Loading...
HomeMy WebLinkAbout2021 TOWN OF SOUTHOLD _ ELIZABETH A.NEVILLE,TOWN•CLERK 'i P.O.BOX 1.179 SOUTHOLD,NEW YORK 11971 ELIZABETH A.NEVILLE,MMC ��<< �✓,� Town Hall, 53095 Main Road TOWN CLERK ® P.O. Box 1179 CIO Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER ®1 .��® Telephone www.southoldt 765-1800 ldtownny.goy FREEDOM OF INFORMATION OFFICER OFFICE OF,THE TOWN CLERK TOWN'OF SOUTHOLD PERMIT 2021-6 PUBLIC DISPLAY OF FIREWORKS I, ELIZABETH A. NEVILLE,Town Clerk of the Toon 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: GREENPORT FIRE DEPARTMENT PHENIX HOOK&LADDER COMPANY,THIRD STREET,GREENPORT 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 at Sunday July 4, 2021 @ 10:00 PM: Raindate: none) on the property of GREENPORT PUBLIC SCHOOL Athletic Field, located on tht north side Front Street and east side Moores Lane, Greenport, New York. ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feel from the nearest above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines; that all fireworks that fire a projectile shall be so set up that the projectile will go in the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore or a lake or other large body of water, then they may be directed in such manner that the falling residue from the deflagration will fall in to such lake or body of water;that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour, that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task,that there shall be at least two such operators constantly on duty during the discharge and that at 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 subiect to the applicants compliance with any Executive Orders issued by the Governor and to applicants compliance with any conditions and all requirements of the Town of Southold Policy regarding the issuance of fireworks permits. . Eliza h A. Neville, Town Clerk Suffolk County, New York Town of Southold (Town Seal) Dated:June 2021 THIS PERMIT IS NOT TRANSFERABLE RESOLUTION 2021-507 ADOPTED DOC ID: 17157 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2021-507 WAS ADOPTED AT THE REGULAR MEE'T`ING OF THE SOUTHOLD TOWN BOARD ON JUNE 15,2021: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a Fireworks Permit by the Town Cleric to the Greenport Fire Department Phoenix Hook & Ladder Company for a Fireworks display on Sunday, July 4 2021 at 10:00PM ( No Rain e Date), at the Greenport Athletic Field, Greenport Hiah School, located at 725 Front Street and east side of Moores Lane, Greenport, New York, upon single payment of $100.00 and subject to the applicant's compliance witli, any Executive Orders issued by the Governor and to applicants compliance with any conditions°and all requirements of the Town of Southold Policy regarding the issuance of fireworks permit$. Elizabeth A. Neville r Soutliold Town Cleric RESULT: ADOPTED [UNANIMOUS] MOVER: Robert Ghosio, Councilmafi SECONDER:Louisa P. Evans, Justice It AYES: Nappa, Dinizio Jr, Doherty, Ghosio, Evans ABSENT: Scott A. Russell 5/26/2021 Mail-Mail Service-Outlook Fe—r vymt `ELVA11=H k NEVILLE,MMC Town lialt,53095 Alain-Road TOWN CLERK -CD P.O.Box 1179 en �_ Southc�tilrNcnvYorlr 13971 REGISTRAR OF WTAL STATISTICS Q_ Ftu (633)765-6145 MARRIAGE OFFICER '�, RECORDS OT- 3AGEhi>~N 0FFICEI� d� � .��0 Z�tboldt a t6.nb 7 fort 0 FR=-MIA Or,01701MMON OFFICER southaldtosen.norEhibrk net RECEIVED OFFICE OF-THE TOUN CLERK TOWN OF SOUTHOLD MAY 2 8 2021 APPLICATION PEP.AW TO DISPLAY-FIREWORKS Southold Tom Clerk APPLICATION IS I-HMEBY:MADE, pursuant to the provisions of Section 405.00 ofthe Penal Law of the State ofNewf York,fora permit to display fireworks-as hereindfier specified: Relief" Ho se- IDISpLAyjS To BE Sp0Nj SOREDBY Phenix Hook A Ladder Co, #1 & Co*`. 2. -,PRINCIPAiL OFFICEAT - 3rd Street Greenport-,' NY 1-1944. 7/4J2021 R .Q5. DATE&TIME OF llISPLAY Start Time M _ _ "P COAG`TLoCATION-OFIIISPLAYGreenport H3.gh,�Sc�hool .Athletic Field.. .L5 s - '-�{rrtrn o�".NY SUFFOLK-COUNTY TAX MAP NUMBER FOR SITES Q010- RMN,DATE&TIMIv � o in_,� Start Time: PM The following persons are to be in charge of the actual shooting of-the fireworks: Naime Age Experience Physical Condition Lee Becker 51 10+Years &cclle'nt (Additional names-and-information may be-submitted on an-attached sheet Number and type of fireworks is as follows: Approximately (1,820 Shots) Z-S" - 5" Manner and place- of storage of fireworks prior _to display: -In a NYS Licensed: Magazine @ Legion Fireworks Co. , Inc. 10, Legion- Lane ,Wappinge'rs Falls, NY. 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 ok,policy of insurance-coverage. i+N6TICE:-Written perwissionj�-%Vith.signature of the-Pro erty Owner -must tie"submitted with-the Application: iA2 FEE-1. $100 "Nam Organi ation See policy-for' additional jnformation BY Signature of Applicant 011V a &to t of A� �� oplication ( 631 8177 - aL4 v7 ho g httpsJ/outlook.live.com/mail/0/inbox/id/AQMkADAwAT[wMTAwACOwMT[iLTRkMmEtMDACLTAwCgBGAAADuyEglSndMOW22n7izJv8%2FAAHAGPd... 1/2 ELIZABETH A.NEVILLE,MMC ��, G� Town Hall,53095 Main Road TOWN CLERK ® P.O.Box 1179 CA = Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ;s Fax(631)765-6145 MARRIAGE OFFICER 'f'� ® o�� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER 0,� �� FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov OFFICE OF, THE TOWN CLERK TOWN•OF SOUTHOLD PERMIT 2021-5 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 Boardof the Town of Southold for this purpose, do hereby GRANTTO: GREENPORT FIRE DEPARTMENT PHENIX HOOK&LADDER COMPANY,THIRD STREET,GREENPORT 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 at Friday July 2, 2021 @ 10:00 PM; Raindate:Saturday July 3, 2021 at 10:00PM) on the property of GREENPORT PUBLIC SCHOOL Athletic Field, located on the north side Front Street and east side Moores Lane,Greenport, New York. ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feel from the nearest above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines; that all fireworks that fire a projectile shall be so set up that the projectile will go in the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore or a lake or other large body of water, then they may be directed in such manner that the falling residue from the deflagration will fall in to such lake or body of water;that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual charge of firing the fireworks shall be over the age of eighteen years,competent and physically fit for the task,that there shall be at least two such operators constantly on duty during the discharge and that at 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 subject to the applicants compliance with any Executive Orders issued by the Governor and to applicants compliance with any conditions and all requirements of the Town of Southold Policy regarding the issuance of fireworks permits. Eliza e h A. Neville,Town Clerk Suffolk County, New York Town of Southold (Town Seal Dated:June 16, 2021 THIS PERMIT IS NOT TRANSFERABLE yUFFat/ RESOLUTION 2021-506 ADOPTED DOC ID: 17156 i THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2021-506 WAS ADOPTED AT THE REGULAR MEET NG OF THE SOUTHOLD TOWN BOARD ON JUNE 15, 2021: ki J RESOLVED that the Town Board of the 'Town of Southold hereby approves the issuance of a Fireworks Permit by the Town Clerk to the Greenport Fire Department Phoenix Hook & Ladder Company for a Fireworks display on Friday, July 2, 2021 at 10:OOPM (Rain Date, Saturday Julv 3, 2021 at 10:OOPM at the Greenport Athletic Field, Greenport High School, located at 725 Front Street and cast side of Moores Lane, Greenport, New York, upon single payment of$100.00 and subjFct to the applicant's compliance with any Executive Orders issued by the Governor and to'.applicants compliance with any conditions and all requirements of the Town of Southold Policy regarding the issuance of fireworks permits. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER:Robert Ghosio, Councilman AYES: Nappa, Dinizio Jr, Doherty,4Ghosio, Evans ABSENT: Scott A. Russell 5/26/2021 }' Mad-Mad Service-Outlook Re—Iryn4i =XkAWI H:&MWILLE,MKO Tows tia[f.U- 095 Main Road TOWNS CLERK P.O.BOX 1179 - Zw Southold,NcWTork U071 REGISTRAR Or,VITAL STATISTICS - . Pax-(6.31)76 5-41415 MARRUGE OFFICER Telephone(63 1)76:rI800 Ttucoltw br W' " GEMENT OFFICER �� `�►`� snuthcildtowri,nc Tork.�set F=7 MOPWOP ATIONOFFICER � RECEIVED f}MCE OF-TEM TOWCL-EVA TOWN OF-s©UTHaLD MAY 2 8 2021 APPLICATION- PERN T TO DISPLAY FIREWORKS Southold Town Clerk APPLICATION,IS HEREBY MADE,pursuant to the provisions of Section 405.00 of the Pedal Law of the, State of New York,-for a per it to-displaySrreworks as hereinafter specified; Relief Hcase tadder Co. #1 & C6T TISPLAVIS To BE SpONISOnD BY Phenix 'Hook & 2., PRINCWALO FFICEAT ---3rd Street Greenport, NY 11944 DATE'&TIME OF DISPLAY 7/2/2021 Start Time: FN' EX.CT LOCA-flOiN-OF TDISPLAyG- re port °High-School Athletic F3 el c7.159'rA; SUF#0LK CObWY TAX-MAP NUMBER FOR. RAN DATE&TIi 7-3-c9®a f start Tune.fy PM Thefolioiving penons-are to be.in charge of the actual shooting-Of the fireworks: Name Age Experience Physical Condition Lee Becker 51 ivy Year§ Excellcnt (Additional names and information may be submitted on an attached sheet Number and"of fireworks.is as follows: Approximately (1,31D0 Shots) 1.5" - 5" Alanner and place of storage of fireworks prior -to display: in a ,nYS Licensed Magazine C Legion Fir'ewox-ks Co., Inc. 1.0 Legion- Lane Wappingers Pal-lis,, -XV., Attached hereto aced made a part of hereof_is-a diagram of the grads on Whitt the,display is to be bell. Also attached is c reerttilicate or policy ofirtsetrance-cgv+eragc. NOTIM Written permission,•with sittgnaturc ofthe-l'rogerfv'Qw-neir.must b6 submitted-with-the 0EE: $100 N cifDtganiza`on- See policy•for-additional information ley. Signature ofApplicard tt&;of Application https://outlook.live.com/mail/Ohnbox/id/AQMkADAwATIwMTAwACOwMTIiLTRkMmEtMDACLTAwCgBGAAADuyEglSndMOW22n7lzJv8%2FAAHAGPd... 1/2 l RECEIVED d O MAY 2 8 2021 Southold Town Clerk / Ui T-f r� , FEC 1 � To H1i �4f I r. .....;. .. ., 1.n :'f'+J.`'+,.,�. •:.,-,ry.q:.`..,{sr�- .,:r. ':x •I.k, Rn`•:',' 'r .,.rJ14 Ilw' \ Y FM1rv,:V�'�Ml ll: y"LSv�/R�rlhf id !�;. �. �a s�-e a�r"yrc.+ 'l,.Lhq, +j�•i.Si i�, u�t 1�"�'� �:�(,' rf? 73"r r , � � 4. Y N V R '. � 1: �'trr,•.t.'MKF;?'yW>;,Hr','.�'t5Ll;1Fl�(.;h}�„• ..ft;••l�'L re, d .4 .,t;+1'�r ..�r.�,,,... �f1 a'tJ, �i} 7`,i,:ii!> k«a[t r�'r,,�,Zu+ 4"i .�r'F.C�`.�n)�+'l tk rt ,�Y•r_,r5- y,. .� 5E E ,.hy,��r try+ � ��1�: �-r• t �'rf •t.;��:.,c'Id 1rz� kr ;.��' ,y-. V.F.,y;e �, } � r� .. � '.�r•, ...kll. ��" 5:t1r' •4� A1' .� ", � '. i 14.:�e xl �1 l .2'c,!tT:''�Y P 7�fJ,l�%5;�3.. {.• '.1�V �V 1 .,1•. / y'7F: F.4 v , r '�i}°���'T rl uf^.';-r%',C}",�ir,"':';rt`t ) FJ:�!j�..1 i rllj���,(•���ei^�b,�t:!i,:''!c�'`.4 .;?7t` ��„,y�Tt `t?°1��''.h-y1'1S hLt'�H.,� 111 ' ft('y¢'i �: , 'ia:�+t� 'ykl� -GS:,t,� nn011TwU t,5a>•. `:,'�".�r?.; ,tt ;`n a�.�'S. ;"'"`,i•,�t: �':,��. _ j.. hely a;��t rf?y yvt;{'� 4. � r O I � 1` .�•5 � fr�' .f+:�:�-��1 :m_• _ � � r r ;reV!,^Iv•>/. �� ��' �"� �,,L.. >t; �+ � tai � +Y� .� �y'I�: ;- � r •sr: Lq � 4'- h ��,kk. •`r�1.7.` •J l�1 2M�7c x �. 11.4��LII�:.. ti"L•n�iL' , ,y�i' , f iFt �•,�Y+ i ��5r4��� •C .P� SJr T. ^s `'i' .�., F11 � K�"�t d r.r f�15.0 $'r .v' �•1 .., ri; 3c'>•1,,�4t,Ir,'St 7:�-,,.:+.��' 'r '}'r, i.' r,.S. •+�i,}d�'; ,rrA .,�;yz .;^�5 tt�,jk+��tr ,�i'�: d;%�f, l�t�i�•r',,.� t.,fie' r,'c��r,i� c ri, i�+� ��. -_ '*i:�t�''rti'. ,'�+:F + 1. -•w, 1,3 .;.h,•.l �,.i+ v, 1�4��' ,�lT qrl� 7. �'t"i�i'yF�'L �43�rv1+�,, a",� ,:Y�..,�t�h � r r•e.r �'• t ,,�� t;' .. :.P`D•,i�r",�r'�:•,�1.: 'aL. � i. 1 �,r.S A i!rt-�•�1,�(a(1C r.kt tr ,� �tia i`,�t,. YF' t l� x��1 �v'f' y. � ��o � i.t r r �.;'h,.T.. r 4ef .,p.•°a#`. ?y,�}y� �"h3. /�. � .t•a�,'°`�-�Sk,i.r�G";;°�r;f:`ILt(`t �'F+�r1 �• tb: ;.Y�,r', .,•�nL^jrgtli 4�4 3'r,-,'•ly n.,�•. -,r,'r r r.�;f �Y �� '::xs Nrt .•il,.�s'., �, � •t, t�.^��''�-�1`S.r,,i•{Y tail r1.,�r.Qtx�,qr,r,•4', w q�. r:a;'-.: /..,,.,; i - '4�!�•. �{'•,1..•;:t,v'1.� A! n .,¢3� �.. 1!r , ;Ll i+ r'at, .1.�-,.YR•iE.,�'� �)� 14�,r..!s �. I H� G �.t��. -el.. ..f J S;,+a. rll�i>• y,y'aii'�.'�. ..�t{•.,^• r.,:, A:`rC?..:. l r�. 'xi, P?i ;J�. �:hc �� a c,:}J•r• t r' F`.. •-h'•ff 4: �.,.W;.ii•!, �il�,a a. .^i*,-x t .•>IS "•Ls.c,,,x:^.F.1::1^15:�71Js r1f �•�wry��.,, l-k'�'t.:3.Jai;� ?}%�. ;!x?f Ick:- cl��f. ra!%: s. s;i'g r{ro .,i,, rY:.r,�+)t.f.qf,::a:ii.�.(•)•cr:,Obis..?s. •r,).�+.,rst �Yghr,, ..1 .r';e2,�gtly�n ar`.�• .+:L i .a„lhYi. 'S.:.t 'i. •d�� a �l, •,.`k� -:4.^.O•;r �?•','�,s7e'r, .L.,, �, _��,fi.g.d•:r,.�ry,r ;>l�:(..� :t..-ppip. F;.r.-{t,��:7, a:_ ?t•' �" !.: 'x,>: ,a } ��`��,�� '��,�,(,. '•p-t. 1', �., .`Jl',,'tv:. f." !o. ..� i •✓,.r.E. 'J, .t: .'S.L F.. •l' •'.�� J [, • ,,;:y- v.SF"r- •i;. .7�,.,a .r.:�. �.`� 1 ,:c:.r�'•;mB.0 g:.1 71:,:r.. ..l:: JI. r..d, pp '�,•J��• ,r,:;�. ,�' ` .r 1 :E .(�S'.ni'� �. ...;2Si1, �±y,� t •r r;II. Y r•., ` 1:rr9::;}.^;. 'h.r t 1,. Yi!....•ina;'{Y:1.,�;, C .!•�.;�'{!:F�,,x� ,^+;)f' ni ;•� ,r1� l� �'.V G�:.:'Y,�';i�,ikl{^ ri:.=a.�.b1,.,r4+/.,:Y.,r?1,'..r',K,.I.,J� .:,. r.4'✓t.,�i,yytC f..�..:,. ,�`r .:`:.1. .rt.,lj.:l _y��'' ,,,9{k, ., \ �;,. y$a '}r'..hint, t:�"r ...SrS... L {,,: .,,L,.,„ ,`}a. +'�:.ar6• ':):.� •`:L�a, .._`:3r1.' ,.,�;"r.. ,tier .S,1... Id`.;,ySn,; .��f'.�r, ;,�_�,,• w^�: ..r a,r?14:r d{, ,.�;1:, •.;srrc�. er'#..„, C /f:f r..� .!'.r�r. � _,ut;':: � ,�1u>...§ :r.t�,rY .y,�,.y,t;#. i rf •`{ rn.. .y u�..t,��f..' .f` n6 r••..nii::).•�'h;�.... ra. l k4t,�cf...,ri'• ,r8•• 1'+ -earl I y f, r 4�,,,, +X, ._�_(�i': !:f' -�1'•.;i� i3)1•<}14..1.11.7}J�. '” �,':. ). i .,�., F'3'�` ``S tti�iy wfalLXa�r1.d� CS�`'�: ,ti r. .+n'sdt",'xylY• tTj; �1L -r us1i7 t i• I t ,?.',�c C ;>..:. r; r..- �,'•iA t F1r t f r,it - 1 c s t1 {- .{� '7 T ,i.t. 11' Yf•1r a `rN5/ 4 .''F J r Y•. :e X4, en:..,,f1 ?.'•<�;n'1"R ISo •t) 5 ,�Y.�,' l+f, cPdt`d4' 1 .��.. fY ry"I:'''R :1"r�. :4 '.:f>.ej^I` _:,tfe. fiq �' r•^,;r � • ?"c'- .���5���.-•ri�YfSryy.�,��','�,'l�"slft.r, "�i :�_ Nr.,;Z"��1 .!. .w• '•CrN. lr}r!:.i )�•:'J i.../'.:'a'Yk r 1 !� r+.�Ti.m ti. ;ryxit; ,71 f 1.TrT':4G?5!:� „,a`,1 :,q.