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Neville, Elizabeth From: Christopher Grucci <cgrucci@grucci.com> Sent: Friday,June 28, 2019 10:07 AM To: Neville, Elizabeth Cc: Leslie Fernandez Subject: RE: FireworksPermit-OrHarbor_20190625124256.pdf Received,thank you! Thank You, FIREWORKS BY Christopher Grucci �• Logistics Manager Fireworks by Grucci,Inc. p: 631.286.0088 ext.121 a: 20 Pinehurst Drive Bellport,NY 11713 w: www.grucci.com e:cgrucci@grucci.com t 77 .S From: Neville, Elizabeth<E.Neville @town.southold.nv.us> Sent: Friday,June 28, 201910:04 AM To: Christopher Grucci<cgrucci@grucci.com> Subject: FireworksPermit-OrHarbor_20190625124256.pdf Attached, please find the issued "Fireworks Permit for the Orient Harbor July 4th Festivities, Inc." 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 i Neville, Elizabeth From: Neville, Elizabeth Sent: Friday,June 28, 2019 10:31 AM To: 'Theodore Strauel' Subject: RE: FireworksPermit-OrHarbor_20190625124256.pdf You are very welcome. Happy Fourth and have a great event! !(ED(cD## 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 From: Theodore Strauel [mailto:tstrauek-agmail.com] Sent: Friday, June 28, 2019 10:30 AM To: Neville, Elizabeth Subject: Re: FireworksPermit-OrHarbor_20190625124256.pdf Thank you so much! Regards, Ted On Jun 28, 2019, at 10:24 AM, Neville, Elizabeth<E.NevilleCO)town.southold.ny.us>wrote: Attached, please find the issued "Fireworks Permit for the Orient Harbor July 4th Festivities, Inc.". 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 <FireworksPermit-OrHarbor 20190625124256.pdf> i ff04 ELIZABETH A.NEVILLE,MMC Town Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 r"° Southold,New York 11971 REGISTRAR OF VITAL STATISTICS � "��•..,,. Fax(631)765-6145 , 4.,, r� Telephone(631)765-1800 MARRIAGE OFFICER > »." RECORDS MANAGEMENT OFFICER �; www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT 2019-4 for 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: Orient Harbor July 4t"Festivities,Inc. A 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 Shtuidavg•Jbl�_6, 2014 at 9:15 P.M. (Rhhi`Date• Sunday,July7,•2019 at-9o15 PAC,'bn-a barEo,_6ff Orient'`�'acht:Club,2110 V lla�e.lLan+e, Orient New,York,the time and place set forth in the application therefore, 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 a 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 into 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 a 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 concluded 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 least two soda-acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. El' abeth A. Neville,Town Clerk- Town of Southold Suffolk County,New York (TOWN SEAL) q RESOLUTION (ID # 15332) REVIEWED DOC ID: 15332 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. (ID# 15332) WAS REVIEWED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 18,2019: R1J50LVED,that the Town.Board-cif the,Town of Southold-herebv"annroyes,1he,Wuance,bf a. Fireworks`Permif=be"I`oiviu•Clerklb the Orient Harb&3uly 4'"Fest1yities,'Ine.for a fireworks display on Saturday, July 6,2019 at 9:15 PM(Rain Date: Sunday, July 1, 2019 at 9:15PM)on Barge off Orient Yacht Club,2110 Village Lane, Orient,New York upon 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 Orient Fire Chief. Elizabeth A. Neville Southold Town Clerk Neville, Elizabeth From: Neville, Elizabeth Sent: Tuesday,June 25, 2019 12:51 PM To: Burke,John; Duffy, Bill; Fisher, Robert; Flatley, Martin; Hagan, Damon; Norklun, Stacey; Spiro, Melissa; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland,William; Russell, Scott - co' v Cc: 'tstraud@gmail.com'; 'egrucci@grucci.com'; myaty ives yahoo. Subject: Emailing: FireworksPermit-OrHarbor_20190625124256 Attachments: FireworksPermit-OrHarbor_20190625124256.pdf Attached, please find the"Fireworks Permit" issued for the Orient Harbor July 4th Festivities Inc. 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: FireworksPermit-OrHarbor 20190625124256 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 Y , •.�'-y,�,k,Y",��" t oi.�a .,,�, +; .i�`q^,�,} x-. wws ... .Mw-.ter•.. .,...�._,.a. ..... T• n �." .I.wa; •w'..' ��t�'�,„?'.itlli: 001 NY . �'+5a :, -' t;�`"•-c��'�� i"X 4u.3�' R :.a y .,<.d.z-..