 'ted@strongsmarine.com' <ted@strongsmarine.com>; Dinizio,James<fames.dinizio@town.southold.ny.us>; Doherty,Jill <fill.doherty@town.southold.nv.us>; Evans, Louisa <louisae southoldtownnv.eov>; Ghosio, Bob <bob.ehosio@town.southold.nv.us>; Ruland,William<williamr@southoldtownny.sov>; Russell,Scott <scottr southoldtownny.gov> Cc: Norklun, Stacey<Stacey.Norklun town.southold.ny.us> Subject: Emailing: Fireworks Matt Lions Str_20190514095215 Attached, please find an application for a Fireworks Permit for the 2019 Strawberry Festival submitted by the Mattituck Lions Club. Please review it and send me your comments and recommendations. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext.228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: Fireworks Matt Lions Str 20190514095215 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. 2 Al, Neville, Elizabeth From: Neville, Elizabeth Sent: Wednesday, May 15, 2019 2:50 PM To: Du ill; Fisher,Vert; Flatl' in; S ' o, Melissa; 'ted@strongsmarine.com'; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland, William; Russell, Scott Cc: Norklun, Stacey Subject: Emailing• Fireworks Matt Lions Sty a0514,09521 Attachments: Fireworks Matt Lions Str_20190514095215.pdf Attached, please find an application for a Fireworks Permit for the 2019 Strawberry Festival submitted by the Mattituck Lions Club. Please review it and send me your comments and recommendations. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: Fireworks Matt Lions Str 20190514095215 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. � ® s ELIZABETH A.NEVIT.1 RMC,CMC �z '`"' Town Hall,53095 Main Road y "I , P.O.Box 1179 TOWN CLERK + REGISTRAR.OF VITAL STATISTICS '','',9i',°N''1;p+'u '^,^d i¢',,, ,iM1F Southold,New York 11971 MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER � c®� •Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net ��-�- RECEIVED OFFH ClE OF THE TOWN CLERK M AY 1 3 2019 TOWN OF SOUTHOLD APPLICATION PERMIT TO DISPLAY FIREWORKS Southold Town Clerk APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law of the State of New York, for a permit to display fireworks as hereinafter specified: DISPLAY IS TO DE SPONSORED BY r, 4A-% u C te. 616 q Jr- C f -1 4 PRINCIPAL OFFICE AT Ge- 5�ea :6 it d`j 0 l?or f(3 1.- 4-W, /1 '� 1 DATE & TIME OF DISPLAY 0e,'Ll 3 pF - �ld� ®6 �� /� - !0 �� . 0 G 1 e /S- /n If EXACT LOCATION OF DISPLAY 1/09 5t "P% 9'� , /4t- C-ne SUFFOLK COUNTY TAX MAP NUMBER FOR SITE l X00 RAIN DATE & TIME O.,U F The following persons are to he in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition 1.. CJ G f+ �,��+� '�.�,1 e r G✓�/ 3 (Additional names and information may be submitted on an attached sheet Number and type of firewao°rrk.,�s is as follows: )f p � d 7 r s el 0 — I I I 'f� ,��.k'° e� V` Yj a - P 1/g II �✓M/yr 14 1 T C� - � dl -`�• �Yi Ll s, 3 o ® �'9 dr 17�i/'e L"s.,•l ^� �� r�.: Y o - 3 1< e-c' ve P S a 9�' t� Manner and place of storage of fireworks prior to display: Ea'rcl"'olI's C�C, Attached hereto and made a part of hereof is a diagram of the grounds on which the display is to be held. Also attached is a certificate or policy of insurance coverage. NOTICE: ''written permission,with signature of the Property Owner, must be submitted with the Application. Name of Organization By Signature of Applicant 'Jc� lie. At least two of the following people will be on the display site as pyrotechnicians. One as lead operator(with NYS Pyro Certificate of Competence) and one person as an Authorized Assistant(with or without a certificate of competence). Certified Pvrotechnicians Name Driver's Lic# Years Experience NYS Pvro Cert # Fritschler, Kevin NY633715082 30+ PR-95 exp 10/2021 Banks,Jennifer NY933267221 10 PR-594 exp 7/2021 Banks,John NY173171537 12 PR-307 exp 4/2022 Blasetti, Louis NY208450857 8 PR-624 exp 7/2022 Bue,Cima NY180909735 8 PR-629 exp 7/2022 Chiavelli, Richard NY942966115 16 PR-410 exp 4/2022 Coyle, Michael NY141135360 12 PR-711 exp 2/2021 Ebersol,Shawn NY100110988 9 PR-401 exp 4/2022 Farquhar,Jody NY410553501 10 PR-388 exp 4/2022 Frank, David NY541337976 14 PR-456 exp 5/2022 Fritschler, Brian NY164029290 14 PR-370 exp 4/2022 Harrad,Matthew NY248789664 4 PR-730 exp 6/2021 Kilgallen, Michael NY397011832 15 PR-442 exp 5/2022 Lisk,James NY761967816 4 PR-713 exp 2/2021 McGrath,Thomas NY549876681 10 PR-549 exp 8/2022 Newton,Timothy NY409531821 12 PR-346 exp 4/2022 Ostrowsky,Joseph NY227424840 4 PR-712 exp 2/2021 Sarpriacone, Brian NY219205362 14 PR-343 exp 4/2022 Sadowski,James NY177205855 10 PR-604 exp 7/2021 Smith, Raub NY648792590 9 PR-589 Smith, Raub Jr. NY730805237 9 PR-593 exp 7/2021 Thomas, Harvey NY801631891 13+ PR-531 exp 7/2022 Wakefield,Jeremy NY872077323 12 PR-606 exp 7/2021 Authorized Assistants Name Driver's License DOB Corn,Gerald NY840331958 2/26/1985 Coyle,Jeffrey 3/31/1980 DiFondi, Michael NY312017662 5/21/1998 DiGeorgio, Randy NY450512353 7/5/1996 Ebersol,Tyler NY122836855 6/21/1996 Fazzio, Morgan NY982372330 6/26/1982 Fritschler, Karl NY263669573 6/2/1954 Garard,Gerald NY310062259 1/27/1971 Garrison, Krystle PA29745646 9/28/1985 Gillette, David NY972051529 12/21/1982 Mazza,John NY9643983'32 5/23/1996 Morley,Vernon R.Jr. NY529042387 11/9/1970 Rabe,Scott NY149169496 4/10/1968 Riley, Rich NY156607483 4/20/1974 Roane,William NY603087773, 3/3/1955 Swift,Jeremy NY411696458 2/28/1971 Wes, Michael NY995862607 2/13/1967 Voelker, Pamela NY948970223 5/5/1962 Wakefield,Jamie M. NY210479056 9/2/1987 Town of Southold, _ - y P.0 Box 1179 Southold, NY 11971 ; °- , celpt#. ' (((� Date: 05/13/19 •� �- '' _: ,. 54®74 Quantity Transactions ° , ' . 3\` laefernce- 'Siubtotal 1 Fireworks _ r - t;, 6.13-14-15.19 $10A.00 ,.`��;_Y - -YoX100.00 tal Paid: Notes: Payment Type Amount Paid By CASH $100.00 Mattituck, Li'ons_�Clutir Southold Town Clerk's Office 53095 Main Road,'PO Box 1179 , „ Southold, NY,11971 ' t 1+ rfl Name: Mattituck, Lions Club Po Box 91 Mattituck, NY 11952 §'t Clerk ID: BONNIED '? =. ' Intem al ITS:6.13-14-15.19 Federal Explosives L-icenselPermit U.S..Departinent of Justice Bureau of Alcohol,Tobacco,Firearms and Explosives (18'U.S."C" .Chapter 4.0) �?runarmnmmt¢mtauialeetnumiiizrai In accordance with the,provisions of Title XI,-Organized Cnme Control Act of 1970,and;the regulations'issued'thereunder(27°CFR Part`555),.you may engage in the activity specified'ir this license or permit within the limitations of Chapter 40 �Title.l 8,-United States Code and the regulations issued thereunder,-until the expiration date shown. THIS'LICENSE IS NOT TIPANSFERABLEt'N' 'ER,27,CFR 555.53.,,,,See"WARNINGS"and"NOTICES"on reverse. Direct ATF ATF-Chief,FELL ` ' "mow;; :T;icenseernvt` p 244 Needy Road .'.: „, y, „M=�� a':A Cones onclence To .�; �P: ,r-� ''^- .;,._ ��Number_�°�=s • I -OG.-00982 Martinsburg,WV 25405=9431' Chief,Federal E losives Licensing Center(FELC iJuly 1 � 2020 �Z/�/D!/l ►ii3�'C !�-• f 1 ;'f: Date , - :'' Name AMERICAN FIREWORKS DISPLAY•ILL,6' ,;'k °pry• Premises Address(Changes?Notify the Fk161 t4"140 da�ysbeforetfie'move:}'ea . . _NJ-'. , 1 S t?l ^* r; -• ,a 105 COUNTY ROAD 7 .f • / %:, d'. q`'yam; NI6DONOl1GH, NY 13801; Type of License or Permiti 1 �^ �g .., �a ' °;i`` t{ -; Y.. i 51-IMPORTER OF EXPLOSIVES : tar` 7' r t''" v:t. "•`' ,C<i.. S F,- .� :awl n- ,Purchasing CeitificAtibtirStateinent a Ssv 1„a Mailing Addr'e'i'`,<(Change`'i?