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DENIS NONCARROW �S � Town Hall,53095 Main Road TOWN CLERK ® P.O.Box'1179 &0 U. Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICERTelephone(631)765-1800 RECORDS MANAGEMENT OFFICER ®•� �� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT 2022 for PUBLIC DISPLAY OF FIREWORKS I,Denis Noncarrow,Town Clerk of the Town of Southold, Suffolk County,New York,being an officer duly designated by the Town Board of the Town of Southold for this purpose, do hereby GRANT TO: SANTORE'S FIREWORKS on behalf of MATTITUCK ENVIRONMENTAL,LLC/ STANLEY LOMANGINO A PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York, on Monday, July 4, 2022 at 9:15 P.M. (Rain Date: Tuesday, July 5, 2022 at 9:15 P.M.) on private beach located at 9205 Skunk Lane, Cutchol!ue, New York,the time and place set forth in the application therefore, ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feet from the nearest above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such a display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines; that all fireworks that fire a projectile shall be so set up that the projectile will go into the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore or a lake or other large body of water, then they may be directed in such a manner that the falling residue from the deflagration will fall into such lake, or body of water; that any fireworks that remain unfired after the display is concluded shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task,that there shall be at least two such operators constantly on duty during the discharge and that at least two soda-acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actu 1-ea of the dis lay. This permit is issued subject to the applicants com liancV ,with all Exec ive Orders of the State of New York and the requirements of the Town's policy re ardin e ishuance w4 fireworkspermits; and conditions and requirements of the New York State Environmental C n e ation• a UWVish &Wildlife Service. Dated: May 24 ,2022 e is Noncarrow,,Town Clerk Town of Southold. Suffolk County,New York THIS PERMIT IS NOT TRANSFERABLE Southold Town Board - Letter Board Meeting of May 24, 2022 RESOLUTION 2022-466 Item # 5.48 off y�a ADOPTED DOC ID: 18133 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2022-466 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MAY 24, 2022: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a Fireworks Permit by the Town Clerk to Mattituck Environmental LLC for a fireworks display on Monday, July 4, 2022 at 9:15PM (Rain Date: Tuesday, July 5, 2022 at 9:15 PTA) at 9205 Skunk Lane, Cutchogue, New Yor]<, upon payment of a single fee of$100.00 and subject to the applicant's compliance with the requirements of the Town's Policy regarding the issuance of fireworks permits. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIiMOUS] MOVER: Greg Doroski, Councilman SECONDER:Louisa P. Evans, Justice AYES: Nappa, Doroski, Nlealy, Doherty, Evans, Russell Generated May 25, 2022 Pale FW: [EXTERNAL]Re: Letter for Fireworks Stanley Lomangino <slomangino@mesliny.com> RECEIVED Mon 5/23/2022 10:04 AM To:Krystal Bialeski <kbialeski@mesliny.com> This needs to go to town along with the letter. SAY 2 3 2022 4 From:August Santore<santore.law@gmail.com> Du thold T own C, Sent: Friday, May 20, 2022 8:57 PM -+ ------ To:Stanley Lomangino<slomangino@mesliny.com> Subject: [EXTERNAL]Re: Letter for Fireworks Caution: This is an external email from outside your organization. Please take care when clicking links, opening attachments or someone asking for sensitive information. When in doubt, contact your IT Department. Stanley--my staff sent the email which I dictated and just saw. Sorry for the typo in the subject they sent. I had instructed them to make sure you send in the check with the letter. Same amount as last year. Believe it is $100. I am not in the office to confirm. I sent everything else. Let's connect on Monday to make sure we are on the same page with the environmental elements. My cell 9088720624. Please call at me your convenience. If tomorrow is better--I am available tomorrow until 1 pm and then I have some games and functions with some different teams I coach in town that will take the rest of the day. Have a nice weekend. -Augie Sent from my iPhone On May 20, 2022, at 4:07 PM,August N. Santore, Jr. <asantorejr@santorefireworks.com> wrote: Stanley, Please see attached letter which you should sign and bring to the town as part of the application for the fireworks display. The rest of the application was sent via FedEx to the town today and will arrive on Monday. August N. Santore,jr. nb Virus-free. www.avast.com <Letter for App Packet.pdf> Date: 5/17/22 Town of Southold Office of Town Clerk Ms. Elizabeth Neville, MMC 53095 Main Road Southold,NY 11971 Dear Ms. Neville, Santore's World Famous Fireworks has been contracted by Mattituck Environmental for firework display on July 4, 2022 with a rain date of July 5, 2022 on my property located at 9205 Skunk Lane, Cutchogue,NY. As required in the application for a permit to display fireworks in the town of Southhold, this is a notice of written permission for said display. Thank you, 1 �` Stanley Lomangino E .. CEavE® MAY 2 3 2022 SANT Southold Town Clerk -WORLD MOUS- FIREWORKS ORKS Date: 5/17/22 Town of Southold Office of Town Clerk Ms. Elizabeth Neville, MMC 53095 Main Road Southold, NY 11971 Dear Ms. Neville, Enclosed please find one application for a permit to display fireworks on July 4, 2022 at the Lomangino property at 9205 Skunk Lane. All the required paperwork is attached for your review for each application. If you have any questions or concerns, please do not hesitate to contact me at (908) 872-0624 or my email, asantorejr@santorefireworks.com. Thank and stay safe, 4 Aug st ntore, Jr. Santore's Wo ld Famous Fireworks Main Office: PO Box 687, Stillwater, NY 12170 (P) 518-664-9994 Email: Info@santoreworldfamousfireworks.com Visit Our Website at: www.santoreworldfamousfireworks.com v®g�FFOL�` , ELIZABETH A.NEVILLE,MMC �y� �y Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 � Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ® Fax(631)765-6145 MARRIAGE OFFICER �� ®�' Telephone(631)765 1800 RECORDS MANAGEMENT OFFICER ®1 `�► www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER 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. 