�'t Y•+ < °"o, Tw liz�aotla WAN-,T iown Cc-rk I ha' r r'ivie -ed the application torthe,firer.orks permit subhmitt by Ori;ent Harbor Jul Fe5tivhziew, Inc,event on 5 ztui-dava 2019 Fit 9*15p.m.with a rain.d ate of Suoday,3 u 1 7. at x:15 .m, and appmie of t,<� i searccc�cif the pQrr it.The'Onent Pit P Dopartment will ba n clan bl with etxo rn`6 to Inc!Nide foremen and fkn�t miuks,�hoold bey be, nee led, Beit Regards, TAki hael rsYa's f Chief Orient'Fire Department - RE\✓ENVED JUN 2. 0. I ' Southold Town Clerk. Neville, Elizabeth From: Neville, Elizabeth Sent: Friday,June 14, 2019 2:33 PM To: 'myatvlives@yahoo.com' Subject: Orient Harbor July 4th Festivities FIREWORKS referral Attachments: FireworksReferralOrientH_20190614125001.pdf; SAMPLE LETTER.docx Importance: High Good Afternoon Mike, Attached, please the application for Fireworks Permit submitted by Orient Harbor July 4th'Festivities; Inc.for your review. The 2nd attachment is a sample text of a letter for you. I will look forward to your response. 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: Webster, Kevin Sent: Friday,June 14, 2019 12:33 PM To: Neville, Elizabeth Subject: Orient Chief Good Afternoon, I have his phone number. Mike Prindle 631-484-1141 Sincerely, Kevin Webster Assessor Town of Southold 631-765-1937 t Neville, Elizabeth From: Neville, Elizabeth Sent: Friday,June 14, 201 2:58 PM To: Burke,John; Du Bill; Fishert; Flat artin; Hagan, Damon; Norklun, Stacey; Spir elissa; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland,William; Russell, Scott Cc: Webster, Kevin Subject: FireworksOrientHarbor Festivities Attachments: FireworksReferralOrientH_20190614125001.pdf Importance: High Good Afternoon, Transmitted herewith, please find an application for a Fireworks Permit submitted by Grucci Fireworks on behalf of the Orient Harbor July 4th Festivities for July 6, 2019; RD:July7, 2019 Event. Please review and advise of any concerns questions and/or objections that you may have regarding the granting of this Fireworks Permit. 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 Town of Southold Police Department Special Event Cost Analysis Event: Orient Harbor Fireworks Display Date(s): July 6, 2019 Location: Orient Harbor Patrol Allocation for Event J Reg Hours OT Hrs Hrly Wage Total Comments Poltce Officers PO Onufrak 2 $69.09 $138.18 Special Patrol _. , . W. �. Reg Hours OT Hrs y Hrly Wage Total Comments GIREI .. Bicycle,Parol_ -- _ � k4 Unit Highway Patral, . Wrihe Uniis _ Marine 2 3 $36.85 x1.5 $165.82 Marine 3 3 $34.32 x1.5 $154.44 Marine 43 $27.51 x 1.5 $123.79 Traffic'Coritrol -- Reg Hours OT Hrs Hrly Wage Total Comments TC Officer#1 2 $17.47 $34.94 TC. Officer TC Officer TC officer TC Officer EquipMPT— -os ts... - PD!Vehicles #of vehicles $/hr Total 2 $10.00 $40 $40.00 Command fan Marine Patrol Boats 2 $20/hr $80 $80.00 Total Department Cost for Event = $737.17 Prepared by Chief M. Flatley 6/24/2019 Page 1 From: Neville, Elizabeth ,Sent: Monday,June 17, 2019 11:05 AM To: Flatley, Martin<mflatlevC&town.southold.nv.us> Subject: RE: FireworksOrientHarbor Festivities Importance: High Thank you Chief. I you would please let us know what that $ amount will be. Thank you. Betty 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 From: Flatley, Martin , Sent: Friday;June 14,' 2019 5:02 PM To: Neville, Elizabeth; Burke,John; Duffy, Bill; Fisher, Robert; Hagan, Damon; Norklun, Stacey; Spiro, Melissa; Dinizio, James; Doherty, Jill; Evans,,Louisa; Ghosio, Bob; Ruland, William; Russell, Scott Cc: Webster, Kevin Subject: RE: FireworksOrientHarbor Festivities I have no objections to this permit being approved.There will be a cost incurred'by our department for security surrounding the barge and for traffic control on the Orient/East Marion Causeway. Sent from Chief M. Flatley Mail for,Windows 10 From: Neville, Elizabeth Sent: Friday,June 14, 201912:57 PM To: Burke,John; Duffy, Bill; Fisher, Robert; Flatley, Martin: Hagan, Damon; Norklun, Stacey; Spiro, Melissa, Dinizio, James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland, William: Russell, Scott Cc:Webster, Kevin Subject: FireworksOrientHarbor Festivities Importance: High Good Afternoon, Transmitted herewith, please find an application for a Fireworks Permit submitted by Grucci Fireworks on behalf of the Orient Harbor July 4th Festivities for July 6, 2019; RD:July7, 2019 Event. 