`)�,6 ify the FELC of any,changes) The licensee or permittee named above shall use a copy�iftlus license or'peEmtt to`assist,a, transferor of explosives to verify the identity and the-licen e'd,statirs of,the beeiisee oY" permittee as providedby 27 CFRPart 555. 'Me simaivre,on,each coot/must-be/an.ori¢inal' »'�"•«` x 5 � ANIERICA =F-•.•I'REW.ORKS DISPLAY LLC signature A faxed,scanned or e-mailed copy of the°license orpettrit with as[ afore :.„. ., "Ma ;f intended to be an original signature is acceptable. Ttizi•$igni�titre mustethat of the-Federal atPO BOX',980",? E losives Licensee FEL or a r onsible person o the Z "�'°i" '% `r^ i ap (FEL) exp p on f FfiL>.T'c tifytliaGliis;isatrue OXFO'RD'Mff'/1; 880- copy of a license or permit issuedto the licensee or permittee named oS eAto en`a`e`iu•the `; ;"' ' business or operations specified above under"'type of-Licenae^or-T''ekin Licensee/PennitteeResponsible Person Signature Position/Title^ ----_.Pmnted,bjalme__. _ -_ _.. .._. _._. _ -date"w — -- .__ .. _ ATF Form540o_14/Sa_oo_.15Partr r __-_ - •- ,_.,.. _/- _ Previous Edition is Obsolete ANERICANFIREWORNSDISPIAYnG•1@SCDDpTYROA0713nl9-MY-01751-0PO09BLuIP1 ZMaZi-INPDRTFRDFEYPL08NE4 Revised October-2011 Federal Explosives License(FEL)'Cdstoiner Service Information Federal Explosives Licensing Center(FELC) Toll-free Telephone Number: (877)283-3352 ATF Homepage:www•atfgov 244 Needy Road Fax Number. (304)616-44,01 Martinsburg,WV25405-9431 E-mail:'FELC@atf.gov t - Chana of Address 27 CFR 5-55.54(a)(1)). Licensees or ermrttees may durin the term'of their cureetrt license or ermit remove their-business or rations to a Change ( P Y g P o0 rations at which they intend;reguNrly to carry on such,business,or operations, The licensee or pemittee is required;to.give'notification of the new location of the business or operations not less.than 10 days prior to such`removal with the Clikt Federal Explosives Licensing Center. The license or'peimit will be valid for the remainder of the term of the original license or permit. (The Chief,FELC,shaN,,if the licensee or permittee is not qualified,refer die,request for amended license or permitto the Director of Industry Operations for denial in•accordance with§555.54.) Right of Succession (27 CFR 555:59). (a)Certain persons other than the licensee or permittee may secure the righf to carry on the shine explosive materials ' business or operations at the,same address shown on,and for the remainder of the term of,a current license or'permit. Such persons are• (1)The surviving spouse or child,or executor,administrator,or other legal representative of a deceased licensee or permittc6,'and(2)A reoeiver'or trustee in bankruptcy,or an assignee for benefit of creditors. (b)In order to secure the right provided by this section,•the person or persons continuing the business or operations shall furnish the license or $ permit for-for that business or operations for endorsement of such succession to the Chief,FELC,within 30 days from the date on which the successor begins to carry on the business or operations. (Continued on reverse side) Cut Here Federal Explosives License/Permit(FEL)Information Card I Lieense/PermitName:AMERICAN:FIREWORKS'DISPLAY LLC I I Business Name: ;`' License/Pennit•Number.6�NYOf17-51=0G(J09382 I License/Permit Type-51-IMPORTER'O�EXPhOSIVES Expiration- July 1,2020 i I I Please Note. Not Valid for the'Sale or Other Disposition of Explosives, i I I S7T;ATE t0 NE1Nr YORKt u r,Y.�,. 'F`_r` -j DE_PAR-TME_NT OF'�LABO.R' i( 1 ) 'FE�, `;A'NDYNEA 4;.1_� ' _ - - ,� } `�.._�`^ ' , -.�a;`•' '�}, 111, i �'t� x�T - , , - ,ter � `}L' a't ..l � •z. `- IQFt SE jO D AL,'I, DR', UFMAC;1 c RElex PLOS _ ti ln-e� .��.^v...1 .-�._ .1�- .✓•� `.--n. Ezpires; 4l3©/�2020'1 V_ r� 1;; ani . -i AYmgricanF Firework-tD'isplay},;iLLC; - _ �Pq�`�Boz 980 '- 'fHI��LI,�CEN4SE'rMUST'BE; - - - '• � - ;Oz rid,(NY 138 0 IP15-61T 0"1(N7j q'4< ILA@E'' 10F°L6INORE S :K,v,iJri,ot-F;ntsct ler - ^n ILtce�s_g1p,ID:,5r1�71' i`sYhi�re6yfiicensedtto deal morrmanu acture ezplosivesi!n gl ance'Z+Lfi'�'the eGuirerne iso e L bo,t-AWAnd± ` IndustnaltC_a Rules, Any,che gn�he;conditions underwhiCc_Kth Ii_censeCis7�g�rantedlmayrca��&be } _ ' � {pl en,M6�ranko�A�ctingl�Director .F� ,' , - - '_ „ .- ...� - TH,,',,,�!✓,COMM SI03NER F'iLABOR' - , . .- - _ - ', Every6pe�son;iseiling;;deli,`veri g(orrgivin9�:wayan�/explosives;m`_usffKeen=,at;;th (principalfplaCe offbusmeCSJ' h`in, the�state�a�reco�d�o;each�,t�ansaction;igicluding; - - 1)p th`eN,AME';o °fmgYPE,andLQUANT rITZY,ot explosesSOLD;'DELI,UERED,,or,GLVEN!„Note fNo'Dicense,Ts - �heeiietl oto( u�chase�smoKeless;`• owdi:r,;oritilack owoer.7n!"'uantiUesdnot;exceedin eve ou nds torrruse�in'. " - ' he'r D al Ma u a to R po f ErgF��s e I ansactio s ode'alers�MU_S,T�Post,;alUsu'ch;tr`a�arctions'on, ,[ , s`th'e DATE',OF4EACHfSA�E,,DEL UER�Y 3) (h�INAME„(LICE�NS�NUMBER;anWkO,SINESS,ADDR,ESS ,ihe purchaser,'donee,-or+,personat_g whom; ;the explosives'•,wt e'delive�ed;and''ffie frm;(ffaany;:representedh'§”-cherson:, } 4) ithe'N,-AgME',,,,AQQ SSj-andj,LIaNSE'NMEof�t e-ersoq,Mfti-TLI Eb§X OSIVESAUVAYrf�om sellgriofdono'i; { Aco CERTIFICATE OF LIABILITY INSURANCE DATE(13/2019 Y) �� 05/13/2019 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 have ADDITIONAL INSURED provisions or 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 Allied Specialty Insurance,Inc NAME CT Michelle Kugler 10451 Gulf BlvdPHCN o xt• 727-547-3070 NC No• 727'367-5695 Treasure Island,FL 33706-4814 E-MAIL ADDRESS: mkugler@alliedspecialty com INSURERS AFFORDING COVERAGE NAIC# INSURERA: T.H E.Insurance Company 12866 INSURED AMERICAN FIREWORKS DISPLAY,LLC INSURERB: P.O.BOX 980 INSURER C: OXFORD NY 13830 INSURER D: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCEI=WVD POLICY NUMBER MM/DD/YYYYI (MMIDDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CPP0105319-03 03/17/2019 03/17/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE -X OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 5,000,000 POLICY E PRO- JECT 7 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER Protection&Indemnity $ 1,000,000 A AUTOMOBILE LIABILITY CPP0105319-03 03/17/2019 03/17/2020 IN Ee acccdentSINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED td Per accident)AUTOS ONLY X AUTOS BODILY INJURY( ) $ X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident $ A UMBRELLA LIAB X OCCUR ELP0012117-03 GL 03/17/2019 03/17/2020 EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED I I RETENTION$ $ A WORKERS COMPENSATION STATUTE OERH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A Coverage is afforded in the State(s of (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ A Excess VL ELP0012118-03 VL 03/17/2019 03/17/2020 Each Occurrence Limit $4,000,000 Aggregate Limit $4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Display Date 6/13119,6/14/19,6/15/19 Rain Date TBD Location Sound Ave.,Mattituck,NY RE General Liability,the following are named as additional Insured in respects to the negligence of the named insured Reithoffer Shows,Inc.,Mattituck Lions Club,Town of Southold,NY,County of Suffolk,NY,JIMD Corp.