-•�- ^'r ¢t w ,ir+:v::°':s �'.;2 dt's _�qae,+; .G"32;2:••. '`r�:s'�'•,' %r3'�'•.. "ai• � .r•�' {,,.�4ta ..{:� (��,r` �� �i �sC,y.7� S.�,i� t'((1�r5� 1��' ,k.�.<• yi r,r�'�,_�,�f,, C7,'�7_4� ".iri' t174?i,{y. t y/.rrY�br-`.5.�$ �: irS`,y(7'�EYa Uf:'•;��:Va rr,� � /Sf4': N 1':f:ra�8�12,. ,7,.p:..t.��?'.5r,�!! 4.,Y(�•xn.:.1,i�Yn•�'�G:Y.s�..y,t.�.••� $'�'rt-h,-v.}%''E'• �`;;`rt' ,. �r'N Y1E" . `t~�tt"� ' � ;Y., Yui � i•,5a� riY• � n f I;.. � r;1'tr�L. ,tC'• +� :,,.tib rt�G'�;G. T>XXtl.y55-h 6`�F�+�y�����'Rt �'f�• �j� I.Qr-j��f�91�r A� �g,[�E��y�� fyc�1° Ir .lr�tr +`!r�{ ��. _ rA{' -• � ,�Y ��i ',7 �� t:lfi. 1' J r f•J° Ir ..1EIP. �l ,fit � 7�' '�' ' 1�t�,��:� 1 ro' ,r � .f�.� yi 'j�P�-,�:! '}�.� C '� ,r�jil� �E k•,+rz ,,),.EJ t ,�. ,,� t i�` a I � � ,�,� Y�,�rti :rY !{yy �, yy�, k^' rF,tiCr tart., '� 5 ,• r "rF� ,�•41����rY��$-ry��r��t� �kl" ie �'l4 'k4 � t -1 R: �s'�i�tki.•tLfr�^..,F.`§il�t,r��.� � •r. :r .�.11`�j �� � 'iYury��r ` : '`ry �.�t�itY5llt te�+'7i, 'Li��ure •� o �yl + !J c 5 f)�,a X74. �:7 �ba � N 1 r •S•'Yr?s72,'C.''tY„1ML(,2t'1111`L r�� � .• �' r `/y`^c �',I rfi {�, -'`) 't "k' r y� .fit rr�n�•,.�'!.� v.y ••E' r r'1, rF,., i 1 �1.•r Y� "I'r�jl+r �Yvr�•�y fY ry 1C5�:�'I •� Y' 7_'7t,. W N.r ; .iY r >F-+Cuf •� �1�'�j>'� r. i �^S.< Y) y L• ¢; ,�{ Y a� 4,N 1 ': , n q��a7i,.�}�1f-l)i`j(1. •' :• ,}l' 9 t;r: ''S.}l bl'f •ri4 a r- ��' `i �`4 �t 71 t/1 ,�� •. `���c'r�jy 1 Ic4 .,•a' 3.�# ,�.Y 41h1hc71`'�'TR�3f '� v � � c 'M rot 1 1. ry .1MUT` .,��''�'�tFi•y?�3� b; ���.. )..�7t 3 t�irlr+ � �,r I Snc�r ��Y},y Irl} �ih�Sl x�„5,sy✓ ��`��I {�����, t t , , b�} r"ar� t�ll`g• ,/F,' J t..•Fc .5'' r"-y 1 ,1: rJ 3� 1,(...� 'T i,rk',r�4 F .r'Ir� C' y 1+Xjtrs, 5�`�y r^'1,. �r><4-r^.0 � ;t"r'� •:C t Ps• '106^r}(`�'{� � s t 4 •��" �t' l�f ,r�O3FF' �,�r}'�'�r$`'v�,� '�,fz4� ,1�4'rt' t'� •�• V0.Y�N•.fLJ e,�'�a�7}r`�`�+' J r W�.,i,'r;' 4a• L{'r'"+'�f�•fr`,•• cc""c'���Y` .fit ', '1ky��7C'it'F1�� `'� af3f3'�'' r .t,'• �� � i ) 'I "'�.Z,f r V a.,; ' �"fi•��'�r� � r{ �; , �> �' it>� 'i.J 2•'7„a tr a � 1�,�1 Maplo s y,V'�.I�'� F rr5(�i�•'�z'3s � � � :r •ic `3_'Sr"+�. „� ..f•�rr Ia� i.�r5 of �' i,,. 4�}�1 J ts1•�3y,S ti)y j�Y r.+l �• yt .'� .�% � ,;Ly �•` St i•, 4 ".Sltis•�'Y,�(?�`� � r r•s.���t t�� �h/rt� �71�r'^. 1�. }. h1� '�,ilrit,'+'3'�iiy�k,G'1 .�..rLiAc # �-' Q' r. + �r�• �1�� ,s r (ry1�•,-`ryhSY -Sr r-.III 4(J, {;.(,(�",�•� �S R I r t '' 77 j} `WJ'' 1461- '1%`�l;C"� t'!� l jjff����ffJJ {1 a; ••I ..li, l _��,/{ "+i•Y...v� •- .T!f`�I. �7 uy',�yl: ,,••,�'/-"��i�h�1��(�1^%`Lt/.:,��� u�f L .�'',W'., -.l• .:di ll� 'l,� n•• r+ll'•� ,>(Irr •.:t^fz Ix; m gA icgfi)� r„rtLn m” I.� ,� a�iWT•a..•Ys N r _� ';,' rA w'r •f �•,� n , r-tr ,,x S w �t t •7fA,�'h``�t'rrN...�„�x :1 r. .yt',^;I r5�� '�• `ft �©t l „�1;: :t+• � ) �I r• i;.. r 2rt�(7 tL 1�! ,','j t. *.F.;t .1.. .•t ar Y.rs, ..?�� t, r ,q�_ � � uT, r;� " T..:, M1) .J.. .*n• :•i - t :<y ` .1 S,r f+r..'v r: `:nom �'? >f ;Tai•..�r>i�� t,t� 1't�5�i�W:" 7C� r>2c";'; t��' �t�- ii. ii 1t: i3'br�l ri�i�' ii''R }C.t �y'�j':::�;.. _ L �^ari'�iYS r�< �t .,:�#r: 1 „F� � .t: .5, �5.�c-1-r,�' �r+�14> ,✓� ,,t�7,r t.�I �53, i lF ' : Fly _I 1;j'Mst. i ,Uj t ilj 'L r i tayY7 i.j•• � i ,`, t•' 1'tia.N,ti }`C.•V.'+ 1'1 �� . � 1 S _ [r1•t ,' tYJ.r •{.`.n �r) -�. ��.1��)'I'4r�a �l�JrtS�c.?*r`�,f® � tT.., 1�, >,. � �r) �' x� �4 �i ��a}�� r.}�I�Ry !T!!4.+ t r• �%;,���' „r,i�k t r i 5 tiA ?�� ,SyV"!S '1 PPY .`; f rF :y i +,j''�1�•! �r.r.; } r(i,�:yfr l�r� :. �b 47`{ -�1 r e. � yr•r•t' r CC �y'� O I(?SI ._�. �i t.� � �1iv�t?Y•N �k1 r ♦' ''� 1 e,���� ✓ '•v-I'.; '.- 9� �� 1n.q ,J}J�17 - rlq°t T� 5 r n 2FL '� ,1' �.e� • r.a it l� % �.� M��r�r }' .(`, •.�k� V��:�.7(�'a:+ �,`�'I��ae f(�x�; - c�' .:`^�S r � ���TC±�, f r ��` r 6 < <i f[ 1�;1 � •r►�'( }c '�'•ti�`?�� •r�>t�1iY "5' a��Cr�`,••� t� Sit .t:i.`.'. ,. ; t� ty r t . +'��.fi', 2 `'F'�. } ,fNa{ T`�Y t(:'�{�..�.�� � 4: I �_OtO,Gooplt• �f��s,�r- r. t7. a.yw },j rr?, �' �:i r`' a.: z�_�r' '1 � a'-�L�L�:"z@Jnnjt � � +/l y, � ;n: 1.,, `' E _ ? � r x I c� +1 Fr/r"•r r �r ��4'J' � .S� �;ry;,�y,�t��t�r��kr�r`.•�[.,<�%Z4°��Rj �� � t� ..r Im c x•120111 Now YtiiF Gfs p.,,,-��yr r�, Tr � .�+i 'tr N �,} 4, ,>, tT .I. 3f �lrr`�,�5`�'i1':(��X''.At~�f5�'T.i.yr,a•C: � a�� + 0 w,F�� �'; 2� rt •"(4�r`Y1Tf�r:51'�X.�,�k'. .�r. 7 .,r--"�c. �J�:. •'h.�: l.. ViO 6, A VF M 'N IV-6- Nil y O'R Tr E -, C-� I" -CE l., COMPETENCE Tl C , 77 _77 i MP-7 -1-jr, ,Uu�n va �iar­wmz 7v:� la, _+ -,'OR E R,� At LE IN gl� "i -4 'A ­A , L ,S-- !5 K zX ty NE-0,N 181 Ef 'N, N X ,A--T, ,,- PRO E D T A V "N U I H; -E �Y A 77"w7 oi E ,mq Rt ) 'y N"W YC -z. c lift CHIEF WAYDE MANWARING ! • (631)477-9801 -STATION 1 1ST ASST CHIEF JAMES KALIN (631)477-8261 -STATION 2 2NDASST CHIEF ALAIN DeKERILLIS U i; (631)477-1943-CHIEFS OFFICE (631)477-4012-FAX CHAPLAIN FRANK MUSTO ���do 311 THIRD STREET•P.O.BOX 58 CHAPLAIN CLAUDE KUMJIAN ! GREENPORT,NY 11944 SECRETARYITREASURER JAMES KALIN �• Email:gfdfire@optonline.net www.greenpartfd.org RECEIVED MAY 2 8 2021 June 26, 2021 Southold Town Clerk Town Clerk Elizabeth Neville Southold Town Hall 53095 Main Road Southold, NY 11971 Re: July 2021 Carnival Fireworks Dear Ms. Neville: The Board of Wardens of the Greenport Fire Department at a regular meeting on April 20, 2021 approved the Phenix Hook& Ladder Co.#1 and Relief Hose Co.#2 request to hold a Carnival at the Polo Grounds on Moores Lane from June 30 through July 04, 2021 with Fireworks to be held on Friday,July 02 and Sunday,July 04,2021 at 10:00 pm (rain date of Saturday,July 03, 2021 same time). If you wish to discuss this event with me or have any questions, please do not hesitate to contact me. I can be reached at 631.466.5294. R spectfully, James H. Kalin 1st.Assistant Chief Greenport Fire Department ACOOR" CERTIFICATE OF LIABILITY INSURANCEDA s(MMID02';YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Britton Gallagher PHONE FAX One Cleveland Center, Floor 30 c a E :216-658-7100 A/C No):216-658-7101 1375 East 9th Street ADDRIESS. Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A•AXIS Surplus Ins Company 26620 INSURED INSURER B:Everest National Insurance Company 10120 Legion Fireworks Co, Inc. 10 Legion Lane INSURER C. Wappingers Falls NY 12590 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 1874866577 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 rypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY B GENERAL LIABILITY S18ML00116-211 3/15/2021 3/15/2022 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE Fx_]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ B AUTOMOBILE LIABILITY SISCA00058-211 3/15/2021 3/15/2022 COMBINED SINGLE LIMIT Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PER X HIREDAUTOS X AUTOS ED Peoa cdentDAMAGE $ $ A UMBRELLA LIAB X OCCUR P-001-000091848-03 3/15/2021 3/15/2022 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N I E ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E L DISEASE-EA EMPLOYE $ If yes,descnbe 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. Date of Display.7/2/2021. Location of Display Greenport High School 720 Front Street Greenport,NY 11944 Additionally Insured:Certificate Holder,Greenport Highschool,Village of Greenport,Greenport Public Schools,Phenix Hook&Ladder Co.#1 &Relief Hose Co. #2, and Greenport Fire Department. 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. Town Hall 53095 Main Road PO Box 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 C�b � ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD •, r � ro Aaree ' en Tor case �� -r`�c-( V GREENPORT UNION FREE SCHOOL DISTRICT 720 FRONT STREET GREENPORT,NEW YORK 11944 USE OF BUILDINGS AND GROUNDS' Out-of-School Hours—Rules and Regulations Greenport Union Free School District Policy On Use Of School Buildings And Grounds: "The buildings and grounds of the Greenport School District may be used for such purposes as are authorized by the provisions of Section 414 of the Education Law of the State of New York, as currently in effect, and as same, may be amended from time to time; and that such uses be in accord with the rules and regulations set forth below." RULES AND REGULATIONS 1. The Board of Education has the authority to regulate the date and hours that the building may be used. School activities take precedence in the use of school buildings. The Board has delegated authority to the Superintendent of Schools, who shall determine whether to grant or reject requests for the use of school facilities and equipment. 2. Any person or persons using school facilities must comply with applicable State and Local laws and District rules and regulations. 3. The applicant shall report immediately any loss of school property or damage to buildings or grounds that occurred through its use of the school facility and shall be financially responsible for its repair and replacement. 4. Applicants are required to present evidence of liability insurance at least 3 day in advance of the event. The absence of such a certificate will preclude use of the facility. The liability insurance must designate both the using organization and the Greenport Union Free School District with ISO endorsement CG2026, as set forth in the following schedule: a. Public Liability: $1,000,000 per occurrence; b. Property Damage: $50,000; and c. Aggregate Liability: $2,000,000 each accident. 5. The applicant is responsible for the preservation of order and safety. 6. All functions in school buildings must be adequately supervised. Applicant is to furnish all information specified in the request form.Adequacy of supervision will be determined by the administration. 7. Smoking is prohibited in school buildings and on the outdoor grounds within the property boundaries. Possession, consumption, or sale of controlled substances(e.g., alcohol)is prohibited. 8. People attending any function are restricted in the use of the building to areas actually designated in the application. Custodians have no authority to supply facilities or equipment not listed on the application. In the absence of the Superintendent, the Principal, or Athletic Director, the custodian on duty is to be regarded as the representative of the District. 9. The facility must be left clean and orderly. Groups leaving the facility in need of a cleaning will be charged for custodial services. Additional expenses that may accrue as a result of the use of the facility shall be the responsibility of the applicant. Bills will be rendered and will be payable to the District Treasurer. Pending receipt of payment, further use of school facilities may be denied by the Superintendent. 10. School officials shall have access to the building at all times and shall have the right to revoke a permit at any time for any violation of this policy. 11. When requested, a roster containing the names and addresses of the members of any applicant shall be submitted to the building principal. 12.In the event that the District incurs expenses related to an event, those expenses shall be born by the s applicant requesting the facility. RULES FOR THE USE OF THE AUDITORIUM 1. Putting up decorations or scenery, or moving equipment, is prohibited unles's specific permission is given by the Superintendent. 2. Food and beverages are not permitted in the auditorium. RULES FOR THE USE OF THE GYMNASIUMS 1. No one shall participate in athletics on the gym floor unless he or she has sneakers on.No street shoes or rubber boots allowed. 2. Putting up decorations or scenery, or moving equipment, is prohibited unless specific permission is given by the Superintendent. 3. Food and beverages are not permitted in the gymnasiums without prior approval. Revised 7/31/18 FEES AND COSTS Certain groups are charged a flat fee for use of the facility. In addition, personnel costs incurred by the district will be paid b the applicant. The applicant is a district sponsored group, class, club, or organization, or the PTA, Athletic Category 1 Association, Music Boosters, Southold Town, Greenport Village, a neighboring school district or a not-for-profit organization charging no admission fee. Category 2 The applicant is a not-for-profit organization that is charging an admission fee or participation fee. Category 3 The applicant is considered a for-profit organization. Category 4 The applicant is considered a for-profit organization that is charging an admission fee or participation fee. Auditorium Classrooms, Gyms Fields Personnel Etc. Category 1 NO FEE NO FEE NO FEE NO FEE A Category 2 $75/hr $50 $100 $50/Day B $150/Week Category 3 $100/hr $50 $150 $100/Day B $200/Week Category 4 $150/hr $50 $150 $150/Day B $250/Week PARKING FEE If an organization would like to use our parking lot for an event not to be held on school grounds (e.g., additional parking with a trolley service to an alternate site), a fee will be assessed by the District for each event. PERSONNEL COSTS The District will determine the appropriate assignment of District personnel to an event or function. In general, school custodial coverage will be required for all indoor events. Use of the Auditorium will usually require the assignment of district technical supervision and support. Users will be charged for the time required for district personnel to make special arrangements prior to, or to clean up after an event as well as the actual time that the user occupies the facility. PERSONNEL FEE SCHEDULE Custodian-Mon-Fri: $40.00/hour- Sat-Sun: $60.00/hour Audio-Visual Technician- $60.00/hour Note A: User pays for overtime hours only Note B: User pays for all time spent on the event *A week is defined as Monday-Friday Saturday& Sunday are treated as individual days Revised 7/31/18 � l R. GREENPORT UNION FREE SCHOOL DISTRICT 720 FRONT STREET GREENPORT,NEW YORK 11944 Request to Use Building and/or Grounds Date Submitted: 1926Lq ada Areas to be used (check all that apply): **Subject to availability when not in use by the school ❑ ❑ Classrooms ❑ Gyms Fields&Grounds ❑ Front Lobby Auditorium (Please Specify (Please Specify) (Please Specify, (Including Rooms) including Front / Hallways) Driv ❑ Other Organization and Event Details 