2 Neville, Elizabeth From: Flatley, Martin Sent: Monday,June 24, 2019 12:55 PM To: Neville, Elizabeth Subject: RE: FireworksOrientHarbor Festivities Attachments: Orient Harbor Fireworks.xls Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic,New York 11958 631-765-3115 3 From: Neville, Elizabeth Sent: Monday,June 24, 2019 12:17 PM To: Flatley, Martin<mflatley@town.southold.nv.us> Subject: FW: FireworksOrientHarbor Festivities Chief, Have you had a chance to do the costs for thi's ? Betty From: Neville, Elizabeth Sent: Monday, June 17, 2019 2:21 PM To: Flatley, Martin Subject: RE: FireworksOrientHarbor Festivities Thank you Chief! From: Flatley, Martin Sent: Monday, June 17, 2019 2:16 PM To: Neville, Elizabeth Subject: RE: FireworksOrientHarbor-Festivities I'll do one now, I was up in Albany and away from my records when I answered previously Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 i Neville, Elizabeth From: Fisher, Robert Sent: Tuesday, May 22, 2018 9:37 AM To: Neville, Elizabeth; Duffy, Bill; Flatley, Martin; Spiro, Melissa; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland,William; Russell, Scott Subject: Orient Fireworks Aplic_20180518150905 Betty I have no reservations about this event taking place as planned. Bob Robert Fisher Fire Marshal,Town of Southold robert.fisher@town.southold.nv.us (W) 631-765-1802-(C) 631-786-9180 PRIVILEGED AND CONFIDENTIAL COMMUNICATION CONFIDENTIALITY NOTICE:This electronic mail transmission is intended only for the use of the individual or entity to which it is addressed and may contain confidential information belonging to the sender which is protected by privilege. If you are not the intended recipient,you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this transmission in error;please notify the sender immediately by e-mail and delete the original message. -----Original Message----- From: Neville, Elizabeth Sent: Friday, May 18, 2018 3:29 PM To: Duffy, Bill<billd@southoldtownnv.gov>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>; Flatley, Martin <mflatlev@town.southoId.ny.us>; Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; 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 <williamr@southoldtownny.gov>; Russell,Scott<scottr@southoldtownny.gov> Subject: Emailing: Referral Fireworks Aplic_20180518150905 Transmitted herewith is the application of the Orient Harbor July 4th Festivities for a Fireworks Display to be held on June 30, 2018 (RainDate:July 1,2018 on a barge in Orient Harbor. Please review and advise of any concerns, questions and/or objections that you may have to the granting of this Fireworks Permit. 823.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:' Referral Fireworks Aplic_20180518150905 i 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: Dufll Sent: Monday,June 24, 2019 3:26 PM To: Neville, Elizabeth; Burke,John; Hagan, Damon; Silleck, Mary Subject: RE:FireworksOrientHarbor Festivities No objection. - From: Neville, Elizabeth<E.Neville @town.southold.nv.us> Sent: Monday,June 24, 2019 3:01 PM To: Burke,John<iohnbu@southoldtownny.Rov>; Duffy, Bill<billd@southoldtownnv.sov>; Hagan, Damon <damonh@southoldtownny.gov>;Silleck, Mary<marys@town.southold.nv.us> Subject: FW: FireworksOrientHarbor Festivities Importance: High Please advise if the Town Attorney has any objections to this fireworks permit being issued as approved by the Town Board at their June 18, 2019 meeting. I have received approvals from the Chief of Police, Fire Marshall, and Land Preservation Dept. and Orient Fire Chief. 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 From: Neville, Elizabeth Sent: Friday, June 14, 2019 12:58 PM To: Burke, John; Duffy,,Bill; Fisher, Robert; Flatley, Martin; Hagan, Damon; Norklun, Stacey; Spiro, Melissa; Dinizio, James; Doherty, Jill; Evans, Louisa; Ghosio, Bob; Ruland, William; Russell, Scott Cc: Webster, Kevin Subject: FireworksOrientHarbor Festivities Importance: High Good Afternoon, Transmitted herewith, please find an application for a Fireworks Permit submitted by Grucci Fireworks on behalf of the Orient Harbor July 4th Festivities for July 6, 2019; RD:July7, 2019 Event. Please review and advise of any concerns questions and/or objections that you may have regarding the granting of this Fireworks Permit. Elizabeth A. Neville, MMC Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 1 Southold,NY 11971 Tel. 631765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 2 Neville, Elizabeth From: Spl c , Melissa Sent: Friday,June 14, 2019 1:43 PM To: Neville, Elizabeth; Burke,John; Duffy, Bill; Fisher, Robert; Flatley, Martin; Hagan, Damon; Norklun, Stacey; Dinizio,James; Doherty,Jill; Evans, Louisa;`Ghosio, Bob; Ruland,William; Russell, Scott Cc: Webster, Kevin Subject: RE: FireworksOrientHarbor Festivities This is not Town preserved land. Melissa Spiro From: Neville, Elizabeth Sent: Friday,June 14, 2019 12:58 PM To: Burke,John<iohnbu@southoldtownny.gov>; Duffy, Bill<billd@southoldtownnv.gov>; Fisher, Robert <Robert.Fisher@town.southold.nv.us>; Flatley, Martin<mflatley@town.southold.nv.us>; Hagan, Damon <damonh@southoldtownnv.gov>; Norklun,Stacey<Stacey.Norklun@town.southold.nv.us>;Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Dinizio,James<iames.dinizio@town.southold.nv.us>; Doherty,Jill <fill.dohertv@town.southold.nv.us>; Evans, Louisa<louisae@southoldtownnv.gov>;Ghosio, Bob <bob.ghosio@town.southold.nv.us>; Ruland,William<williamr@southoldtownnv.gov>; Russell,Scott <scottr@southoldtownnv.gov> Cc:Webster, Kevin<kevin.webster@town.southold.nv.us> Subject: FireworksOrientHarbor Festivities Importance: High Good Afternoon, Transmitted herewith, please find an application for a Fireworks Permit submitted by Grucci Fireworks on behalf of the Orient Harbor July 4th Festivities for July 6, 2019; RD:July7, 2019 Event. Please review and advise of any concerns questions and/or objections that you may have regarding the granting of this Fireworks Permit. 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 i June 10,2019 Theodore Strauel Orient Harbor July 4`h Festivities,Inc. 680 Croton Lake Road Bedford Corners,NY 10549 Cell: 914-523-9289 Email: tstrauelQgmail.com Dear Mr. Strauel: Please find attached hereto for the Orient Harbor July 4"'Festivities, Inc. fireworks display scheduled for July 6,2019 with a Rain Date of July 7, 2019 at 9:15 PM the following: 1) Letter to Town of Southold Clerk's Office 2) Town of Southold Permit to Display Fireworks Application 3) Insurance Certificate 4) Site Plan 5) FAA Notification Letter 6) Chief Pyrotechnician's Data Form 7) Chief Pyrotechnician's NYS Certificate of Fitness 8), Pyrotechnic Product Count 9) U.S. Fish &Wildlife Notification 10) DEC Notification Soon to Follow: , 1) FAA Notification Approval 2) US Coast Guard Permit (Filled on-line) Please sign the enclosed application and forward to the Town of Southold along check for $100 made out to the Town of Southold with written permission from the Orient Yacht Club's property owner to: Elizabeth Neville,Town Clerk Town of Southold 53095 Route 25 Southold,NY 11971 Thank you for your help in this matter and if you should have any questions please call. Sincerely, j�j� Christopher Grucci Logistics Manager Fireworks by Grucci,Inc. Office #: (631) 286-0088 20 Pinehurst Drive Fax#: (631) 286-9036 Bellport,NY 11713 E-mail: cgrucci@grucci.com THE FIRST FAMILY OF FIREWORKS ilFW4 ELIZABETH A. NEVILLE, MMC �� G� Town Hall; 53095 Main Road TOWN CLERK q P.O Box 1179 Southold7!j New York 11971 REGISTRAR OF VITAL STATISTICS FaxMARRIAGE OFFICER � ®�' Teleph ®RECORDS OF MANAGEMENT OFFICER Ol `�+� southolFREEDOM OFINFORMATION OFFICER 19OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION Clerk PERMIT TO DISPLAY FIREWORKS 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 OnentHarborJuly4thFestivities, Inc PRINCIPAL OFFICE AT PO Box 653, Orient, NY 11957 DATE&TIME OF DISPLAY July 6,2019(cD approx.9:15pm EXACT LOCATION OF DISPLAY Barge off Orient Yacht Club—41'8'2 71"N, 72°18'34 28"W SUFFOLK COUNTY TAX MAP NUMBER FOR SITE 1000-24-2-28 1 RAIN DATE&TIME July 7 ?019 n approx 9.1 rpm The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition James Lipp 51 26 years Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Grucci Grand Illuminations-4500 2'/z- 3"- 1020 4"- 325 5"- 300 6"-275 8"-32 Total Not to exceed 1952 Firework Shells and 4500 Illuminations Manner and place of storage of fireworks prior to display: In UN approved boxes in company vehicle 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. Orient Harbor July 4th Festivities, Inc FEE: $100 Name of Organization See pol icy for additional information By Signature of Applicant Date of Application CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Yl'YY) 5/29/2019 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER `- CONTACT NAME: Britton Gallagher ONE AIC,N Ext•216-658-7100 FAC Noi 216-658-7101 One Cleyeland Center, Floor 30 E-MAIL i 1375 East 9 fh Street ;;9�t ADDRESS' i Cleveland OH 44114 t INSURERS AFFORDING COVERAGE NAIC# S INSURERA Everest National Insurance Company 10120 •INSURED - INSURERB Continental Indemnity Company Fireworks By Gruccl Inc- and/or Pyrotechnlque INSURERC-AXIS Surplus Ins ompany 26620 By Grucci, Inc and/or Phllny Effects, Inc INSURER D: 