(property owner) CERTIFICATE HOLDER CANCELLATION Town of Southold 53095 Route 25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southold,NY 11971 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD j� `!1 t c: P launcFlrewoeKs h sit 3 Ih May 12, 2019 1:2,257 Town of Southold P.0 Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/13/19 Receipt#: 254074 Quantity Transactions 'Reference Subtotal 1 Fireworks 6.13-14-15.19 $100.00 Total Paid: $100.00 Notes: i Payment Type - Amount Paid By ' CASH $100.00 Mattituck, Lions Club _ # r _ Southold Town Clerk't Office " 53095 Main Road, 'PO Box 1179 Southold, NY 11971 ti y i 9 Name: Mattituck, Lions Club Po Box 91 Mattituck, NY 11952 Clerk ID: BONNIED Intemal ID:6.13-14-15.19 a , - tir r a{� e t - 4 Neville, Elizabeth From: Flatley, Martin Sent: Wednesday, May 15, 2019 2:39 PM To: Neville, Elizabeth Subject: RE: Emailing: New Liq Lic-Good Food 5_20190515132014 I have no objections to this license being approved Martin Flatley, Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Neville, Elizabeth Sent:Wednesday, May 15, 2019 2:36 PM To: Baylinson, Lester<lesterb@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.southold.nv.us>; Flatley, Martin <mflatlev@town.southold.ny.us>; Lanza, Heather<heather.lanza@town.southold.ny.us>; Norklun,Stacey <Stacey.Norklun@town.southold.nv.us>;Verity, Mike<Mike.Verity@town.southold.ny.us>; Weisman, Leslie <lesliew@town.southold.nv.us>; Doherty,Jill<rill.doherty@town.southold.ny.us>; Doroski, Bonnie <Bonnie.Doroski@town.southold.nv.us>; Duffy, Bill<billd@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.ny.us>; Hagan, Damon<damonh@southoldtownny.gov>;Jim Dinizio <iim@iamesdinizio.com>;Standish, Lauren,<Lauren.Standish@town.southold.nv.us>;'Louisa Evans <Ipevans06390@gmail.com>; Neville, Elizabeth<E.Neville @town.southoId.ny.us>; Noncarrow, Denis <denisn@southoldtownny.gov>; Rudder, Lynda <lynda.rudder@town.southold.ny.us>; Russell, Scott <scottr@southoldtownny.gov>;Silleck, Mary<marvs@town.southold.ny.us>;Tomaszewski, Michelle <michellet@town.southold.ny.us>;William Ruland <rulandfarm@yahoo.com> Subject: Emailing: New Liq Lic-Good Food 5_20190515132014 Attached, please find an application for a New Liquor License submitted by Gula Gula NY, LLC. Please review it and send me your comments and recommendation. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: New Liq Lic-Good Food 5_20190515132014 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. Neville, Elizabeth From: Flatley, Martin E Sent: Thursday,,May 16, 2019 3:14 PM To: Neville, Elizabeth; Duffy, Bill; Fisher, Robert; Spiro, Melissa;'ted @strongsmarine.com'; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland,William; Russell, Scott Cc: Norklun, Stacey Subject: RE: Emailing: Fireworks Matt Lions Str_20190514095215 I have no objections to this permit being approved as long as the Mattituck Fire Department has signed off on it.This is a new location for their shoot this year in an area which was formerly a horse corral surrounded by trees. We will still be closing down Rt.48 while the display is being fired because of its proximity to the roadway:Just want to make sure any local properties will be safe from failing embers and fire potential. Martin Flatley, Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Neville, Elizabeth Sent: Wednesday, May 15, 2019 2:50 PM To: Duffy, Bill<billd@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Spiro, Melissa<Melissa.Spiro@town.southold.nv.us>; 'ted@strongsmarine.com' <ted@strongsmarine.com>; Dinizio,James<iames.dinizio@town.southold.nv.us>; Doherty,Jill <iill.doherty@town.southold.nv.us>; Evans, Louisa<louisae@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.nv.us>; Ruland,William<wiIlia mr@southoldtownny.gov>; Russell,Scott <scottr@southoldtownny.gov> Cc: Norklun, Stacey<Stacey.Norklun@town.southold.ny.us> Subject: Emailing: Fireworks Matt Lions Str_20190514095215 Attached, please find an application for a Fireworks Permit for the 2019 Strawberry Festiva] submitted by the Mattituck Lions Club. Please review it and send me your comments and recommendations. Elizabeth A. Neville, MMC. Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: Fireworks Matt Lions Str 20190514095215 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 Neville, Elizabeth From: Neville, Elizabeth Sent: Friday, May 31, 2019 1:03 PM To: Neville, Elizabeth I Subject: FW: Need pyro license Mattituck Lions From: Neville, Elizabeth Sent: Friday, May 31, 2019 1:02 PM To: Neville, Elizabeth Subject: FW: Need pyro license Mattituck Lions / Sent: Friday, May 18, 2018 1:02 PM To: Neville, Elizabeth; Fisher, Robert; Flatley, Martin Subject: RE: Need pyro license Mattituck Lions Ok. Good with me 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.duffy@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 maylcontain 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: Neville, Elizabeth Sent: Friday, May 18, 2018 11:23 AM i To: Duffy, Bill; Fisher, Robert; Flatley, Martin Subject: FW: Need pyro license Mattituck Lions Attached, please find the proper pyrotechnics license for the Mattituck Lions Club Fireworks Permit. Betty From: Jennifer Banks [mailto:americanfireworksjen(a cimail.com] Sent: Friday, May 18, 2018 10:01 AM To: bsualia0)mattlaundry.com Cc: Jen Subject: Re: Need pyro license Here you go, let me know if you can't open it. Have a great weekend! On Fri, May 18, 2018 at 9:56 AM, <bsu lia kmattlaundr.ccom>wrote: Good Morning Jen, The town contacted me and said they need one more of Kevin's licenses. I scanned the one from last year and attached it. If you could forward it to me that would be great. Thank you, Ben Suglia Mattituck Laundry 631-298-1963 2 Neville, Elizabeth From: Flatley, Martin Sent: Thursday, May 16, 2019 3:14 PM To: Neville, Elizabeth; Duffy, Bill; Fisher, Robert; Spiro, Melissa; 'ted@strongsmarine.com'; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland,William; Russell, Scott Cc: Norklun, Stacey Subject: RE: Emailing: Fireworks Matt Lions Str 20190514095215 i I have no objections to this permit being approved as long as the Mattituck Fire Department has signed off on it.This is a new location for their shoot this year in an area which was formerly a horse corral surrounded by trees.We will still be closing down Rt.48 while the display is being fired because of its proximity to the roadway.Just want to make sure any local properties will be safe from falling embers and fire potential. Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Neville, Elizabeth Sent:Wednesday, May 15,2019 2:50 PM To: Duffy, Bill<billd@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.southold.nv.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Spiro, Melissa<Melissa.Spiro@town.southold.nv.us>; 'ted@strongsmarine.com' <ted@strongsmarine.com>; Dinizio,James<iames.dinizio@town.southold.ny.us>; Doherty,Jill <iill.dohertv@town.southold.nv.us>; Evans, Louisa<louisae@southoldtownny.Rov>; Ghosio, Bob <bob.ghosio@town.southold.ny.us>; Ruland,William<williamr@southoldtownny.gov>; Russell,Scott <scottr@southoldtownny.gov> Cc: Norklun,Stacey<Stacey.Norklun@town.southold.ny.us> Subject: Emailing: Fireworks Matt Lions Str_20190514095215 Attached, please find an application for a Fireworks Permit for the 2019 Strawberry Festival submitted by the Mattituck Lions Club. Please review it and send me your comments and recommendations. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: Fireworks Matt Lions Str 20190514095215 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 Neville, Elizabeth From: Neville, Elizabeth - Sent: Thursday, May 16, 2019 3:15 PM To: Flatley, Martin Subject: RE: Emailing: Fireworks Matt Lions Str_20190514095215' Thank you Chief! -----Original Message----- From: Flatley, Martin Sent:Thursday, May 16, 2019 3:14 PM To: Neville, Elizabeth; Duffy, Bill; Fisher, Robert; Spiro, Melissa; 'ted@strongsmarine.com'; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland,William; Russell,Scott Cc: Norklun,Stacey Subject: RE: Emailing: Fireworks Math Lions Str_20190514095215 I have no objections to this permit being approved as long as the Mattituck Fire Department has signed off on it.This is a new location for their shoot this year in an area which was formerly a horse corral surrounded by trees.We will still be closing down Rt.48 while the display is being fired because of its proximity to the roadway.Just want to make sure any local properties will be safe from falling embers and fire potential. Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Neville, Elizabeth Sent: Wednesday, May 15, 2019 2:50 PM To: Duffy, Bill<billdC@southoldtownny.gov>; Fisher, Robert<Robert.FisherCa@town.southold.ny.us>; Flatley, Martin <mflatlev@town.southoId.ny.us>; Spiro, Melissa <Melissa:Spiro@town.southold.ny.us>; 'ted@strongsmarine.com' <ted@strongsmarine.com>; Dinizio,James<iames.dinizioC«@town.southold.nv.us>; Doherty,Jill <Oil l.doherty@town.southold.nv.us>; Evans, Louisa<louisae@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.nv.us>; Ruland,William<williamr@southoldtownnv.sov>; Russell,Scott <scottr@southoldtownnv.gov> Cc: Norklun,Stacey<Stacey.Norklun@towmsouthold.ny.us> Subject: Emailing: Fireworks Matt Lions Str_20190514095215 Attached, please find an application for a Fireworks Permit for the,2019 Strawberry Festival submitted by the Mattituck Lions Club. Please review it and send me your comments and recommendations. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 1 Your message is ready to be sent with the following file or link attachments: Fireworks Matt Lions Str 20190514095215 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. R ; 2 Neville, Elizabeth From: Neville, Elizabeth Sent: Wednesday, May 15, 2019 2:50 PM To: Duffy, Bill; Fisher, Robert; Flatley, Martin; Spiro, Melissa; 'ted@strongsmarine.com'; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland, William; Russell, Scott Cc: Norklun, Stacey Subject: Emailing: Fireworks Matt Lions Str_20190514095215 Attachments: Fireworks Matt Lions Str_20190514095215.pdf Attached, please find an application for a Fireworks Permit for the 2019 Strawberry Festival submitted by the Mattituck Lions Club. Please review it and send me your comments and recommendations. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the'following file or link attachments: Fireworks Matt Lions Str 20190514095215 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 Town Hall,53095 Main Road ELIZABETH A.NEVMLE C CMC P.O.Box 1179 TOWN CLERK Southold,New York 11971 REGISTRAR.OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER ',�a RECORDS MANAGEMENT OFFICER w Telephone(631)765-1800 FREEDOM OF INFORMATION OFFICER - � � s�.rf southoldtown.northfork.net RECEIVED OFFICCE OF -TOWN CLERK MAY 1 3 2019 TOWN OF SOUTHOLD APPLICATION PERMIT TO DISPLAY FIREWORKS Southold Town Clerk APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the, Penal Law of the State of New York, for a permit to display fireworks as hereinafter specified:. DISPLAY IS TO BE SPONSORED BY. . � g c _ ! a^s- C-1 PRINCIPAL OFFICE AT. j � G` i'� =® ` �a� /`'�''� "ue & -" DATE &TIME OF]DISPLAY 41hJ .r . = .d ;,. ®�'.®�� r l'�„ �a PG re i.S- I0 5, EXACT LOCATION OF DISPLAY, //�® +!7 ,-/ _KG Ay ,%�cie:sd .r ,?r'�°d L-,�4C�i�� SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE&TIMEThe following persons are to be in charge of the actual shooting of the fireworks: Name / Agee Experience Physical Condition (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: f B ,;w.1f d/ a` [I, r/y� ► S' G'l r 1, lo- J 'r S- Ie-ctea[ --4, f - -- - Danner and place of storage of fireworks prior to display: F(%r-� -,4 Attached hereto and made a part of hereof is a diagram of the grounds on which the display is to be held. Also attached is a certificate or policy of insurance coverage. NOTICE: Written permission,with signature of the-Piroperly_G-64 must be submitted with the Application. Name'of Organization Signature of Applicant At least two of the following people will be on the display site as pyrotechnicians. One as lead operator(with NYS Pyro Certificate of Competence)and one person as an Authorized Assistant(with or without a certificate of competence). Certified-P4totechniciani _ Name Driver's-1-10 _ Years Experience NY§PyroCert Fritschler, Kevin NY633715082 30+ - PR-95 exp 10/2021 Banks,Jennifer NY933267221 10 PR-594 exp 7/2021. Banks,-"John NY173171537 12 PR-307 exp 4/2022 Blasetti, Louis NY208450857 8 PR-624 exp 7/2022 _ Bue,Cima NY180909735 __-__ 8 PR-629 exp 7/2022_ Chiavelli, Richard NY942966115 15 PR=410 exp 4 /2022 " Coyle,Michael NY141135360_- __- ,12 PR-711 exp 2/2021 Ebersol,Shawn NY100110988 9 PR-401 exp 4/2022 Farquhar,Jody NY410553501 _ 10 PR-388 exp 4/2022, Frank, David NY541337976 _ 14 PR-456-exp 5/2022_ Fritschler, Brian NY164029290 14,1311-370 exp 4/2022 Harrad, Matthew _ NY248789664_ __ __ 4 PR 730 exp 6/2021_ Kilgalleh,Michael NY391011832- 15 PR-442 exp 5/2022 Lisk,James NY761967816 __ _ _ 4 PR-113 exp 2/2021 McGrath,Thomas NY549876681 10 PR7549 exp-8/2022__ Newton,Timothy NY409531821 12 PR-346 exp-4/2022 Ostrowsky,Joseph NY227424840 _ __ 4 PR-712-exp 2/2021 Sarpriacone,:Brian NY219205362 14 PR-343 exp 4/2022 Sadowski,.James NY177205855 , 10 PR-604 exp 7%2021 Smith, Raub NY648792590 9 PR-589 Smith, Raub Jr. NY730805237 _- _ 9 PR-593 exp 7/2021 Thomas, Harvey NY801631891 13+- PR-531 exp 7/2022 Wakefield,Jeremy INY972077323 12 PR-606 exp 7/2021 Name Driver's License DOB_ Corn, Gerald _ NY840331958 2/26/1985 Coyle,Jeffrey _ 3/31/1980 DiFondi,Michael NY312017662 5/21/1998 DiGeorgio,Randy NY450512353, _ 7/5/1996 Ebersol,Tyler NY122836855 _ - _6/21/1996 Fazzlo,'Morgan NY582372330 6/26/1982 Fritschler,Karl NY263669573 .6/2/1954 Garard,Gerald NY310062259' 1/27/1971 Garrison, Krystle PA29745646 9%28/1985 Gillette,David NY972051529 12/21/1982 Mazza,John NY964398332 5/23/1996 Morley,Vernon R.Jr. NY529042387_ _11/9/1970 Rabe,Scott NY149169496 4'/10/1968 Riley, Rich NY156607483 -1 _ _ _ s _ 4/20/1974 Roane,William NY603087773 3/3/1955 Swift,Jeremy NY411696458 2/28/1971 Ules, Michael NY995862607 2/13/1967 Voelker, Pamela NY948970223 5/5/1962 Wakefield,Jamie M. INY210479056 _ 9/2/1987- Federal Explosives License/Perrnit U.S.Department ofA Alcohol,' 'Tobacof ice (18 U.S C Chi7pter 4®) Bureau of Alcohol,'Tobaeco,Fnrearms and Explosives rnasrenraa®lr®rtam®etataniiru f In accordance with the provisions of Title XI,Organized Crime Control Act of 1970,end the regulations issued thereunder(27 CFR Part 555),you may engage in the activity specified in this license or permit within the limitations of Chapter 40,,Title,18,United States Code and the regulations issued thereunder,until the ' expiration date shown. T-Hi LtCE1VSE ISl�tC}'i'-T_�AAIS19El1alILE-UNDEA-:- _ R_95k.53: See'.WARNINGS"and"NOTICES"on reverse. _ Direct ATF ATF-Chief,FELC 7 `r" w m a:=rd Elh'SCctn1tt- T Correspondence To 244 Needy Road z ;'r r` ,: _ uitltr= - naa' , i 'nP: AA _ __ -`'$,ems'•:•'!q yt' _-_ _ - _-_ _ _ - _ _ -___ -_ Iviertinsbifr�i WV 25405-9431� ;.. ,'' �;'<i`F :'sig..' 