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Home My WebLink About2021 ELIZABETH A.NEVILLE,MMC �� G,j, Town Hall,53095 Main Road TOWN CLERK ® P.O.Box 1179 C a Southold,New York 11971 REGISTRAR OF VITAL STATISTICS • Fax(631)765-6145 MARRIAGE OFFICER y� Q Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ®l �►a www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT#2021-2 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: SANTORE'S FIREWORKS on behalf of MATTITUCK ENVIRONMENTAL,LLC/ STANLEY LOMANGINO 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 Sunday, July 4, 2021 at 9:15 P.M. (Rain Date: Monday, July 5, 2021 at 9:15 P.M.) on private beach located at 9205 Skunk Lane, Cutchogue, 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. This permit is issued subiect to the applicants compliance with all Executive Orders of the State of New York and the requirements of the Town's policy regarding the issuance of fireworks permits; and conditions and requirements of the New York State Environmental Conservation; and US Fish &Wildlife Service. 00.Dated: June 16 , 2021 . Elizabet A.Neville,Town Clerk Tow of Southold Suffolk County,New York (TOWN SEAL) THIS PERMIT IS NOT TRANSFERABLE �gUFFUlA'C's RESOLUTION 2021-458 oyMC�� AI)OPTED DOC ID: 17111 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2021-458 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 1,2021: RESOLVED that the Town Board of the Town of Southold hereby ratifies and approves the issuance of Fireworks Permit#2 of 2021 by the Town Clerk to Santore's Fireworks on behalf of Mattituck Environmental, LLC for a fireworks display on Sunday,July 4,2021 at 9:15PM (Rain Date: Monday,Ju!X 5, 2021 at 9:15 PM) at 9205 Skunk Lane, Cutchogue, New York, upon payment of a single fee of$100.00 and subject to any Executive Orders issued by the Governor's Office and to the applicant's compliance with the requirements of the Town's Policy regarding the issuance of fireworks permits,the approval of the Town Attorney,the Chief of the Cutchogue Fire Department, and the New York State Department of Environmental Conservation approval and any conditions and requirements placed upon the permit for any matter or concern. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER:Robert Ghosio, Councilman AYES: Nappa, Dinizio Jr, Doherty, Ghosio, Evans, Russell Neville, Elizabeth From: Neville, Elizabeth Sent: Wednesday,June 16, 20216:17 PM To: Hagan, Damon Cc: 'Kelly Santore' Subject: RE: sorry, me again... Attachments: Fireworks Permit#2021-2_20210616181443.pdf Importance: High Damon, Attached, please find Fireworks Permit#2021-2 issued to Santore's Fireworks on behalf of Mattituck Environmental, LLC/Stanley Lomangino. Elizabeth A.Neville 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 j From: Hagan, Damon Sent: Wednesday, June 16, 20214:57 PM To: Neville, Elizabeth; 'Kelly Santore' Subject: RE: sorry, me again... Betty, We are ready for the issuance of the Town Firework Permit and the DEC has assigned a reviewing officer that I am working with. Please scan and send me the Town's issued permit at your earliest convenience. Yours Truly etc., Damon A.Hagan Assistant Town Attorney Town of Southold Town Hall Annex 54375 Route 25 PO Box 1179 Southold,NY 11971-0959 Phone(631)765-1939 Fax(631)765-6639 *********** This electronic mail transmission may contain confidential or privileged information. If you 1 believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. ****************************************************************************************************** *********** From: Neville, Elizabeth<E.Neville @town.southold.ny.us> Sent:Wednesday,June 16, 202112:38 PM To: 'Kelly Santore' <kelly@santorefireworks.com> Cc: Hagan, Damon<damonh@southoldtownny.gov> Subject: RE: sorry, me again... Hi Kelly, I have everything prepared and ready to go. However, Damon Hagan,Assistant Town Attorney is handling the monitoring of the situation and final approval for the issuance of the permit. His telephone number is 631765-1939 e- mail damonh@southoldtownny.gov; Please copy me on all updates. Thank you. Elizabeth A.Neville 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: Kelly Santore [ma iIto:kellyCabsantorefireworks.com] Sent: Wednesday, June 16, 2021 12:33 PM To: Neville, Elizabeth Subject: Re: sorry, me again... Sorry Elizabeth-I was writing two emails at once and the wedding details went to your email instead of the other one -please ignore it! Thanks. Kelly On Wed, Jun 16, 2021 at 12:28 PM Kelly Santore <kelly@santorefireworks.com>wrote: ! Hi Elizabeth, I wanted to thank you for helping us with the wedding display last weekend -it was a wonderful occasion and the happy couple were, well, happy! I just wanted to double check as I am down to the wire with my shows (Lomangino, who's working on the plover/parking situation and North Fork CC) in your jurisdiction and make sure you have all the papers for the permit approvals. If you do get any approvals, could you please let me know so I can keep the clients (and my boss) up to date on where we are at. 2 Neville, Elizabeth From: Hagan, Damon Sent: Wednesday, June 16, 20214:57 PM To: Neville, Elizabeth; 'Kelly Santore' Subject: RE:sorry, me again... Betty, We are ready for the issuance of the Town Firework Permit and the DEC has assigned a reviewing officer that I am working with. Please scan and send me the Town's issued permit at your earliest convenience. Yours Truly etc., Damon A.Hagan Assistant Town Attorney Town of Southold Town Hall Annex 54375 Route 25 PO Box 1179 Southold,NY 11971-0959 Phone(631)765-1939 Fax(631)765-6639 *********** This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error, please notify the sender by reply transmission and delete the message without copying or disclosing it. ****************************************************************************************************** *********** From: Neville, Elizabeth <E.Neville@town.southold.ny.us> Sent:Wednesday,June 16, 202112:38 PM To: 'Kelly Santore' <kellv@santorefireworks.com> Cc: Hagan, Damon<damonh@southoldtownny.gov> Subject: RE: sorry, me again... Hi Kelly, I have everything prepared and ready to go. However, Damon Hagan, Assistant Town Attorney is handling the monitoring of the situation and final approval for the issuance of the permit. His telephone number is 631765-1939 e- mail damonh@southoldtownny.gov; Please copy me on all updates. Thank you. Elizabeth A.Neville 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 631 765-6145 Cell 631466-6064 From: Kelly Santore [mailto:kelly0santorefireworks.com] Sent: Wednesday, June 16, 2021 12:33 PM To: Neville, Elizabeth Subject: Re: sorry, me again... Sorry Elizabeth -I was writing two emails at once and the wedding details went to your email instead of the other one -please ignore it! Thanks. Kelly On Wed, Jun 16, 2021 at 12:28 PM Kelly Santore <kelly@santorefireworks.com> wrote: Hi Elizabeth, I wanted to thank you for helping us with the wedding display last weekend-it was a wonderful occasion and the happy couple were, well, happy! I just wanted to double cheek as I am down to the wire with my shows (Lomangino, who's working on the plover/parking situation and North Fork CC) in your jurisdiction and make sure you have all the papers for the permit approvals. If you do get any approvals, could you please let me know so I can keep the clients (and my boss) up to date on where we are at. Thank you again for always