06 r+ c Name of Organization: f Email: Address: Telephone: 7k"Inee P/ a1/ ILI Event Supervisor: P,—P Name of Event: (fir kS rs Time of Use:Date: ,in /o?Pw— //��l V 1,207 J/ 't Number of Participants Expected: Will the Event be Open to the Public: Is this a FOR PROFIT Organization: A/� Admission Charge Amount: 116 Purpose of Admission Charge: /\10 P Will refreshments be served?Give details: Specific Equipment and Services Needed Number of Tables Needed: Where Placed: Number of Chairs Needed: Where Placed: Lighting(Auditorium): Sound(Auditorium): Gymnasium Bleachers Needed: Other: AGREEMENT: The undersigned is over 21 years of age and has read this form and attached regulations and agrees to comply with them.He/She agrees to be responsible to Greenport Union Free School District for the use and care of the facilities.He/She,on behalf of the user organization does hereby covenant and agree to defend,indemnify and hold harmless the District from and against any and all liability,loss,damages, claims,or actions(including costs and attorney's fees)for bodily injury and/or property damage,to the extent permissible by law,arising out of or in connection with the actual or proposed use of the District's pro facilities and/or services by the user organization. ada:l l Signature of Organization's Representative Date Print Name of Organization's Representative Date V Approved Disa proved Signature of Superintendent Date Revised 7/31/18 ACC>R" CERTIFICATE OF LIABILITY INSURANCEFDATE(MMIDD1YYY) 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 PHONE FAX One Cleveland Center, Floor 30 c a Ext):216-658-7100 ruc No):216-658-7101 1375 East 9th Street A DRIESS Cleveland OH 44114 INSVRER(S)AFFORDING COVERAGE NAIC# INSURER A.AXIS Surplus Ins Company 26620 INSURED INSURER B:Everest National Insurance Company 10120 Legion Fireworks Co, Inc 10 Legion Lane INSURER C: Wappingers Falls NY 12590 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:502468597 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 POLICY NUMBER MMIDD/YYYY MM/DD/YYYY B GENERAL LIABILITY SIBML00116-211 3/15/2021 3/15/2022 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGEPREMISESPREMISESSEa occurrence) $500,000 CLAIMS-MADE FT1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- F-1 JE LOC $ B AUTOMOBILE LIABILITY S18CA00058-211 3/15/2021 3/15/2022 COMBINED SINGLE LIMIT Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ 1ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X AUTOS ED Peoa cRdePETnt AMAGE $ A UMBRELLA LIAB X OCCUR P-001-000091848-03 3/15/2021 3/15/2022 EACH OCCURRENCE $4,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION WC STALIMTUORY - I OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ If yesnbe under E.6descDRIPTION OF OPERATIONS below E L 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 Date of Display*7/4/2021. Location of Display Greenport High School 720 Front Street Greenport,NY 11944. Additionally Insured:Certificate Holder,Greenport Highschool,Village of Greenport,Greenport Public Schools,Phenix Hook&Ladder Co.#1 &Relief Hose Co #2, and Greenport Fire Department. 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. Town Hall 53095 Main Road PO 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 I Neville, Elizabeth From: Neville, Elizabeth Sent: Friday, May 28, 20 2:13 PM To: Burke,John; , ' ; rt; Flatley, Martin; Hagan, Damon; Mirabelli, Melissa; Norklun, Stacey; Spiro, Melissa; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Nappa, Sarah; Russell, Scott Subject: Emailing: SitePlan-Gpt FD Firework 20210528140229 Attachments: SitePlan-Gpt FD Firework_20210528140229.pdf Attached, please find site plan for the Greenport Fire Department Fireworks. 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: SitePlan-Gpt FD Firework_20210528140229 Note:To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. i Neville, Elizabeth From: Neville, Elizabeth Sent: Friday, May 28, 202110:28 AM To: Burke,John; Duffy, Bill; Easton,James; Fisher, Robert; Flatley, Martin; Hagan, Damon; Mirabelli, Melissa; Norklun, Stacey; Spiro, Melissa; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Nappa, Sarah; Russell, Scott Subject: Emailing: Gpt Fire Dept Fireworks_20210528102531 Attachments: Gpt Fire Dept Fireworks_20210528102531.pdf Importance: High Attached please find Fireworks application of Greenport Fire Department Phenix Hook Ladder co.#1 &Co.#2 Please review them and send me your comments/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: Gpt Fire Dept Fireworks_20210528102531 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: Duffy, Bill Sent: Monday,June 07, 2O2l12:l2PK4 To: Neville, Elizabeth Subject: RE: Greenport Fireworks 7/2 &7/4 I'm good. William M. Duffy,� Esq. Town Attorney Town ofSouthold Southold Town Annex G4375Route 2S (Main Road) P.C). Box 1279 Southold, New York 11971-O9S9 Office: 631.765-1939 Fax: 631.765.6639 Email: From: Neville, Elizabeth Sent: Monday,June 7, 2O211D:Z4AM To: Duffy, Bill Subject: FW: Greenport Fireworks 7/2 &7/4 Bill, Please find the two (2)certificates of insurance in the name of the Town of Southold as Certificate Holder and the pyrotechnickan'scertUicate. Please advise ifyou approve ofthe issuance ofthese permits. Thank you. Betty Elizabeth A.Neville Southold Town Clerk,Registrar ofVital Statistics Records Management Officer;FOIL Officer Marriage Officer POBox ll7y Southold,NYll97l Tel.63l76j'l8O0.Ext.228 Fax 631765-6145 Cell 631466-6064 From: Legion Fireworks Sent: Tuesday, June O1, 3021 13:41 PM To: Neville, Elizabeth Subject: Greenport Fireworks 7/2 &7/4 Good Afternoon Elizabeth, � Please see the certificates attached as per your request. I have also attached a copy of our lead shooter, Lee Becker's Pyro License ID. Please confirm receipt of this email. Please email me with any questions or concerns and I will be happy to help! Thank you, Deanna Administrative Assistant Legion Fireworks Co., Inc. 10 Legion Lane Wappingers Falls, NY 12590 Legionfireworks@outlook.com /845.831.8328 M-F 8am - 3pm ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. z Neville, Elizabeth From: Neville, Elizabeth Sent: Friday, May 28, 20213:19 PM To: Duffy, Bill Subject: RE: Emailing: Gpt Fire Dept Fireworks_20210528102531 1 notified Peter Harris. He will get the additional Certificate and the pyrotechnician's license. 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 -----Original Message----- From: Duffy, Bill Sent: Friday, May 28, 20212:28 PM To: Neville, Elizabeth Subject: RE: Emailing: Gpt Fire Dept Fireworks_20210528102531 Hi Betty, Although I see that we are listed as additional insureds on the various certificates, I do not see certificate listing us as certificate holder. I am sure it was just an oversight that we did not get it. In addition, we need paperwork on who the pyrotechnician for this display will be. Thanks, Bill William M. Duffy, Esq. Town Attorney Town of Southold Southold Town Annex 54375 Route 25 (Main Road) P.O. Box 1179 Southold, New York 11971-0959 Office: 631.765-1939 Fax: 631.765.6639 Email: billd@southoldtownny.eov -----Original Message----- From: Neville, Elizabeth<E.Neville@town.southold.ny.us> Sent: Friday, May 28, 202110:28 AM To: Burke,John<iohnbu@southoldtownny.gov>; Duffy,'Bill<billd@southoldtownny.gov>; Easton,James <iamese@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Hagan, Damon <damonh@southoldtownny.gov>; Mirabelli, Melissa <melissam@southoldtownny.gov>; Norklun, Stacey<Stacey.Norklun@town.southold.ny.us>;Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Dinizio,James<fames.dinizio@town.southold.nv.us>; Doherty,Jill 1 <rill.doherty@town.southold.ny.us>; Evans, Louisa<louisae@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.ny.us>; Nappa,Sarah<sarahn@southoldtownny.gov>; Russell,Scott <scottr@southoldtownny.sov> Subject: Emailing: Gpt Fire Dept Fireworks_20210528102531 Importance: High Attached please find Fireworks application of Greenport Fire Department Phenix Hook Ladder co.#1 &Co.#2 Please review them and send me your comments/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: Gpt Fire Dept Fireworks_20210528102531 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 Neville, Elizabeth From: Easton,James Sent: Friday, May 28, 20213:10 PM To: Neville, Elizabeth; Burke,John; Duffy, Bill; Fisher, Robert; Flatley, Martin; Hagan, Damon; Mirabelli, Melissa; Norklun, Stacey;Spiro, Melissa; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Nappa, Sarah; Russell, Scott Subject: RE: Emailing: SitePlan-Gpt FD Firework_20210528140229 I have no concerns with this event taking place. Thank you, James Easton Fire Marshal,Town of Southold JamesE@southoldtownny.gov (W) 631-765-1802 PRIVELEGED 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<E.Neville@town.southold.ny.us> Sent: Friday, May 28, 20212:13 PM To: Burke,John<iohnbu@southoldtownny.gov>; Duffy, Bill<billd@southoldtownny.gov>; Easton,James <iamese@southoldtownny.eov>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Hagan, Damon <damonh@southoldtownny.gov>; Mirabelli, Melissa <melissam@southoldtownny.eov>; Norklun,Stacey<Stacey.Norklun@town.southold.ny.us>;Spiro, Melissa <Melissa.Spiro@town.southold.ny.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.shosio@town.southold.nv.us>; Nappa, Sarah<sarahn@southoldtownny.gov>; Russell,Scott <scottr@southoldtownny.gov> Subject: Emailing:SitePlan-Gpt FD Firework_20210528140229 Attached, please find site plan for the Greenport Fire Department Fireworks. 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: SitePlan-Gpt FD Firework_20210528140229 i Note:To protect against computer viruses, a-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 Neville, Elizabeth From: Neville, Elizabeth Sent: Friday, May 28, 202112:48 PM To: Easton,James Subject: RE: Emailing: Gpt Fire Dept Fireworks_20210528102531 Peter Harris will be dropping it off to me within the hour, as soon as I get it I will e-mail it to 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 -----Original Message----- From: Easton,James Sent: Friday, May 28, 202111:52 AM To: Neville, Elizabeth; Burke,John; Duffy, Bill; Fisher, Robert; Flatley, Martin; Hagan, Damon; Mirabelli, Melissa; Norklun, Stacey;Spiro, Melissa; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Nappa,Sarah; Russell, Scott Subject: RE: Emailing: Gpt Fire Dept Fireworks_20210528102531 Was a site plan/diagram provided with the application?We should have a site plan showing the location of the discharge site, spectator viewing areas, parking areas, etc. and the associated separation distances. Thank you, James Easton Fire Marshal,Town of Southold JamesE@southoldtownny.sov (W) 631-765-1802 PRIVELEGED 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<E.Neville@town.southold.nv.us> Sent: Friday, May 28, 202110:28 AM To: Burke,John<iohnbu@southoldtownny.gov>; Duffy, Bill<billd@southoldtownny.gov>; Easton,lames <iamese@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Hagan, Damon<damonh@southoldtownny.sov>; Mirabelli, Melissa <melissam@southoldtownny.gov>; Norklun, Stacey<Stacey.Norklun@town.southold.ny.us>;Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Dinizio,James<Oames.dinizio@town.southold.nv.us>; Doherty,Jill <iill.doherty@town.southold.ny.us>; Evans, Louisa <louisae@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.nv.us>; Nappa,Sarah<sarahn@southoldtownny.gov>; Russell, Scott <scottr@southoldtownny.gov> Subject: Emailing: Gpt Fire Dept Fireworks_20210528102531 1 Importance: High, Attached please find Fireworks application of Greenport Fire Department Phenix Hook Ladder co.#1 &Co.#2 Please review them and send me your comments/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: Gpt Fire Dept Fireworks_20210528102531 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 Neville, Elizabeth From: Spiro, Melissa Sent: Friday, May 28, 202110:41 AM To: Neville, Elizabeth; Burke,John; Duffy, Bill; Easton,James; Fisher, Robert; Flatley, Martin; Hagan, Damon; Mirabelli, Melissa; Norklun, Stacey,; Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Nappa, Sarah; Russell, Scott Subject: RE: Emailin,g: Gpt Fire Dept Fireworks_20210528102531 This is not preserved land. Melissa S. -----Original Message----- From: Neville, Elizabeth Sent: Friday, May 28, 202110:28 AM To: Burke,John<iohnbu@southoldtownny_gov>; Duffy, Bill<billd@southoldtownny.gov>; Easton,James <jamese@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.southold.nv.us>; Flatley, Martin <mflatlev@town.southold.nv.us>; Hagan, Damon <damonh@southoldtownny.gov>; Mirabelli, Melissa <melissam@southoldtownnv.g�ov>; Norklun, Stacey<Stacey.Norklun @town.southold.ny.us>;Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Dinizio,James<iames.dinizio@town.southold.nv.us>; Doherty,Jill <iill.dohertv@town.southold.nv.us>; Evans, Louisa <louisae@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.n ..us>; Nappa, Sarah<sarahn@southoldtownny.gov>; Russell, Scott <scottr@southoldtownny.gov> Subject: Emailing: Gpt Fire Dept Fireworks_20210528102531 Importance: High Attached please find Fireworks application of Greenport Fire Department Phenix Hook Ladder co.#1 &Co.#2 Please review them and send me your comments/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: Gpt Fire Dept Fireworks_20210528102531 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. Town of Southold P0Box 1179, Southold, NY 11971 * * * RECEIPT * * * Date: 05/28/21 Receipt#: 281641 Quantity Transactions Reference Subtotal 1 Fireworks 7/2/21 $100.00 Total Paid: $100.00 Notes: V14 Payment Type Amount Paid By CK#1468 $10000 Greenport Fire Dept. Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Phenix, Hook& Ladder Co Po Box 58 Third Street Greenoort, NY 11944 Clerk ID: SABRINA Internal ID,7/2/21 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/28/21 Receipt#: 281642 Quantity Transactions Reference Subtotal 1 Fireworks 7/4/21 $10000 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#1467 $100.00 Greenport Fire Dept. Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Phenix, Hook & Ladder Co Po Box 58 Third Street Greenport, N Y 11944 Clerk ID: SABRINA Internal ID•7/4/21 �iwp.,-,.a,,,, �„"rnH,. u,�a.c ' ,r"+VY.at1:'.'+7s"t"'f"".S?v:ti..yr r•w na:z:w' :.a_?y"+c.•.i�1�t:�'»nC �C,��",.... _ .. _._ "�=^9,t �� ,� �.'a ay;-app ���r �c'�.eeVns�i�;rt 5a=*�`�vt•„ •r-+�4e^s$•�-:r"�-=.rc�a_�.. _ k � .�,1'rx.`f j'•ACZ.g,i"'s"11 „ 1' "A+S `�S'�. .„f 4W'1,4,•r =�' ldr i �%' S'/:`'' }f'fi„rMi•"Y:u.�N,1.'" r! b:."v'`•9A �,.`'Ma� ti_"'• a' ,.. " '<n +A _,' .:�i"''e�r.'r 'Y„',pNty�+, - - " i•.:hx .a77�%:•rrr�Y" ,a,., _ . ., .+r "- LLs €; - "' ^ _ ,- �.,':�! ._ -n's� .°f•: ^� r"'"r, »w, k':=�' ;� .,.�s:,4w,; rl:xt' ' ,.- ...I„4 wrtr. rz" `?- Y - ,�+�f.... - �s+-tg2sl'•iera' .`:"?:".' '�fr•� - .1,f'."' r'9P+" ,rs;N^:.>&::�' •�1' w}�rM. ^r, �,,.;"-gyp,,-i' _ .'_._ ��` „`.'.R#7�° - x �•�trf_'.{it:v TA..@°�'�A rWn+Yar S'',��f•y"rrt,.,'4' S�«r;« ,ppaq"yq,,, .. ,., f ,,.=. h3''a,.• _ ya.�: f:{ 's�,,'_c*,,'; ,• ia..:s�.t. ?rt:!. •ir..'i r ,;r` • ~�, ";�=t''n •5? 4Rbtv`c. , �'s •�,.•c_�, pC�,.,`r'�s-,tai,,.- " ,. .vapt_yjv�`t,. """fit '' t'75. y. .,�,Y Mk..^i:. ;A„w..,;?w"•."..� �5v.n��K�e',�-,-,.,_. , � '"�5`i ti 4^ -C._t....�"�i•`e'V' :.R' sr�.:„=:'77a' ">r "ts ,y rvrf..`r`r.x•?,.i r � v •,+,. a.+`'•y,"� s�*' m ,�~ 7i, �r.d,j,., 'e '��'-`` ".t � �+,�" FR;,a•r'•,C',,,, b" ' "�fiy`a-, " '!a s "�,'i„''?`�r';7;�`::;s•'r Y;+'''t�;."k43,; 7,`•', _ ) c;A' is �'3z.',?Lsw[ _"_"s, ,i;.,;��'�-'�,,'�L. i' =;� 'FThr'r,�� �a..i¢5'c, Y,jxru; t a•,,• 'r , ti� r�^7.4 ��`7:v`kh�'r.'1'1,;,,:;'k�°� "�-5=�,•i:�.,p,,;uxt,,,, A't'+r a'«°";,>-*?�':".'�,Fi��,1't::P,,,4_ t., �,}J',++'•r:-.:v",,ar!s:' [�'�� +,;:'r'+.i, -',;; .- r�rwan,+.rw1 i:l` �.,�.K "' . °?�;-�'3a+;'az<ti»,",yx�� '•�^, 9r�n'+:r�,,, z r'Ey...,be;f c^r,,',' -l'�:1"{ �,�,K.�r•_,.;~t y,-;.iy,;-,;'?r, � 1 .-r ;y,�yu vY"'"" �e"+,' r„y 'o."'�e,,•'�:.`:a+, .a" -F-,.+, �', ,-f.. .--" � r *�+e«zwr~ ,,1�'^?."�`+5R 5�. .xk:S"e„'t".' � '.1."-c,�w • ,'�k•+,.i,:,l„5 t, •,�'"r- ", 't"'R`:t^°5W7, s '6. �B;_, " � 7""�;'.`'^mr•,+ 4;-« r�'ht:sg....x..N w.;, '" ;a, ff��;i,1,t%,Jr+ v xr:, ... "rJ',' „c.,.•2•,+y'' m-W� .•z-"�a"c;��l�?'�„�.'i:L�."a^�Ss�ti?t,N+' '.r.Y*',"r„°k-,;,+,"�$"f'�.,°•[§_�✓'„ :wc �/ r[�-�,,,,1 _' t -y':sFg'�� -C�.'��i i"+�'' ,.k8''.k -•., -:� '` ,tiy•�` - e:. r"w, f. PON DIT r';�"�„+cl+ rn." }�;4,'M+N ,�•":^,,*�:'`8` . Gc,-s �, �`.�3- , �.rn •i�3i;�",�c:�y,.`±s"�.4 �5',F '• _; •"yy..2s "b .y.-r:•v ,. v %iT 'Y•eY ."`�ii^4'"ly;w, � My;'F 'Gx_ "a"aCfi`, �p>_Z- - mC�_t '"�`i�% -,f,,''tt,` 'a'F4^r °•''<r C �'�',�„"G�?cti ++eT. ,' _ ;..['..;�, •a."��'L%'S,`f_5i��,.ti ..,*"n,x"","+'�,yu`r'tr-:`•', ,,,�Y-:=`i.�:•". .. a �. _ '_'�;.�ti�"`+tti ., ��a?x-,- ,..',L��, '��., ''Sr.r•.�;•�ifb,�'.`�.,!..�fk'i; -. :sc'w";'s7i,�:, �,'=; :w ` `'!i"`hY^• 4 Y ;,`"`, `y? i _v ."., ;,.moi" -, :''r '=-' `^v':% :e_.wr.,,•.x.� _ Y -^ , Y+{ r,�r�y,.�,�, �� ryr�C..:"'�' Y�stt�;:3�y`,�4cn�C���� `�-�.`'��:_,.�a'z#?e3.����c.,�„-�`„°L��.`!^�.t;'�> �i-u sT.�",.•„`tF71�- ��''�`-' � ��.-:._v-:,,t.c lL,;. �� •', '�NNW'E''-","yOt3`fr' %'w'Wr�i '••h`.4,tw ... ,q.rr•yyyg. ;.>w,,. :=tb,t•,yy s z sY s i+7,�' ? t.,•�„':": w +-. , _ -G, ,,-�'"-r:'"'n :"awec �4v. ,4� .u,. �;.�' ',"�,'�r?!;'r � t l, ' GREENPORT. R��PARTMB .' h zio ��y °, :.a•1 ?M.,• .y'dY*n ,rye K�`'�4" .y'7 'r5",�'e� `4'_'Lr'L."1''tJx,},�d�:;` - Txy, � x ,4.,,,5.-y�^ yx9•>`F- :^�i � "�n'".v<', .' !,^«,„iP" FT,;�i4cy�t Y i . ®ui�j'�`c; .St,'yhr %FtS.�Ql�fif� ' "•�'��r� Y'� �,` �Gy' PHPICi00K bDBRaCO.•_. " '' s, :;'. u t / r, '�A' .sit 'ly x, •'rM+ ` *,R';~:,y`e ''` -- 4r 4 [TEtt:'t -,« ;; ,rte (�Fa�./I:Jt?' L ;i�a` f:�'•-•�,•;:,_. {x� .`,212 CGREE ���' � J " '�tsr2 .f' < n�y�f ,- ,;.'etr", �?`,;`,i�,`�" iF,>�� �', r�5y.,•l`��' t t:,'S` n <;�,•� •.fir� " .,,ti'.� ;� ��; d _ ,.- _�.;��:, h �y Q:,., ,• , �' ... �� )Ac ' _•..rt"`uxi,[[w>_vrwmae:m-,s,[o•.d^4"t`^'G�, - ,- J,y� ,r;SA TO IIW/G10 Q'F'!:b v:'u-r ..,w_.��t'x,.. `�_`�r.,r,;r,f;t:-i i },:.�`."+F '{,n�:``';";.`s;•,Sf;C,Cu',, " ` h �1 }}, R. �`�-•"c ?i;t'+"*. .:a+v;�.•,•x .fiJ».kti'.."` ,,,.x iC`i;�irr�?f,;ihvR:''s"tFrr,{'v3tydk: "aY t` '�"r` I j{ J 4 .'ir -e, ,2.$=r p�,/•� a�� '"'k°igi°�.w°lr[:w.[ _ EY '` .•+?.1�b;'�i"!f�`,""iySJ. �A't' 14�.4'_b�r'. .... ,r1^1 _ ,'R_.,,a,:,�e.,S�W4,llt�•','8t , ro 'Avstw'^r...` SJ - •r.."vyyanBtt; "',w,;•J-5 �e w'r1r '�.a�a''"•"% 4�r,r.:,e�n. uv"a'.a� ',�, �-y, W, � �rLk � o,� " " ;i,,,`•, �`� :;�� �.k; 'Smc°,,y.';;c�,[s�z,�rr�w, '',�r ••5s^ka, t }"_ Fv•" p d--n'�7,+y� ;• _,C;Y.=;". -:�.� 7ti a's ;,�,,. kxac1 �5 . e 6v. i '-*F�u -+• "'f� yr• er% fNi`_,t }y5' 't r>+ 4 `.913q'r. :,.., ,. ,� _W���� �,`+ts�w�r., w,l`o^.,'eO�Yr;'";`4�" )�' cf'• `c••.e`S',[�a"w.�?`rz`',xt• '�;?, �, '�L,zF''", . �. i.(w CHASE - � trr 6:.1; kn•,� --^'" C 7".;i"•-''�,;s�.--f k,�.;tS,' `Y'''' w"t" `k. =.a•;t. � .� y{n., n Se I.L,rv,„) .,�A° •,1' S''"fYYM✓e..rt""'W ,v'�`4"� i�K3. Mr,-•1 t '" J�PMor an.Cliase Ban ?� ` ��•="� >r . �;;.W; 4 yz ._� p,� �,-.y j • ',^l K WWW.Chase.com '4F 1 t h, riw, P,g5T1•-�, ��4re' , [.� �,a''a' k �;Myy« x" ., .,'nCj,!tA�Y �i��' •d`v?"LN ,}.??',`v"� �•��' {'w' �Tr +,Nr�4�"SYr,'•'[L' r,t� n'ti;'?S',7"r v3� i r_ '^•. _ � •4' h.�'Yva'1"fir tom.: `•:3F' •e� ""y+""'¢'1".s's { f'°ess,!f fd4lEfVfiO' +�T° .,.->,._-��•ua,K �titg-:a..,+�.�, _ - ,'��,-.,eb�,; •,,n SI*:' a'3 M15� � . L- �.et r n4,��*�'�" r,- - �'f-;•q,,,` ,^ i• 'S ;,�,i='e°i' :$i ',: fi+•"tet fir,ftt`•L�:`::�� Y�y•,,u.,it�::°,1...� ° .4rE,,a'C'--k2v-;•e,st`�='.�';i+:11. �,,�.,1 / 'Y-''z�•'_ .r�';, t` ..�i'"; _.J;yyf,�'&!,.,•",§hi-:`7r; 'cro`fir>:Win ,' I,•` .-'t' :^L.' . --� :•,`;,l'.`nY3•...4 `a;.. 9i. ,9tS:y ••�;�` �'•t`�," _. .sys:-rC''�i"�r-a-w,.G',xt'r�..j � y "%_ •�' .r`,.,.,r ;J - ,.. �,-+<ri;,:, I Y _ - n _,�-7+=CK� r � _..w'K��^.�,,,- ':x-.ry "S;.^;,xc'��1hi*�.,��� •�a=• -•��'"cg�Y [;:''•'F,.:<is �`--'-.: =%'rti;�-, .-- ' ��^'°'1"'"s+?.4�:•��sjc- - �' �;..}'�Y.�nt�� 'r .;.�s�;�, i'i;�,; - [ ''•'z::i`ti:.��f.,r, ,, _' awn" .c x •,<v:,`;i:P,k, -` ;r -�aki4xi' .�ni*«•,.'=P,r,`^�A�-�`ti,. ,-,:r r�z-•a^� 's'+r .:i4 •7Y:`Ls.� �.g, ^� [.r�o. _.r71 � mom.,_ .7µ„�,;�+Y:r• "aew',^.. _ .. Sti'„.:'r•.-•;z...i-:,.- �_i a.M �; ".,,•,f,�..�tt .,.�., __ ,wcN - "P.ou.,t. 4, 2r s,_.,.- .a„,.,:,i�q"�.r:n�`<•'� 3 5 ,.•',^s"��":.33f „-y'• h_.S-*ti`'`p k'kt*�x.*:1tr e» =:Z='+.'._l_-=�'� lii,�i. +`.,i";3C`:a2F,i�,.a•�,�;,:•aY t� }"r.�,+o,�.� 'r '• a'�;'t�r°�,rm �.i:a 1, ' . , ,,,», ' :ra`; ';;.,a-Je„^tx7:* moi,,, '�^�r�x '��i+i' "s'�`-��i•��;:Y 4'_�a`§R Sr aY�'y�;_; :-2..vc �„ear:` 7 �>N,r.:�+ ,,, _ �'_ ,�ay-�,�",�'yiu;��.�`,'1,,,t--.:tom +t i„i#.' .z�,�F,',",�.� '• n'- ^*_;_�K�ve», ry �:`�,:�' tiy'r�, q ti,v�p'��r- _ _` :fir,• ,S ds�,'--• s� -d;�i;,r-=n, ',�.,����"rT:&t;a '- if'._4fi:'i,ry�,ii, •'r_ti�� ;"!e;i:pry x;•,rv�, a•7°.i";rs`�'�2��.��T:.,�yak... '.Ea� '7; ^�,es'.;T�'al!�' •c- -` - s'+ i e � ' �:.� :^sE _ }; �',-. ;k��,'�n�;;'Em��ki'x,',-� ly� ,.r`rt�•t`���� �1�:�"e� '3 .�Fvaa,��u,,r_ =''rStii,'3,x- '•,t"'sl 'p"'.1�:�'a'Z "U• �' k 1;`•CC •.,ins..,r,-�• a'.rrl�_ ,[•la'.MR�'Jk`'t ''r � -t 's+`o.N,.-'c,�:. ,,ti°,r.:„,- , ,r�P •, ,g.,• ,~~L,- ix�.t, :•5 �'�a;--`. M, _aka»�,,,t,�.,�;;�,,�, ,., a - , yy��,�,,'' 31;,}•� 1`'aJ_t,^, F, �Y��.� =i�al.ltiny'� '+y. k' 1��t°S'��'t'"��''�;.��,� �2r'.0 }i4^9•'u Ctt�,rf'it•s`...,..•s.. ;.l,ys-^ ;a. Y':.. •aiiti'�; �"` �.. .�H �i'�"..gip,t -'1."h,.-..,}',lic',- -� iJ':%.'a - tW • rr`n"x:1'1.1r v rL., t , :.4✓c'`Ry'h�� `_t .`'.it'+'gf'd. " .�z`cs.,"'i.�".!r,.. ti5"'�s".;:'��f,>t> ��p•�r;;�"��., '}', '` ' "�t�. :�' -•� ����A�4.'- ,+`•�;.li`.,�5�•n'.. -•`'t'rt;%csPsa'vs<..� Nv.� ','�'»[y7�'t�..;yt4n.;, .dam rti*��'�� - ' '� �:A :, ct;gir_;�.r"r�s3� �= t,,�. ,J _ Y„?.:;•�(Y",:.�,.�'`�:�tr","'"�7+..�r�sr-�.c '�"a,.f.�-`y, 'e��i�'hu,rY=> t. +e5�i:4;`a�w'„m,z:_k+,'^�><31',.ikk'_: L .J' a4'-1:�✓-=5'_ - �-`5` !:c a �:rr:. ..,�,;j,,.a;,f;" _ � •�..p �v.k. '4+t", - � =_.- , - �� r a"';*,°,.' �'4;•-'*Ert `f' `z'�'�7�=t'�,,;:!t "�i!4e, ,�,r"tb',a, P*}.f�y<,y[s7, ";'r,-,�'��'`e �"i''7"+,'P,{ �'--•A_'� - ,- _^�(;�s;-�:S'2;-` - , 'fir '••;.� ..,r ;.,;�._ ,tibn�d'z+f '„iwt,,•S ', --�,,,..,h�2`.4.'�k�-.._.t:,,z�" � ,,.F;�,�"-;", t: '3�ti _..+ti.�t�i��w,� ,7, - ,x .• ' _ rw=�',,. .. - - _ , r 3`.�.�! :'r _ .:. y?b�A'?ab-vya>,a� -"._L.,`�,�:7 n•,d'i'�.,W _^✓.�''.,�l�k•f'�aai,::cF ,u-r �'S:+f�ryy�l4'�ui'r'::SS-++- _. .r"1'��,f�t ;i:a 7l„3.i'$:o1,WL�'i,�iu_Y_ik• •,,A.,rs.1'�s� �''`irJ.,� �"" _ ''L- , �� ,a,. , ,',�''s'"'�°`•` -�,r."E"[S3".r�.,F-� e �°'�'�T.1„ .Gi... .. �y'�,.r��t-Y � � '_' _ �`"=:tri»• "^ :';.,f,ri� -,-: �'{;§�m:'::i����; [r- - aua,. • .,4a;p. - ,-•, �•,. ••^�3N. ., ` +•,.'.'-1+"1 "Fbr r���a.T fF;�•t, sinb�r)�c�:r i�,�Y2n Y'�'h��'f,:J3,',+_p.���n�+=���5S'.,]'v �""S'Y,nsa"X'�";C:S}Y Cr.�r.a�-`r.-` _ ~ '{�'+`t` !•!n-'.a ,51'• _ _ 'rw',,..w+i:c•T1.' - ':av-. T iC z-.+'s.,.rp; x=f+ 'rlg rba �; -« e,i-.%,;� E,fr x,aE;';c!' .w•'.a.� •�"�,.:.;.,��... ,y..,ak<7•�;c` �.*#' �'.,.1. ..;,,.y,�.'f't..%a<nge�t;'.�',t'::- ..4I4:;,,"r :r* •".C.".^t F t`:,a -"", - -7%F ._'�• - -.,_ •LL''-•-�j: 4. _ r t t.. � .. = ':P• .. .. `�'%�•�'''.^vsrTu'•:a',-y;,r y.�'r a:'�c ,,'"r�.�.�•�s,�;;4r>�--?5 •�.�+-,-a,:'+�.,,-._ ,. .,v'„ ±'>rnra+,�.,�r:"' '� ..,x >. r:.y. iz xh,'. �:r;"s.' r-"'• a: eGc.,ti - ,s4S�:�.,,.•M.- tlr,_` '::C�'�'1'sb:�i'h �s." Vt_g"[ ,, ,y-•_.r-3,'v'4.'#.[,`i": � _ - f, �.c,._�.z,rv�f ,4'`�se�yyr,u+,;. '-�'� .,> ,.�,t ., = _�+9'h.=^, .r !�� ;n7'"t,`'" s 35�`^"�aal,�i�•`flc„»„�:,!r3"; �r,r=;tn :'^�..,�.._r~yMrs, " � ,-_ '-r•` ^✓�-'.">`� � .., ::1:= `%•t=,:'p, ,;,�� -'=9:ri:s•` r. _ �''t'^tr;"Hc:4„ '. 7_ •- 'xk';-:•� r""�"#." s,T°'ln �_•a��,,.`_S•s:`u„*,s.�. ,,,y� --., ,k''-:� _ ' z� ^„i, _d "•F`�*!`>X ka-M .s�.(t!. �.�?;n'or. �'V,_:airr.F°-t�i''�"�d•,, L�•i;, " '.,,v...:x%s - "..'vW.t.mmpr�,Y -..• ;, -,°,2^a. ;r>-1y�`;:iLw�=r�^"� �"^``.�ff7Kwx.• ��" .,.. �,h" , _ 1'"" '1F� � + -• _ Pyr•;;fr - �i:X�„ � :��_,> >r,.• ., ,`"'E+'ih'fi$°n`•;;�"a •;��rs.a,�` '�:1t}.ri%£•e -' .:d.% R"n.f.�+,.,rd� '^ 'i°''`°'r;•,t„ -•`Rr:•y,.,:' a 7 .�: .n '"' - ,^ r,frt...,, '.;.r";e.�eN3T: We ••`�Sa _ >,�„"'".r,.�;';<,h';;^[j';..1}�✓.�,.. �5,+,�.- '`..2.x; •-yFxc- '^:_�-, -"" _- :*.mak'...i��.y ra::.��.. ,.,- I, ".,4':. %a". ..Y*ir+-ti,,_.a - .'`�,_, t,tf ^:y�i•-o .7-d'`ato •-tir , le,y,,; ,enl"�wF�� �;,�"r,,.,,,,,,. �` :..al�..y. _ �',,,..:.: fa•. r Lbr: SL ul''` "A` " s a 4 r'1 w -e _ ^i't5 ,,4F::,• :,%,j'_:• ,'` r.., ""ter:,+?l,�i�-,i; r�r�ir>r +ir:�iy�`r�f�`:? S5•.X�,e°t , •%,""'""' y: 4x'tt:£,F.1•.y5�'txt*;;'rra -!; r*`'i�'"Y ,y. ;f 'i_r -• Y ` M.i:a`.•.- G.'. l;r,[ `>;�.+.�•_' _ ' ,`ff�'+:s�'. '�`4�`$i,: �, y` 41 Y+�.;n'Ft�g+yy,,�r�kk xR43,»,.'r,�, ,�i;JeS;i i-d't`"'`�_'!�:.�"•��•_�.,�xi.�ci� N,«r�:,.r ,1,^ {� y�rz S S ��, .C,r�i O„�.,v,•�-S4if�CSS�� .:1�.1�e��i�,,,Y•.lam..,. - l,. S;.'� ;i4� � �-,�:f„✓J'„'`: 'P" i ''"+3`'c• 7v.1 `7 "a %S'r,%! ,£mi°i`-Aw,t � •11'"',•'"`r,"daw` a-;`7�'N Zi"'3- '7».zpp, `-; '"`'ant2.,{:iy3p{,t +.,„ .y7x�jfi :N'`;. �,s:}.r-"�SY.3:rY<jtwfi",��:r r,'-:-t_, '.1_;�,fiFT�=�, l•-•- '''�,,��,� „r ,.�'�r',-_a„"£�y�,,��,}any..;}y:Y:,,:v��--"{�;'�"'P'w�"t'`ri. ''"�''�' _ _ ' -�•-• ;.l,i• �`, -�� -'�, ' ,.ti" . '.%fig •.iv.;, :vl�'r t•^,o!a.^}:."'+r,�+" •$;r-.,•_; °S'.9•._a?°ytX.,,.�rr.i�4�*•;r-•- f:^ ;rf+'1 •i",tv%'�iY wx '� fir,,. � `�ius. ` E, �, ,f 'x. •_, "- .'`,4 oC�r`'"' .��,.h,?4W''r'ajH?,�7a,?'-,`zRy�J"\'6'`-' •4 .�% .✓f�+�''•..f.:, ,� '9Y:,_"�''M:",«.e CS� yay:.�- , d•,". s*uY 'y bwrti� '' "#Y,xz,'1=;fr_#�,r. .>rf.;.ir' L'• a- rh' .�,x � ',.� pf i`•7,.ct;r�•,�,:"� r v:��-�"i y'r��+a �.\Sa�_�J'Sx-a�•�;�� ovt(N-+f"St•..a! ,t .`+..-ror , A .•,:+"p,�'z ,, ;,.x 't,;,.•j7;GF�n'4,'..s7,;tik,�%;� 1si-�.;a:�._ ` _ - . . ., �`a_i< ,• F;;i•.6%d`a¢,.r;''„y -. -5� __ '.�`- a,,� .c,. - `r .�b;•t',7.'.r1'' "i •' �5b•�;i 4r•4 ;'+4'�' "- � ., ,�, '-'.t>.sa4t,1,•��- �,y..•, ,-i.;;dr' s.�;9•'M`"'};r• ,C '�-r'�µ',�r.;u�z;,' "'A:J't``k'S . .,F tt , ^=:fY ,.rh, � ski�4"-�;r*�a `A•' '�C� aSax•.�: ,:� „ a »Syy+«-. �`�ad ":*'t(w.,ttr'F .,,'.,�,,•'M"''4��0 ;�,-, a,r, s ' i.;.k`!ry�q:!`��r�,_• ;r`"a'a.i';�r s, "�ew,nrv.� e.w �s� iT�:S,.�„� ;•�:..,,,x, ., .,, F- .,:ca,t'w^,,..�, r ,•'rte, ��:�.:4 • ,- %w`„�y �".�s>� "^i�c � �"Y.4,-4`iktis��.'7,'_ aatyjs,. ."'rr .�.•r!4"�,«Ini@:I;' {'+,i-,h�,,,�� - '',<r~ «m� ''�•P-_, a ;mss,. 'IrstCa'A•.+Ns'K-�,;,*7 `?.Fi;., �"rea�rx„a�r'i+"ks._'��,ahl.`z�Y_,,:v:?,c:,•z.�,�s;'�EL'r, "�i."" '�'1� ��h'S:.•w,y,5;,�,`,vim, '`..Sita t°,�r`if�i�YX,t- .�C._+:_„�s�.^:'�-�%.,F'�`�',y WL?_-w,*;1�_-^ ., ,., ' _ �F�,.�;4,d+x,.,K�s•+'1S=q, i'12,`-y �k.,ty, s� e�„ mr4 � '- ;»=�,a'rx?nrv, ;3,++;�'' a.`:ts, ='w�:-},"rw.•c.':;.. :� !tti{¢z. ,r .y6ou •r-2�saf�D >��xl7;q�y'',r':: c.rn� '}:,�.1,y ;'` gn t"t.Firi•'�'�flr, -'y'... y�u•�°t1yr,';:(.k! "` ..".� ' {,:.:X ,.•, ° ','�?a;,5, 4 ,sw'; %h `'•{s ,h'.,' ° 'cR• :aw:a:"4tm,'a 4_�..,;_ sn ,"; _' ,-. _ ^ ' .•cY7i�C�'� '"",`�,, ^,'.,`a:.TA».»cg_ J'+" -:+' �'���;�'+,nx» -';'{;s,4. Y[,Xr' �,.'krT 's•M cN �d+k-. _i»rz_�,- „ -, ' yxi, .-sf,{,_? .,y . �.,., '� �''GOse{r •mak ,+3."}:...:,ori �ti�a�,>s"ni-=a= !_,. _ _ `� '�k_.is�, .� .o�� 3i",• arc:•�;..;�,,, �, - _�.,... ':,,,•„_,,'•�,. 7;v, - •-re- � 3fi?'. r;=w;.atw-,ri , rti5 _ ice, � ^-.,�_.�, •_• " �:�•+3�..� -`�zL�'$", 'r°"''`•>`,.:�:i'cc"3:/es'c'�"irxzaL•`4•r .,r•,=.w.t;a�.r�_,�%�w,,,:ywY:, , ' � <r;.. '""- '. , - n.�'�v��• :�-':/:�.r..,. e.C+,x_n:- - -9,}•,,�,,,r a,e,-,,n;r n.n, ,..., _4.•`a'rtfi�a�Fenw, .o-._,p,n.,.., •- '-'",t,�tr,>;ruae->``rL=`a'c,z:',��.,.. „rle},;,n+:: 1 _ ..,•,::rr•i a;3'.." a -i p"�'c7Ter.yam c -._. -r..'- ^'.z.'�.•x..r -1hFF•. .,.a'•t'4y1, } - -.. _._7z .. v` rwr-..src>• .7xy,s, {, flLYc;• 't' `'Hidi'" •,�}x,"^, z., - „,•,,,..+,,..3.. :-�q:.a `_ :�-?�i�:Fu"'-�,`�-n �'• .� �'-"est. -`'' •'.?''-`-".'':��`:'=s,;:+.: - ' i -".;'�S'..t `r4, �z t„ Via, •my, �°_>_._ .f r . J �5 +;> a h" fx ?k'atY�Xr`l't �,� :,,r•'" ` 1.9 -r"r—T '.'^�fti�"'u;3v:.,,,� ., -, - '�I .w�aew.rr•Ax:. - `�+a �'^�4 dt -. •`, tea..: o^.-, 'eL`<n -•_'i,r- ."�� ,. .tww `f�tY^•-r�:�.,�.� i �b1i�=�.^:;:•�" y `t - �h�y�,,� -3V_ "L'rssc�+4�'�^? ��1 'a�l,�l���Y&KyS.,.,. ...,t. � _S•1_ - -_ x% y ,'+' �°R%>�_,7�cu`a t a*,�v`w"ti� "�'?i6'�: 1 a'4,y" - `,g`�;;•Jt��,,`-''",.-'-!'s;. _ ;:myirt§r _ _ -I.T`_na,_�;�,y;;: ;,3* 5}-`k,'�".`-;r„ •'1•r;a: �#�`-,t. �' y ;''ri':C^ -_ `'�-"__ °!'