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Miesii�tttuiruo2r:eaeh'convttttiix'kieairoPiainat"w 'r% AMERICAN F1RE1N.uORKS DISPLAY LLC 'citainhtrc:• a faxed.scanned or e-mailed copy ofthe9icegsc orpgermi2iwEh a signature tiw Iran. •) i4' intended to be an original signature is acceptable. The signiitur'e n-siVb'etttat of the Fedeiiil PO-BOX;980„ ,+ ;' Explosives Licensee(FEL)or a responsible person ofthe FEL%t'ceitify,that;{iiis,is a true OXFORD"~(:1Y copy of a license or permit issued'tothe lieensce or permittee,named'a6t3yetoltitiguge°im.the..ri••d, • z•, ' •; business or operations specified above under"'type of License or P'atitlil:'i ^W T, mss'?` 1^`' •” " , w;zw ".i - - -- - - - -- - -- _ '.�A.,�.,',bow�:-,,t.,i �,�"' .-°� .�• d , Licensee-TennitteeResponsible Person Signature Position/Title: F r �r ciruivia�wext.l;Pay,l i Previous Edition uObsolete eafquwnREWBKS aseurueImcauNrrnoLO7i3OLfa,Nraiaiaaa:eo2jL0.m�fiweomrnovavwarvo^ — __- -- _- Revised ctobu201_1 - t Federal Explosives License(FEL)Customer Sen-ice Information Federal Explosives Licensing Center(FELC) Toll-Fru:Telephone Number. (877)283-3352 ATF Homepage www,atf gov 244 Needy Road Fax Number. (304)616-4401 Martinsburg,WV 25405-9431 E-mail- FELC@atfgov 9 Change of Address (27 CFR 555.54(a)(1)),Licensees or permittees may during the term of their current license or permit remove their business or operations to a new location at which they intend regularly to carry on such business or operations. The licensee or permittee is required to give notification of the new location of the business or operations not less than 10 days prior to such removal with the Chief,Federal Explosives Licensing Center. The license or permit will be valid forthe remainder of the term of the original license or permit (The Chief,FELC,shall,if the licensee or permittee is not qualified,refer the request for amended license # or permit to the Director of Industry Operations for denial in accordance with§555.54.) Right of Succession (27 CFR 555 59). (a)Certain persons other than the licensee-or permittee may secure the right to carry on the same explosive materials m business or operations at the sae address shown on,and for the remainder of the tertwof,a current license or permit. Such persons are. (1)The surviving spouse or child,or executor-administrator,or other legal representative of a deceased licensee or permittee;and(2)A recerver or trustee to bankruptcy,or an assignee for benefit of creditors: (b)In order to secure the right provided,by this section,the person or persons continuing the business or operations shall furnish the license or i permit for for that business or operations for endorsement of such succession to the Chief,FELC,within 30 days from the date on which the successor begins to { cam on the business or operations. — — ———— (Continued on reverse side) Cut Here Federal Explosives Liceuse/Pernait(FEL)Information Card j LicenselPermd Name.AMERICAN.FIREWORKS DISPLAY LLC 1 J, BusmessName. 3 t { i License/Pennit Number:6-ldY=017-51=013-00982 j 1 1 Lieerim'Perm t Type.51-IMP0RTEFfOF,EX6?LOSIVES Expiration* July 1,2020 l 1 I]Please Note: Not Valid for the Sale or 011ier Disposition of Explosives I {` _ -_ tea! . .k •- f••- :- - jn �• �' - ._, � 'f , J •- --- _ '- _ _ 1' - ' 'rti_ �,N,,e ,4',. , � _ - -- .-_ -'C�,.,l�+x'r- - - j'i 4'•t+A z__2' '3 -' - '-^�zb;Vit-'., •'- - " r _ ,{ 't„ 14�1. _� z+tC- '••4` i ' - t.- - `.�"'c•F�NE f,+_-.,a � "�'� �+rte'_�a=tib.:�rt, _ -r,-,z ,•,•._G;`; rC"' STA 4•:�i,'-4 „'i4,,.L,.� IluiJ�oNP,QF' TE OF'�NE1N-YORK ESTA 71 S Y - I - .4 A..-. .-!'- _ -- ,v^ +_ - ' ' I� . � - - - - - 4-_-a:.i,-'i�- 1.1.- •<t, - r'•- -`�',` •• - i- D,EP/�RTM'ENT'OF?;LAB,OR'. TfSAF,ETY� J . A++ND`f�AL?H::+: � , ;L ti'1 .t. . - ?LICENSf 1T0 DE�AL6IN;AOR'�MANUFAC�T�UREEXPLm:SINESIr« t � .��..n.-�i�.-r - .1..a _f- _ t"---•5,., �.. ✓•,1,.--"_- _• -�4;'.t l _ - r • .,,., -- - ",S[ - - a..' - - ,:F` -. T .'i_ _•'i..s - _} ,�,;.--_ - 4}:�':,Y��•;` ;•:\'4t •r"w - � _ ,q•f ,Expiiss,- =A1-3020207. {_ - , - ' . - e-4 _- - �','�..3'`yF ~i.4 '{ `_,�-"_�'(F- �'S'r'' - - "J -'i - rµJ,,4},'''S •i�.-T ,L, C' 'r'.r_=.1�'`,4 i' -sr�-s�\,� --.� !� - ,'•llmer•Ivan,�Ei�ewor_ksfDlsplayrr,3LSLC, �f� _ .�=,l = - - - - i:a- :- "v - �r r r• ' - ` - -fIO_a'zfto-rtdv.NYrf,-(:�'1-'3-8',3, : " ,,I:- • _,k.-"' ' ,e ,YIM�.�IS'Y IVIyC`r+.N`.tS�E._.",M,..;�U,STCB " + E40 POSTYAE { ,'. OF�BUSII�IESS; , + ;4 = ICev nlJontF� it"schlep. Lie,No,D5'1'T1• cent.` 3 = i"s herebylliceiisedto,tlea 'orzm`ariufacturatexplosivas,,injcomplionce'witht#ierequirements of,theitLaborlLaw,andf'+' 'Industrial6Code Rules.'tir�ycFiange�injttie,corid(tiortsr ndewtiictinthislldense,�s,g�antedEmay,',iuse,Rto?tie _ l dustd ':- - •„�.y- `-' 5-_,�,.-�+-- ,� = es -;_ -=- --, ;rte- __.r _ :::, c-','� -,,:,fir„rv'=r,-,- ,� I h _I _ ' FJI en.lUl?IFrarik;(Acting Director' ”�F10R, Eve,'""ersonfsellin IRderveriri'L ole ivi`3'•auva zany exploswes,mustlkeep.af�ffie',pnncipal:place oRtiu in'essrw%thin the state;`a�,record�;nf'eacti'fransacfion*incl ding ) ''= =+ �» .t;•° - _ , i; [��: _ .�y, [w,',:- ;b ;,•sT 3M ' `siSes'SOLD'{DEIVERED''or,GNEN Note'No,�hcen`se.is. 'lie.NAME tirTYPE",and�QUANTiT,1'�ofeacplo SQ o _R .�. ,-� a _ - " -'neededlto purcfiasi:,smokele s�.powdi:,on,tilack"powddkiniguantdie�"noloxceeding�five;pounds:for�usa`in,`� ! - fi�ingparitigue fisea s �da�rtifact's'6or,repllcasttiereof., F,{o evedealeFstM19STpost,all6such trai sadtions6nt'''_: +-f '1-t=.. rs',ter.- , ...t i. n _ - - ra;`f'-.• ,.s' - _ , _ ''tFie`"pealerrMa�tufactueraRepoitof#Eicplosives;3Tlansac�tions.x,, c•- -._•,` --- 1;- '2•)' , ,ttie?DA7EAOF EACH3ALE;;DEL[VE'RYtortGIFT. ,t'r- t' 3 ,`;fhe3NAME,,LIEl_NSE+NUMBER;andtBlJS�NESSIADDRESS.�fithe�purcher,don__ee;_;or;pe_�son`to,whom, "'-L'fhe ex`IosiSes`were 6 ered=and�ttie}fi rt yif any;reP�esented 6y sucfi;perso , �n -L:-_GE Sw=NU -sYAAAKINT -4tWNAMEADDE _ FiE`EXI�LOSI1lESt\W�Y,afrom=' - ' }.. {=x4' ihe`sellerordono�c' t° 4: _ ir' _ _ •`'o` _ � 'rte ',. •J - , , t. ., ^' - -3T-_ri \--i,� :J-'�1-'t t `-, ` �_- Y <<- _.}- - - -•�' _�`- -_ ��,_,,; - •�' �; `aJ - ti•t_ ,`r+v'--{`��' = d;-: - .'v` q• "->t; -,}' --_ I a§` -_ ,J , _ 'Fsl, _ � • L 'ipa., - .3,', itt- -a«I N.,J-_- --_'� i sj Yt E,, -_ n _ 'Il c _ _ - _ r,l�i, 4Y•- �'�_•/"'-'_'J!,'�&-�i�jyy H; � � ` ,' - - •' t _ - ,t y'� 4`� _ - ' - _ „A',,` _ _ _ ''�..` ,C ,p*r_-- r t�rL'' -C ''� '�3' Vy -� - t-.- -_- }f - F r 'P P _ - I'..v _ _ �'Y _ •i h-W F *� 4¢f --_ , - �-,~�'' - T- ---- ter'•.- `t^ ..i _- �,t' i_ _- - - yf � -' - 4 -- - • ,:j i - _-f•L r_`,'" ps. _ r_ - - L,+,l'A1 .0( - - .'-,_� _ .zaL.:o-= ,�•r! - - =)��` - - 1 - s;� _ `'L�t"`'-j'. - , - = -i: rte, r.,.t 's.� - - s•- `.,-S':x i.Y.�= _ `_'ssrt.>,•w- - -� ,'}". I __ "-,t `�`I. i' - *,`'� _ -. ,`•l°- -, _ c` _ ',1� r;'<= -_ �,Y r .� -.A,-.`r _ �I =71--,lTr!`.1r -- - 3 - -,1F -'Y r - '� - - -<'' - nR`-•/r'• " 'ti ar- . 'a' - -, .� 1 ,- ,�+,'_ - -rte t• ,- _3 `'"'' "��` - .`°'' 1>_ .r,`r.a _ 'Yc• ,"; ,i„ 't,t i2, - �4 - - To. [-;�,5-; -- 'r}� -_ -4 - - ,}T J' „'�.,`�.f .:>..= `_l i '.s•._-`, ( - - - - -- _ -6" __ ,=ti' -mow _ '� _ ,- ,.'- - _ _ rn-,,•�_ _ -`ai'__:_* n'`r t<d•'�,.