being so patient and helpful with me. Still getting the hang of this job and want to be sure I still have it next year :) Take care and I look forward to hearing from you, Kelly Santore's World Famous Fireworks, LLC Kelly Santore Santore's World Famous Fireworks, ILC 2 Neville, Elizabeth From: Kelly Santore <kelly@santorefireworks.com> Sent: Wednesday,June 16, 20218:07 PM To: Neville, Elizabeth Cc: Hagan, Damon Subject: Re:sorry, me again... Thank you so much! I appreciate all your time and effort! Have a great week! Kelly On Wed, Jun 16, 2021 at 6:16 PM Neville, Elizabeth<E.Neville@,town.southold.ny.us> wrote: Damon, Attached, please find Fireworks Permit#2021-2 issued to Santore's Fireworks on behalf of Mattituck Environmental, LLC/Stanley Lomangino. Elizabeth A.Neville 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 631 765-6145 Cell 631466-6064 From: Hagan, Damon Sent: Wednesday, June 16, 20214:57 PM To: Neville, Elizabeth; 'Kelly Santore' Subject: RE: sorry, me again... i Betty, We are ready for the issuance of the Town Firework Permit and the DEC has assigned a reviewing officer that I am working with. Please scan and send me the Town's issued permit at your earliest convenience. Yours Truly etc., Damon A.Hagan Assistant Town Attorney Town of Southold Town Hall Annex 54375 Route 25 PO Box 1179 Southold,NY 11971-0959 Phone(631)765-1939 Fax(631)765-6639 ************ This electronic mail transmission may contain confidential or privileged information. If you believe that you have received the message in error,please notify the sender by reply transmission and delete the message without copying or disclosing it. From: Neville, Elizabeth <E.Neville@town.southold.riy.us> Sent: Wednesday,June 16, 202112:38 PM To: 'Kelly Santore' <kelly@santorefireworks.corh> 2 RESOLUTION 2021-458 ADOPTED DOC ID: 17111 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2021-458 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 1,2021: RESOLVED that the Town Board of the Town of Southold hereby ratifies and approves the issuance of Fireworks Permit#2 of 2021 by the Town Clerk to Mattituck Environmental, LLC for a fireworks display on Sunday,July 4,2021 at 9:15PM (Rain Date: Monday,July 5,2021 at 9:15 PM) at 9205 Skunk Lane, Cutchogue, New York, upon payment of a single fee of$100.00 and subject to any Executive Orders issued by the Governor's Office and to the applicant's compliance with the requirements of the Town's Policy regarding the issuance of fireworks permits,the approval of the Town Attorney,the Chief of the Cutchogue Fire Department, and the New York State Department of Environmental Conservation approval and any conditions and requirements placed upon the permit for any matter or concern. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER:Robert Ghosio, Councilman AYES: Nappa, Dinizio Jr,Doherty, Ghosio, Evans, Russell Neville, Elizabeth From: Kelly Santore <kelly@santorefireworks.com> Sent: Wednesday,June 02, 20212:59 PM To: Neville, Elizabeth Subject: Re: Matt. Environ.,LLC/Lomangino Thank you Elizabeth, I will notify Mr. Lomangino and the appropriate parties for the parking situation. I also know they have people working with wildlife on the situation with the Plovers, so I will notify them as well. Kelly On Wed, Jun 2, 2021 at 2:23 PM Neville, Elizabeth<E.Neville@town.southold.ny.us>wrote: Good Afternoon Kelly, The Southold Town Board approved the Fireworks Permit for Mattituck Environmental, LLC/S. Lomangino for the July 4th fireworks display. However, I cannot issue the permit until such time as I receive written permission from the NYS DEC, the USFWS regarding the bird nesting on the beach. Also, last year there were issues with parking &traffic control on the park district and private properties which the USFWS said must be addressed in the future. I do not know what the situation is with the birds this year......But, I will have the permit ready to go once I receive notification from these agencies. Elizabeth A. Neville Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel:631 765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 Kelly Santore Santore's World Famous Fireworks, LLC i x - 2 Neville, Elizabeth From: Neville, Elizabeth Sent: Wednesday,June 02, 20212:24 PM To: kelly@santorefireworks.com Subject: Matt. Environ.,LLC/Lomangino Attachments: Printout-17111-1Q34-M 57095.doc Good Afternoon Kelly, The Southold Town Board approved the Fireworks Permit for Mattituck Environmental, LLC/S. Lomangino for the July 4th fireworks display. However, I cannot issue the permit until such time as I receive written permission from the NYS DEC, the USFWS regarding the bird nesting on the beach. Also, last year there were issues with parking&traffic control on the park district and private properties which the USFWS said must be addressed in the future. I do not know what the situation is with the birds this year......But, I will have the permit ready to go once I receive notification from these agencies. Elizabeth A.Neville 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: Hagan, Damon Sent: Tuesday, May 25, 20219:23 AM To: Sepenoski,John; Spiro, Melissa; Neville, Elizabeth; Burke,John; Duffy, Bill; Fisher, Robert; Flatley, Martin; Norklun, Stacey,Verity, Mike; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Nappa, Sarah; Russell, Scott Cc: Mirabelli, Melissa Subject: RE: Matt. Environ Lomangino Emailing: Fireworks Permit Referra_20210524114308 Our office will address it. Damon -----Original Message----- From:Sepenoski,John<iohnsep@town.southold.ny.us> Sent: Monday, May 24, 20213:13 PM To:Spiro, Melissa<Melissa.Spiro@town.southold.nv.us>; Neville, Elizabeth<E.Neville@town.southold.nv.us>; Burke, John <iohnbu@southoldtownnv.gov>; Duffy, Bill<billd@southoldtownny.gov>; Fisher, Robert <Robert.Fisher@town.southold.nv.us>; Flatley, Martin<mflatlev@town.southold.nv.us>; Hagan, Damon <damonh@southoldtownny.gov>; Norklun,Stacey<Stacey.Norklun@town.southold.ny.us>;Verity, Mike <Mike.Verity@town.southold.ny.us>; Dinizio,James<iames.dinizio@town.southold.nv.us>; Doherty,Jill <fill.doherty@town.southold.nv.us>; Evans, Louisa<louisae@southoldtownny.gov>;Ghosio, Bob <bob.ghosio@town.southold.nv.us>; Nappa, Sarah<sarahn@southoldtownny.gov>; Russell, Scott <scottr@southoldtownny.gov> Subject: RE: Matt. Environ Lomangino Emailing: Fireworks Permit Referra_20210524114308 I am no longer handling the beach nesting contract but whoever is handling it needs to coordinate with NYS DEC and/or USFWS and the contractor hired to run the program this year. Last year there were parking/traffic control issues that USFWS required the applicant to deal with. Not sure if they will again this year but there was an attempt to have us deal with these issues last year by the applicant's agents but it was not our responsibility last year due to the issues being on park district and private property so keep this in mind. I see that this message will not be delivered to Bill Duffy because his email box is full so someone in the attorney's office should deal with this and make sure that he receives the information. John Sep From:Spiro, Melissa Sent: Monday, May 24, 20212:59 PM To: Neville, Elizabeth; Burke,John; Duffy, Bill; Fisher, Robert; Flatley, Martin; Hagan, Damon; Norklun,Stacey;Verity, Mike; Sepenoski,John; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio,.Bob; Nappa, Sarah; Russell, Scott Subject: RE: Matt. Environ Lomangino Emailing: Fireworks Permit