20 Pinehurst Drive Bellport NY 11713 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:48897664 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYY A GENERAL LIABILITY S18ML00093-191 2/17/2019 2/17/2020 EACH OCCURRENCE $1,000,000 DAMAGE X COMMERCIAL GENERAL LIABILITY PREMISES(E.occurrence) $500,000 CLAIMS-MADE IT]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 Liability GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 1-1 POLICY X PRO- LOC $ A AUTOMOBILE LIABILITYS18CA00044-191 2/17/2019 2/17/2020 Ea accident) $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ C UMBRELLA LIAB X OCCUR P-001-000082173-01 2/17/2019 2/17/2020 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION 73-474435-01-07(MASTER) 5/27/2019 5/27/2020 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEF-1 N/A E L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatoryin NH) E L DISEASE-EA EMPLOYEd$1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT 1$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Date July 6, 2019, Rain Date July 7, 2019, Location Orient Yacht Club, Orient, NY, Additional Insured(s)Orient Harbor July 4th Festivities, Inc, its Directors and Committee Members,Thomas E Foster III, Nathalie&Theodore A Strauel, Orient Yacht Club, its Officers and Board Members, Orient Wharf Company, and its Officers, Greenport Shipyard, Orient Fire Department, Town of Southold, State of New York, Crowley Marine, Costello Marine Construction, CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orient Harbor July 4th Festivities, Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P O Box 653 ACCORDANCE WITH THE POLICY PROVISIONS Orient NY 11957 AUTHORIZED REPRESENTATIVE I I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Town of Southold P O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/14/19 Receipt#: 255885 Quantity Transactions Reference Subtotal 1 Fireworks 7.16.19 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#20142 $100.00 Orient Harbor, July 4th Festivities Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Orient Harbor, July 4th Festivities Po Box 653 Orient, NY 11957 Clerk ID: BONNIED Internal ID 7.16.19 FIREWORKS,�GRUCCI, INC`.' - : 20142 VENDOR NO: EAN001 NAME: = ELIZABETH A:NEVILLE,MMC,TOWN CLERK CHECK DATE: 6/12/2019 inN f. M �, � �`}� ,CLI: ,:MYr+3.,t�sa <�` �ac�'Gi...:s.s•,d >.ait.�J:n4>:- •� �•�•�j��� j,� REF R Keg; 00 o1 e7 P F FS n1Y1�,U1�<<P{UQ F ` rr �a�c w , <..�,r :� °�1 COUNTIAKEN•.... .- i �1 7 <`r Z;: ., nY " � ' Yt,( 7356::ORIENT 6/10/2019 100.00 0.00 100.00 kk TOTAL > f' 100.00 0.00 100.00 x _ ------ ---------------------------------------------- ---------------------------------------------------------------- ------ ------------------- -- - ----- -- ----- -- ------ -- -- -- --- - -- - - - r44 - THIS CHECK IS • • • •• o • - • • • „"' 'J� '> a 3. ^ ` �'• „•'♦ < I GENA R• s '�IONAI", `NJNTtU EURS�D I p AltP+ �• ,.•f": �;F� e c-cf:>;C .� a.� � .� _' ♦° '-�� r�• Y� �,✓�5� 3• �• ��t .nr.'7>•"" '�°7`.. 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ORIGIN IDIISPA (631) 286-0088 SHIP DATE: 13JUN19 LESLIE FERNANDEZ ACTWGT: 1.00 LB MAN " FIREWORKS BY GRUCCI CAD 20 PINEHURST DRIVE BELLPORT, NY 11713 BILL SENDE� UNITED STATES US TO ELIZABETH NEVILLE, TOWN C IRK a # TOWN OF SOUTHOLD ,� 1 4 k19 53095 ROUTE 25 a SOUTHOLD NY 11971 'MMOF1&17 ., :�9� 1 4631)786-1800 GEF ; ht<n rrtt 1 FedEx ' Express t. 0 a � s jsaLi,,,� FRI - 14 JUN 4:30P D 020 7087 8249 6761 STA ,e NDARD OVERNIGHT `E 11971 , WSHA NY_us JFK _ m Q < r a i Orient Yacht Club - 049K NY jUly th, 2019- Fireworks by Grucd PIAP-WORKS BY .a�.`�, ..:�ti . ::.�`r^-A,:§ma, e�,' a^=''4���?,',�,pp �, ,9"'�:;"x�+�, 'u's. �sx :�c'y°rve'..e .- " .:' i• �`"':at % sf h.. ,..`S�',T„g" f u d � h a,.«.mad' ..�,.a' � � .. 's�"�a•'':�. T'' .,, ,�s�s, a 1 � �.. � J0.'RBv '.ne - % 4u.�3 `�'*[a wye•.,' "mA.��° •�-Y .° c � � � p�yp. i. Z,v}� a � f V'�,u., "�,C�,C dis. S�°;' ,�$ .�6+• � ��'.° 'fie �� �a{'�ii �e9 �arcpe ®uslp9aV Site>gyp•.. , Y A �R M� Max Shell Size 8" 4 ',;� � ��Y n.