�;`,1, -,} ! _- ;r - - :- -=a:'F"` ti¢�f�,--{i� -�j�i'.' �,;.�, - ,;',•S'• - - _, -Ns.'^f''_,,;z�'.`1'_ :��.F.Y��•-.- .`.3:�w.s'-/ �,� ,i;'t,o-_ ''t`- i,S ;''W = --'r-;'+'" - "a= ,\-!` ':s`• - - `-`�' '`'.' -_--.'''�'`is=-' - �`-i� __-j'_.,c.rrs,m r: �- (� DATE(MMIDDIYYYY) A(CC>RE CERTIFICATE OF LIABILITY INSURANCE 05/13/2019 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 ADDITIONALmay INSURED,-the policy(ies)must have'ADDITIONAL-INSURED-provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies ay require an endorsement. A statement on this certificate does not.confer rights to the certificate_h_older in lieu.of such endorsement(s). PRODUCER .- ---_—_-- - - -_-- - ----`- =C NTACT Michelle Kugler _ Allied Specialty Insurance,Inc. n(aME:` = g 10451 Gulf Blvd PHONEa� t727-547-3070 FAX,fA/C 727-367-5695 Treasure Island,FL 33706-4814 EtdAtL,. rrikugler@alliedspeaalty.com D mss' INSURERS AFFORDING COVERAGE _ _ NAIC 9 wsURERA: T.H.E.Insurance Company 12866 INSURED AMERICAN FIREWORKS DISPLAY,LLC INSURERB: P.O.BOX 980 INSURER C: OXFORD NY 13830 INSURERD: _ 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.__ IL R TYPE OF INSURANCE AODL S BR f • POLICY NUMBER- --4 PM/DD EFF MMIDDrYYYY POLICY EXP -LIMITS - A X COMMERCIAL GE NERAL LIABILITY CPP0105319-03 ,03/17/2019 03/17/2020 EACH OCCURRENCE - S 1,000,000 oA fOTFE`Ff1'Efe'--'"- ,$ 100,000 CLAIMS-MADE ®OCCUR PREMISES En-aarurlartca MED EXP_(Aq one person)__ s N/A PERSONAL&ADV INJURY S 1,000,000 GEN'LAGGREGATELIMITAPPLIES PER, GENERAL AGGREGATE is 5,000,000 RPOLICY D 181 F-1LOC PRODUCTS-COMP/OP AGG $ 2,000,000&I OTHER Protection ndemnity $ 1,000,000 AUTOMOBILE LIABILITY COMBI�ED5)NGLELiM{T $ 1.,000,000 A CPP0105319-03 03/17/2019 03/17/2020. Es 2 dant _ ANY AUTO BODILY INJURY(Per person) '$ OWNED t/ SCHEDULEDBODILY INJURY(Per accident) S AUTOSONLY rx"I AUTOS $ HIRED NON-OWNEDeQdAUTOS ONLY AUTOS ONLY cd ) s A UM13 ELLALIAS X OCCUR ELP0012117-03 GL 03/17/2019 03/17/2020' EACH OCCURRENCE. $ 4,000,000 _ < X EXCESS LIAB CLAIMS-MADE' AGGREGATE_ _ - $ 4,000,_000 DED RETENTION S = -- -°- 'S ' WORKERS COMPENSATION - - - - _ A AND EMPLOYERS'LIABILITY Y/N ,.) - ANYPROPRIETORIPARTNERIEXECUTIVE ❑ N/A ,Coverage is afforded in the States Of: 1 E•L,EACHACCIDENT S. -- OFFICER/MEMBEREXCLUDED7 ( - ` (Mandatory In NH) E L.DISEASE-EA EMPLOYEEIf yes,describe under = DESCRIPTION OF OPERATIONS below _ - E.L.DISEASE-POLICY LIMIT A Excess VL ELP0012118-03 VL 03/17/2019 .03/17/2020 Each Occurrence Limit $4,000,000 Aggregate Limit $4,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Display Date 6113/19,6114/19,6/15119 Rain Date: TBD Location' Sound Ave.,Mattituck,NY RE-General Liability,the following are named as additional insured in respects to the negligence of the named insured• Relthoffer Shows,Inc.;Mattituck Lions Club,Town of Southold,NY,County of Suffolk,NY;JIMD Corp.(property owner) CERTIFICATE HOLDER .. CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 Route 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold,NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. 'AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION:All rights reserved, ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD \.(. .. is„i"4 x�.,�?.`�'. '�.r$• ,tea �-�}+. _ .. _ .., .4�•� - > a�q r tz' Y Yz- r� �y Y C} j e�✓ x i \k •S €TM ^f• KYR`: yec a ey4` i _ =5 e , .s g ''tom a a vara' �ry 3 S F.f=• a-�r , £ yr _ a «s 1 _•� � ia>r.x'T'. s'iTM. a.i€• y-,az 1 `g«'`w'a°^� Y'{ ,.�,w - � 3 .. -. -d p”<, s.i w < s y a«Y - �a# • y H, y�u - -R vA M < ,a a=5, s� s� ,r i n J �t v ' tel. P «f z• a x N:a ro ge>s`. r§a �:r,. a„ -�• �,'�`� :�-�==,,. $ls - .tea. �.'�,_ 'Y=, za - 'S: a'?. P 'J'�S-'� "i - - ,J. "f�•,'-,:• �`�.�• -^ex's �' • ;Y t�., q Y rtf tx+ - L -- �•.2R- t8 A e °z- N�=r,.. - i L'.� .v�o5�..;'°xa:: 'Q� re3°sa£y -�'. 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May 12, 2019 1:2,257 Neville, Elizabeth From: Neville, Elizabeth Sent: Thursday, May 16, 2019 3:15 PM To: Flatley, Martin Subject: RE: Emailing: Fireworks Matt Lions Str_201905-14095215 Thank you Chief! -----Original Message----- From: Flatley, Martin Sent:Thursday, May 16, 2019 3:14 PM To: Neville, Elizabeth; Duffy, Bill; Fisher, Robert;Spiro, Melissa; 'ted@strongsmarine.com'; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland, William; Russell,Scott Cc: Norklun,Stacey Subject: RE: Emailing: Fireworks Matt Lions Str_20190514095215 I have no objections to this permit being approved as long as the Mattituck Fire Department has signed off on it.This is a new location for their shoot this year in an area which was formerly a horse corral surrounded by trees. We will still be closing down Rt.48 while the display is being fired because of its proximity to the roadway.Just want to make sure any local properties will be safe from falling embers and fire potential. Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Neville, Elizabeth Sent:Wednesday, May 15, 2019 2:50 PM To: Duffy, Bill<billd@southoldtownnv.gov>; Fisher, Robert<Robert.Fisher@town.southold.ny.up; Flatley, Martin <mflatlev@town.southold.ny.us>; Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; 'ted@strongsmarine.com' <ted@strongsmarine.com>; Dinizio,James<iames.dinizio@town.southold.nv.us>; Doherty,Jill <iill.doherty@town.southold.ny.us>; Evans, Louisa<louisae@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.nv.us>; Ruland,William<williamr@southoldtownnv:eov>; Russell,Scott <scottr@southoldtownny.gov> Cc: Norklun,Stacey<Stacey.Norklun@town.southold.nv.us> Subject: Emailing: Fireworks Matt Lions Str_20190514095215 Attached, please find an application for a Fireworks,Permit for the 2019 Strawberry Festival submitted by the Mattituck Lions Club. Please review it and send me your comments and recommendations. Elizabeth A. Neville, M'MC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 i Your message is ready to be sent with the following file or link attachments: Fireworks Matt Lions Str 20190514095215 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. z Neville, Elizabeth From: Neville, Elizabeth Sent: Wednesday, May 15, 2019 2:50 PM To: Duffy, Bill; Fisher, Robert; Flatley, Martin;Spiro, Melissa; 'ted@strongsmarine.com'; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland,William; Russell, Scott Cc: Norklun, Stacey Subject: Emailing: Fireworks Matt Lions Str_20190514095215 Attachments: Fireworks Matt Lions Str_20190514095215.pdf Attached, please find an application for a Fireworks Permit for the 2019 Strawberry Festival submitted by the Mattituck Lions Club. Please review it and send me your comments and recommendations. Elizabeth A. Neville, MMC Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: Fireworks Matt Lions Str 20190514095215 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 ELIZABETH A.NEVILLE,RMC,CMCY Town Hall,53095 Main Road P.O.Box 1179 TOWN CLERK ; Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145 MARRIAGE OFFICER ;F RECORDS MANAGEMENT OFFICER „ pt Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER . southoldtown.northfork.net RECEIVED OFFICE OF THE, TOWN CLERK °, ,: ' TOWN OF SOUTHOLD °" APPLICATION PERMIT TO DISPLAY FIREWORKS Southold Town Clerk APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law of the State of New York, for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY__? j- PRINCIPAL OFFICE AT A TIME OF DISPLAY 13 " ,� .n " EXACT LOCATION OF // W"� i . A/1'1.._.. SUFFOLK COUNTY TAX MAP NUMBER FOR SITES RAIN DATE & TIME /0 The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition _ -� _......... (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: m 0 M illl ou �o. � f Lf �`.,...