Referra_20210524114308 This is not Town preserved land. In the past there have been reviews/restrictions regarding nesting birds. I see that John Sep is on this e-mail chain and I am assuming that he will respond regarding any further coordination recommended for this permit. Melissa S. 1 -----Original Message----- From: Neville, Elizabeth Sent: Monday, May 24, 20212:24 PM To: Burke,John<iohnbu@southoldtownny.gov>; Duffy, Bill<billd@southoldtownny.gov>; Fisher, Robert <Robert.Fisher town.southold.nv.us>; Flatley, Martin<mflatlev@town.southold.nv.us>; Hagan, Damon <damonh@southoldtownnv.gov>; Norklun,Stacey<Stacey.Norklun town.southold.nv.us>;Spiro, Melissa <Melissa.Spiro Ptown.southold.nv.us>;Verity, Mike<Mike.Verity@town.southold.,nv.us>; Sepenoski,John <iohnsep town.southold.ny.us>; Dinizio,James<iames.dinizio@town.southold.ny.us>; Doherty,Jill <iill.doherty town.southold.nv.us>; Evans, Louisa <louisae@southoldtownnv.gov>; Ghosio, Bob <bob.ghosio@town.southold.nv.us>; Nappa, Sarah <sarahn@southoldtownnv.gov>; Russell, Scott <scottr southoldtownny.gov> Subject: Matt. Environ Lomangino Emailing: Fireworks Permit Referra_20210524114308 Attached, please find an application submitted by Santore's World Famous Fireworks on behalf of Mattituck Environmental/Lomangino. Please review it and send me your comments and recommendations for approval and issuance. Elizabeth A. Neville 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 Permit Referra 20210524114308 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 l� Neville, Elizabeth From: Spiro, Melissa Sent: Monday, May 24, 20212:59 PM To: Neville, Elizabeth; Burke,John; Duffy, Bill; Fisher, Robert; Flatley, Martin; Hagan, Damon; Norklun, Stacey;Verity, Mike; Sepenoski,John; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Nappa, Sarah; Russell, Scott Subject: RE: Matt. Environ Lomangino Emailing: Fireworks Permit Referra_20210524114308 This is not Town-preserved land. In the past there have been reviews/restrictions regarding nesting birds. I see that John Sep is on-this e-mail chain and I am assuming that he will respond regarding any further coordination recommended for this permit. Melissa S. -----Original Message----- From: Neville, Elizabeth Sent: Monday, May 24, 20212:24 PM To: Burke,John<iohnbu@southoldtownny.gov>; Duffy, Bill<billd@southoldtownnv.gov>; Fisher, Robert <Robert.Fisher@town.southoId.nv.us>; Flatley, Martin<mflatley@town.southold.nv.us>; Hagan, Damon <damonhCc@southoldtownny.gov>; Norklun,Stacey<Stacey.Norklun@town.southold.ny.us>;Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>;Verity, Mike<Mike.Verity@town.southold.nv.us>;Sepenoski,John <iohnsep@town.southold.ny.us>; Dinizio,James<fames.dinizio@town.southold,.ny.us>;,Doherty,Jill <iill.doherty@town.southold.nv.us>; Evans, Louisa <louisae@southoldtownnv.gov>; Ghosio, Bob <bob.ghosio@town.southold.ny.us>; Nappa,Sarah<sarahn@southoldtownny.gov>; Russell, Scott <scottr@southoldtownny.gov> Subject: Matt. Environ Lomangino Emailing: Fireworks Permit Referra_20210524114308 Attached, please find an application submitted by Santore's World Famous Fireworks on behalf of Mattituck Environmental/Lomangino. Please review it and send me your comments and recommendations for approval and issuance. Elizabeth A. Neville 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 Permit Referra 20210524114308 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: Flatley, Martin Sent: Wednesday,June 17, 2020 3:36 PM To: Neville, Elizabeth Subject: RE: Emailing: FireworksApplic-MattEnvi_20200617104052 I have no objections to this permit being approved Martin Flatley, Chief of Police Town of Southold Police Department 41405 State Route 25 Peconic, N.Y. 11958 Tel: 631-765-3115 -----Original Message----- From: Neville, Elizabeth<E.Neville@town.southold.ny.us> Sent: Wednesday,June 17,2020 10:52 AM To: Burke,John<i'ohnbu@southoldtownny.eov>; Duffy, Bill<billd@southoldtownny.gov>; Fisher, Robert <Robert.Fisher@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.nv.us>; Hagan, Damon <damonh@southoldtownny.goy>; Norklun, Stacey<Stacey.Norklun@town.southold.nv.us>; Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Dinizio,James<lames.dinizioCc@town.southold.ny.us>; Doherty,Jill <fill.doherty@town.southold.ny.us>; Evans, Louisa<louisae@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.nv.us>; Nappa,Sarah<sarahn@southoldtownny.gov>; Russell,Scott <scottr@southoldtownny.gov> Subject: Emailing: FireworksApplic-MattEnvi_20200617104052 Importance: High Attached, please find Fireworks Application by Santore's Fireworks Application for July 4th on behalf of Mattituck Environmental. Although it was received on May 18, 2020, the Town Board was not entertaining any fireworks applications at that time. However,they have agreed to approve the issuance of this permit at this time, provided strict adherence to all safety precautions and COVID Protocols. Please review and send me your comments and recommendations. Thank you. Elizabeth A. Neville 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: FireworksApplic-MattEnvi_20200617104052 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 ire l"la,r,5'Ral( From: Neville, Elizabeth EL Sent: Monday, May 24, 20212:24 PM TDWN To: Burke,John; Duffy, Bill; Fisher, Robert; �; Hagan, Damvn;rvvnciun;�zacey, _SpirgW4 ssa;.Verity, Mike;Sepe ci�ohn; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Nappa, Sarah; Russell, Scott Subject: Matt. Environ Lomangino Emailing: Fireworks Permit Referra_20210524114308 Attachments: Fireworks Permit Referra_20210524114308.pdf , Attached, please find an application submitted by Santore's World Famous Fireworks on behalf of Mattituck Environmental/Lomangino. Please review it and send me your comments and recommendations for approval and issuance. Elizabeth A. Neville 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 Permit Referra 20210524114308 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: Wednesday, May 26, 20212:40 PM To: 'Cutchogue Fire District' Subject: RE: Fireworks Permit Application Matt Environ Thank you very much Matt! Elizabeth A.Neville 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: Cutchogue Fire District [mailto:cutfd(a@optonline.net] Sent: Wednesday, May 26, 20212:27 PM To: Neville, Elizabeth Subject: Re: Fireworks Permit Application Matt Environ Hi Betty, Thank you for your permit applications (2). North Fork Country Club & Mattituck Environmental. I have passed-it on to Chief Amos Meringer for his approval. We expect-his prompt reply and will return the letter thereafter. Yours-truly,- Matthew Martin, District Secretary Matt Martin Cutchogue Fire District Secretary 631-766-2666 cell; 631-734-5444 office Ext 202 260 New Suffolk Rd, Cutchogue, NY 11935 1 Neville, Elizabeth From: Neville, Elizabeth Sent: Wednesday, May 26, 202110:34 AM To: 'cutfd@optonline.net' Subject: Fireworks Permit Application Matt Environ Attachments: Fireworks Permit Referra_20210524114308.pdf; Laserfiche Documents.zip Importance: High Good Morning, A Fireworks Permit Application has been filed by Santore's World Famous Fireworks on behalf of Mattituck Environmental/Stanly Lomangino. The attached application must be reviewed by the Chief of the Cutchogue Fire Department who must send a letter to the Town Clerk's Office stating his approval and any comments/recommendations before the Town Board can adopt a resolution to issue the permit. The 2nd attachment is a sample copy of last