>"-� r' � ., ,,. �4 �;� °���� •����-; ; �,� ���. � �>' � 1,000 Fallout Area , Exceeds Coast Guard Required 100' / 1' -- Exceeds NFPA 1123 Recommended 70"/ 1„ Latitude' ° 08' 02'71" N 750' " 1000' t° Longitude 18' 34.28"W All Information contained on this document is copyright material and the intellectual property of Fireworks by Grucci Inc Reproduction and/or circulation without approval of Fireworks by Grucci�is, prohibited Rev 1 4/5/19 CERTIFICATE OF LIABILITY INSURANCEF512912019 DATE(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME Britton Gallagher PHONE FAX One Cleveland Center, Floor 30 A/c No Ext•216-658-7100 AC, c No 216-658-7101 E-MAIL 1375 East 9th Street ADDRESS Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC# INSURER Everest National Insurance Company 10120 INSURED INSURERB Continental Indemnity Company Fireworks By Grucci Inc and/or Pyrotechnique INSURERc AXIS Surplus Ins Company 6620 By Gruccl, Inc and/or Philny Effects, Inc INSURER 20 Pinehurst Drive Bellport NY 11713 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:1086481407 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDD/YYYY W MMIDD/YY A GENERAL LIABILITY S18ML00093-191 2/17/2019 2/17/2020 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 Liability GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $2,000,000 POLICY X PRO- :CLOC $ A AUTOMOBILE LIABILITY S18CA00044-191 2/17/2019 2/17/2020 Ea accident $1,000,000 AINY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE $ X AUTOS Per accident C UMBRELLA LIAB X OCCUR P-001-000082173-01 2/17/2019 2/17/2020 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ B WORKERS COMPENSATION 73-474435-01-07(MASTER) 5/27/2019 5/27/2020 X WORY C STATULIMITS R - 0 AND EMPLOYERS'LIABILITY YIN T1ER _. ANY PROPRIETOR/PARTNER/EXECUTIVEE L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED' ❑ NIA (Mandatorym NH) E L DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured extension of coverage is provided by above,referenced General Liability policy where required by written agreement Date July 6, 2019, Rain Date July 7, 2019, Location Orient Yacht Club, Orient, NY, Additional Insured Orient Harbor July 4th Festivities, Inc, Its Directors and Committee Members,Thomas E Foster III, Nathalie&Theodore A Strauel, Orient Yacht Club, its Officers and Board Members, Orient Wharf Company,and Its Officers, Greenport Shipyard, Orient Fire Department,Town of Southold, State of New York, Crowley Marine, Costello Marine Construction, i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Hall 53095 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. South Hold NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD June 10,2019 TO: Mr. Steve Papa ' COMPANY: U.S. Fish &Wildlife Service E-MAIL: stevepapa@fws.gov PHONE: 631-776-1404 x 201 FAX: 631-776-1405 FROM: Christopher Grucci Dear Mr. Papa: Attached please find site map for the fireworks display noted below. EVENT: Orient Harbor July 4"'Festivities,Inc. LOCATION: Barge off Orient Yacht Club 2110 Village Lane, Orient,NY LATITUDE: 410 08'02.71"N LONGITUDE: 72° 18'34.28"W DATE: July 6, 2019 RAIN DATE. July 7, 2019 TIME Approx. 9.15 PM DURATION: 16 - 17 Minutes We would appreciate your assistance in getting a notice out to the Coast Guard with copy to us of your agency having no objections to this site being used. Thank you for your help and cooperation in this matter. Sincerely, Christopher Grucci Logistics Manager Fireworks by Grucci, Inc Office # (631) 286-0088 20 Pinehurst Drive Fax #. (631) 286-9036 Bellport,NY 11713 E-mail: cgrucci@grucci com THE FIRST FAMILY OF FIREWORKS June 10,2019 TO: Frederick "Chip" Hamilton COMPANY: Senior Wildlife Biologist 50 Circle Road SUNY Stony Brook Stony Brook,NY 11790 PHONE: 631-444-0308 FAX: 631-444-0272 EMAIL: frederickhamilton@dec.ny.gov FROM: Christopher Grucci Dear Mr. Hamilton. Below please find display information for a coming contracted fireworks display with our site plan for this event attached. EVENT: Orient Harbor July 4"' Festivities,Inc. LOCATION: Barge off Orient Yacht Club 2110 Village Lane, Orient,NY LATITUDE: 41°08'02.71"N LONGITUDE:72° 18'34.28"W DATE: July 6, 2019 RAIN DATE: July 7,2019 TIME: Approx. 9:15 PM DURATION: 16 - 17 Minutes We would appreciate your assistance in getting a notice out to the Coast Guard ASAP with copy to us of your agency having no objections to this site being used. Thank you for your help and cooperation in this matter. Sincerely, Christopher Grucci Logistics Manager Fireworks by Grucci, Inc. Office #: (631) 286-0088 20 Pinehurst Drive Fax #: (631) 286-9036 Bellport,NY 11713 E-mail:ccgmcci@grucci com THE FIRST FAMILY OF FIREWORKS L?00!0!50 June 10,2019 As per the document N F.P.A. 1123-2018 Code for Fireworks Display and the Town of Southold regulations, the following information is provided. Sponsor/Client Name: Orient Harbor July 4"' Festivities, Inc. Location and Date of Fireworks Display: Barge