3. The exact location planned for the fireworks display,including TAX MAP NUMBER. 4. The age,experience and physical characteristics of the persons who are to. do the actual discharging of the fireworks. . 5. The number and kind of fireworks to be discharged. 6. The manner and place of storage of such fireworks prior to the display. 7. A diagram of the grounds on which the display is to be held,showing the point at which the fireworks are to be discharged, the location of all buildings, highways and other lines of communication, the lines behind which the audience will be restrained and location of all nearby trees, telegraph or telephone lines or other overhead obstructions. 8.1 Such other information as the Southold Town Clerk may deem necessary to protect persons and property. Written permission of the property owner is required. 9. An indemnity insurance policy with liability coverage and indemnity protection of $1,000,000.00 per person for bodily injury; $1,000,000.00 per accident; $1,000,000.00 property damage. 10. The Town Clerk of the Town of Southold must have the insurance policy in her possession before the fireworks permit is issued. The named insured must read:TOWN OF SOUTHOLD. Thirty (30)Town of Southold POLICY 11. Application for a fireworks permit must be made at least fdays in advance of the date of the fireworks di, splay. (The above instructions are in accordance with the Penal Law, Article 405 - Licensing and other provisions relating to fireworks.) MYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) D. .'� .9. n A A'A A n 472010297 SANTORE'S WORLD FAMOUS - FIREWORKS LLC .v 143 SUMMIT AVE BERKELEY HEIGHTS NJ 07922 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SANTORE'S WORLD FAMOUS LOMANGINO, STANLEY FIREWORKS LLC 9205 SKUNK LANE 143 SUMMIT AVE CUTCHOGUE NY 11935 BERKELEY HEIGHTS NJ 07922 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2353 260-9 783074 02/07/2022 TO 02/07/2023 5/17/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2353 260-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:484113184 o��S11FF01�►co ELIZABETH A.NEVILLE,MMC �Q+ Gyp Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 y Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p . Fax(631)765-6145 MARRIAGE OFFICER �' RECORDS OF MANAGEMENT OFFICER ��1 .�� Telephone n.no 7 fork. 0 FREEDOM OF INFORMATION OFFICER. southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisipns of Section 405.00 of the Penal Law of the State of New York,for a permit to display f'i'reworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY Mattituck Environmental PRINCIPAL OFFICE AT 800 Wickham Avenue;Mattituck, NY 11952 DATE&TIME OF;DISPLAY 7/4/22 at 9:15 PM EXACT LOCATION•OF DISPLAY Private Beach at 9205 Skunk Lane, Cutchogue, NY SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE &TIME 7/5/22 at 9:15 PM The following persons are to be in charge,of the actual shooting of the fireworks: Name Age Experience Physical Condition Christopher Acierno 47 14 + Years Health: Excellent (Additional names and information may be submitted on an attached sheet Number and type of fir=/e�w�j rk. as follows: 1.4 G Cakes-. 155 1.3 G Cakes-48" 5 2.5" Shells-0@ wo Manner and place of stora of fireworks prior to display: Delivery of product on day of display Attached hereto and made a part of hereof is a diagram of the grounds on which the display is to be held. Also attached is a certificate or policy of insurance coverage. NOTICE: Written permission,,with signature of the Property Owner, must be submitted with the Application. Santore's.World Famous Fireworks, LLC FEE: $10.0 Name of Org tion Sge_goficv:_for__.a�j+�^ al information August N. Santore, Jr. By PrintedName of Applicant Signature of A licant e-mail address. asantorejr@santorefireworks.com 5/17/22 Telephone Number (908)872-0624 Date of Application ELIZABETH A.NEVILLE,MMC �� .y Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ® Fax(631)765-6145 MARRIAGE OFFICER � ®�' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ®.` `� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD POLICY for the Issuance of Fireworks Permits 1. The Town may grant a permit for the display of fireworks by municipalities, fair associations, amusement parks, erp sons or organizations of individuals. Penal Law Section 405.00(2). 2. An"organization of individuals"is a religious, civic, or comparable organization. Op. Atty. Gen No. 2007-3. 3. Fireworks permits shall indicate that the display must be concluded by 10:00 p.m. if held Sunday-Thursday, 11:00 p.m. if held Friday or Saturday, and there shall be no time restriction if held on July 4. 