�:j'y'tt r�-, ik" �',3•ir:i Y',r„„ Pw: _^[f, r'`"':, ` }.''k> _ - ,\,.�.. ��,J'^';`: moi•-:jt„^6„„s :.�.., L > � - •• , ° =��'yy? "'",!`taC�4”-a:'l3•��:°L"i'�e:yr/.K•_; M-'x"�',1...., '^i,i^.., ..w.e-",_� ._.n:. - _ .L 1a{� .. „ ', a � :Td.Y..`w' �.%' �.a. �`^. 4`X-^Zi2:•`^•ni:,, ,c�� gVi,•A�, _ - +� .• � � r , f "`�". -S.=vaM:{,,`,'- „42;,yV l'ui.JTHJ,:N.,:Y;'-l��C,t,:^r S, .,�'i+11�1�J•`✓�``•'`"., t. :3' ='�=r';i4•.ax+hisiw,7eCJ.:'y.4`�',;>a'•a� +'�T�•„w; F" '' '�',yr;a:;>'.,.�i i r", r• �. _ ' ,,.y,^i�iLxw>•x^7„-s-'�`:z :- �, �. ,:a,;Y;. a'i'sri_ .,�a<. �`3:,,���"�,'�'(•k�j;;�:�t[�.,`d'i,'s.. �•I,1;;:'v' - .''"r��-r1r"�:ha•"_,:".,,:;,rs; - ,.ns� ii lit it AM%�ill ' •.��:•�c' r; - '�'`'£'.: -'�_'.;-z•.: :Sr"v,'., '"�''`1`T'r.'a'?iiW':a,7,�.`_.c�'�,'rr%;�� :x'`�e i.%y.Y''�'i"::ti.'-�V�.;,t�'.•va.*.i�'';fi;"'• .s .< PAGErtW� u' 1' . �-,f•,,-.,4,:a'�ye?.�;i.;,u;`.;"+ '�-• r',`:'r 1G.e Y 'a, ,, ' }, GREENPORTTIREyDEPARTMENT :yrs,;.`' -1-2 0 3st . : k, E 6 7•,, r" iADD zrOOK,& I;R.CO: PHENIX H ,212KNAPPP -L` ,�"+.7f`'� �k r2fi"ri �� ffie�lc , + '?'` F�;,•,ry, S-n.?ekY,`" ,t1, rr: '•-�n ':.,'�..C . rn� {t`.'.s�•^0,. GRE}itVPORT f4ti r, v , '."_rte 7s::'at •, n;e l = •a N- Y.11944'r ? sa: i" ,r.• r; ; 'rd� ! % ` ,fit raw .e;�ya,^, ,,'t+ `tt.,r,S�:-r.5'� •f';Mti%k�i�"" ., _;s�� ;.,�.r.:�.,r.h�"�=�c.�•'t "xy 1 '¢�-^> .`ice a �`j `I,O�'-°Yi•, �s-'•:'.;., '�.- ;, ., '~ ,>_ nrwF.`.^yytia�%::".��h�3`?.}`$�M� i'p `"-�: ��'`�JC�1l'�1:1�1��� •:�;•z.,�,�ti. -,•l'."' zi ,�-- ^"'*:ter l:i��r�� - y,:�jk; ��'j' _ > - '. .,�' t PAX•'d'O'p'gt�01k]�1E1�dk � <.,',w�. ,,�;:. v _<+�}�,:'�.: - �;:; _ -�'-� .'--�C��L�la JL .Lr �s.`.t.",#;e"s x•k,,�,t �' �:e' ...._,y,•� - 3 S. - `-fe5-"- K , >.F,Sy1'-rrz�°.`n.. `x s Tree;^' 3n?•�c..,,N, h_ w,.�.�e,a. _- I•. HAS a •' vv ^fit >+^'„s, f,Y; x" 'e'+.�i``; n T'"-:,_'•', -i,:a.,:%t;;7t.:�., .,„,�v' ''` 1P ��'. ,�•�r 3ir,--�+�.,•� ''}"vkL} k. - ; Morgan"Ctiasc.Vank,N:A " +':'Ilwww Ch850.COt1'1 'r > rg4P+0. . _ ' �;,`-, ••~'• •� - - � s• 't�:i� �-.r.,. .ray,µ- �.-•,-•, ,;r, • "'`?s?i':i .,v-� it, ." AAFF,to `'A'ry�' / I _ -{ Imo, y;`c .3"r"i w' - 3'_ ,;¢ >.'- ;. - - ` ■' - �y:t• =x'3:1, - _ �''PS.._ _'/ - ,- .�"ta..•e�.,'At-.>�..� 7^d �.,'-e^•rP'L+1'Pd'Pe'SF �r'�.we• "-' ' ,..•!.. •t, � ,le �.,'1'1lgS�v.-i p•Xt,r •Ta'S$�a4'o—'i c ^fit 'T'�.a'I�dR -^ -5; i, �t�-Mew:.f+L"ar�13_�:.: ::R.z':.t. `��� -, ��"'7�xkC'Z.vti,e r�'t-,.�:�, ^.;r"qt�,,.�-i,rs.r r..: - _ __`__•_-____- __ `- _ r - _- - �� ✓ ,.-.'r,'*Ys`5'S,�s'a• `rt$�i��Y�itiC?`Sk„ z•>:if�' �>.,��� {y,� •�.>.. ,,. - ”' '9`m'" - ,;4>.;, fix: ,+`Y - - j ,7.6'w» 1 aYt ,-�:?'M?r"�-dr' ,'-4•s n`" - ,- ".�;4:z .a„e , ,arF•1�•4:i.'r'$"^Li:t;�\vti.4'ij� " •-' .�t,l-.- ,w_ , ,,,,,� � •'v:�(:t;}•�{" ".:ti;,.,'� �krtt?;,v,,,, -t," '?^ii. - ,' � - ' _ � �SSa"' e `ter'` -„ .. •�,,� _, 'rlt,•ya{,.�., `a, -' -_. ... ,- .:� _. , , '• ,-fir-i'Ktsl'ir..y_?".Lt_ "., ..,:�'�^� r•` r�d'^,a'".xnx+�"` ., r1�„t `,�. `.n``I�-t;�3;+ '�;;��4+ 'f`gi"�r�c•s,• .;�{:�e`,z In�`.a`�' �, -�I'.::=''» t'�•,T^e Y�'e�j>•.��' +/ ,yF.ra:}Tfa.,t�": ,{'s rtr,, 1"rny3.t+ t.: •.�,`..-:. �;'i r-�"`i���"T.4', ,f,',9�f:•^'c.`` r. '+':r-• j,C:>=.�,5 :a3'dy,ti -���+5•:'1'.i. `''�'� y '.`i �•' _ .l,.v^sem>{,tr, � �S .' �,'c+,•7 .1 _•"? •, -Rt-a...o "-f h•.`, i.r_ -=,�iFiy,. :�. `i' - 'cF- x .,f'� bii�R��`',' ", .. .Y, ' w':<cxn;a:4�;';;, - - .-=''ly'`+c^^_ar,- ", ;�i"•,~, y. ,;y.�F :,_ - rr +`a.`+o7.>�,' _ '� �M' -�i?r-4ti }`i;..,,,. ✓i "A•gi•,;, `.e r�L-vrs"{."'A,w_,c»?•`�..F�:fir_,,•.••:,:� ' " - _k _ -:x _. .ca-�_� ';a+�+at.*b=o-.,:``�'bl%r_Fr• ��.;i,,.`-iv:i,v,P_r{a_s s•.r ,,Y+,'_.-•q,:,e..m,._ Y - - " .,^.i'="r4�..ety:," •" �". _ '__ - x. �c�iky,.3,:�x:S7_C;'V, t' k5;` +�;30��:4±a t;•'- - - ,_ - �:;?'��rt3,." .CJ'+J+sD{�P,�jS.$�SSr••.Yi�a-'+4-�CS�.1_Y ti��,ue:•-_'^` `J y�,4 �5,' `-'T,'�"O '^'>RjP.•+ ,(`L 3._„- ,5,•"(..;re`,f.,.s 4='1 --_, a'' a .'�"'.�.� : ;tip ,„; - •,4b�,`:F�='+- ,' "4;-�� '-�• , "aa':�•.':-a .•1"•t:'_Dp`,: I' :ice•'-`-rr"$�sa�3c'. ';t:+•-_ _ -- ^'°.„ �.�,- f't8x'.`{' y�.�''•"'•�.t% ,� ^.`1%°'PSS ry-�w4•,� ^3 ,/, - I may. '+`3'iV-. .'yl'n rT_A�,Y•�>X:�;f�' LVr_y.� •` t'r'yn v��y„y • +'U�'IRyGs+:'-C ?;7t)z�^bns:. , X-_ xrfi 'ei:sY, 'i"12. :i '�i Ae+`_1i?n` S,; _.x _ _, _ - -• „ - �,,'r�'�yJr, tic`!q,• `-:kirF: - .-;M��v'i':ti:�i.. .., - . hh,•v�;r ��� _ - "<y"-;4-"-i.;r,',..,,np,c..,, rcC^,,r, *-r,t :^d xis,7;i";•tt,•i��'t%=„�,,j y � •_ ' _,. , _ %),IN^.sn N`r,:var�,"l:...' Z;,t,:�ti I�•2: - - K#✓y`i.;T(...7rr'Y5' ..' _ - :"P;v;h!-`;.:i.' r ;"i,'»�.y.,�.A.,� _ _ ` -•, i -.. ..'� .. w5;v i`•='Yi+„r YS-yJ�_ro:,Ri' ' ',:�'�c`,.� �.,�?•`sx.. s„n, .."- �,�'•:ne'".:'`':r�� -"- _ '"v<„-�F,e ''' -,.'-?�'e' Y�+;;F,, ^ .,.t•,_ '::�.rzx"',2r'x,s=,6,:.- _, i; .<r,, .-�..e•, Wit:"•'-,;', • 4 - ;..r,q:cr: ,'�.w2?"•- w7"`('Sti i�; ,' °'"Ynv. ..,r;;�,w,l` ``z" -' - r 'C•n..�fxaws.aa�-.:..- � ._� _ `„ 'ez t ;1iJ='7fj,;•'�+ `2z; .,..sr �^ n',:.• ,-_ .'4-.•€L�,S' YY,y. -• - ._ • vim. `' ,.,aC n ;r�arr is �rtc 1s°r; i "a• �`° ir' % i;;;ms+'r.;n'_,^>t•:-�r/ri<,'•a r,',,.r. a ' i]ts ;.Y''-�'f:w'tir^,'l� r -- _ x ,'?' •`+ ,ty"'n''!�i,�'6b <�'�t,^ ,: ,_, " ,x-,"'.�: 9:i.:ir', u ,-•-C.�c:"%., tyti„�Y• "'1,t:Y�"S.°-' 'a`;+^`.'�"GY;';,; 'es,: .. i n t+- Y' �` ` �f" _, Y-' ,�✓ -•+`"`' ;1kV.t --`tz�%-;�°•',,• t:�.,,:; C-e •.?•r:�t r=:; '-., �'=%� ���,_,. '^-�+a4=;::;z • .r�-,r, ; '.,,`'f' , 5,t;: _ �"•;iti:1 ,,r 3�FJ iB`..x� .•. }S�'.' +y "`A'^-` i • �'Y,rgty:.,,rt: �y ,• •,.' s,i{:S;tiU+r''S•,., �xir '-iy • - Vi=a -, �. a`.,,jvAJ'y\. :'�i,.. 'r`�.�.,+tn{ ;..x 2JrtE Sy..-.`.,;•i .,2y..`/` .>' - (•;Ee j .:�8i%F=k:�:•xc>sao•, .^?!:�1r "' ,F7iv,'t:',_� - - ^_ .n _ �'3:++;r?:)-• a. 4„r^” "3Y''�i'vG:'�Eiii4'h nss' ,i i1;Jay ,�:aY,,j; as„, �.,�✓r.>,.•�a:.ar.-��,;;..k-..`..-", ,_ ,. -,.. '' - av'.e"";��`Y.is.,i:R. ;.. _ - ., "' �^i�'a_4TtM�75°•#c-'•,._�•.:r.,- '/'Y:.;•,�..,...o,>?'�.:5,'.r�.ex?__. _ ._w __ .. ” '` . •. -:xAiit:.i.'pal-,.`ra`�k•.n;�cg,.,!'N�a� ��'e3).,� "'"t`+'t`k;4j,� - :`*i�`'o:,:gF. - - , '"S•'9if+tr"�}`'tcL•'�:. :�sS's<�x:, _ .�, �, - ?, >g�:•��i+ -' ai'13F=ts• �a,�'-,-:r�sfit?k.,:::r � R��7:'7;�Fil 1�„`+> -�" ,,.,. `-,<-,- n.� ,,.- ' �. htSF `t P'? _ 'o,,i a,3;5' T?�y., �<t.-ir H_�`;,ti'btsn=r,,��•”' _' _ ;. ,.;;i,�^�:`.r':.n= >"'''-' - ` : i; ^„ai:;y�nt""P_;,€x;�,ty�._''�:,}7�:u. - >^�;' >•r�,�.:;v�*�-?t';C”- �'�^„�y3w%S"">a. `'at`_.�_ ''�.''a-�cv5 r ^sict;.--` . , •';sn. .,',..: .:�i�• ��':"n_.•,;riFr._.4.;�md;:�r:,,iv-S, n�,.:..,,-. �Sy<}A:�” ... ._ '" - - _ ` _ yAa; --`'tihv.r•<,.;r' y,- '.ai:,r,P,J, � `•„ v •`-n,•sn. _ .xi^_,-,.: �.ti,,..., „•i•<>c3* .,t.f ` •ICY 4". � u6.,,. \", , . >:x'N:Y,w� '`.R,. 'e,:'`w i,\'� w _ "• _� *� + }ell: .tit>•, _ ., .-{'�i�Mu,:>•g%n"r�:'1J•_r,�' ., ,�j.:isr�ro�;•';a�'r�+'�"�`Pvt'�",;:�'F�;:p,�",�.,�,,,i�b' �7=n'a^,, ,��^.�"_r�.'.�ka:.<r+,,�`,.., ,. � _ `1_-,. :x: r ,. ' Neville, Elizabeth ;. From: Legion Fireworks'<'Ldgiorrfireworks.@ou`_tl'ook.com> Sent: Tuesday,June 01;2021 12.41 PM,Fll,. To: Neville, Elizabeth Subject: Greenport Fireworks 7/2 &7/4 Attachments: Certificate 7-2 Town'of Southold.pdf, Certificate 7-4'Town of Southold.pdf, 193454462_ 315461006738111_80343835561].8984064_njpg Good Afternoon Elizabeth, Please see the certificates attached as per your request. I have also attached a copy of our lead shooter, Lee Becker's Pyro License ID. Please confirm receipt of this email. Please email me with any questions or concerns and 1-will be happy to help! Thank you, Deanna Administrative Assistant Legion Fireworks Co., Inc. 10 Legion Lane Wappingers Falls, NY 12590 Legionfireworks@outlook.com/845.831.8328 M-F 8am - 3pm ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. 1 ,aco CERTIFICATE OF 'LIABI ' ° DATE(MM/DD/YYYY) LIT,Y_INSURANCE 6/1/2021 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 _ Britton Gallagher - PHONE FAX One Cleveland Center, Floor 30 A/c o E.D.216-658-7100 A/c No).216-658-7101 1375 East 9th Street ^- E-MAIL" 'ADDRESS%�-L - ,'- Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:AXIS Surplus Ins Company 26620 INSURED INSURER B:Everest National Insurance Company 10120, Legion Fireworks Co., Inc. 10 Legion Lane INSURER C Wappingers Falls NY 12590 INSURER D. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1874866577 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 INSURANCE111M WVP_ POLICY NUMBER MM/DDIYYVY) (MMIDDfYYYYI LIMITS B GENERAL LIABILITY S18ML00116-211 3/15/2021 3/15/2022 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO RENTEDPREMISES Ea occurrence $500,000 CLAIMS-MADE F_�_I OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ B AUTOMOBILE LIABILITY SI8CA00058-211 3/15/2021 3/15/2022 COMBINED SINGLE LIMIT Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident A UMBRELLA LIAB X OCCUR P-001-000091848-03 3/15/2021 3/15/2022 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 TORY LI E ANY PROPRIETOR/PARTNER/EXECUTIVEE L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F-1 N/A (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT I$ 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. Date of Display.7/2/2021. Location of Display Greenport High School 720 Front Street Greenport,NY 11944 Additionally Insured Certificate Holder,Greenport Highschool,Village of Greenport,Greenport Public Schools,Phenix Hook&Ladder Co.#1 &Relief Hose Co. #2, and Greenport Fire Department 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. Town Hall 53095 Main Road PO 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 h ACC)R" CERTIFICATE OF LIABILITY INSURANCE DATE6/1/2021 "' 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 Britton Gallagher PHONE FAX One Cleveland Center, Floor 30 Ic o E •216-658-7100 A/C No•216-658-7101 1375 East 9th Street ADDRESS* Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC tl INSURER A:AXIS Surplus Ins Company 26620 INSURED INSURER 13:Everest National Insurance Company 10120 Legion Fireworks Co., Inc. 10 Legion Lane INSURER C: Wappingers Falls NY 12590 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:502468597 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 POLICY NUMBER MM/DD/YYYY MM/DD/YYYY B GENERAL LIABILITY S18ML00116-211 3/15/2021 3/15/2022 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE FxI OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 1-1 POLICY X PRO- LOC $JEC B AUTOMOBILE LIABILITY S18CA00058-211 3/15/2021 3/15/2022 COMBINED SINGLE LIMIT Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOOr AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per.accident A UMBRELLA LIAB X OCCUR P-001-000091848-03 3/15/2021 3/15/2022 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/NER IRY ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ 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. Date of Display.7/4/2021. Location of Display Greenport High School 720 Front Street Greenport,NY 11944. Additionally Insured,Certificate Holder,Greenport Highschool,Village of Greenport,Greenport Public Schools,Phenix Hook&Ladder Co.#1 &Relief Hose Co. #2, and Greenport Fire Department. 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. Town Hall 53095 Main Road PO 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 � l ® E(MM/ �`�o DATDD/YYYI) CERTIFICATE OF LIABILITY INSURANCE DATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON rHE 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 IS UING 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 o Ext:216-658-7100 fAIC,me):216-658-7101 1375 East 9th Street A IRESS, Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:AXIS Surplus Ins Company 26620 INSURED Legion Fireworks Co., Inc. INSURER B:Everest National Insurance Company 10120 10 Legion Lane INSURER C: Wappingers Falls NY 12590 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1193566324 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. POLICY LTR TYPE OF INSURANCE ADSR WVDSUBR POLICY NUMBER MMIDDPOLICY FBF MMIDD EXP LIMITS B GENERAL LIABILITY SIBML00116-211 3/15/2021 3/15/2022 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE I—XI OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $2,000,000 POLICYX PECO LOC $ B AUTOMOBILE LIABILITY S18CA00058-211 3/15/2021 3/15/2022 COMBINED SINGLE LIMIT Ea acadent $1.000.000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS A UMBRELLA LIAB X OCCUR P-001-000091848-03 3/15/2021 3/15/2022 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YINI!-QRY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTNE❑ EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 1$ 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 of Display:7/4/2021. Location of Display:Greenport High School 720 Front Street Greenport,NY 11944. Additionally Insured:Certificate Holder,Town of Southold,Village of Greenport,Greenport Public Schools,Phenix Hook&Ladder Co.#1 &Relief Hose-Co.#2, and Greenport Fire Department. 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. Greenport High School 720 Front Street AUTHORIZED REPRESE Greenport NY 11944 NTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name.and logo are registered marks of ACORD Federal Mphsives License/Permit U.S.Department of Justice Bureau of Alcohol,Tobacco,Firearms and Explosives (18 U.S.C. Chapter 40) - rri®®m¢��s©muum�unn� In accordance with the provisions,of Title XI,Organized Crime-Control Act of 1970,and the regulations issued thereunder(27 CFR Part-555);you may engage in the activity specified in this license or permit within the limitations of Chapter 40,Title-18,United-States Code and the regulations issued thereunder,until the expiration date shown. THIS LICENSE IS NOT TRANSFERABLE UNDER 27 SFR$i&53,„See"WARNINGS"and"NOTICES"on reverse. DirectATF ATF-Chief,FELG =`' ceiisePeimif Correspondence To 244 Needy Road F , -°art" t _ " `"; L°F 4` Y' 1 1 1 1 1 N;iiiiitec�'�;�v Martinsburg,WV25405-9431 Chief,Federal Explosives ice iCenter �L nsng (FE LC March 1 , 2022 �y`€� T Date Name LEGION FIREWORKS CO ftc,;,` s j, i' Premises Address(Changes? Notifythe'TELG'at1 _astl µ' ., «i_. _ , ,e0 days;lieforetfie`move",)'��e 10 LEGION LANE h` 3= .' 'Z SY$ y` =. =":�, is T,""5F^.. - ;�Fr x 'J' .• ;.: irZw € .xs . r: WAPPINGERS FALLS, rx{:4 Type ofLicense orPermit 20-MANUFACTURER OF EXER3NiES Purchasing Certificatidn:Statement" ?,% `, - Mailing Address(Changes?