off Orient Yacht Club 2110 Village Lane, Orient,NY 11957 July 6, 2019—Rain Date July 7, 2019 @ Approximately 9:15 PM Chief Pyrotechnician: Health: Age: Years Experience James Lipp Excellent 51 26 Product: Not to Exceed 1952 Firework Shells and 4500 Illuminations 1.3G & 1AG explosives, UN0335, Maximum Aerial Shell Diameter= 8 inches. Storage will beat secured safety zone in D.O.T. approved fiberboard containers # UN-4G, and stored in company vehicle approved for this purpose. Fireworks by Grucci complies with all requirements of the NFPA 1123 and The Town of Southold The above information is submitted and verified by. Christopher Grucci Logistics Manager Fireworks by Grucci, Inc. Office # (631) 286-0088 20 Pinehurst Drive Fax #: (631) 286-9036 Bellport,NY 11713 E-mail ccgiucci@grucct com '1 THE FIRST FAMILY OF FIREWORKS June 10,2019 DISPLAY: Orient Harbor July 4"'Festivities, Inc. FROM: Christopher Gucci Re: July 6, 2019 Fireworks Displays / Rain Date.July 7, 2019 SHELL SIZE NOT TO EXCEED 8" SHELL SIZE: QUANTITY IN PCS. Grucci Grand Illuminations - 4500 2'/2 - 3" - 1020 4" - 325 5" - 300 6" - 275 8" - 32 10" - N/A 12" - N/A 24" - N/A Grucci Grand Illuminations = Gerbs, Mines, SPX, Comets,Roman Candles Water Falls, Strobe Pots Storage will be at secured safety zone in D.O.T. approved fiberboard containers # UN-4G, and stored in company vehicle approved for this purpose. Total: Not to exceed 1952 Firework Shells and 4500 Illuminations Type: Fireworks UN0335 (Display Fireworks) (Explosive 1.3G) Fireworks UN0336 (Special Effects) (Explosive 1.4G) Thank You, Christopher Grucci Logistics Manager Fireworks by Grucci, Inc Office#: (631) 286-0088 20 Pinehurst Drive Fax#: (631) 286-9036 Bellport,NY 11713 E-mail CgjUcgj@grucci Com THE FIRST FAMILY OF FIREWORKS few US Department of Eastern Service Center 1701 Columbia Ave Transportation Operations Support Group College Park,GA 30337 Group AJV-E2 FIREWORKS DISPLAY NOTIFICATION Company,Name: Fireworks by Grucci,Inc. Email Address of Person Submitting Request: Ifernandez@grucci.com Initials: LMF Cell phone Number for On-Site Technician: 631-745-5087 Event Name: Orient Independence Day Celebration Display Date: July 6. 2019 Rain Date: July 7. 2019 Display Start Time: 9:15pm Zulu:0115 Duration of Fireworks,Display:0132 Max Height of Fireworks: Not To Exceed ABG of .2 Nautical Mile (1200' Height) Address, City and State: Barge of Orient Yacht Club, Orient, NY Latitude: 41°8'2.71" (North) Longitude: 72°18'34.28" (West) Display Radius: Not To Exceed .33 Nautical Miles (2000' Radius) List the closet public use airports within 5 nautical Miles of the Display if the Fireworks will reach or exceed 500 ft.: (1) Rose Field (2)Westmoreland Distance:(1)2 mi (2)4.4 mi Direction: 1 SW2 N from Airport to Fireworks Display location Special Notes: Please email your request to: 9-ATO-ESA-OSG-Fireworks@faa.gov Fax to Flight Data at: ,1-571-223-1593 Phone: 1-877-487-6867 Fax 24-48 Hours prior -T,'I '-OFz 1ABOR STA 'I,01 "IF-I T k C" " CERI-11FICi-, P'V,,R;G'T FCC ONW, ET -4CE HNIC 0 )'A w'v I "E' AUM NO N'-P RGA"MAT 'N XT-T-'- f 'w Sl PYROIT 0-4#,Ilt�, As Yr -T, h RECEIVED JIM JI 'M June 10,2019 40 Elizabeth Neville,Town Clerk Southold Town Cler Town of Southold 53095 Route 25 Southold,NY 11971 Phone: 631-765-1800 Fax: 631-765-6145 Email. e.neville@town.southold.ny.us CC: lynda.rudder@town.southold.ny.us Dear Ms.Neville Please find attached-hereto for the Orient Harbor July Th Festivities,Inc. fireworks display scheduled for July 6, 2019 with a Rain Date of July 7, 2019 at 9:15 PM the following- 1) Town of Southold Permit to Display Fireworks Application 2) Insurance Certificate 3) Site Plan 4) FAA Notification Letter 5) Chief Pyrotechnician's Data Form 6) Chief Pyrotechnician's NYS Certificate of Fitness 7) Pyrotechnic Product Count 8) U.S. Fish &Wildlife Notification 9) DEC Notification 10) Letter to Sponsor Soon to Follow: 1) FAA Notification Approval 2) US Coast Guard Permit (Filed on-line) 3) Check for$100.00 for Permit Fee Thank you for your help in this matter and if you should have any questions please call Sincerely, Christopher Grucci Logistics Manager Fireworks by Grucci,Inc. Fireworks by Grucct, Inc. Office #: (631) 286-0088 20 Pinehurst Drive Fax # (631) 286-9036 Bellport,NY 11713 E-mail: cgrucci@grucci.com THE FIRST FAMILY OF FIREWORKS t «.....-.-...S,+.v�rn-�w�M.vv.• ..,stim',.e Mv.z.-.�.+t+taM- .e� ''s<c%+ L y6 IND s.NNi�y. ryS `,r"i rcwT ' A+' aq:Cp E t INSTRUCTIONS FOR DISPLAY OF FIREWORKS 1. Name of body sponsoring fireworks display. 