4. No person shall engage in or allow the manufacture,assembly, storage or display of any fireworks or pyrotechnics display without first obtaining a permit issued by the Town Clerk. A completed application for display of fireworks must be received by the Town Clerk a minimum of 30 days prior to the date of display. The permit application for any fireworks or pyrotechnics display shall,be accompanied by the following: (a) a copy of a valid certificate of competency as a pyrotechnician for the individual supervising the firing of the display; (b) Certificate of Insurance naming the Town of Southold as additional insured with coverage limits of$2,000,000 for public liability and$2,000,000 for property damage; (c) Detailed diagram showing location of fireworks discharge and minimum separation distances in accordance with the applicable requirements of Penal Law Section 405(2); (d) A copy of the contract with fireworks display company; and (e) All applications shall require the approval of the Fire Chief of the District in which the display will take place and the Fire Marshal before being presented for approval by the Town Board. 5. All applications for a fireworks 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. (The above instructions are in accordance with the Penal Law, Article 405 - Licensing and other provisions relating to fireworks.) A P HYSIF New York state Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) U. .D ^"^^^n 472010297 _ SANTORE'S WORLD FAMOUS FIREWORKS LLC 0 .f 143 SUMMIT AVE BERKELEY HEIGHTS NJ 07922 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SANTORE'S WORLD FAMOUS LOMANGINO, STANLEY FIREWORKS LLC 9205 SKUNK LANE 143 SUMMIT AVE CUTCHOGUE NY 11935 BERKELEY HEIGHTS NJ 07922 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2353 260-9 783074 02/07/2022 TO 02/07/2023 5/17/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2353260-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:INVWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO 'THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS , CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:484113184 U-26.3 S.I NT , WORLD FA OOS- EIREWORI .S SPONSOR: Mattituck Environmental Fireworks Company Santore's World Famous Fireworks, LLC P: 518-664-9994 F:518-662-9811 Email: Info@santoreworldfamousfireworks.com Show Date(s):7/4/22 Rain Dates(s): 7/5/22 Location: Stanley Lomangino Property, 9205 Skunk Lane, Cutchogue, NY Time: 9:15 pm 1. Total number of Class B shells being used: 330—2.5" Total Cakes: 1.3G—48; 1AG - 34 2. All shells are DOT approved. 3. Display will be fired electrically and/or manually. 4. Delivery to site will be approximately 12 o'clock Set up will take approximately 4-5 hours 5. All displays will comply with all requirements as set forth in NYS Penal Code 405 and NFPA 1123, 1124. 6. Santore's World Famous Fireworks has complete understanding of all rules and regulations governing public fireworks displays and this display will be in accordance with those rules and regulations. 7. Personnel representing fireworks display company: Lead: Christopher Acierno (NYS DOL license#PR-177) 8. Technicians: TBD Signed Main Office: PO Box 687, Stillwater,NY 12170 (P) 518-664-9994 Email: Info a,santoreworldfamousfireworks.coin Visit Our Website at: www.santoreworldfamousfireworks.com U.S. Eastern Service Center 1701 Columbia Ave. Department of Operations Support College Park,GA Transportation Group AJV-E2 30337 FIREWORKS DISPLAY NOTIFICATION Company Name: Santore's World Famous Fireworks Email Address of Person Submitting Request: asantoreir&santorefireworks.com Cell Phone Number for On-Site Technician: Chris Acierno, (516)426-0334 Event Name: Lomangino Private Party Display Date:7/4/2 2 Rain Date:7/5/22 & 7/9/22 Display Start Time:9:15 pm Duration of Fireworks Display: 15-20 min. Max Height of Fireworks:200 feet Address,City and State: 9205 Skunk Lane, Cutchogue, NY Latitude:41° 01' 0 4" (North) Longitude: 7 2 0 2 6' 5 6" (West) List the Closest Public Use Airport Within 5 Nautical Miles of the Display if the Fireworks Will Reach or Exceed 500 Ft. Special Notes Please email your request to: 9-ATO-ESA-OSG-Fireworks@faa.gov 10580 FIREWORKS DISPLAY AGREEMENT Display Date: 07/4/22 AGREEMENT by and between Santore's World Famous Fireworks, LLC whose address is 846 Stillwater Bridge Road, Schaghticoke, NY 12154(hereinafter"Santore");and Stanley Lomangino,9205 Skunk Lane, Cutchogue, NY 11935 (hereinafter"SPONSOR"). WHEREAS, SANTORE designs,produces,and conducts fireworks displays;and WHEREAS,SPONSOR wishes to engage Santore to design, produce and perform a fireworks display on the terms and conditions hereinafter set forth; NOW,THEREFORE, in consideration of the terms,conditions and covenants hereinafter set forth,the parties hereto do mutually agree as follows: 1. FIREWORKS DISPLAY: On,July 4,2022(hereinafter"the Display Date"), Santore shall provide the fireworks and equipment for the display at the Fireworks Display location.The display will be under the supervision of a Santore trained technician. It is agreed that Santore shall be the sole fireworks supplier and producer for the event contracted for herein. (Note: The actual start and stop time of the display will be determined by the governmental authorities having jurisdiction over the display). ALTERNATE DATE.July 5, 2022 2. COSTAND PAYMENTS: FIREWORKS DISPLAY PRICE: $ The total(Fireworks Display Price plus all other applicable charges)sum ofshall be due and payable as follows: a. The sum of: ' due by February 15,2022. b. The Balance of (which includes any taxes that may be applied to this sale) shall be paid to Santore within 10 days after display. ""C.$10,000.00 CREDIT OF ADDITIONAL MATERIAL PRODUCT WILL BE PROVIDED BY SANTORE INCREASING THE SHOW BY APPROXIMATELY 1/3 LARGER AT NO CHARGE TO SPONSOR. Please Note: SPONSOR is responsible for the payment of all governmental fees and taxes, including, but not limited to,sales, use, excise,license,permit,entertainment,or other fees,taxes or surcharges imposed or otherwise applied to this exhibition. Also,please see Section 16(c)below. 