—.... � d" � �✓ M �..d' b � '^M1y�"'" �N Y I k �.r I d. " !o - 3 � Manner andr lace of storage fireworks prior to p .._..ag a of - p display:, E ^ � v j", 7 � �� , e4,' ," Attached hereto and made a part of hereof is a diagram of the grounds on which the display is to be held. Also attached is a certificate or policy of insurance coverage. NOTICE: Written permission,with signature of the Proper Own r°, must be submitted with the Application. ..,.. ... Name of Organization By_ Signature of Applicant .. At least two of the following people will be on the display site as pyrotechnicians. One as lead operator(with NYS Pyro Certificate of Competence)and one person as an Authorized Assistant(with or without a certificate of competence). Certified Pyru techni inns ,Name, Driver's Lic# Years& edence NYS Pvro Cert # Fritschler, Kevin NY633715082 30+ PR-95 exp 10/2021 Banks,Jennifer NY933267221 10 PR-594 exp 7/2021 Banks,John NY173171537 12 PR-307 exp 4/2022 Blasetti, Louis NY208450857 8 PR-624 exp 7/2022 Bue,Cima NY180909735 8 PR-629 exp 7/2022 Chiavelli, RichardNY942966115 16'PR-410 exp 4/2022 ............... Coyle, Michael NY141135360 12 PR-711 exp 2/2021 Ebersol,Shawn NY100110988 9 PR-401 exp 4/2022 ....... Farquhar,Jody NY410553501 10 1 PR-388 exp 4/2022 Frank, David NY541337976 14 7PR-456 exp 5/2022 Fritschler, Brian NY164029290 14 PR-370 exp 4/2022 Harrad, Matthew INY248.789664 4 PR_730 exp 6/2021 Kilallen, Michael NY397011832 15 g PR-442 exp 5/2022 . Lisk,James NY761967816 4 PR-713 exp 2/2021 McGrath,Thomas NY549876681 10 PR-549 exp 8/2022 ......... Newton,Timothy NY409531821 12 PR-346 exp 4/2022 Ostrowsky,Joseph NY227424840 4 PR-712 exp 2/2021 Sarpriacone, Brian NY219205362 14 PR-343 exp 4/2022 Sadowski,James NY177205855 10 PR-604 exp 7/2021 Smith, Raub NY648792590 9 PR-589 Smith, Raub Jr, NY730805237 9 PR-593 exp 7/2021 Thomas, Harvey INY801631891 13+ PR-531 exp 7/2022 Wakefield,Jeremy INY872077323 12 PR-606 exp 7/2021 Autinen azied a�ssest a�°nts Name....-.............-....._.._--�. Driver's License DOB Corn, Gerald NY840331958 2/26/1985 Coyle,Jeffrey 3/31/1980 DiFondi, Michael NY312017662 5/21/1998 DiGeorgio, Randy NY450512353 7/5/1996 Ebersol,Tyler NY122836855 6/21/1996 Fazzio, Morgan NY982372330 6/26/1982 Fritschler, Karl NY263669573 6/2/1954 Garard, Gerald NY310062259 1/27/1971 Garrison, Krystle PA29745646 9/28/1985 Gillette, David NY972051529 12/21/1982 Mazza,John NY964398332 5/23/1996 _._.._........ _ _.................. Morley,Vernon R.Jr. NY529042387 11/9/1970 Rabe,Scott NY149169496 4/10/1968 Riley, Rich NY156607483 4/20/1974 Roane,William NY603087773 3/3/1955 Swift,Jeremy INY411696458 2/28/1971' Ules, Michael INY995862607 2/13/1967 Voelker, Pamela INY948970223 5/5/1962 Wakefield,Jamie M. INY210479056 9/2/1987 U.S.Department of Justice Federal Explosives LicenseNermit Bureau of Alcohol,Tobacco,Firearms and Explosives (18 U.S.C. Chapter 0) rm�smtt ¢arrmm■r nu® In accordance with the provisions of Title XI,Organized Crime Control Act of 1970,and the regulations issued thereunder(27 CFR Part 555), you may engage in the activity specified in this license or permit within the limitations of Chapter 40,Title 19,United States Code and the regulations issued thereunder,until the expiration date shown. THIS LICENSE IS NOT'rRANSFERABLE UNDER 2 CffeR 555.53. See"WARNINGS"and"NOTICES"on reverse. Direct ATF ATF-Chief, C arra it Corr spo denee To 44 Needy Road NiVtCtub 1 Martinsburg,:WV 25405-9431 Chief Federal F,ApIritiivcti Licensing Center(FELL Ewpiiiifhnt bate Narne AMERICAN FIREWORKS DISPLAY LLC .�........... ...__ Premises Address(Changes? Notify the FELCIaf least 10 days beforethe move) 105 COUNTY ROAD 7 MCDONOUGH NY 13801- Type of License or Pen-nit " 51-IMPORTER OF EXPLOSIVES Purchasing Certification Statement Mailing Address(Changes?-Notify the FELC of any changes.) Tlse licensee or permittee named above shall use a copy of this license or permit to assist a transferor of explosives to verify the identity and the licensed status ofthe licensee or permittee as provided by 27 CFR Part 555. 'ore sN at4re cii Kuii-r�ry mu b ua`oct inal" " P lt/IERICAN-FIREWORKS DISPLAY LLC 2, im ture. A faxed,scanned or e-mailed copy ofthe license or pemirt:with a signature intended to be an original signature is acceptable. The signature must'be'that ofthe Federal PO BOX1980' " EVlosives Licensee(FEL)or a responsible person ofthe FEL.,I,; r ifythattlats is atrue OXFORD NY 13830- copy of a license or permit issued to the licensee or permittee.named aboveto engage tn the p, , business or operations specified above under"Type of License or Perntrt" � �2 nl LicenseePernittee Responsible Person Signature PositiortlTitle Printed Name _ Datel-I __ ATF Form 5,M1nO 1415400.15 Pan 1 Previous Edition is Obsolete KOEPJUK FIREWORK]DISPLAY LLLIM COOKY RUB 7:13101:EOF UPL63PJFS Rev1SU1 OCLoba 2011 Federal Explosives license(FEL)Customer Service Information Federal Explosives Licensing Center(FELL) Toll-free Telephone Number: (877)293-3352 ATF Homepage:www.atf.gov 244 Needy Road Fax Number: (304)616-4401 Martinsburg,WV 25405-9431 E-mail: FELC@atf.gov Change.of.Address (27 CTT{555.54(x)(1)),. Licensees or permittees may during the term of their current license or permit remove their business or operations to a new location at which they intend regularly to carry on such business or operations. The licensee or permittee is required to give notification ofthe new location ofthe business or operations not less than 10 days prior to such removal with the Chief..Federal Explosives Licensing Center. The license or permit will be valid for the remainder ofthe term ofthe original license or permit. (The Chief,FELC,shall,if the licensee or permittee is not qualified,refer(he request for amended license or permit to the Director of Industry Operations for denial in accordance with§555.54.) Right of Succession (27 CFR 555.59). (a)Certain persons other than the licensee or permittee may secure the right to cant'on the same explosive materials business or operations at the same address shown on,and for the remainder of the teen of,a current license or permit. Such persons are: (])The surviving spouse or child,or executor_administrator,or other legal representative of a deceased licensee or permittee;and(2)A receiver or trustee in bankruptcy,or an assignee for benefit of creditors. (b)In order to secure the right provided by this section,the person or persons continuing the business or operations shall furnish the license or permit for for that business or operations for endorsement of such succession to the Chief,FELC,within 30 days from the date on which the successor begins to carry on the business or operations. (Continued on reverse side) Cut Here X u - -_...___ — .__----- ,,.--.._._____..__--.,.........