2. The date and time of day at which the fireworks display is to be held. 3. The exact location planned for the fireworks display, including TAX MAP NUMBER. 4. The age, experience and physical characteristics of the persons who are to do the actual discharging of the fireworks. 5. The number and kind of fireworks to be discharged. 6. The manner and place of storage of such fireworks prior to the display. 7. A diagram of the grounds on which the display is to be held, showing the point at which the fireworks are to be discharged, the location of all buildings, highways and other lines of communication, the lines behind which the audience will be restrained and location of all nearby trees, telegraph or telephone lines or other overhead obstructions. 8. Such other information as the Southold Town Clerk may deem necessary to protect persons and property. Written permission of the property owner is required. 9. An indemnity insurance policy with liability coverage and indemnity protection of $1,000,000.00 per person for bodily injury; $1,000,000.00 per-accident; $1,000,000.00 property damage. 10. The Town Clerk of the Town of Southold must have the insurance policy in her possession before the fireworks permit is issued. The named insured must read: TOWN OF SOUTHOLD. 11. Application for a fireworks permit must be made at least five days in advance of the date of the fireworks display. (The above instructions are in accordance with the Penal Law, Article 405 - Licensing and other provisions relating to fireworks.) To reuse,cover or mark through any previous shipping information. Align top of FedEx Express®shipping label here. ORIGIN IDIISPA (631) 286-0088 SHIP DATE: 13JUN19 �I LESLIE FERNANDEZ ACTWGTI 1.00 LB MAN s ?. FIREWORKS BY GRUCCI CAD: 20 PINEHURST DRIVE BELLPORT NY 11713 BILL SENDEqrW C D, ELIZABUNITED STATES US a, To ETH NEVILLE, TOWN G ERK TOWN o OF SOUTHOLD ,tU 1 4 1019 53095 ROUTE 25 SOUTHOLD NY 11971 �� ��. .. •� � Y � ,- 1N8��7B6-1800 REFI i III IIIIIIIIIIIIIIIIIIIIIIIII IIIIIII II II IIIIIIIIII IIIIII OEPTI a FedEx ' - 1 , 1� Express - s a 1 1 I ro ito FRI — 14 JUN 4:30P ' ozo" 7087 8249 6761 STANDARD OVERNIGHT 11971 WSHA �, Nv—us JFK ' i SAMPLE LETTER (Orient Fire Department Stationery) Date: To: Elizabeth Neville,Town Clerk I have reviewed the application for a fireworks permit submitted by Orient Harbor July 4th Festivities, Inc.for event on Saturday,July 6, 2019 9:15PM with Rain Date: Sunday,July 7, 2019 at 9:15 PM and approve of the issuance of the permit. The Orient Fire Department will be on standby with coverage to include firemen and fire trucks, if needed. Mike Prindle,Chief Orient fire Department ELIZABETH A. NEVILLE,MMC Town Hall, 53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS � m� � Fax(631)765-6145 MARRIAGE OFFICER ;w&y m Telephone(631)765-1800 RECORDS MANAGEMENT FREEDOM OF INFORMATION OFFICER �� � ���� �'�'�'�'•southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT 2019-4 for 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: Orient Harbor July 4th Festivities, Inc. A 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 Saturda, July C 2019 at 9:1.5 P.M. Rain Date: Sundal, July 7 2019 at 9:15 P.M. on a bare off Orient Yacht Club 2110 Village Lane Orient New Yor!!6 the time and place set forth in the application therefore, 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 a 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 into 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 a 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 concluded 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 least two soda-acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. El' abeth A. IN, Town Clerk Town of Southold Suffolk County, New York (TOWN SEAL) ,yranak" RESOLUTION (ID # 15332) REVIEWED DOC ID: 15332 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. (ID # 15332) WAS REVIEWED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 18, 2019: RESOLVED that the Town Board of the Tower of Southold hereby a ) roves the issuancce of to Fireworks Permit by the Town. Clerk to the Orient Harbor July 4 T'estivities Inc. for a fireworks display on Saturday, July 6, 2019 at 9:15 PM (Rain Date: Sunday, July 7, 2019 at 9:15PM) on Barge off Orient Yacht Club, 2110 Village Lane, Orient,New York upon 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 Orient Fire Chief. Elizabeth A. Neville Southold Town Clerk