3. POSTPONEMENT/RESCHEDULING:Rain Date 7/5/22, If show is postponed as per below Description /o of Fireworks Display Price Additional Costs If notified by 6:01 AM on 07/412022 10% Any 3rd Party Vendor Expenses When fireworks tech leaves facility 0% Any 3rd Party Vendor Expenses Any request made by SPONSOR for rescheduling/canceling shall be directed to info santorefireworks.com or by phone(518)664- 9994. It is understood and agreed that SANTORE shall have no obligation to reschedule a display except as required by inclement weather or reasons beyond the control of SANTORE. 4. SPONSOR'S AGENT: CELL PHONE: shall be designated as SPONSOR'S agent to whom all questions and inquiries shall be relayed. Sponsor's agent shall be the only agent of SPONSOR authorized to make decisions on behalf of SPONSOR or to request rescheduling of the fireworks display on the part of SPONSOR. 5. EXHIBITION PLANNER CHECKLIST. It is understood and agreed by the parties hereto that the Fireworks Display shall be contingent upon the strict compliance by SPONSOR with all items specified on the Exhibition Planner Checklist(EPC)which is annexed hereto and made a part hereof. Failure on the part of SPONSOR to comply with all requirements set forth in the EPC to the satisfaction of Santore within the time limits therein set forth shall be deemed to be an event of default of SPONSOR'S obligations hereunder. 6. SECURITY/SAFETY: SPONSOR shall provide and maintain sufficient Security before,during and after the Fireworks Display until the pyrotechnician in charge declares the area clear. Security shall be deemed to include, but not limited to, be all security lines,police protection,snow fencing, rope lines,barricades or any other item deemed necessary by the local government or by Santore.SPONSOR shall also provide and maintain an area clear of any buildings cars and spectators with a minimum radius Please initial each page. Initial here: Sponsor SANTORE as specified by current edition of NFPA Code 1123, as a Fire Safety Zone(FSZ)during the entire period commencing from the time the fireworks are delivered to the site until the area is declared clear by the pyrotechnician. It is understood and agreed that Santore will cease all fireworks discharge due to any security breach of the FSZ. Santore shall not be responsible for personal injury,vehicle or property damage occurring within the FSZ as a result of the SPONSOR's failure to maintain the FSZ in accordance with the standards of current edition of NFPA 1123 which, incidentally,are only minimum standards of distances. SPONSOR acknowledges and agrees that Santore responsibilities are limited to the Fireworks Display and that Santore is relying on SPONSOR to maintain the aforementioned FSZ and to comply with all Federal,State, municipal and local laws, orders,regulations and ordinances pertaining to the implementation of any and all security measures at the site of the Fireworks Display.Any site visits made during the display setup by or on behalf of SPONSOR shall be in accordance with the current edition of NFPA 1123-and under the direct supervision of the Santore technician in charge.Any such inspection shall not in any way interfere with the safety,setup or schedule of the preparation for and disassembly after the Fireworks Display. The Santore technician in charge may,at his discretion,cancel any inspection that in his sole opinion may compromise the safety of the setup or the Fireworks Display or the setup schedule. The SANTORE technician may at any time temporarily discontinue the discharge of fireworks for any reason. 7. CREDITS: As.a material inducement to Santore agreeing to enter into this Agreement,SPONSOR shall give Santore program credit as sole fireworks supplier and producer in all press releases,advertising,and any other program announcements, printed or otherwise. 8. INABILITY to DELIVER or CONDUCT FIREWORKS DISPLAY/FORCE MAJEURE. Santore shall not incur any liability for any loss or for any failure to perform any obligation hereunder due to causes beyond its reasonable control including without limitation legal or regulatory restrictions, labor disputes of whatever nature, power loss,telecommunications failure,acts of God, or any other cause beyond its reasonable control. In the event SANTORE is unable to deliver the Fireworks Display on the Delivery Date this contract will remain in full force and effect and the Fireworks Display will be performed on the Alternate Date or if no Alternate Date is stated then on such other date as may be agreed upon by the parties. 9. CONTRACT SUBJECT TO GOVERNMENT REGULATION: This Agreement and Santore obligations hereunder are subject to all applicable Federal,State, Municipal and local laws, rules,ordinances,regulations and codes, now or hereinafter in effect, and to the conditions and limitations contained in the permits required to be obtained by SPONSOR prior to the Fireworks Display. In the event any Federal,State,municipal or local law, rule, regulation or ordinance shall be enacted which in any way prohibits, limits or restricts the sale, performance or operation of the exhibition of the Fireworks Display or in the event SPONSOR'S permit in any way limits or restricts the sale, performance or operation of said exhibition, Santore shall limit or restrict its performance or the Fireworks Display so,as to comply with such law, rule, regulation or ordinance or limitation or restriction of SPONSOR'S permit.SPONSOR acknowledges that any such limit or restriction placed on the performance or operation of the Fireworks Display shall in no way result in or entitle SPONSOR to a reduction or abatement in the full contract price. 