=ryNotify the FELC of any changes.)' The licensee or,permittee named above shall use'a copp'of this license`ox jierniit to°assist.a ='"n n `__ `TM+t G' transferor of explosives to verilythe identity and the c�¢zd •lien's_ ,$talus ofthe�liceris`eeor.,-��� permittee as provided by 27 CFR Part 555. The sianatiire on,eacli cony musCbe anonain--zPr" 15=�= -.. f 4= LEGION FI,F,EWORKS Gb INC signature. Afaxed,scanned or e-mailed copy ofthe-license ot�periiyih ith a signature -_ intended to be an original signature is acceptable. T1ie,si�atureii%usftiliethat ofthe Federal _ 10-LEGION,tANE_ Explosives Licensee(FEL)or aresponsible person ofttieFEP -2=ceq*,-.hiihisis atrue WAPP,INGERS`:FALLS, NY 12590- copy of a license or permit issuedto the licensee orpennittee rained atioggto.engage uithe N;-. _ •`" - i,.; i. business or mations specified aboyg under a of 'censeor-f _ _ 2A LicenseeEPermitteeResponsible Person Signature PositioilTifle Print&NaM — __. _,... _ Date _ _ __ ___w. _ _ _ ATF!Form 54UQ.IW_k4OU.15Part I PreviwsEditioni's Obsolete LEGION FIREINORKSDO1NCi0LEGION rAW-125236.Nr-027.16X-00072'MartA1.207720-MMUFAMOMOFUFLUS= Revised October 2011 Federal Explosives License(FEL),Customer Service Information Federal Explosives Licensing-Center(FELC) Toil-free Telephone Number: (877)283=3352 ATF Homepage:www.atf gov 244 Needy Road FaxNumber: (304)616-4401 Martinsburg,WV 25405-9431 E-mail: FELCqutf gov Change ofAddress (?7 CFR 555,54(a)(1)). Licensees or permittees may during the term ofthe-ir 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 licenseeor permittee is required,to-give notification ofthe new location of the business or operations not less than 10 days prior to such-removal with the Chief;Tederal Explosives Licensing Center. The license or permit will be valid for the remainder of the term ofthe original license or,permit. (The Chief FELC,shall,if the licensee or permittee is not qualified,refer the request-for amended license or permit to the Director of Industry Operations for dental in accordance"ith§555.54) I Right of Succession (27 CPR 553:59). (a)Certain persons other than the licensee or permittee may secure the right to carry on the same explosive materials business or operations at the same address shown on,and'for the remainder of theternrof,a current license or permit. Such persons are: (1)The surviving spouse or child,or executor,administrator,or other legal representative of a deceased licensee or permittee;,and(2)A receiver or trustee injbankruptcy,or an assignee for benefit of creditors: (b)In orderto secure the right provided by this section,-the person or persons-continuing the business or operations shall.furnish the license or permit for for that business or operations for endorsement of such succession to the Chief,FELC,within 30 days from the date on which the successor begins to carry on the business or operations. (Continued on reverse side) Cut Here Federal Explosives License/Permit(FEL)Infotmat'ion Card I License/PermitName:LEGION FIREWORKS CO INC I Business Name: � - License.Bermit Number.6=RY-027-20=2C-00077 LieenseTermit Type:20-MANUFACTURER,-OF EXPLOSIVES Expiration: March 1,2022 f I I I Please Note:Not Vali Sale or Other Disposition of Explosives, I I 1 i ! STATE OF NEW YORK A�NEw� DIVISION OF { DEPARTMENT OF LABORo a SAFETY AND HEALTH o ENT OF 1 LICENSE TO DEAL IN OR MANUFACTURE EXPLOSIVES ! Expires: 5'/31/2022 - j Legion Fireworks Co., Inc. a' f 10 Legion Lane THIS'L-ICENSE,M0ST BE :-- ' Wappingers Falls, NY 12590 P09-rLD IN YOUR'PfLAC-E T_ i OF BUSINESS' -' r Frank Coluccio License No D 2' _0._ is hereby licensed to,deal in or manufacture explosives in compliance with the requirement§of the Labor Law and i - - —Iiidt7§tiial erode RuteT. change u5 the condit�ns unde"r wnich-this iicense is granted may cause if to 6e revoked. ' i I I � I Eileen M. Franko,Acting Director FOR + THE COMMISSIONER OF LABOR I Every person selling,delivering or giving away any explosives must keep at the principal place,of business within 4 the state,a record of each transaction,including: i i j 1) the NAME or TYPE and QUANTITY of explosives SOLD, DELIVERED of 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 i the"Dealer-Manufacturer Report of Explosives Transactions" ! 2) the DATE OF EACH SALE, DELIVERY or GIFT. i 3) the NAME, LICENSE NUMBER, and BUSINESS ADDRESS of the purchaser,donee,or person to whom " I the explosives were delivered and the firm,if any, represented by such person. j 4) the NAME,ADDRESS,and LICENSE NUMBER of the,person TAKING THE EXPLOSIVES AWAY from,the seller or donor. I j SH-862(5-98) 1 I i I I 1 _ I i f I i . " I " i U.S.Department of Justice Federal-Explosives Liceitse/Permit Bureau of Alcohol,Tobacco,Firearms and Explosives (18 U.S.C. Chapter 40) zt�ma «®itanmu�mne�m In accordance with the provisions of Title XI,Organized Crime Control Act of 1970,and the regulations issued thereunder(27 CFR Part 555),you may engage in the activity specified in this license or permit within the limitations of Chapter 40,Title 1,8,,United States Code and the regulations issued thereunder,until the expiration date shown. THIS-LICENSE IS NOT TRANSFERARL-V NDIJR 27.6 �5'S:53.�_,See"WARNINGS"and'NOTICES"on reverse. Direct ATF ATF-Chief,FELL Correspondence To 244 Needy Road Number `= 1 • Martinsburg,WV25405-91>-,� .43 �%;� • go-yt`A,'ir I',_-S. +'.•:'*uz wRA-. Chief,Federal E plosives Licensing Center(FELC i }, Expiratiort`N-'s•' ��/tit/•4i .Date -arch 1 , 2022 -� tame r;r • ,r<< _ .- _,�.,.-•...-._ `,; :�� r F ?' 4 �t` „;4 LEGION FIREWORKS CO INC. °� `� Premises Address(Changes?Notify the FELG,`at least;10 ilays,beforethe m6ve.) 10 LEGION LANE —' r , ,, e,T,•_ It=`' ; f`,k 5: ; 6".'..w.=`'`1 i'4' i _E WAPPINGERS FALLS, NY 12590- Type of License or Permit 51-IMPORTER OF EXPLOSIVES t- Purchasing Certification,Statement '` MailingAddress(Changes?,%1Votify the FELC of any changes.) Die licensee or permittee named above shall use,a cbp-vof tl is,license or Pei tk�ist, _,, transferorof explosives to verify the identity and the-licensed statusoftliz,licensee of:M e V K a-` permittee as provided by 27 CFR Part 555. Th-sign, on;eacli oopy must'be.,dr,i``sinal'-' �- signature. A faxed,scanned or e-mailed copy of th&Iicense`oc p5init_�yith a si iatiire - __ - LEGION Flgl]11/ORK'S CO INC intended to be an original signature is acceptable. The-signature-mustliethatofthe Fed al' _ 10 LEGION;, NE.• T < e. LLS, NY 12590- ivesLicensee(FEL)orar�responsible ersEx losoftie'FEL attliiatrue - aIz" WAPPINGERSFA copy of a licens r permit issuedto licensee ermitfeenairied above to;engage inthe —- "" t fF' busiin erations specif, �+Funder" e 0 ense or P LicenseetPermittee Responsible Person Signature P_ositionjitler`"l~ R M, Co�uCG� XX r Printed Name Date AIF Form 540014'5400.15 Part 1 - Previous Edition is Obsolete LEGION FIREWGRKSCOINCI0 LEGION lAl✓E.12S9tr6 NY-02731-PC-0009114.mh 1,20t2:514TONTEN of wi0.5NES Revised Octobei 2011 Federal Explosives License(FEL)Customer Service Information Federal Explosives Licensing Center(FELC) Toll-free Telephone Number: (877)283-3352 ATF Homepage:www.at£gov 244 Needy Road Fax Number. (304)616.4401 Martinsburg,WV 25405-9431 E-mail: FELCOitf gov Change of Address (27 CFR 555.54(a)(1)). Licensees or permittees may during the tern of their current license or permit iemove 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 oftlie 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 qualified,refer the request for amended license or permit to the Director of Industry Operations for denial in accordance with§555.54) Right of Succession (27 CFR 555.59). (a)Certain persons other than the licensee or permittee may secure the right to carry on the same explosive materials business or operations at the same address shown on,and for the remainder of the term of,a current license or permit. 'Such persons are:`(1)The surviving-spouse or child,or executor,administrator,or other legal representative of a deceased-licensee or 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 thus-section,the person or persons-continuing the business or operations shall furnish the license or permit for for that business or operations for endorsement of such succession to the"Chief,FELC,within 30 days from the date on which the successor begins to carry on the business or operations. (Continued on reverse side) Cut Here`f Federal Explosives License/Permit(FEL)Information Card i LieenselPermitName:LEGION FIREWORKS CO INC I I BusinessName—: ± _ Licensor?ermitNumber:6 y 027 51-2C Q0Q91 License/Permit Type:51-IMPORTER'4jF.;EXPLOSIVES I Expiration: March 1,-2022 I I I Please Note: Not Valid for the Sale or Other Disposition of Explosives.---------------------------------- - 1 I I A4C R CERTIFICATE.OF LIABILITY INSURANCE RAN C E DATE(MM/DD/YYYY) 5/26/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS J 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 AIC No:216-658-7101 One Cleveland Center,Floor 30 c o Ext:21 6-658-7100 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC# INSURERA:AXIS Surplus Ins Company 26620 INSURED INSURER B:Everest National Insurance Company 10120 Legion Fireworks Co., Inc. 10 Legion Lane 114SURERC: Wappingers Falls NY 12590 INSURERD: -INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1229504566 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 CONTRACTOR 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. NS TYPE OF INSURANCEADDL SUBR POLICY EFF POLICY EXP NSR POLICY NUMBER MM/DD MMIDD LIMITS B GENERAL LIABILITY SIBML00116-211 3/15/2021 3/15/2022 EACH OCCURRENCE $1=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 GENERAL AGGREGATE $2,0001000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY E PCT LOC $ B AUTOMOBILE LIABILITY S18CA00058-211 3/15/2021 3/15/2022 COMBINED SINGLE LIMIT a accident) $1,000,000' X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURYPer accident) $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Perarxident $ A UMBRELLA LIAB X OCCUR P-001-000091848-03 3/15/2021 3/1512022 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I RETENTION$ $ WORKERS COMPENSATIONSTATU- OTH- AND EMPLOYERS'LIABILITY YIN TWC Y ( 5 E ANY PROPRIETORIPARTNEWEXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below F-L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 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 of Display:7/4/2021 Location of Display: Greenport High School 720 Front Street Greenport,NY 11944. Additionally Insured: Certificate Holder,Town of Southold,Village of Greenport,Greenport Public Schools and Greenport Fire Department. pi CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Phenix Hook&Ladder Co.#1 &Relief Hose Co.#2 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 58 3rd Street AUTHORIZED REPRESENTATIVE Greenport NY 11944 / -V ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ACC) CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDNYYY) Ilk. � 5/26/2021 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Britton Gallagher PHONE FAX One Cleveland Center,Floor 30 N Ext•216-658-7100 A/c No:216-658-7101 1375 East 9th Street DRESS: Cleveland OH 44114 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:AXIS Surplus Ins Company 26620 INSURED INSURER B:Everest National Insurance Company 10120 Legion Fireworks Co., Inc. 10 Legion Lane INSURER C: Wappingers Falls NY 12590 INSURERD: INSURER E- INSURER F: COVERAGES CERTIFICATE NUMBER:1137930019 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. QTR TYPE OF INSURANCE i ryg L Syy�p POLICY NUMBER INNWDY E POLICY EXP LIMITS B GENERAL LIABILITY S18MLOO116-211 3/15/2021 3/15/2022 EACH OCCURRENCE $1,000,000 DAMAGE To RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurren X ce $500,000 CLAIMS-MADE Fx_1 OCCUR MED EXP(Any one person) $ PERSONAL a ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS--COMP/OP AGG $2,000,000 POLICY 1XI PRCO- LOC $ B AUTOMOBILE LIABILITY SIBCA00058-211 3/15/2021 3115/2022 COMBINED SINGLE LIMIT Ea accident $1,0()0,0()0 1 000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ $ A UMBRELLA LIAB X OCCUR P-001-000091848-03 3/1512021 3/15/2022 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I RETENTION$ $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTNE❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below J E.L_DISEASE-POLICY LIMIT $ 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 of Display:7/2/2021. Location of Display:Greenport High School 720 Front Street Greenport,NY 11944. Additionally Insured:Certificate Holder,Town of Southold,Village of Greenport,Greenport Public Schools,Phenix Hook&Ladder Co.#1 &Relief Hose Co.#2, and Greenport Fire Department. 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. Greenport High School 720 Front Street Greenport NY 11944 AUTHORIZED REPRESENTATIVE 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ,eco CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) 5/26/2021 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 Britton Gallagher PHONE FAX One Cleveland Center, Floor 30 Arc No Ext:216-658-7100 Arc No):216-658-7101 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIL# INSURERA:AXIS Surplus Ins Company 26620 INSURED INSURER B:Everest National Insurance Company 10120 Legion Fireworks Co.,Inc. 10 Legion Lane INSURER C: Wappingers Falls NY 12590 INSURER D: INSURERE, INSURER F: COVERAGES CERTIFICATE NUMBER:1861810038 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. NSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE S POLICY NUMBER M/DD MM/DD LIMA B GENERAL LIABILITY S18ML00116-211 3/15/2021 3/15/1022 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 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ B AUTOMOBILE LIABILITY S18CA00058-211 3/15/2021 3/15/2022 COMBINED SINGLE LIMIT Ea acadent $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ A UMBRELLA LIAB X OCCUR P-001-000091848-03 3/15/2021 3/15/2022 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N T I ANY PROPRIETORIPARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) EL DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS r LOCATIONS r 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 of Display:7/2/2021 Location of Display: Greenport High School 720 Front Street Greenport,NY 11944. Additionally Insured: Certificate Holder,Town of Southold,Village of Greenport,Greenport Public Schools and Greenport Fire Department_ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Phenix Hook&Ladder Co.