year's letter. Please respond at your earliest convenience. Thank you. Elizabeth A.Neville 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 Cutchogue Fire Department - Suffolk County, New York Page 1 of 2 SORE Gam' PAdUDLY SERVING THE COMMUNTTYSINCE1928 Home Fire District (_ History DL=aartment Of'f'icers Inside CFD Apparatus Ft Events IL Amos Meringer - Chief Photo Galleries I Recruitment William Brewer - Ist Assistant Chief Prevention ( a Store Christian Voegel - 2nd Assistanct Chief Guestbook News Archives Members Area Local weather Links Department Secretary -Tom Shalvey Jr. Contact us Chaplain-Thomas Roslak 2021 Incidents Jan 40hi ed Fire Company . I Officers Feb 34 Mar Apr 3o Christopher Dinizio - Captain May 32 Jun o Thomas Cybulski - Recording Secretary Michael C. Boken - Jul o Financial Secretary Aug 0 Sep 0 Oct o Timothy Horton - Treasurer Nov 0 Dec 0 Lieutenants Total 174 Past Incidents Michael C. Boken, Richard Horton, Garrett Lake, Thomas Behr, Joe 2020 476 Hinton, Kate Michalak, 2019 435 2018 413 2017 387 Will Voegel, Ken Pearsall, Arthur Brewer, Christian Figurniak 2016 433 2015 438 Chief Drivers 2014 439 2013 464 2012 521 Allan Glover, ,Robert Scott Charles WitczakrSr.,John Hinton . John 2011 484 Hinton Jr., 2010 507 �R� 2009 351 Jim Rocco, ex S lelmann, Wil] Voegel, Everrett Glover Zoos 375 , R P� 9 , Rescue ad Richard Hartmann - Captain Kate Michalak- Lieutenant https://www.cutchoguefiredept.org/content/officers/ 5/26/2021 Cutchogue Fire Department - Suffolk County, New York Page 2 of 2 - I I., Water Rescue 00" C-IF11'" C"ReDEPIT!, Ed Nicholson - Captain Tom Robbins - Lieutenant NflyYORkf Erk POI!Clq Arthur Brewer - Captain Web Counters Website Visitors Since Matthew J. Martin - Lieutenant June 25,2008 2,586,490 Trustees V:sitors Today May 26,2021 697 Andre Cybulski, T.J. BehrRobert Scott , Website Designed and Hosted By Content Proudly Maintained By Contact Info Cutchogue Fire District Emergency Dial 911 260 New Suffolk Rd Station;(631)-734-6907 www.FirchouseSoltitions.com Cutchogue,New York 11935 District Fax:(631)-734-7079 Copyright 2021 Firehouse Solutions(A Service of Technology Reflections,Inc.) https://www.cutchoguefiredept.org/content/officers/ 5/26/2021 Cutchogue Fire Department - Suffolk County, New York Page 1 of 2 r d.,93 ix � y '•�.°«h ..,. 1;. �4�w`�S^�!t a�da`ry�'�`a Brei ,`,t iii sl! ARE co, p *�' '6,� i�?�r , ,;,-�...-mss`•" " °.� . Home Fire District ( ' History Deyartment Officers Inside CFD L Events i Amos Meringer - Chief Photo Galleries I Recruitment William Brewer - 1st Assistant Chief Prevention Storeook Christian Voegel - 2nd Assistanct Chief Guestb Dews Archives Members Area Local Weather Links Department Secretary -Tom Shalvey Jr. Contact Us Chaplain-Thomas Roslak 2021 Incidents Jan 40 United Fire Company No. I Officers Feb 34 Mar Apr 3o Christopher Dinizio - Captain May 32 Jun o Thomas Cybulski - Recording Secretary Michael C. Boken - Jul 0 Financial Secretary Aug 0 Sep 0 Oct o Timothy Horton - Treasurer Nov 0 Dec 0 Lieutenants Total 174 Past Incidents Michael C. Boken, Richard Horton, Garrett Lake, Thomas Behr, Joe 2020 476 Hinton, Kate Michalak, 2019 435 2018 413 2017 387 will Voegel, Ken Pearsall, Arthur Brewer, Christian Figurniak 2016 433 2015 438 Chef Drivers 2014 439 2013 464 Allan Glover Robert Scott Charles witczak John Hinton John zoiz szi � � , Sr., 2011 484 Hinton Jr., 2010 507 2009 351 zoos 375 exp�Jim Rocco RS lelmannf will Voe9 el Everrett Glover Rescue Sauad Richard Hartmann - Captain Kate Michalak- Lieutenant hops://www.cutchoguefiredept.org/content/officers/ 5/26/2021 RECEIVED MAY 2 4 2021 � FF84&I Southold Town Clerk ELIZABETH A.NEVILLE,MINK �� Thwn 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 RE,CORDS OF MANAGEMENT OFFICER ��. �►� southoldtown northfork.net FREEDOM OF INFORMA!ITO T OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Laser of the State of New York,for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY Mattituck Environmental PRINCIPAL OFFICE AT 800 Wickam Avenue,Mattituck,NY 11952 DATE&TIME 01i;DISPLAAY 7/4/21 at 9:15 pm EXACT LOCATION-OF DISPLAY Private beach at 9205 Skunk Lane,Cutchogue,NY SUFFOLK COMITY TAX MAP NUMBER FOR SITE ___---------------- RAIN BA'R'E &TIME 7/5/21 at 9:15 pm The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Christopher Acierno 46 13+years Health: Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: 1AG Cakes-34 1.3G Cakes-48 2.5" Shells- 330 Manner and place of storage of fireworks prior to display: Delivery of product on day of display 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. Santore's World Famous Fireworks LLC EEE. $100 Name o rganization See policy far- additional information August N. Santore, Jr. By I rinte . ame of Applicant— Signature of Applicant e--mail address:asantorejr@santorefireworks.com - 5/20/21 Telephone Number 908-872-0624 Date of Application RECEIVE[ — 1 ;✓�_ MAY 2 4 2021 / t� Southold Town Clerk SANT WORLD FAMOUS- FIREWORKS Date: 5/20/21 Town of Southold Office of Town Clerk Ms. Elizabeth Neville, MMC 53095 Main Road Southold,NY 11971 Dear Ms. Neville, Enclosed please find two applications for permits to display fireworks on July 3, 2021 at the North Fork Country Club and on July 4, 2021 at the Lomangino property at 9205 Skunk Lane. All the required paperwork is attached for your review for each application. If you have any questions or concerns, please do not hesitate to contact me at (908) 418-0989 or my email, kelly@santorefireworks.com. Thank you and stay safe, Kelly Santore Santore's World Famous Fireworks Main Office: PO Box 687, Stillwater, NY 12170 (P) 518-664-9994 Email: Info@santoreworldfamousfireworks.com Visit Our Website at: www.santoreworldfamousfireworks.com Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/24/21 Receipt#: 281236 Quantity Transactions Reference Subtotal 1 Fireworks 7/4/21 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#001744 $100.00 Santore's World Famous Fireworks LLC Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Mattituck, Environmental 800 Wickham Ave Po Box 1402 Mattituck, NY 11952 Clerk ID: SABRINA Internal ID 7/4/21 nTl°r,,"Y. .... 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'� ,, o`�'id^7ywu;�� - 1'-p;�r`_,,,t•at' �, ,, :�r �t._'..�111'1�+r':..4 s' ,r,�..s;, ..r:' �• o-..,y-. ��"• -, ,�i><".LcA.._"}--.`Ylk',_ - �?QST",-"�5�.;��I:_.'Y�y�'�''�Y.` "...765' - t� a1�`"'�"��"' ... -' ' - ' „'fi;X'_4',- "` ,:"psi#�y1! r'. W„ -�„*"?3';itC :•4 s't,,,',',",;, r kfi:,k;;Y.TM'.Zi?rl'�'Jr':� --,y}'^t'�,`3j: •. .�`v�y'' i�i,.iSw�;.;:C°:"}..' X'e'"' 1. T'TI,�°,';, I..�,_. <kjaNl; ;..,I L4.T,lfi.'r r^',�R"4',wR',0.ti.'uryi'fi;.� ' !:, ,..,- ' -...t ":4,h.:>.'•Sx•:�.,}rl.i 4 i-t �' .>-i v.'33'> r? `:y �,r'",•Fdi e,•q ,dl, .., 'n:^=1;7y-n,. _ rr _ _ ;'_;J„Y- -<nrF's;r rev- �`%�cn%:d3 .�C4,et+F�,v;�q ��r?,F1s•�a+t, r•'u2,i• eu�,-` , .aw:vh ws.s.-,r ', �¢7'1,,y,.�'x;1,��R1��9 Asti, .;r "-''•; , 1 �as�'k,;•xa. °:. •.; _ .x.r;,: 'd .%'ia;; #c is •,3:�, ° - rM' ., �45•!7t Y?,ti _ w.,t,i�y.,..+��:.',;i-tP4�t yt ,,.. :r '6,,.'. ELIZABETH A. NEVILLE, MMIC ��, Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 Southold,New Yolk 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 CLERK TOWN OF SOUTHOLD POLICY for the Issuance of Fireworks Permits 1. The Town may grant a permit for the display of fireworks by municipalities, fair associations, amusement parks, ep rsons or organizations of individuals. Penal Law Section 405.00(2). 