10. GENERAL PROVISIONS: a) This agreement constitutes the entire agreement between the parties relating to the subject matter hereof,and may not be changed, modified, renewed or extended except by a written agreement,signed by both parties. SPONSOR acknowledges and agrees that Santore has not made any representations or warranties except those specifically set forth in this contract. Should any clause,section,or part of this agreement be held or declared to be void or illegal for any reason,all other clauses, sections,or parts of this agreement which can be effected without such illegal clause,section, or part shall nevertheless continue in full force and effect. b) SPONSOR is responsible for removal of paper debris associated with the Fireworks Display. c) Santore is not responsible for procuring any marine services associated with the production of SPONSOR'S event. Should SPONSOR require these services, Santore may, upon written request, assist SPONSOR in the location and. contracting of such services. All additional costs and fees associated with marine services are the responsibility of the SPONSOR. It is specifically understood and agreed that Santore shall not be responsible in any way if any third-party service with which SPONSOR has contracted for service fails to perform and the display cannot proceed as planned. d) SPONSOR is responsible for any additional marine costs and fees, city permitlescort fees, County/State/PD/FD/FM fees, local town permit fees,etc. e) In the event SPONSOR cancels the Fireworks Display the full contract price as set forth herein shall become immediately due and payable. SPONSOR will have up to 30 days from the date of cancellation to request Santore to reschedule the Fireworks Display. Fireworks Display shall take place no later than six months from originally scheduled Fireworks Display and may not be rescheduled to 7/1 —7/4 of any year without express consent of Santore. f) Santore agrees to procure liability insurance on behalf of SPONSOR,and to indemnify SPONSOR,to the extent thereof, for all claims arising out of Santore negligence. Any additional insurance that is required that incurs a cost,will be the SPONSOR'S responsibility. Please initial each page. Initial here: Sponsor SANTORE 11. SPONSOR'S DEFAULT: In the event SPONSOR shall fail to pay any sum when due under the terms of this contract, SPONSOR shall pay,in addition to such amount, interest at the rate of 1.5%per month on the unpaid amount from the original due date. SPONSOR does further agree that it shall pay Santore reasonable attorney fees and other costs in the event Santore shall commence any proceeding(Arbitration or any other proceeding)or incur fees to compel SPONSOR to pay any sums due hereunder or otherwise as a result of SPONSOR'S default of any of the terms and provisions herein contained. 12. LIQUIDATED DAMAGES: It is agreed by and between the parties hereto that in the event of SPONSOR'S default hereunder Santore shall be entitled to receive the entire contract price and same shall be considered"liquidated damages"based upon an understanding between the parties hereto that Santore will have suffered damages due to Sponsor's default.The damages suffered by Santore as a result of Sponsor's default will be substantial, but incapable of determination with mathematical precision. It is,therefore,agreed by the parties that the amount due Santore is not a penalty, but rather a mutually beneficial and reasonable estimate of the damages suffered by Santore. 13. SUBSTITUTIONS: Santore shall have the right,at its discretion,to substitute any fireworks it deems necessary provided same does not detract from the aesthetic value or quality of the program.This includes, but is not limited to,shell sizes, quantities,types and brand names. Any substitutions shall in no way result in or entitle SPONSOR to a reduction or abatement of the full contract price. 14. ARBITRATION: Any and all disputes,differences,or any other type of controversy arising out of or in relation to this Agreement, including as to the meaning or interpretation of any provision hereof,shall be resolved by arbitration in Union County, NJ, pursuant to the commercial rules then obtaining of the American Arbitration Association. Only one(1)arbitrator shall be required,and the arbitrator may award attorneys'fees.The award of the arbitrator shall be final and binding and judgment may be entered thereon in any court of competent jurisdiction.The arbitrator sitting in such controversy shall have no power to alter or modify any express provision of this.Agreement,nor to make any award which by its terms effects any such alteration or modification. Either party may seek from the court of competent jurisdiction any provisional remedy in aid of arbitration,including, but not limited to,injunction,attachment or replevin,pending the determination of any claim or controversy in arbitration. Any and all disputes,controversies,actions,claims,causes of action, or proceedings arising under, out of,or in connection with or relating to the terms of this contract,and any amendment thereof,commenced by, between or against any of the parties of this contract shall be deemed to have arisen from a transaction of business in New York, and shall be resolved by application of the substantive laws of the State of New Jersey. 