____G Ci Federal Explosives License/Perrrtit(FEL)Information Card N L,ieense7Permit Name:AMERICAN FIREWORKS DISPLAY LLC d l t I N Business Name: 1 NI t n License/Pennit Number:6-NY-017-51-OG-00982 g I t LicensaPennit Type:51-IMPORTER OF EXPLOSIVES I l Expiration: July 1,2020 N, I Please Note: Not Valid for the Sale or Other Disposition of Explosives N I ', I g 1, /% / / / �/ ni�r. i//�� // // ��,/✓ /ii„�//�/1( �tYi// �, i/ is , / i. S, T ,OF,;NEW YORK ;i%! �e/ c,,: „ / /i //i i/,,., pJ/ r. ✓�// / ,/� ', / E 'i. fir�Jlk�� y� / Ii/�/,,,,, TM.ENTt OF LABOR y D,EPAR / IC NSE TOrDE'AL 1Nl�^R;MANUFACTURE EXPLOSII/ES �� / r ;,,, s,,, �, /, ,� / / rr e, ,r/ ;!/it,l/l � �%/i' ��/0%//�r w,� ri�r /i ///�f � ��,,✓ :, � �, ,�rl% / Expires � ✓4/30/2020 � „� �,r ✓%U/,/ ',. i ��!/� ✓ � ( t/jam%%�j //�ii/ Ainerlcan�Fireworks//Display, S P..,Ot Box 9$0 //iii ye; /ioi, TH� ir� ✓� ,,o/%�r ✓i�l. / / l?%,l/��%� Oxfiortl%NY „ ow of / r' ,, /,ii2s %�/ / �, ,r ,i, /r//,. � Kevin Jon Frltschler �/ //,mac;�icen�e No%y , , iii/�l/� ,.„ - , (/r.:,, „.,,�; r / _/,.,,-, , ' ,„r is fiereb` lice'6sed,to�deal an'or, anufacture,ex losivesrin compliance with't sire uirements of the,Labo�Law/andir,�j,�, ' dustri6(Code Rules.° An chan sir,%the contlihons'under whi hpthas�llcense��s��ran#etl maycauseiCto b� //,G,,,, %�/ Irt ,,,„ 'rEVOked.Sg,,,, „ ,t;,G ✓�� r,„ . � ��/�/ %i��i/ „, t/ i �--.ir/� / / ,,,,i/ / ,//l ✓,Eileen,M.,Franko ,Actin � / r✓r//o � / � ,, , , , ”, ,,, /. ..,1 �/ ,.., .,, f% , ,„iG. r,„ ,, r. �..,, :%�r ✓D �ii�%//!/ /�;'//J:1 r�/,/,iI/1��✓/0 ,r r' „�,,, // /,, ✓i r„ ,: C°OMMISSIONER,.oF,LgBOR,� �,/%/,// i, �t/� �i i� ,, /,-.„ �/,- „,, /� / Dior ✓,,., l�/l ,, r..�/i, /i� // �.� /,/r r.., ,�rug////��..�./ir,/l� /i,.r,< /',,, ,,,,. > ;, .,,, l/i ,I, ,,,m., f/ J ?% „//��i// � .. ��,ava ,r ori,,.�, „r /a//1.,�� ;,ri/�%„r�0�/✓�/ ,i /i/„/ r,,, a iii / /./�,,,,, i oe,/ ../ / r/�,�i✓l/, t/// �rfi r a ;J/ iIx I; es/must,kee =at the/ rmci a p ..Eve erson sellin delivenn or i n p Y P P o / %, / ,poi // ,,r /.. r, /.✓�� , ��p %/�/, i ranSaGtlO thesta e,a„reCO� -� „> ,, ,,' ,,;' /i/// a/ / i/:” /r /i /il /.i-/ /;., i / ,,.. / /i/,�/�///�� Y111lp�JI1;/r,/iii!%i✓i...: �.. ",` , ,'s �/,/r // r/�. „<0/l/1�/,/, ,i 1 iii/i/,/ii�r✓�l re,,, � ,a r;>c !,��,//✓/i!„ r,.r,, // /�Lii 1 / ��I/ii�/%��/ ,i,- -.,�'� U Tl of x osi es�SOLD,�t)EL 1/ tED or GIVEN Note,No license�le,//� ,i / , /%�/,, i/ //�� 1the,NAMEor;TY,PEandQ AN 7Y e „r „:)t /�/„f/ot ///i//r,,,„✓,r Grl,'✓✓Tir,:�j�%/n fig,,,,� ,,,,,„ �::,,i„, ,..,,,, /rrr ..I: ,,p// /i//// -��f�:!, ,/;i,; ,: smokeless';; owder�or%bfack� ows�er,i ua Utiesrrnok/exceeding five you nds for use,in ,/,!�,'i, �/ r,,;,/ nEeLledto/f��JfCh3Se� p i ti irng anue fire � a s,or,ar#1 acts or a licasthereof However dialers MUST/pAst aflisuch transacfions on ✓ /✓�;r /,/;ii/fir, f ,Q r ,r./, r r fPLNfi / r%, ,/ � the"Dealer-Manufacturer`ij'Report of Explosrves Transaetiar�s /,i� %/ a // %'�/✓/`/,,�,, l 2 tfie DATE;OF EACN�SALUDELIVERY,;orrG1FT � /%%//G%q� rG„r�%�/✓%,c�/ �,�!moi/�, i,,, 3)` the'NAME,�LICENSE'NUMBER and BUSINESS ADD] ESSyof`the/purchaster donee,or person m whom the explosives were deliv�red and the firm if�any'representedtbylsuch pe�so� �/✓ �/ s;” 4) the/NAM E;;ADDRESS;and`LIC> NSE:NUMBER of the�persontT KING;THEtEXPLdSIVESAINAY from ,Ihe,seller or,donor, ��✓�i�i%/ /% % / �// / / /,p� / %/ // ;” / a,i/%i✓/i /i/%ii%��/ /%i%i�/ I� ��/�/ire i/�;/✓ �/��/%i/,%,/,,,, /� '% i✓/ ,,,'.. ”, ,;f;5n ,? /i i�/,; it/�%��/�ii�i�� /��/%/✓r/l� :;%��o/�/,a � v ,,, ,,, /// / ✓//// /� /lit%/ � / ,'y. / /i� t„, „i,,, i �/✓//�� / / ti�/%��/ / SH ; 862598 ,` ,✓� r /,r/� ,Ij•r/✓�/ %%% �:�f�/a��i�ti/Hr/ gr ”; c / i.:. sir°a F/„ f // % ag, � "�/ pit %(%r„ /�� i� a i� // /�Z/% / l / / l // i, 1p//%/�/,a�/ a i / G /✓�/% pD�t�i ray��/✓ /i / /// t//% iii ,p grisly, /� ', � ,,-,i ," �, ? / ✓ ,,:, t//i% // f � / /;'�/ %��/'j it /i/�% r r „ - if/ i n i ✓ iJ W /ii ✓ �� / r ///G / t / /i //� /�//✓/✓i J / / t i�t/„ / �/�/j/j✓f ✓ �/r IM” ;, % %/✓/%/ ///�/; "t'' i/ /%/ � /, rani/ / �,////i/i ACC �,. DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/13/2019 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 have ADDITIONAL INSURED provisions or 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 ECONTACT Michelle Kugler Allied Specialty Insurance,Inc. P.AM - 10451 Gulf Blvd PHONE 727-547-3070 FAX 727-367-5695 ..II3,I IN4..Ex0.m. ...... ..........,�....,._fAl-C.Nal—....... ..,�. Treasure Island,FL 33706-4814 E-MAIL pf?R ? mkug4eralliedspecialty.com ....... .. .._ ................. ... — _ INSURER(S)AFFORDING COVERAGE NAIC# T.H.E.,..a.a.M....m_.__ INSURERA. Insurance Company 12866 ............---.—.......... ------- INSURED AMERICAN FIREWORKS DISPLAY,LLC INSURERB: P.O.BOX 980 INSURER C: .,_.m....,._-- - .�.�.,, OXFORD NY 13830 INSURER D: 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. LTR, ----...... ....__ ... -..... ,...,.. POLICY-.......,. ........ -OLICY E�.�......m._ ....�.. ---.-. .----- W SR A470L.SUBk -...._ E r POLICY EXP TYPE OF INSURANCE NUMBER €, IDDIYYYY MM/DDIYYYY. LIMITS A X COMMERCIAL GENERAL LIABILITY CPP0105319-03 03/17/2019 03/17/2020 EACH OCCURRENCE 5 1,000,000 DAMA ('03iEN'1tb _ � ,kZCMI�ES�S"a�Lcurmern�e� $ 100,000 J,CLAIMS-MADE Cn."�)OCCUR P,,. ,...._ ....._.. _ MED EXP(Any one person) s N/A PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000,000 PRO- PRODUCTS $ 2 000 000 POLICY FI JECT 0 LOC PRODUCTS..-COMPIO p. ____ OTHER. OTIIE.R:. Protection&Indemnity $ 1,000,000 A AUTOMOBILE LIABILITY CPP0105319-03 03/17/2019 03/17/2020 CO acca_rMBINE�aD SINGLE LIMIT $ 1,000,000 Ga �r _.� . . .....) „ ,-..... ............ I'll ANY AUTO BODILY INJURY(Per person) $ ....._� OWNED AUTOS ONLY X SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ NON-OWNED PROPFRT^c”DAM.F( X HIRED C"E $ Per accJrarnnt� . ..- (AUTOS ONLY AUTOS ONLY .-t•.- $ X CLAIMS-MADE ELP0012117-03 GL 03/17/2019 03/17/2020 EACHOCCURAGGREGATE RENCE $ 4,000,000 EXCESS LIAB MS-MADE'' 4,000,000 A � UMBRELLA LIABX OCC.....-- ............. $ ....... ... ...... DEC) I RETENTION$'- A WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY ....._ STATUTE ,,,,,,,ER____— ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N' NIA Coverage is afforded in the State s of: -- -- $ OFFICER/MEMBER EXCLUDED? g ( E._L.Da EASECH CEDA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 1$ A Excess VL ELP0012118-03 VIL 03/17/2019 03/17/2020 Each Occurrence Limit $4,000,000 Aggregate Limit $4,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Display Date: 6/13/19,6/14/19,6/15/19 Rain Date: TBD Location: Sound Ave.,Mattituck,NY RE:General Liability,the following are named as additional insured in respects to the negligence of the named insured: Reithoffer Shows,Inc.;Mattituck Lions Club;Town of Southold,NY;County of Suffolk,NY;JIMD Corp.(property owner) CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 Route 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold,NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ) i s ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD „ \ NO MINER qq NICK \ \ \O\ JOA\Vv \ vv A� a v ” May 12, 2019 1:2,257 Town of Southold P.0 Box 1179 Southold, NY 11971 I * * * RECEIPT Date: 05/13/19 �h" ��.ry �iu f#n, 2540'74 a i Quantity Transactions Referince u total 4 1 Fireworks 6.13-14-15.19 $100.00 :Total Paid: $100.00 Notes: i Payment Type Amount Paid By CASH $100.00 Mattituck, Lions Club r f 1 Southold Town Clerk's Office 53095 Main Road, 'PO Box 1179 Southold, NY 11971 i 4 f r Name: Mattituck, Lions Club �l Po Box 91 Mattituck, NY 11952 i Clerk ID: BONNIED Intemal Ib:6:13-14-15.19