2. An "organization of individuals" is a religious, civic, or comparable organization. Op. Atty. Gen No. 2007-3. J Fireworks permits shall indicate that the display must be concluded by 10:00 p.m. ifheld Sunday-Thursday, 11 :00 p.m. ifheld Friday or Saturday, and there shall be no time restriction ifheld on July 4. 4. No person shall engage in or allow the manufacture, assembly, storage or display of any fireworks or pyrotechnics display without first obtaining a permit issued by the Town Clerk. A completed application for display of fireworks must be received by the Town Clerk a minimum of 30 days prior to the date of display. The permit application for any fireworks or pyrotechnics display shall be accompanied by the following: (a) a copy of a valid certificate of competency as a pyrotechnician for the individual supervising the firing ofthe display; (b) Certificate of Insurance naming the Town of Southold as additional insured with coverage limits of$2,000,000 for public liability and $2,000,000 for property damage; (c) Detailed diagram showing location of fireworks discharge and minimum separation distances in accordance with the applicable requirements of Penal Law Section 405(2); (d) A copy ofthe contract with fireworks display company; and (e) All applications shall require the approval ofthe Fire Chief ofthe District in which the display will take place and the Fire Marshal before being presented for approval by the Town Board. 5. All applications for a fireworks pennit shall be subject to an application fee in an amount o f$100.00, together with a processing fee in an amount to be detennined by the Town Board to cover the Town's costs for monitoring and enforcing compliance with the Penal Law. (The above instructions are in accordance with the Penal Law, Article 405 -Licensing and other provisions relating to fireworks.) LOMANGiNO PARTY 175 ft radius 9205 SKUNK LANE 2.5 inch max CUTCHOG U E NY N 41-01-04 N j 072-2&,56 W 70�l t Skink Lrt `-ATORS Gow" °h-t i E l � Date: 5/20/21 Town of Southold Office of Town Clerk Ms. Elizabeth Neville, MMC 53095 Main Road Southold,NY 11971 Dear Ms. Neville, Santore's World Famous Fireworks has been contracted by Mattituck Environmental for a firework display on July 4, 2021, with a rain date of July 5, 2021, on my property located at 9205 Skunk Lane, Cutchogue,NY. As required in the application for a permit to display fireworks in the town of Southold,this is a notice of written permission for said display. Thank you, Stanley Lomangino ACCO CERTIFICATE OF LIABILITY INSURANCE DATE;;9 02'�"Y' 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 Britton-Gallagher and Associates, Inc. NAME: PHONE FAX One Cleveland Center,Floor 30 A/c o xt:E 216-658-7100 A/c Nol:216-658-7101 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURERS AFFORDING COVERAGE MAIC u INSURER A:Everest National Insurance Gompany 10120 INSURED 18341 INSURER B:AXIS Surplus Ins Company 26620 Santore's World Famous Fireworks LLC 846 Stillwater Bridge Road INSURER C: Schaghticoke NY 12154 INSURER D INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER:1167303559 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 LIMBS LTR INS POLICY NUMBER M1DD MM10D A GENERAL LIABILITY Y Y SIBML00235-211 2/9/2021 2/9/2022 EACH OCCURRENCE $1,000,000 TO X COMMERCIAL GENERAL LIABILITY PAREM SES Ea occurrence) $500,000 CLAIMS-MADE I-k]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICYFX]JEQ LOC $ A AUTOMOBILE LIABILITY Y Y S18CA00102-211 2/9/2021 2/9/2022 COMBINED SINGLE LIMIT Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOSAUTOS X Ix NON-OWNED PROPERTY DAMAGE $ HIRED AUTOSAUTOS B UMBRELLA LIAR X OCCUR Y Y P-001-000074909-03 2/912021 2/9/2022 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNERIEXECUTNE YE L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E L DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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. Display Date:7/4/21.Rain Date:7/5/21.Location:Lomangino property,9205 Skunk Lane,Cutchogue Town of Southold,Stanley Lomangino,Mattituck Environmental,Suffolk County are named as additional insureds,but only in respect of liability caused by the negligent acts or omissions of the named insured.Subrogation waived to the extent required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF SOUTHOLD ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Road P.O.Box 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ,�►co CERTIFICATE OF LIABILITY INSURANCE DATE(MMDIYYYY) 5/19/2021 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 WANED,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 Bretton-Gallagher and Associates,Inc. NAME: PHONE FAx One Cleveland Center,Floor 30 ac No EA:216-658-7100 11C.No):216-658-7101 AI 1375 East 9th Street EA DRESS- Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE MAIC# INSURER A:Everest National Insurance Company 10120 ISa ore's World Famous Fireworks LLC NSURED 18341 INSURERS:AXIS Surplus Ins Company 26620 846 Stillwater Bridge Road INSURER C: Schaghticoke NY 12154 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1077950738 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 INSURANCE INSR WVD POLICY NUMBER MMIOD MMIDD - LIMITS A GENERAL UABIUTY Y Y S18ML00235-211 2/912021 219/2022 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE (RENTED PREMISESS Ea occurrence) $500,000 CLAIMS-MADE F—X1 OCCUR MED ECP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PFR PRODUCTS-COMP/OP AGG $2,000,000 POLICY X P'0. LOC $ A AUTOMOBILE LIABILITY Y Y SIBCA00102-211 2/912021 2/9/2022 COMBINED SINGLE LIMIT F�accident $1,000,000 Ix ANY AUTO BODILY INJURY(Per person) $er accientALL OWNED SCHEDULED BODILY INJURY Pd $ AUTOS AUTOSNON-OWN ( )PER HIRED AUTOS LX AUTOS ED FIR .dZDAMAGE$ B UMBRELLA LIAB X OCCUR Y• Y P-001-000074909-03 2/9/2021 2/912022 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS*LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) EL DISEASE-EA EMPLOYE $ IF yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/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. Display Date:7/4/21.Rain date:7/5/21.Location:Lomangino Property,9205 Skunk Ln. Stanley Lomangino,Mattituck Environmental,Town of Southold,Suffolk County are additional insureds,but only in respect of liability caused by the negligent acts or omissions of the named insured.Subrogation waived to the extent required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Stanley Lomangino 9205 Skunk Lane Cutchogue NY 11935 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. Ail rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 4% NYSIF New YorY State Insurance Fund 1 WATERVLIET AVENUE ALBANY,NEW YORK 12206-1649 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE lil. •MOM w n n n n n n 472010297 SANTORE'S WORLD FAMOUS FIREWORKS LLC Iwo . 143 SUMMIT AVE BERKELEY HEIGHTS NJ 07922 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SANTORE'S WORLD FAMOUS STANLEY LOMANGINO FIREWORKS LLC 9205 SKUNK LANE 143 SUMMIT AVE CUTCHOGUE NY 11935 BERKELEY HEIGHTS NJ 07922 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2353 260-9 203015 02/07/2020 TO 02/07/2021 5/19/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2353 260-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:IIWWW.NYSIF.COM/CER`T/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 935867054 U-26.3 �s(?:��Jhili�<w wlawt,l��` u��'��.ha.�.��rM� w.• r '—+ ' ,.:.rr�, .�°SF�t�t,{Y�i, STATE OF NEW FORK - DEPAR 4NT OF LABOR, t; CHRUSTWHER ACI E if O CLASS: A 'a AMY DISPLAY THIS CARD MUST BE-CARRIED WHEN USING PYPQT C FTO PR,' 177 `^ _NYC &,.SYS CERTIFICATIONS RE(�LJI'REDIN NYC ' . .--------- —— TWEE, i s` STATE OF NEW'YORK': DIVISIAN"OF -015PARTIYIENT-OF LABOR ' : - n' ; 'SAFETY ANQ,,H'EALTH �1ENT i LICENE TO DEA IRI OFt,MANl1 AMFt XPI OSIVES = Expires: 12/31'/2021 ,• San'tore's,lWorld Famous',Flreworks, LLC I. 346-.8tillwater. , , HIS LICENSE MUST'BE ,1g15POS�Pl INYOUR-PLACB Sohaghticoke,.N124 ; OF BUSINESS 3 August N:•Santora,Jr. Lic n e'No '15796 D_ is hereby licensed.to deal fri or manufacture explosives in compliance with the requirements'of the Labor`Law and Industrial Code Rules. Any ehange`in the conditions'under which this,license-is-granted may cause it to be E revoked. Eileen M.Franko,Acting•Director FOR I THE COMMISSIONER,OF LABOR` ' Eve person sellin-,delivering or ivgi awa an ®x losives must keep M the rind al, lace of business within i Every P 9 9 9 9 a Y , Y p P. A. P P - the state,a record of each transaction,including: 1)' the NAME or TYPE and,QUANTITY of explosives SOLD,DEUVERED,or GIVEN. Note:No'license is 1 needed to purchase sriiokeless powder,or black powder in quantities not•exceeding five pounds for use in ' firing antique firearms,or artifacts or replicas thereof. However,dealers,MUST post all such transaotioris on" { the"Deald-Manufacturer•Report of Explosives `Transactions'. „ I 2) the DATE OF EACH SALE 'DELIVERY or GIFT. ttie NAME,LICENSE NUMBER,and BU ADDRESS the purchaser,donee,or person to whom the explosibes were delivered and the'firm',if any;,represented by such person, s i i 4) the NAME,ADbkESS,and LICENSE NUMSER of the person7AKING THE°EXRt OSIVES AWAY from th®, r i. seller,or donori U S.Mpartmenit ofJustice Federal Explosives License/Permit Bureau ofAlcohol,Tobacco,Firmnns and Explosives (18 I.S.G Chapter 40) In accordance with the provisions of Titfe}G,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,Titicl 8,United States Code and the regulations issued thereunder,until the expiration date shown. THIS LICENSE IS NOT TRANSFERABLE7UNDER 27.CFR555.53.- See"WARNINGS"and"NOTICES"on reverse. Direct ATF ATF-Chiet,FELL - :.bicenseJEermi{; - Correspondence To 244 Needy Road ; ; Martinsburg,RrV 25405-9431 $ Chi Expiration. Date 2024 Name - SANTORES WORLD FAMOUS FIREWORKS,L•LC + Premises Address(Changes?Notify the-FELC at least 10 days before the move.). 846 STILLWATER BRIDGE ROAD SCHAGHTICOKE, NY 12154- Type ofLicense or Permit - --- : - — 20-MANUFACTURER OF EXOLOSIVES ' Purchasing Certification Statement : Mailing Address:(Changes?=Notify the FELC of any changes.) The licensee or permittee named above sW1 use a copy of this license of permit to mist a.. transferor of explosives to verifythe identity and the•licensed status ofthe licensee orr.r. ;:=. -• permittee as provided by 27 CFR Part 555. The signature on each copy must bean orieinal ' + signature. Afar scanned or o-mailed copy ofthe liceiim orlidmiYwith a signature SANTORES:VtIORLD FAMOUS FIREWORKS LLC intended to be an original sigaature is acceptable. The sigi 'e must be that ofthe Federal 143 SUMM17 AVE, Explosives licensee(FEL)or a responsible person ofthe JlEL,Icartifythatthisisatrue DERKEI:EY HEIGHTS, NJ 07922- copy ofa license or permit issued to the licensee or permittee named abotretctengage in3he �-�- -_� d -r business or operations specified above under"type ofLicenseor Permit-'i Licensee/Permittee Responsible Person Signature P6siti6n/T11Ie Printed Name Date ATF Fin 54M.1415400,15pan I PrcyiousEdittonisObsolete RwisedSe{ganber2011 Federal Explosives License(FEL)Customer Service Information Federal Explosives Licensing Center(FELC) Toll-free TelephoneNumber. (877)283-3352 ATF Homepage:www.atf.gov 244 Needy Road Fax Number. (304)616-0401 Martinsburg,RN 25405-9431 ]email. FELCQatfgov Change of Address (27 CFR 555.54(a)(I))_ 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 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 of the original license or permit. (The Chief,FELC,shall,if the licensee or permittee is not qualiSed,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 cant'on the same explosive materials business or operations at the same address shown on,and for the remainder ofthe 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 permitted 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 operalions 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 I Federal Explosives LiceuselPerrrrit(FEL)Information Card I I Lieenso?ermitName:SANTORES.WORLD FAMOUS FIREWORKS LLC I I I I Business Name; t I j L icenseiNrrnit Number:6-NY-083-20-40-01080 I I I I I LicensdPetmit Type:20-MANUFACTURER OF EXPLOSIVES I I d Expiration: March 1,2024 I I I I I Please Note: Not Valid for the Sale or Otho Disposition of Explosives.------------------------------- I I I RECEIVED � Southold Town Clerk Hall,63096 Main Road P.O.TOWN CLERK Box 1179 Southold,New York 11971 REGISTRARF VTrAL STATISTICS � Fax(631)765®6145 MARRIAGE OFFICER Telephone( 1)766-1300 RECORDSA El:ENT OFFICER southoldtownnorthfork.not FREEDOMCER OF'FICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuanto the provisions of Section 405.00 of the Penal Lawthe State of New York,for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY Mattituck ro ental PRINCIPAL OFFICE AT 800 Wickarn Avenue, aiuc ,NY 11952 DATE&'Ti r, DISPLAY—....7/4/21 at 9:15 EXACT LOCATION-OF DISPLAY riva eeac a t 9 m __.... 205 aye, uc ., _.. _..... SUFFOLK COUNTY TAX MAP NUMBER FOR SITE_ RAIN ATE &TIME' 7/5121...at 9.15... The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Christopher Acierno _. _.m ..m_ 46 13'jflµ ru �Health: Excellent (Additional names and information inay be submitted on an attached skeet Number ani type of fir orks is as f' llo s; i.AG.Cafes....34 .._www_ 1a3 Cakes - .... ___ . .{. 2.5"' ells -'330 Manner and place of storage of firewosts prior to displ.ay- , e °ve ofpro ct cin av of display_ Attached hereto and made a,part of hereof is a diagram of the grounds on which-the display is to be bald. Also attached is a ceirtificate or policy of insurance coverage. TI : Written permission,with signature of the Lr g t �u��pL�r,must be submitted with the Application. See poiioy4orr° additional information �~ " �':nii�.�'�c � 11 UDM d' � III(M%!' l 3p 1. . . ._... -- �� W'f t: e- mail 1'�Id�l� r°mms, ur:u� rc `1,bsuut�xs 1�5 w z1 .co r. 5120/21 ... .....908-872-0624 ai � i a li: tm� u 1 Numberof Application RECEIVED P MAY 2 4 2021 Southold Town Clerk SAN WORLD MIMS- Date: 5/20/21 Town of Southold Office of Town Clerk Ms. Elizabeth Neville, NIMC 53095 Main Road Southold, NY 11971 Dear Ms. Neville, Enclosed please find two applications for permits to display fireworks on July 3, 2021 at the North Fork Country Club and on July 4, 2021 at the Lomangino property at 9205 Skunk Lane. All the required paperwork is attached for your review for each application. If you have any questions or concerns, please do not hesitate to contact me at (908) 418-0989 or my email, .. arks.( Thank you and stay safe, Kelly Santore Santore's World Famous Fireworks Main Office: PO Box 687, Stillwater, NY 12170 (P) 518-664-9994 im lil Infra.,( s�.Ijato�p,,A rr dfa moQisfii-(,,wc rks.cor) Visit Our Website at: www.santoreworldfamousfireworks.com Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/24/21 Receipt#: 281236 Quantity Transactions Reference Subtotal 1 Fireworks 7/4/21 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#001744 $100.00 Santore's World Famous Fireworks LLC Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Mattituck, Environmental 800 Wickham Ave Po Box 1402 Mattituck, NY 11952 Clerk ID: SABRINA Internal ID:7/4/21 u ern m+r.,!e+nwfvr ww rJ/ijr ✓'�✓d ✓a� i � o� r�rw a d r nvaw , I r wu� � �� 41VI�1h(�,�m �,urr�Y'aunb U rfy a � r fm+�m!4y1 w o"? n✓ , r "fY!i,"IYJa�CHI�'lYa >J>rr3"f>yrrIlho ✓ou a �k'�7dy" I�IVj��7ti�N„ l�yliN°ry9u'�" 1!l`�r Gs o>J M a r ?rid rrnP ar f s. �r. - ao�,viu}H '4Nfi"il�l�l�r ��, 'aFnc,y ,'a,ff a dl�J�e°9iu,rrrrg,,y rfl Y�IpUIi�,�dh'1`� ,r a r t ............. &y^urr"H mi�'H N�':✓P9f« I t w,,.oa Ch' a f, y� f ' b H.;� a4 ,�"✓�` ��r ' "�D1Hr�$�`rn YwJAJ , ✓r !`�'I ire aP aar n�,., Awe �b,w✓ �iH r 0", 's,pa,ip bSantar 's Vo id a n a r�r wv NL N �n dr r 6# r; c ra yn I„ 7 h M L �. ;. c, 4 nti ��^�„w C��O. w� ,�w'�PM'w�`It( n 1'��R � s.➢�' �`��, lH ��'�� rar�r�ar1�'Cr"'4"d'f71G'VN�dC`9�'.. w`P`w'°��+u�"��rr��/„H+4i�Rb,e`o.e[C4�4 I i.° a '10}U'�t.�%� sF p..,si�9 YV eH r;�a,d i�, "l ,�', r'. ✓ lyp ,�s s ,�"� rM '✓ �a ,741"�Y+�'Y�I�,d fig, y,,. �� ,�,�,. � �Nw„ P" V Ir a �y �i� a i �a�n� Ir P7 f �fy31 t �rY. � „w1Win G. ;J f r "•�"d�9i�IM'dyW�yr"�..J V gYn a'a�'2✓W&a t ribiti"Ir n[P6 . 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NEVILLE, MMC Town Hall, 53095 Main Road TOWN CLERK � P.O. Box 1179 ` Southold,New'York 11971 REGISTRAR OF VITAL ST'ATIST'ICS Fax (631) 765®6145 MARRIAGE OFFICER , Telephone(631) 765®1800 RECORDS MANAGEMENT OFFICER 1 www.southoldtowmy.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD POLICY for the Issuance of Fireworks Permits 1° The Townmay grant a permit for the display of fireworks y municipalities, fair associations, amusement p , pg1lions or organizations of individuals. enal Law Section 405.00(2). 2° An "organization of individuals" is a religious, civic, or comparable organization. Atty. Gen No. 2007®3. J. Fireworks permits shall indicate that the display must be concluded by 10;00 p.m. ifheld Sunday-Thursday, 11 °-00 p.m. ifheld Friday or Saturday, and there shall be no time restriction ifheld o July 4. ° No person shall engage in or allow the manufacture, assembly, storagge or display of any fireworks or pyrotechnics display without first obtainii�ag a permit issued by the Town Clerk. A completed application for display of fireworks must be received by the Town Clerk a minimum of 30 days prior to the date of display. The permit application for any fireworks or pyrotechnics display shall be accompanied by the following: (a) a copy of a valid certificate ofcompetency as a pyrotechnician for the individual supervising e fuing o fthe play; Certificate of Insurance naming the Town of Southold as additionalinsured coverage limits of$2,000,000 for public liability and $2,000,000 for property damage; (c) Detailed diagram showing location offireworks discharge and minimum separation distances in accordance with the applicable requiremems ofPenal Law Section 405(2); (d) A copy ofthe contract with fireworksdisplay company; and (e) All applications shall require the approval ofthe Fire Chief ofe District in which the display will e place and the Fire Marshal before being presented for approval by the ToBoard- 5. All applications for a fireworks pennit shall be subject to an application fee in an amount of$100.00, together with a processing fee in an amount to be d'etenniaxed by the Town Board to cover the Town's costs for monitoring and enforcing compliance with the Penal Law. (The above instructions are in accordance with the Penal Law, Article 405 -Licensing and other provisions relating to fireworks.) V B 1 , i Y y i jw= .w ar �m r Date: 5/20/21 Town of Southold Office of Town Clerk Ms. Elizabeth Neville, MMC 53095 Main Road Southold, NY 11971 Dear Ms.Neville, Santore's World Famous Fireworks has been contracted by Mattituck Environmental for a firework display on July 4, 2021, with a rain date of July 5, 2021, on my property located at 9205 Skunk Lane, Cutchogue,NY. As required in the application for a permit to display fireworks in the town of Southold,this is a notice of written.permission for said display. Thank you, F �w«r, Stanley Lomangino ,SIC C TFC OF' L. S C nATE,MMIDDnrn �'" 5/19/2021 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 and Associates, Inc. PHONE Cr FAX One Cleveland Center, Floor 30 rwc,e+� 21 658 7100 E`.-MAIL 1375 East 9th Street AooRe ......... ....... --------------------------- ... Cleveland OH 44114 _ _ ....)NSURER(s AFFORDING COVERAGE INSURER _....Everest National Insurance Company___ 10120 .... ,m.m.--.-.-.- 18341 INSURE INSURED Faus Fireworks LLC Bridge INSURER B:Axis Surplus Ins Company 26620 a ore's World c Schaghticoke NY 12154 INSURERD: '..INSURER E INSURER F; COVERAGES CERTIFICATE NUMBER:1167303559 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. /A).1YLLIBR ..... ............_ .........�.�,. ..POLICY EFF P00..#CYP.. ......,.,...,.,,, ......._ ....._.-. ,., INSR LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MWOD!'Y LIMITS A GENERAL LIABILITY Y Y S18ML00235-211 2/9/2021 2/9/2022 EACH OCCURRENCE $1,000,000 .... COMMERCIAL GENERAL LIABILITY I',.' MI'„E;S,,(E ,acp urrfans $5 ,. ` "DAIAGE TO RENTED X 00 000 ._.__......1 CLAIMS-MADE X OCCUR MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $1,000,000 ..... ...,,.n,,.... GENERAL AGGREGATE $2,000,000 .----- .... GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 X POLICY � PRO-. LOC $ ' A AUTOMOBILE LIABILITY Y Y.... SIBCA00102-211 2/9/2021 2/9/2022 COMBINED.SINGLE LIMIT pn ..(Ea gacr4c),rzr�f) ®,.m .- ?,000.,J,99.,,.... .......................... 1XI BODILY INJURY(Per person) $ ANY AUTOALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOSAUTOS ,..._..NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS XAUTOS a;Offaccidentt $ B UMBRELLA LIAB X OCCUR Y Y P-001-000074909-03 2/9/2021 2/9/2022 EACH OCCURRENCE $4,000,000 X EXCESS LUAB CLAIMS-MADE AGGREGATE $4000.000 _._....._........ ..----— e DED RIwTENTION$ $ WORKERS COMPENSATION NC STATU- 2RY LIWT6 .... ,_..,,.,. AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y/N „E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory In NH) E L DISEASE EA EMPLOYE $ .— .... -..- .. If yes,describe under DESCRIPTION OF OPERATIONS below -IT E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Addilional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Display Datw 7/4/21.Rain dale:715,121.Location:Lomangino property,9205 Skunk Lane,Cutchogue Town of Southold,Stanley Lomangino,Maltituck Environmental,Suffolk County are named as additional insureds,but only in respect of liability Caused by the negligent acts or omissions of the named'insured.Subrogation waived to the extent required by Written contract.. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF SOUTHOLD ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Road P.O.BOX 1 179 AUTHORIZED REPRESENTATIVE Southold NY 11971 ,'. � " ., r ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD C C IFIC T" OF LIA I'LI I SU C� DA 5/TE 19/2021 Y� 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 endorsements. PRODUCER CONTACT' NAME., Britton-Gallagher and Associates,Inc. PHONE I 0A One Cleveland Center,Floor 30 � -"):216-658 7100 ( ml 2f -7101 AIL 1375 East 9th Street ADINt _t; ........_................... ......... Cleveland OH 44114 ,. .. IMSURE,R,LS).AFFORWMG COVERAGE MAIC............. INSURERA:Everest National Insurance Company 10120 _ ----------- --- INSURED 1a3a1 INSURER B:Axis Surplus Ins Company ........_ 26620 Santore's World Famous Fireworks LLC 846 Stillwater Bridge Road INSDRER c, -------- Schaghticoke NY 12154 NsuRER D ''....INSURER E INSURER.F COVERAGES CERTIFICATE NUMBER:1077950738 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. lksh ADOL SUKK LTR TYPE OF INSURANCE POLICY NUMBER MNfAAC.ryYyY (MM D LIMITS A GENERAL LIABILITY Y Y SIOML00235-211 2/9/2021 2J9M22 EACH OCCURRENCE $1,000.000 COMMERCLAL.GENIERAL.L ABIUTYr�............. $600 WO --- X _.I CLAIMS-MADE �.�OCCUR MED EXP(Anone person)---- $ ............................... PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES S PER:PER PRODUCTS-COMP/OP AGG $2.000,000 POLICY PTY LOC Ea a91NE $1 000,. A AUTOMOBILE LUU31LnY Y Y SIOCA00102-211 2/912021 219/2022 COMBINED SINULE LIMIT X ANY AUTO BODILY INJURY(Per person) $ - ALL OWNED SCHEDULED — -� BODILY INJURY(Peraccident) $ AUTOS AUTOS _.----. .,,,..------. ...... NON-OWNED PROPERTY DAMAGE X HIRED AUTOSX AUTOS (PS( nO ... $ ..........-- $ B UMBRELLA LIAB X OCCUR Y Y P-001-000074909-03 2/9/2021 219/1022 EACH OCCURRENCE $4.000.000 ____.... _-....,,. ...................__ X EXCESS LUIB .CLAIMS-MADE AGGREGATE $4.000.000 .-- -- ..... . .'197...,.,.S .-.- ......... ......__ ......... .... DED RETENTION$ $ II WORKERS COMPENSATION WO STAI'U-......._.1.JDRY Lllhl9: ..ER._,.OTH- ..... AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes.des&be under —.... .... . DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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. Display Elate;7/4I21.Rain dales 7/5121.Location:Lomangino Property,9205 Skunk.Ln. Stanley Lomangino,Matt'ituck Environmental,Town of Southold,Suffolk County are additional insureds,but only in respect of liability caused by the negligent acts or omNssions of the named Insured,Subrogation waived to the extent required by written contract. CERTIFICATE FOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Stanley Lomangino 9205 Skunk Lane AUTHORIZED REPRESATIVE Cutchogue NY 11935 < ,f ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD NYSIF Npw Vark State Ihuw,suraM^ic� II!l:''iii.m3 1 WATERVLIET AVENUE ALBANY,NEW YORK 12206-1649 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ft.w*^^^^^" 472010297 SANTORE'S WORLD FAMOUS FIREWORKS LLC 143 SUMMIT AVE BERKELEY HEIGHTS NJ 07922 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SANTORE'S WORLD FAMOUS STANLEY LOMANGINO FIREWORKS LLC 9205 SKUNK LANE 143 SUMMIT AVE CUTCHOGUE NY 11935 BERKELEY HEIGHTS NJ 07922 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2353 260-9 203015 02/07/2020 TO 02/07/2021 5/19/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2353 260-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/MIWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. STATENEWYORK DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION BER: 935867054 U-26.3 ��,u��,�' If millll�l(IIIIWOu�uutidOuV VuuVUVUV „V, :11111 11111 IlIffl 'I �: LA rm Xn33 s —L m Z LA Ce ® N Aw M ..: C m �v M uiY�w ISI i . : ..� STATE OF NEW YORKDIVISION OF r HEALTHDEPARTMENT OF LABOR SAFETY AND LICENSE TO DEAL IN OR MANUFACTUREEXPLOSIVES Expires: 12/31/2021 Santore's Worldmous Fireworks, LL 846 Stillwater Bridge Rd THIS LICENSE Schaghticoke, NY 12154 POSTED IN YOUR PLACE OF BUSINESS August N. Santore, Jr. License No D-6796 is hereby licensed to deal in or manufacture explosives in compliance with the requirements of the Labor Law and Industrial Code Rules. Any change In the conditions under which this license is granted may cause it to be revoked. Eileen M.Frako,Acting Director FOR THE COMMISSIONER OF LABOR Every person selling,delivering or giving away any explosives must keep at the principal place of business within the state,a record of each transaction,including., 1) the NAME or TYPE and QUANTITY of explosives SOLD, DELIVERED or GIVEN. Note:No license is needed to purchase smokeless powder,or black powder in quantities not exceeding five pounds for use in firing antique firearms or artifacts or replicas thereof, However,dealers MUST post all such transactions on the"Dealer-Manufacturer Report of Explosives`transactions". 2) the DATE OF EACH SALE,DELIVERY or GIFT. 3) the NAME,LICENSE NUMBER,and BUSINESS ADDRESS of the purchaser,donee,or person to whom the explosives were delivered and the firm,if any,represented by such person, 4) the NAME,ADDRESS,and LICENSE NUMBER of the person TAKING THE EXPLOSIVES AWAY from the seller or donor. FI®562(5®9 ) Fede Explosives Lice er °t U.S.Department of Justice Bureau ofAlcohol,Tobacco,Finearws and Explosives (18 U.S.C. Chapter 40) O anrzed Crime ntrol.Act of 1X70 srrd;}� _ „ ou E ance with the provisions of Title X11,, rg a regulations rssucd tla r er 7 T,,.�Marl ),y may engage m the activity specified in this license or permit within the limitations of Chapter 40,Tidt 18,United States Code and theretions issued thereunder,until the expiration . ,^^ LICENSE.M.".� IS Ylr TR ,...FERA...L ��° 3" "WARNINGS" ES"on reverse_ DireetATF a shown A` Clue FELC License/P'I" I" 1r1SF'EF�ABI.�E''CpiI�L� e� See 'WARNINGS and'NOTIC Correspondence To 244 Needy Road Nurribe-r s ® � 1 ® ® ; Martinsburg,WV 25405-9431 Chief,Federal Expl iv ' ensiug conte (1 UX) r 7777 1 4 Name SANTORES WORLD FAMOUS FIREWORKS LLC Premises Address(Changes?Notify the.FFLC at least 10 days before the move.) IL846 STILLWATER BRIDGE ROAD SCHAGHTICOKE'a NY 12154- Type 2154Type ofLicense or Permit 20-MANUFACTURER OF EX-PLOSIVES ..... , Purchasing Certification Statement Mailing Address(Changes?'Notify the FELC of any changes_) The liomsee or pernuffee named above shall use a copy of.this license p to assist a wmisteror of explosives to verify ft identity a nd the,lic r. d stats the lk-ensee or permittee asprovidedby 27 CFR Part 555" e"r each couvrousl be a,ori °nal, = A TO ES. l@'ORL FAMOUS FIREWORKS LLC !jgpamra, Afa ted,scanned a mailed onlay ofthe la nae or permit with a sividure m,tended to be so ci-iainsl signaanare E woViable. l7ac si a auusi Ira that attune Fr itxail 143 SUMMI-rAVE Explosives t" L. 1c4litythatthisisatrueEF�KELEY,`HEl HTS, NJ + 07 22- copyora litzme sade at pi ad to rune licess or `t named fie to ertgaga an tuna - ®�,w..:.,,. busies or operationsspecified earn 'Type of Li -orP " Licensee/Permittee Signature Responsible Person ,... .. P'oaaataonl `itle Pnnted Name Date ATFF%= 1 _15P&tI 1'r sE ' pis liesaaw au&+ narmmo-^:m�a:aaaas.rxra„ aaru iva, Revised aktier ll Federal Explosives license(FEL)Oisstomer Service Information Federal Explosives Licensing Center(FELC) Toll-free Tel rhoneNumber. (877)283-3352 ATF liom ge:www.alf.gov 244 Needy Road Fax Number (304)616-4401 Martinsburg,WV 25405-9431 E-mail: FELC®atfgov Change of Address (27 CFR 555.54(a)(I))_ Licensees or permittees may during the term of their curt-art 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 for the remainder of the term of the original license or permit. ('Ihe Chiu FELL,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 some cKplosive 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 sponse 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) Cot here X linive L icense.Pe it ,. .. ... .... t Federal..... ,xp )Information Ca rdt t License/PermitName:SANTORESS-WORLD FAMOUS FIREIPo/C3FlICS LLC 0 1 I I d Business Name: p , 6 _ 1 Li Number:6-NY-083-20-4C-01 060t, r i LicensrJPermit Type:20-MANUFACTURER OF EXPLOSIVES Expii'alion: March 1,2024 t Please Nate: Not Valid for the Sale or Other Disposition of Explosives. A N _..