15. BINDING EFFECT: This contract shall not be binding on Santore until executed by SPONSOR and Santore and Santore is in receipt of the down payment required hereunder. 16. EXHIBITION PLANNER CHECKLIST(EPC): a) FIREWORKS DISPLAY PERMIT: (Note: The actual start and stop time of the display will be determined by the governmental authorities having jurisdiction over the display). SPONSOR'S RESPONSIBILITY: It is Sponsor's responsibility to call your State, City, County,Town, Borough, or Village Fire Marshal or other appropriate authority to file for and obtain the Fireworks Display permit. Santore will prepare the paperwork for the permit application on SPONSOR'S behalf. Upon receipt of your permit,you must send the permit to our office for our records no later than 30 days prior to your display date. Failure to do so could seriously Jeopardize your display. You must obtain information on: 1. Filing application deadline and fees. 2. Local and state requirements for fireworks license for transportation and/or display. If a license is required,fax all forms immediately to us. 3. Fire Marshal's requirements for security of fireworks truck upon arrival, and the security of the fire zone before and during the display. 4. Federal regulations require that we carry an accurate route plan to the display site. Fax us a copy of the route instructions from the nearest US Interstate to the display area(approved by the fire marshal or other authority,if necessary). 5. Notify FAA on day of your display,according to the instructions in the FAA Letter of Approval,which will be forwarded to you prior to your display. Please initial each page. Initial here: Sponsor SANTORE 6. Sponsor shall be responsible for obtaining necessary U.S. Fish and Wildlife clearance to piping plover's or other species. a.COAST GUARD PERMITS(where required): 1. If the fireworks are to be displayed on or near the water,the following may be required: (Requests for permits must be filed at least 60 days prior to the Display Date(135 days prior for 4th of July events). 2. Coast Guard.Application and Permit to Handle Hazardous Materials. 3. Coast Guard Marine Event Permit. 4. In the event that a Coast Guard Permit is not issued,Santore will be unable to perform the display. c.SPONSOR RESPONSIBILITIES AND EXPENSES(The followina services need to be provided and paid for by the CpnN-ROR in addition to the Fireworks Display Price- 1) rice_1) SECURITY: MUST BE PROVIDED FOR FIREWORKS TRUCK(s)AND TO MAINTAIN THE FIRE SAFETY ZONE AT STAGING AREA FROM FIREWORKS TRUCK(S)ARRIVAL,UNTIL TRUCK DEPARTURE WHICH MAYBE'FOLLOWING THE REQUIRED FIRST LIGHT DUD SEARCH ON THE MORNING AFTER THE DISPLAY. .2) Sand: Please provide yards of sand. 3) Laborer(s): laborers to arrive at fireworks site on (They will not handle fireworks). 4) Hotel Room(s): hotel rooms(within 10 miles of show site). 5) Vehicle(s): Four-wheel drive vehicle for movement on sand:Yes No 6) If you have ordered a set piece(s),you are responsible for erecting the scaffolding and it must be ready when. the crew arrives g.RADIO SIMULCAST EXPENSES(if applicable): 1) Set up and staff a firework simulcast command center on site by 1:00 PM on the display date. 2) Provide broadcast relay to Santore Firing Center. Call our office for details. 3) Speaker system for VIP viewing stands. e. INSURANCE: Please list below the additional insured,as they should appear on the insurance certificate: 1. 3. 2. 4• Name of Sponsor Date Santore Signature Date By: - Signed by on behalf of Sponsor(Signature) Print Name: August N.Santore,Jr. Title of authorized representative of Sponsor Title: Owner Please initial each page. Initial here: Sponsor SANTORE Santore DISPLAY SITE PLAN QUESTIONNAIRE All items listed below are subject to all governing Federal,State,Municipal and local laws,rules,ordinances,regulations and codes,now or hereinafter in effect,and to the conditions and limitations contained in the permits required or to be obtained by Sponsor. SPONSOR: Display Date 7/4/2022. Rain Date: 7/5/2022 Budget: $31,000.00 Display Location: 9205 Skunk Lane, Cutchoque, NY Time of Display: 9:15pm (Note: The,actual start and stop time of the display will be determined by the governmental authorities having jurisdiction over the display). IMPORTANT. PLEASE PROVIDE A SITE PLAN FOR YOUR EVENT LOCATION, INDICATING WITH AN X THE EXACT SPOT WHERE FIREWORKS ARE TO BE SET-UP. Local Fire Marshal: Telephone No: Cell Phone No: Crew Contact Person: Telephone No: Cell Phone No: The Following information is necessary in order for us to provide your community or organization with a digplay that nnnfnrmc with firpwnrks cafatV r6aulatinns and fnr fhp iscuanr_a of Vnijr instirancp cprfifir_afp DISTANCES, IN FEET, FROM THE FIRING AREA TO THE FOLLOWING: FEET SPECTATORS,AUDIENCE OR PARKED CARS.................................................... OCCUPIED BUILDINGS(HOMES,APARTMENTS,ETC.)...................................... PUBLIC BUILDINGS(SCHOOLS, HOSPITALS,CHURCHES,ETC.)...................... TEMPORARY EVENT SET-UPS(CONCESSIONS,TENTS,ETC.)........................... MAINPARKING AREAS.................................................................................. HIGHWAYSOR ROADS.................... ............................................................. OVERHEAD OBJECTS(POWER LINES,LIGHT POLES,TREES,ETC..................... FUELSTORAGE.............................................................................................. Please initial each page.. Initial here: Sponsor SANTORE PLEASE PROVIDE DIRECTIONS FROM NEAREST INTERSTATE TO DISPLAY SITE. A MAP WOULD ALSO BE HELPFUL. Local Motels/Hotels: Telephone Nos. Signature Stanley Lomangino Title: Date Please initial each page. Initial here: Sponsor SANTORE onir `"e- """ � .24 x,33 "`�.�• i f-'i"� '� ,� ��; �` .l ,y � - �:,, �" `"'- '. �� €�..`•�� z,qc:.. -�. .... •'�x �'�,::s ,z�-'� �"�-;:"!.eA s * � :e '... 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'1'.(�' ., � ems'.f :;-." fit,,- r �'.,�t �' '`fix;` >:3-l. � �'=,Q.�"- � �` �� �e,r ', •' ' °';:,P �•� �. v e"s ��,� •,.�� - `� " -��1- air ��.��� � ��:< �� � .-,.; -> �' '.A� �'•-.". -' � C _ i �,- u� ",°tom a*... i-" : ...,..�� .:. t ,.�.. �. a.... �' a.:' "� ���. 'k"t`�..:'r '�v>• ��.era't-'` .,y `dfy ra q=x� me m; _ s US.Department of Justice Federal Explosives License/Permit Bureau ofAlcohol,Tobacco,Firearms aril Explosives (I8 U.S.C Chapter 40) ar�m®rmr�lm®�a®a In accordance with the provisions of Title x1,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 4Q,,Tit1e18,United States Code and the regulations issued thereunder,until the expiration date shown. THIS LICENSE IS NOT TRANSFER413LEUNDER 27 CFR-93.-53._,See"AA S"and"NOTICES"on reverse. Direct ATF ATF-Chiety FELC ::.LicenselPetmif Correspondence To 244 Needy Road N»rntieir.' a j ; Martinsburg,lllrV 25405-9431. Cbie Federal Explosives Licensing Cente (FELC) Expiration i l Date ®arch 1, 2024 Name SANTORES WORLD FAMOUS FIREWORKS.-,LLC Premises Address(Changes?Notify the.FELC at leasi,10 daysIxfore the move.).:.. 846 STILLWATER BRIDGE ROAD,.•, SCHAGHTICOKE NY 12154- Type 2154Type ofLicense or Permit 20-MANUFACTURER OF EXOLOSIVES Purchasing Certification Statement Mailing Address(Changes?`;Notify the FELC of any changes.) The licensee or permittee named above shall use a copy of.lhis license of hamk to,assist,a:. �;- - >•t' transferor of explosives to verify the identity and thelicensed.status of the licensee of i•:.y .. ' pemrittee as provided by 27 CFR Part 555.'Ik signature on ea :caoy must tielan nriem'l' signature.Afaxed,scanned or e-mailed copy ofthe license orpermit'with a signature "Si4NTOREB:INORLD'FAMOUS FIREWORKS LLC intended to bean original signature is acceptable.The sij8atilie musibe that ofthe Federal 143 SUW,jmi-.AVE',' Explosives licensee(FEL)orarapansibleperson ofthe EL,.lcatfy,;hatUiisisaWe B,ERKEGE.IF�HEIGHTS,NJ 07922- copy of a license or penny issued to the licensee or permittee named 45wpgrige-tnthe•� -.. ^=c•` business or operations speed above under"Type ofLiaeosa. .l?etmrt Licensee/Permittee Responsible Person Signature Position/Title ,M Y Printed Name Date ATF F—5400.14151400.25Part r Previ—Edition 3 Obsolete vumnesrmaa ramous rnesom unurmu:nw enaceswoas.asuraesweo:am:v.ze+.rmaoawur e,vnwmentasas Ravised September 2011 Federal Explosives license(FEL)Customer Service Information Federal Explosives Licensing Center(FELL) Toll-free Telephone Number: (977)29j-3352 ATF Homepage:www.atf.gov 244 Needy Road Fax Number. (304)616-4401 Martinsburg,WV 25405.9431 E-mail: FELCQatfgov Orange of Address (27 CFR 555.54(a)(l)). Licensees or permittees may during the term of their current license or permit remove their business or operations to a new location at which they intend regularly to carry on such business or operations.The licensee or permittee is required to give notification of the new location ofthe business or operations not less than 10 days prior to such removal with the Chief Federal Explosives Licensing Center. The license or permit will be valid for the remainder ofthe term 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 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 ofthe term of,a current license or permit. Such persons are: (1)The surviving spouse or child,or executor,administrator,or other legal representative of a deceased licensee or pennittee;and(2)A receiver or trustee in bankruptcy,or an assignee for benefit ofereditors. (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. (Con(im<ed on reverse side) Cut Here Y Federal Explosives LicenselPerntlt(FEL)Information Card I Licome/Permil Name:SANTORES.WORLO FAMOUS FIREWORKS LLC I 1 ' I Business Name: 1 1 I. t Licensedlermit Number:6-NY-083-20.4C-01080 1 1 License/Permit Type:20-MANUFACTURER OF EXPLOSIVES I • t Expiration: March 1,2024 1 I I' I j 1 Please Note:Not Valid for the Sale or Otho Disposition of Explosives. I• 74/5/2022 E(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(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 NAME: Britton-Gallagher and Associates, Inc. PHONE 216-658-7100 a No):216-658-7101 One Cleveland Center,Floor 30 E-MAIL 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Everest National Insurance Company 10120 INSURED 18341 INSURER B:AXIS Surplus Ins Company 26620 Santore's World Famous Fireworks LLC 846 Stillwater Bridge Road INSURERC: Schaghticoke NY 12154 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1636928940 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 NUMBER MMIDDY EFF MMIDD EXP LIMITS LTR A GENERAL LIABILITY Y Y SIOML00235-221 2/9/2022 2/9/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO NTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE FKOCCUR 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 PRO- LOC $ A AUTOMOBILE LIABILITY Y Y SIBCA00102-221 2/9/2022 219/2023 COMBINED SINGLE LIMIT Ea accident $1,000.000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ X HIRED AUTOS X NON-OWNED Per accident B UMBRELLA LIAB X OCCUR Y Y P-001-000074909-04 2/9/2022 219/2023 EACH OCCURRENCE $4,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ I ER WORKERS COMPENSATION WC STATU-LIMITS OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION 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. Display Date:7/4/22.Rain date:7/5/22 and 7/9/22.Location:Lomangino Property,9205 Skunk Ln. Stanley Lomangino,Mattituck Environmental,Town of Southold,Suffolk County are additional insureds,but only in respect of liability caused by the negligent acts or omissions of the named insured.Subrogation waived to the extent required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Stanley Lomangino 9205 Skunk Lane AUTHORIZED REPRESENTATIVE Cutchogue NY 11935 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i t 4. ri v e"f '^, ,� S':°A 7, d o r$ }' '':G g .�.,� ut w ` '7r °f4 Vin. —k`r e J d, '"t a4,.>~ d, •+x '& a''.n 8 2�2 j 't i ys F.� ;.• I } : 9 rwy rFs T rt k " r 's : '} ! SOUTHOLD RECYCLING; LLC = �' oetrolt MlcngB as2�5 t t � p 0 8/X MAft ITUGK ENVIRONMENTAL SERVICES 560;COMNIERCE b r w t &r t } g 'tz :>x.a i ) '} 'a ,� 1 }p:. J•5 t: 3T syr �t CUTCHOGUE NYyrr } a ' ;r°r �• i'1S'(�9sy'� 8 d t4 ; t 9R:xx X .,^x Z, `� * 'S%'wa !` `4 g V,y r ro r id° i 2 "s iOlt.d er t r y t o 1 s _yti y j M } z, a',z }' -,€a s '. 47- Fz j{ DATE 41 x AMOUNT eta �J c��+, E. x ��} 'S .�:•��✓ x' ,� t '�.yf-z� .. ssr ..y + a - v i ,+�� 4 .. r-n 's,:: ",sM1� z, �c f}a^f .P. .a� ,� ,, - ar d. ", Y 5/23/2022r N $1300 00 r r=Q�ne Hun-dred dollars:and X00 Cents rr r a , ,, € ''€ r a v c°`c s ,.�;" 9,r S +. ` s K:. hir ^`y t "2 'aw i t7 xF c'• 7 �, y°an , ',yr Nm t..�t $ . i 4 t r F d cry t t, 4 2 >t 3 fA PAY: i :r sF €� r, 1 54�,>•r x t ; t a j +ete�A',,` iF gzB TO,THE It a f x do F4 1 t8 ORDER 1 Jl�f� ; d z s i y <, f TOWN OF SOUTHOLD 3° , k t »Y..d t z a..,,rl'It� [�'(�: t O x,,a z •'� t .z sF"`"t,, a'1e .€—.•. r; s ,.- 4 s ~w .s! y P x: n 4r,, `+' } +i' t' ! > t. ,,Y :i' 1., ty t .` ;� s Ff Ct a s 1 ' r' >.�;. �.. ,'.^°,'�. r�`,t,'}'k• n.nk a v'' ,Y4"moi :r ..r,'Jy 1 'WY;SUUTHOLD NY �~1197g1 0499 � w Y Lit w S w ryt e AUTHORIZEQ SIGNATURET -x 4 11.0 18 2 2 Lum -1:0 7 20000 9 61: L8 5 308 78 39110 SOUTHOLD RECYCLING, LLC 18221 Vendor 1D° T Name: .:w,F ,. t` Payment Number 17„ ,Chec k Date Check °Number. TOW003 TOWN OF SOUTHOLD 00000000000011334 5/23/2022 18221 OurA1/aucherrNumber _ , Date :E „ Amounts .,,y°,Amount Paltl „.blscount :€Net,Amount Paid 052322 5/23/2022 $100.00 $100.00 $0.00 $100.00 $100.00 $100.00 $0.00 $100.00 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/24/22 Receipt#: 298957 Quantity Transactions Reference Subtotal 1 Fireworks 3 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#18221 $100.00 Lomingino, Stanley Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Lomingino, Stanley 9205 Skunk La Cutchogue, NY 11935 Clerk ID: DENISN Internal ID:3 Noncarrow, Denis To: fireworks appl Subject: Lomingino Attachments: Loma ngino_20220523161649.pdf Please see attached Firework app and please reply Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisn @southoldtownn y.gov 631-765-1800 CONFIDENTIALITY NOTICE: This communication-with its contents may contain confidential and/or legally privileged information. It is solely for the use of the intended recipient(s). Unauthorized interception, review, use or disclosure is prohibited and may violate applicable laws including the Electronic Communications Privacy Act. If you are not the intended recipient, please contact the sender and.destroy all copies of the communication. 1 Noncarrow, Denis From: Flatley, Martin Sent: Monday, May 23, 2022 4:26 PM To: Noncarrow, Denis Subject: RE: Lomingino I have no objections to this application being approved as in the past. Martin Flatley, Chief of Police Town of Southold Police Department 41405 State Route 25 Peconic, N.Y. 11958 Tel: 631-765-3115 The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s)and may contain information that is privileged,confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient,you are hereby notified that any review,retransmission,conversion to hard copy,copying,reproduction,circulation,publication, dissemination or other use of, or taking of any action, or omission to take action,in reliance upon this communication by persons or entities other than the intended recipient is strictly prohibited. If you have received this communication in error,please(i)notify us immediately by telephone at 631.765.2600, (ii)return the original message and all copies to us at the address above via the U.S.Postal Service, and(iii)delete the message and any material attached thereto from any computer, disk drive,diskette, or other storage device or media. From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent: Monday, May 23, 2022 4:21 PM To: Blasko, Regina <rblasko@town.southold.ny.us>; Doroski, Melanie<Melanie.Doroski@town.southold.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Norklun, Stacey<Stacey.Norklun@town.southold.ny.us>; Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Doherty,Jill <jill.doherty@southoldtownny.gov>; Doroski, Greg <greg.doroski@town.southold.ny.us>; Louisa Evans<Ipevans06390@gmail.com>; Mealy, Brian <brian.mealy@town.southold.ny.us>; Nappa, Sarah <sarah.nappa@town.southold.ny.us>; Noncarrow, Denis <denisn@southoldtownny.gov>; Rudder, Lynda <lynda.rudder@town.southold.ny.us>; Russell, Scott <Scott.Russell @town.southold.ny.us>; Standish, Lauren <Lauren.Standish@town.southold.ny.us>; Tomaszewski, Michelle<michellet@town.southold.ny.us>; Burke,John <johnbu@southoldtownny.gov>; Hagan, Damon <damonh@southoldtownny.gov>; Mirabelli, Melissa <melissa.mirabelli@town.southold.ny.us> Cc: Rudder, Lynda <lynda.rudder@town.southold.ny.us> Subject: Lomingino Please see attached Firework app Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownwgov denisn southoldtownny.gov 631-765-1800 CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. It is solely for the use of the intended recipient(s). Unauthorized interception, review, use or disclosure is