#1 &Relief Hose Co.#2 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 58 3rd Street AUTHORIZED REPRESENTATIVE Greenport NY 11944 / / � ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ®�*pv SOU���I ELIZABETH A.NEVILLE,RMC,CMC ® Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICSSouthold,New York 11971 MARRIAGE OFFICER ® �O� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER Ol� sV Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER COON I�,� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD 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. Display must be concluded by 10:00 p.m. if held Sunday through Thursday, 11:00 p.m, if held Friday or Saturday, and there shall be no time restriction if held on July 4. 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 and a copy of a valid certificate of competency as a pyrotechnician for the individual supervising the firing of the display 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. Detailed diagram showing location of fireworks discharge and minimum separation distances in accordance with the applicable requirements of Penal Law Section 405 (2). 8. Copy of the contract with fireworks display company. 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. Certificate of Insurance naming-the Town of Southold as additional insured with coverage limits of $2,000,000.00 for public liability and $2,000,000.00 for 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 30 days in advance of the date of the fireworks display, 12. All applications for a fireworks permit shall be subject to an application fee in an amount of$100.00, together with a processing fee in an amount to be determined by the Town Board to cover the Town's costs for monitoring and enforcing compliance with the Penal Law. ('fhc above instructions aie in accordance with the Penal Law,Aiticle 405-Licensing and other provisions relating to Ilieworks) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: FAX PHONE (A/C, No): (A/C, No, Ext): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSRWVD GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY$ PREMISES (Ea occurrence) CLAIMS-MADEOCCURMED EXP (Any one person)$ PERSONAL & ADV INJURY$ GENERAL AGGREGATE$ GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ PRO- $ POLICYLOC JECT COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident)$ BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Per accident) AUTOS $ UMBRELLA LIAB EACH OCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ WC STATU-OTH- WORKERS COMPENSATION TORY LIMITSER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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). CONTACT PRODUCER NAME: FAX PHONE (A/C, No): (A/C, No, Ext): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSRWVD GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY$ PREMISES (Ea occurrence) CLAIMS-MADEOCCURMED EXP (Any one person)$ PERSONAL & ADV INJURY$ GENERAL AGGREGATE$ GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ PRO- $ POLICYLOC JECT COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident)$ BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Per accident) AUTOS $ UMBRELLA LIAB EACH OCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ WC STATU-OTH- WORKERS COMPENSATION TORY LIMITSER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD / N933% RECEIVED rc) MAY 2 8 2021 Southold Town Clerk JE C ............... t� rT� P V" RE"CEIVED „.` $ a MAY q 2 1 7e w q i w p Wt h Jp m "row � ion X low Aw Y i I , q �ZVI n y�M"t lity m1N W��d mt , y r Wxk Amr'r e Ja~ � �� r 7m MCA la� � r P �a � mpFv�"e� � "✓as *.'m'y+r „, m�" ���.""'M �� ,"r' ., mF KIc All I r . 'w � . •'""k $Gs �. r x"^a'"�,;xi�'r i4 r wd� � Gm' A �� �� NONEa w *w 5/26/2021 Mail-Mail Service-Outlook m 1111R ' ��" ��1.O. w mmc �� �,,, niim~'m�mn Rall, m' mi1��m�m;,m Main�H,11ui1m�wmi. " 1 t.a�m�1:�', Am ail a mum m m 714 mmmmu,mtmm,Wm� ilii.°mw�mmmmwPom 11.91I. t%.MCiul.'A F AR OF VITAL TAL MWIrS"t"tCS III s.!mm 164�1 R 165 Z1, 5 31AR111,11AGE O tER lIOepiw m mll V 711181 RECORDIS WIZAGE,141AO AO mxidmdtomrn.1901 hImmmnm Y1111111 1 OFFICE VIII �" �y� WN C'mW '�Y RECEIVED fff. TOWN F 0I11 11io lll:) MAY 2 8 2021 APPLI!L-_oATVQN' Southold"rown Clerk APPLICATIO?4 IS w " vi,mm�mmm,� mai Sei��i���� ��. . ���': . State of"New 'York,fin permit m MADE, mm TVIW�k as heir rdficr spleen m m� . � 'Re] ,ef OO s 3rd Street Greeriport, NY' 11 ' 4 oivm &,rmv OF DISPLAY '7/4/2021 Start Time'—.-Pm Yercienrort Y SUFFOLK "�I , OWN(JIVIDER FOR SIT E-LQ.QL) � �..� ..... a�-5 , ......� . '.&IN 1, °"'� w, gym&TT. ` Start Tire P1 mIlm 1611owing pej sous mem:to be ill charge of the actlialshoofin of"the fimim . mer mm: me Agv ENiterienrellhysi l :""ondi imw n Lee Becker 51 � .m. Years Exmcilenm .._ .. ..................... (Additional rom m s and infimmation may be subminrAon an attached m hco Number ber and type fir,mvirks is sms rollwmr AQ proximate.1.y ( 1,820 Shots) 1.5" i eU m Manner lactof fireworks prkw � ....�.S ns�.ed..,,� mm"ll,Ae as L "cy�I ��� � � '� m � , 1�.,...oFe�, a �ii.O�. mmm...�. � mO m Attached mreto aiiad mmade a part of Ivereof i imam wuu off" A ;grousads on which the display is to be held. Also aftched in a certificate or polie �Ofjmm ij,�R mjAll"HI„ . �mmmmw mmmm �mmi muoiimm° " mien EE 100 ammmm�.�m� i,uw�g �immtt �ftmmm� See policy for additional information mn� httpsJ/outlook.live.com/mail/OAnbox/id/AQMkADAwATIwMTAwACOwMTIiLTRkMmEtMDACLTAwCgBGAAADuyEglSndMOW22n7lzJv8%2FAAHAGPd... 1/2 5/26/2021 Mail-Mail Service-Outlook KmIAA: tt t A.NEMLE, 1410C a w� � � t�i�uwrvriwu 'H'r� tV aBox ut�910CLERK "wwmmUwwt tte `du k wr11 9 rrP�Vt~1 tttt HAtOF VITAttttSTU tri ( � tt,tww 145 9Ottt Tt t r 55-1 Am Ot4,AG mprOtCHt COtt tC tA � 0� MtuA° tt.;OFFf UER m , I� ED OFFICE OF THLE, TOWN CLE11K MAY . 8 2021 TOWN OFSOUM10LD APPLICATION PERMFT110 DISPLAY FIREWORKS Southol i'"awn Clerk tmaprPLI A`imi iiNN IS i-i REB"V MADE, pz,jr.guw,jtto the p i,ovisiimm,me of Section 405,00 of dw Penal Lew of tine Ho Se �wtetc of N i e mGmmt tmm display ffie orks i eiri . er epm .i.ip i m DISPLAY iii ., E . SPOINSORED BY...ti taO'i� Co. p �� 1'01111"" �.�011WICE X e e p. r e qI O , O 11944 ,00�. . . �.... � . ree uupom t ttgiu... Ai.imm i 'Field. , µ, DAT� m TIME /2/2021 Oil DISPLAY OF Oti.... � YI RA F DISPLAY N DATE "BU',i° '-d,csd f Stark 1I kiia 11) t) The f"eii wing persow are to be in ebeuu� e of the actual sho0fing of the iirrer�ks: �1118nle Are Exper�ienmhs�iipe t Condition Lee Becker 51 n JF xccile 1 - dditieeei....names w inf6f,�� �m�. � J.tmoe may In submitud on an attachelwct lftm irx and type Df fir, "odkt is ws follows'-11 ,Approx irnat .,I. ' (1,300 SIhots) 1. 5" ..... �... . Fireworks . In a NYS [,icensed a...w _ee�m i.l.l ; eei� n4leee e teof fireworks �uiiee todisplay: .g . Inc. tme, OLane i � Y. , e.. .— Attached hereto and madr a part of hel-W u s die �ae `the grounds eui�e w1kierh the display to 1w, held, Also attached ceflificate or policy of inqus�u ee coverage ..,tiGit ittie tpermission,"m�vi sitm t ee Of the r t t p must i gl i�leit ed with the n. t ErE: $100 itm�mtue rrp i �p��uurur� a m".ruu See pmw�eiicy o e iti� m°mei iir, t m����� � t.ie�e � m a...��. ,z—.:, E Sippm°e~mtm.mm ^umij%pmpmiiu°: radii �p ru,ti� ei ,�wp�pudm�.,rtim https://outlook.live.com/mail/O/inbox/id/AQMkADAwATIwMTAwACOwMT[iLTRkMmEtMDACLTAwCgBGAAADuyEglSndMOW22n7lzJv8%2FAAHAGPd,., 1/2 CHIEF WAYDE MANWARING M� (631)477-9801 -STATION 1 1STASST CHIEF JAMES KALIN (631)477-8261 -STATION 2 (631)477-1943-CHIEFS OFFICE 2NDASST CHIEF ALAIN DeKERILLIS (631)477-4012-FAX CHAPLAIN FRANK MUSTO 311 THIRD STREET•P.O.BOX 58 CHAPLAIN CLAUDE KUMJIAN GREENPORT,NY 11944 Email:gfdfire@optonline.net SECRETARY/TREASURER JAMES KALIN www.greenportfd.org RECEIVED MAY 2 8 021 June 26, 2021 Southold Town Clerk Town Clerk Elizabeth Neville Southold Town Hall 53095 Main Road Southold, NY 11971 Re: July 2021 Carnival Fireworks Dear Ms. Neville: The Board of Wardens of the Greenport Fire Department at a regular meeting on April 20, 2021 approved the Phenix Hook& Ladder Co.#1 and Relief Hose Co.#2 request to hold a Carnival at the Polo Grounds on Moores Lane from June 30 through July 04, 2021 with Fireworks to be held on Friday,July 02 and Sunday,July 04, 2021 at 10:00 pm (rain date of Saturday,July 03, 2021 same time). If you wish to discuss this event with me or have any questions, please do not hesitate to contact me. I can be reached at 631.466.5294. I�spectfully, games H. Kalin 1st.Assistant Chief Greenport Fire Department NF"rl, STATE OF NEW YORK DIVISION OF DEPARTMENT OF LABOR Al SAFETY AND HEALTH LICENSE TO DEAL IN OR MANUFACTURE EXPLOSIVES Expires, 573112022._ Legion Fireworks Co., Inc. 10 Legion Lane THISUCENSE,01LIST S- BE- Wappingers Falls, NY 12590 PCS `"ED SIN YOUR s PLACE � OF BUSINESS . Frank Coluccio License No is hereby licensed to deal in or manufacture explosives in compliance with the requirements of the Labor Law and I e - h in the cond i fis under wi iich-this liceh-ge is granted may cause into be revoked. Eileen`M.Franko,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: t) 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. SH-862(5-98) U.S.Department of Justice Federal Explosives Licensi e/Permt Bureau of Alcohol,Tobacco,Firearms and Explosives (18 U.S.C Chapter 40) VNIAM 101=11RU MUMBUHHHURM In accordance with the provisions of Title X1,Organized Crime Control Act of 1970,and the regulations issued 1horeunder(27 CFR Part 535),you may engage in the activity specified in this license or permit within the limitations of Chapter 40,Title 18,United States Code and the regulations issued thereunder,until the expiration date shown. THIS Iff"ENSE IS Nar TRANSFERA,kl,,,r CFR 555.$3. See'WARNINGS"and"NOTICES"on reverse. Direct ATF ATF-Chief.FELC License, errmt Correspondence To 244 Needy Road Number wm Vff!tM1MZ= Martinsburg,WV 25405-9431 Chief,Federal FXplosives Licensing Cenler(I'EIA" Expiration If Date Name LEGION FIREWORKS CO INC Pre m1sesAddress(Changes? NctiR,the FELL at least 10 days before the move.) 10 LEGION LANE WAPPINGERS FALLS, NY 12590- Type of License or Permit 20-MANUFACTURER OF EXPLOSIVES .. ....................- Purchasing Certification Statement Mailing Address(Changes? Notify the FELC of any changes.) The licensee or permittee named above shall use a copy of this license or permit to assist a transferor of explosives to verifd,the identity and the licensed status ofthe licensee or pLi-tiiirteea,qprow'idedb),27C'I'll Past 5i5, LEGION FIREWORKS CO INC sii�iatare. Afluxect.scatiried or,e-mailed cop),offlic kcww or permit with a sijparure intended to be an original signature is acceptable. The signature must be that of the Federal 10 LEGION LANE Explosives Licensee(FEL)or a responsible person ofthe FEl- I certify that this is a true WAPPINGERS FALLS, NY 12590- copy of a license or permit issuedto the licensee or permittee named above to engage in the business oro nations specified zd;eve uu&T eor icenseorvermit", Licensee Permittee Responsible Person Si.-naturc Position'Title n Printed Name Iyate A'IFF'oan 544 14!5400 15 P&I I PrLviou.s Edition is Obwlete REMOR HOMMM,W 1wrWID UMN Mr -.20 OMFAMBM OF D LUSIRS Remsed Oa.ober 2011 Federal Explosives License(FEL),Customer Service Information Federal Explosives Licensing Center(FELC) Toll-free Telephone Number (877)283-3352 ATF Homepage:www.atf gov 244 Needv Road Fax Number: (304)616-4401 Martinsburg,WV 25405®9431 E-mail: FELCOatf 8ov ChangeofAddress (27CFR555.54(a)(1)). Licensees or pennittees may during the to of their current license or permit remove their business or operations to a new location at which they intend regularly to carry on such business or operations. The licensee or permittee is required to give notification ofthe new location ofthe business or operations not less than 10 days prior to such removal with the Chief Federal Explosives Licensing Center, The license or permit will be valid for the remainder of the to of the original license or permit, (The Chief,FELC,shall,if the licensee or permittee is not qualified,refer the request for amended license or permit to the Director of Industry Operations for denial in accordance mith§555.54.) Right of Succession (27 CPR 555.59). (a)Certain persons other than the licensee or permittee may secure the right to carry on the same explosive materials business or operations at the same address sho-w-n on,and for the remainder of the to 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 perritittee-,and(2)A receiver or trustee in bankruptcy,or an assignee for benefit of creditors. (b)In order to secure the right provided by this section,the person or persons continuing the business or operations shall furnish the license or permit for for that business or operations for endorsement of such succession to the Chief,FELC,within 30 days from the date on which the successor begins to carry on the business or operations. (Continued on reverse side) Cut Here Y-- ---- --- --- ---- ------------ - - Federal Explosives License/Permit(FEL)Information Card I Licens--Permit Name:LEGION FIREWORKS CO INC t is t Business Name: LicensePermit Number:6-NY-027-20-2C-00077 License Permit Type:20-MANUFACTURER OF EXPLOSIVES Expiration: March 1,2022 Please Moate„ Nck'Jand for the Sale or Other Disposition of Explosives. --- ---- --- ----- - - U.S.Department of Justice Federal Explosives License/Permit Bureau of Alcohol,Tobacco,Firearms and Explosives (18 U.S.C. Chapter 40) In accordance with the provisions of Title)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,Title 18,United States Code and the regulations issued thereunder,until the expiration date shown. HES'LICENSE TIS NOT TRANSFERABLE UNDER27(711 5i5.53. See"WARNINGS"and"NOTICES"on reverse. Direct ATT ATF-Chief,FELC License1>errrilt Correspondence To 244 Needy Road Number Iffm g lam 0 6 1 Marfinsburg.VTV 25405-9431 Chief,Federal FNphosivcs Licensing Cemer(1-11(';'7 Expiration Date Mame LEGION FIREWORKS CO INC Pre rmsesAddress(Changes? Nctifythe FELC atleast 10 days before the move.) 10 LEGION LANE WAPPINGERS FALLS, NY 12590- Type of License or Permit 51-IMPORTER OF EXPLOSIVES Purchasing Certification Statement Mailing Address(Changes? Notify the FELC of any changes.) The licensee or permittee named above shall use a copy of this license or permit to assist a transferor of explosives to verify the identity and the licensed status of the licensee of permittee as provided by 27 CFR Part 555. LEGION FIREWORKS CO INC ijMgLM A faxed,scanned or e-mailed copy of the license or permit with a signature intended to be an original signature is acceptable. The signature must be that of the Federal 10 LEGION LANE Explosives Licensee(FEL)or a responsible person of the FEL. 1certi6,thatthisisatrue WAPPINGERS FALLS, NY 12590- 1,op-yaralwus irlicnuilissued t 11 licensce iL�rnmitt eenarned above to engage in the b entlionsspecif ab;illau �eT�?of �Iense or lle-intuit."" 17i; 'P re 5;1 c , LicenscePermittee Responsible Person Signature Position'Title aonly rl. CCAUC60 X11Z Printed Name Date ATFForm 54 IJO 1454W 15 Pat I Revised October 2011 Prevujus Edition is Obsolete Federal Explosives license(FEL)Customer Service hiformation Federal Explosives Licensing Center(FELL) Toll-free Telephone Number. (877)283-3352 ATF Homepage:,www.atfaov 244 N Road Fax Number: (304)616-4401 Martinsburg,WV 25405-9431 E-mail: FELC(datfgov ChangeofAddress (27ChR555.54(a)(1)). Licensees or permittees may during the term of their current license or permit remove their business or operations to a new location at which they intend regularly to carry on such business or operations. The licensee or permittee is required to give notification of the new location 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 of the to of the original license or permit. (The Chief,FELC,shall,if the licensee or permittee is not qualified,refer the request for amended license or permit to the Director of Industry Operations ford in accordance%rith§555.54.) Right of Succession (27 CIFR 555.59). (a)Certain persons other than the licensee or permittee may secure the right to cam,on the same explosive materials business or operations at the same address shown on,and for the remainder of the term of,a current license or permit. Such persons are: (1)The surviving spouse or child,or executor,administrator,or other legal representative of a deceased licensee or permittee:and(2)A receiver or trustee in bankruptcy,or an assignee for benefit of creditors. (b)In order to secure the right provided by this section,the person or persons continuing the business or operations shall furnish the license or permit for for that business or operations for endorsement of such succession to the Chief FELC,within 30 days from the date on which the successor begins to carry on the business or operations. (Continued on reverse side) Cut Here X -- --- -- -- - ------- - ------- - ------ - Federal Explosives License/Permit(FEL)Information Card t License'Permit Name:LEGION FIREWORKS CO INC i Business Name: License,Permit Number:6-NY-027-51-2C-00091 LicensePermit Type:61-IMPORTER OF EXPLOSIVES Expiration: March 1,2022 JI'leaseNote: Not Valid for the Sale or Other Disposition of Explosives - - - ------ -- ---- ---------- ------ - ------- DATE(MM/DDI"Y) A CERTIFICATE O LIABILITY INSURANCE 5/26/2021 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 pollcy(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 PHONE 1 FAx 100 One Cleveland Center, Floor 30 1m88�" E-MAIL .... _. .hl� ! I�216-658 7101 1375 East 9th Street ADDRs ;.. .... ....m.,_ ............... �.... . Cleveland OH 44114 INSURERlS)AFFORDING COVERAGE NAIC# - ..... ........ .... .... .......... INSURER Axis Surplus Ins Company _ 26620 INSURED INSURER B:Everest National Insurance Company+ 10120 Legion Fireworks Co., Inc_ " '" 10 Legion Lane IN uRERc: Wappingers Falls NY 12590 INsUIRER D INSURER E INSURER F: COVERAGES C'ERTIFIC'ATE NUMBER:1861810038 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. m 9_. .._ —_..— _ _ _..__ - NSS" ,... �. .. ., ,...,.�.----_......�,ADDLUB� .- �,�. _ ��� POLICY EFF POLICY EXP LIMITS LTIc TYPE OF INSURANCE POLICY NUMBER MM/DD MMIDD B GENERAL LIABILITY S18ML00116-211 3115/2021 3/15/2022 EACH OCCURRENCE $1,000,000 DAaV4E-"9" WED—... X COMMERCIAL GENERAL LIABILITY PFt>MISE IE1 opturrryrp) ,_,.$500,000 CLAIMS-MADE X...� OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000.000 — _ _...... ............. GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000.000 POLICY XI LOC $ B AUTOMOBILE LIABILITY SIBCA00058-211 3/15/2021 3/15/2022 COMBINED SINGLE LIMIT JPer person)denI 10AQ0 000 ..... X BODILY INJURY ANY AUTO ( P AUTOS AUTOS 1 HIRED AUTOS AUTOS BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED B X X - �.., NON-OWNED PROPERTY� DAMAGE $ __._._.. A UMBRELLA LIAB X OCCUR P-001-000091848-03 3/15/2021 3/15/2022 EACH OCCURRENCE $4,000,000 ... — m, - ......... ..... ... _ X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 ..... DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH AND EMPLOYERS'LIABILITY Y N N. . ........:.TPE)LUIMIIT�._ .,,,,,,,�..... ......... ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ i 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 of Display:7/2/2021 Location of Display: Greenport High School 720 Front Street Greenport,NY 11944. Additionally Insured: Certificate Holder,Town of Southotd,Village of Greenport,Greenport Public Schools and Greenport Fire Department. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I Phenix Hook&Ladder Co.#1 &Relief Hose Co.#2 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 58 3rd Street AUTHORIZED REPRESENTATIVE Greenport NY 11944 - ©1988-2010 ACORD CORPORATION. II rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD " CERTIFICATE OFF LIABILITYINSURANCE DATE.26 02 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 IN'SURE'D,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 CONTACTBritton Gallaher ' NAMC 1_­­­­­_­ One Cleveland Center, Floor 30 E �u�, );_216-61 58 7100 mN 21 -658-710 1375 East 9th Street Appm s -11,11......1, Cleveland OH 44114 .....................................---. INSURERS At� -FFORDING COVERAGE.......................-----.._ ...._....... ..._. NAI ...................... C# m.................... INSURER A:AXIS Surplus Ins Company 26620 INSURED I Insurance Com an 10120 Legion Fireworks Co., Inc. ­,""I'll -...-,_.,,..._. P X Legion ane ... ........ . ..... _...... -- Wappingers Falls NY 12590 ►r uRER.n.:.. ... INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:1137930019 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. TYPE OF INSURANCE DLU (d....................._ .......,......_._.,.,,.,.,...... ... POLICY EFF......, -„w .... ,. ........ ........._.. NSR AD POLICY'EXP LIMITS LTR POLICY NUMBER MMIDD MMlITII B GENERAL LIABILITY S18ML00116-211 3/15/2021 3/15/2022 EACH OCCURRENCE $1,000,000 �kRAdE!fb X COMMERCIAL GENERAL LIABRILITY �FMJ5E l5.p rr � 6T ( � rfn nc $500,000 m, CLAIMS-MADE X OCCUR MED EXP Any one person)_ $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 ,..� ....... ,........ ..�.................- POLICY X LOC $ 81 AUTOMOBILE LIABILITY S18CA00058-211 3/15/2021 3/15/2022 COMM(O Mr�NED M"INi LFI IMI' 1 q _ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ —...., X )( NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS _(Peraccdent,)__.. $ A UMBRELLA LIABX OCCUR P-001-000091848-03 3/15/2021 3/15/2022 EACH OCCURRENCE $4,000,000 _. _. XEXCESS LIAB CLAIMS-MADE AGGREGATE �14.11100.000 . ,a ..._ .. , mm..— _---- _ _ ..._DED RETENTION - WORKERS COMPENSATION WC STATU. OTH- AND EMPLOYERS'LIABILITY ACCIDENT TQRY�LIwI,I S ..._._FR $ OFFICER/MEMBER EXCLUDED?ANY ECUTIVE Y� N/A E.L.EACH ENT (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,desco be under — OESCRIPTION OF OPERATIONS below EL_DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS f 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.of Display 76212.021. Location of Display.Greenport High School 720 Front Street Greenport,NY 11944- Addil'ionally Insured:Certificate Holder,Town of Southold„Village:of Greenport,Greenport Public Schools,Phenix Hook&Ladder Co.#1 &Relief Hose Co.#2, and Greenport Fire Department. CERTIFICATEHOLDER 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. Greenport High School 720 Front Street AUTHORED REPRESENTATIVE Greenport NY 11944 -------- @ 1988-2010 ACORD CORPORATION. I rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD A+ O CERTIFICATE O LIABILITY INSURANCE DATE(MM/)D/YYYY) 5/26/2021 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 Nd�4ML. Britton Gallagher PHONE - FAK. One Cleveland Center, Floor 30 ( ( W,f ,2165&7100 Ic wap) 216 658 7101— 1375 East 9th Street AD IRIESS: Cleveland OH 44114 INSURERRAFFORDING COVERAGE NAIC# INSURER._— __..., A:Axis Surplus Ins Company 26620 Legion Fireworks Co., Inc. a Com.aq,. _...... . . 10120 INSURER B Everest National Insurance P y 10 Legion Lane INsuRERa Wappingers Falls NY 12590 iN uRERD:... . ... _,.. ....., INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1229504566 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF„� .....e.,.. ,,... .w Ab L 'Ft s mW....._..__- POLICY EFF POLICY CCP ..i NSR.._. __ ..... INSURANCE INSR WVD POLICY NUMBER MMIDD MMIDDAM" LIMITS B GENERAL LIABILITY SIBML00116-211 3/15/2021 3/1512022 EACH OCCURRENCE $1,000,000X.."' tI�'i;�AG��f�Ikfl=iaTEo .. COMMERCIAL GENERAL LIABILITY PR'EMISFS IES ocr arromrta $500 000 ..., ...._.-_ CLAIMS-MADE X OCCUR MED EXP(Any one person)� $ i PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2000.000 POLICY XII 111; LA LOC $ T ._ B AUTOMOBILE LIABILITY SIBCA00058-211 3/15/2021 3/15/2022 COMBINED Ea BIKED SINGLE LIMIT ,,. . O ) ... _ ... 1.RI S .......... X ANY AUTOBODILY INJURY(Per person) $ .......... ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS XX NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS 2Per alder ---- I 1$ A UMBRELLA LIAB X P-001-000091848-03 3!1512021 3/15/2022 EACH OCCURRENCE $4,000,000 X EXCESS LIAB OCCUR DE AGGREGATE 54000000 DEQ RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN - OR („IMITS R ANY PROPRIETOR/PARTNER/EXECUTIVE N/A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED. - (Mandatory in NH) E.L.DISEASE-EA.EMPLOYEE: $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLIC If yes,describe under Y 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. Date of Display:7/4/2021 Location of Display: Greenport High School 720 Front Street Greenport,NY 11914. Additionally Insured: Certificate Holder,Town of Southold„Village of Greenport,Greenport Public Schools and Greenport Fire Department. CERTIFICATE HOLDER CANCELLATION' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Phenix Hook&Ladder Co.#1 &Relief Hose Co.#2 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 58 3rd Street '..�AUTHOR1770 REPRESENTATIVE Greenport NY 11944 .. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD . CERTIFICATE OLIABILITY INSURANCE DATE(MM/DD/YYYI(J 5/26/2021 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 pollcy(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( ), PRODUCER C NTA T NAME. _ Britton Gallagher PHONE _ FAX No 216-658 710 One Cleveland Center, Floor 30 E-MAIL°. xt)„216-658-7100 --,_�-_ 1 1375 East 9th Street A DDRES& _ Cleveland OH 44114 IN _ I I „ NAIC# �.. .. SURER S AFFORDING COVERAGE .. m. ................. ..__---_ ....... ......... _.. 6620 ___ INSURER A:AXIS SU lus Ins Company INSURER B:Everest National Insurance Company 1 INSURED 0120 Legion Fireworks Co., Inc. 10 Legion Lane ____.,__,_.__ Wappingers Falls NY 12590 INSURER D INSURER E ----------- INSURER F: COVERAGES CERTIFICATE NUMBER:1193566324 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.AWLS0LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ..TYPE OF INSURANCE-.. POLICY NUMBER MIMMDIYYYY MMID IPOLICY EFF Y .. - YYYY LIMITS B GENERAL LIABILITY SIOML00116-211 3/15/2021 3/15/2022 EACH OCCURRENCE $1,000,000 ,.� O SAI� �($ - X � CLAIMS-MADE OCCUR MEEMISES(Ea oer�urroruco) EXP(MY ane�erson) $ m$ _ COMMERCIAL GENERAL LIABILITY PR.. ._ .500.000 .. PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENrL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,090,000 PRO $ V POLICY F LOC B AUTOMOBILE LIABILITY S18CA00058-211 3/15/2021 3115/2022 COMBINED SINGLE LIMIT [.,aarggnr5.�_. ...---....—. 1�000�10a ..... X ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS OWNED SCHEDULED AUNJURY(Peraccident)''$ .................... . �...m......m�BODILYINJURY .--,._,..w....�.....-....................-__— X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS LPC.rlGcmG).w. — $ A UMBRELLA LIAB X OCCUR P-001-000091848-03 3/15/2021 3/15/2022 EACH OCCURRENCE $4,000.000 X EXCESS LIABCLAIMSMADE AGGREGATE $4,000 000 ...... DEDRETENTION.$... . . ._...._. — $ WORKERS COMPENSATIONWC STA7I1- OTH AND EMPLOYERS'LIABILITY YIN - TDRX.I lA?ITs ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA ...., ...... __,. (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under —_.... ._.. DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 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 of Display.7/4/2021. Location of Misplay.Greenport High School 720 Fronk Street Greenport,NY 11944. Additionally Insured:Certificate Holder,'Town of Southold,"pillage o(Greenport,Greenport Public Schools,Phenix Hoofs&Ladder Co..#1 &Relief Hose Co.#2, I and Greenport Fire Department. 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. Greenport High School 720 Front Street AUTHORIZED REPRESENTATIVE Greenport NY 11944 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD