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HomeMy WebLinkAbout2022 Southold Town Board -Letter Board Meeting of July 5, 2022 C"J"R.0, RESOLUTION 2022-575 Item# 5.19 ADOPTED DOC ID: 18237 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2022-575 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JULY 5,2022: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a Fireworks Permit by the Town Clerk to Santore's Fireworks on behalf of the Laurel Links Country Club, for a fireworks display on Saturday, July 30, 2022 at 9:15 PM (Rain Date: Sunday, July, 5th, at 9:15PM) at 6400 Main Road,Laurel,New York upon payment of a single fee of$100.00 and subject to the applicant's compliance with any Executive Orders of the Governor and compliance with any conditions and requirements of the Town of Southold policy regarding the issuance of fireworks permits. Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Greg Doroski, Councilman SECONDER:Brian O. Mealy, Councilman AYES: Nappa, Doroski, Mealy, Doherty,Evans, Russell Generated July 6, 2022 Page 36 FDL/r DENIS NONCARRAW �� ��, 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 RECORDS MANAGEMENT OFFICER ®,` �® Telephone 765-18 FREEDOM OF INFORMATION OFFICER www.southoldtldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT 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: Laurel Links Country Club. 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 Saturday. July 30th, 2022 at 9:15 P.M. (Rain Date: Sunday, July 31st, 2022 at 9:15 P.M.) on property located at 6400 Main Road, Laurel, 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 th i eworks shall be over the age of eighteen years, competent and physically fit for the task, that there sh b at least two such operators constantly on duty during the discharge and that at least two soda-acid or her ppr ved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such w'dely e ated points as possible within the actual area of the display. Deni oncarrow , Town Clerk Town of Southold Date: July 5th, 2022, THIS PERMIT IS NOT TRANSFERABLE RECEIVED Laurel Links Country Club JUN 2 3 2022 Southold Town Clerk June 23, 2022 Southold Town Clerk 53095 Main Road Southold, NY 11971 To whom it may concern, I, Robert Eldon, General manager of Laurel Links Country Club authorize Santore's World famous Fireworks to conduct fireworks display on Saturday July 30,2022,with a rain date of Sunday July 31, 2022. Sincerely, Robert Eldon General Manager Laurel Links Country Club 6400 Main Road • P.O. Box 307 • Laurel, New York 11948-0307 . 631-298-4300 • Fax 631.298-4372 www.laurellinkscc.com 1 Air Traffic Organization 1701 Columbia Avenue Eastern Service Center College Park,GA 30337 U.S. Department of Transportation Federal Aviation Administration Dear Fireworks Proponent: Thank you for informing us of your proposed fireworks display. Although there are currently no federal regulations specific to fireworks displays,the Federal Aviation Administration(FAA)has been tasked with regulating the safe and efficient use of the navigable airspace(49 U.S.C.§ 40103). In recognition of this role in promoting aviation safety, many jurisdictions require notice to the FAA as a condition of approval of a fireworks permit. We acknowledge your notification and have no objection to the fireworks display,provided it is conducted in a manner that does not create a hazard to other persons or their property. To enhance the safety of your event,we recommend the following actions: • Fireworks staff should remain vigilant to ensure that no aircraft are in the area prior to beginning the fireworks display. • If your event is within 5 miles of a public use airport, or if the display will exceed 500 feet Above Ground Level(AGL),contact Leidos Flight Service at 1-877-4-US-NTMS (1-877-487-6867) at least 24 hours (but not more than 7 days)in advance to request a Notice to Air Missions (NOTAM). You will need to provide the following information: o Name and address of the person filing the NOTAM o Date,time(s), and event location(City, State, and location in reference to the airport) o Maximum altitude of the display This letter should not be construed as superseding or invalidating any existing rules or regulations promulgated by any other federal, state, county, or municipal government which may be required for this display. If you have any questions regarding this information,please contact our office at(404)305- 5570 or 9-ATO-ESA-OSG-FireworksAfaa.gov Sincerely, Matthew N. Cathcart Manager, Operations Support Group i 1 e 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: asantorejr()sasantorefireworks.com Cell Phone Number for On-Site Technician: Robert Mardorf(516) 369-2107 Event Name: Laurel Links Country Club Display Date:7/3 0/2 2 Rain Date:7/31/22 Display Start Time: 9:15 pm Duration of Fireworks Display: 15 min. Max Height of Fireworks: 300 feet Address,City and State:6400 Main Road Laurel NY, 11948 Latitude:40' 58' 29.8" (North)Longitude:7 2' 32' 58.4" (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-Fireworics@faa J;ov ��®S�1rrFDL�-�� ELWABL+THA,NL'VILLE,MMC �� Gg, Town Hail,53095 Main Road TOWN CLERK o P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax 1,New York 45 MARRIAGE OFFICER ��'� O�� Telephone(631}76145 RECORDS Off'MANAGEMENT OFFICER �j �►`� FREEDOM OF INFORMATION OFFICER southoldtown.northfark.net OFFICE OF THE TOWN CLERIK TOMN OF SOUTHOLD APPLICATION PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law of the State of New York,for a permit to display fireworks as hereinafter specified.: DISPLAY IS TO BE SPONSORED LY Laurel Links Country PRINCIPAL OFFICE AT DATE&TIME OI DISPLAY . /22 at :15 m EXACT LOCATION,OF DISPLAY Club 6400 Main Road Laurel NY 11948 SUFFOLK COUNTY TAX MAP NUMSER FOR SITE RAIN DATE&TIME The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Robert Mardorf 48 20+years Health: Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows., 1.3G Fireworks: 2 %Z"=50, 3"= 262, Cakes=18 Manner and place of storage of fireworks prior to display: Delivery of product on day of display Attached hereto and made a part of hereof is a diagram of the grounds on which the display is to be held. Also attached is a certificate or policy of insurance coverage. NOTICE: 'Written permission,with signature of the Property Owner,must be submitted with the Application. Santore`s World Famous Fireworks, LLC FEE: $100 Named rganization See policy:for additional information By ante ame o pp cant Signature f Applicant e-mail adc[ress:asantoreir(@santorefireworks.com 06/17/22 Telephone Number J908) 872-0624 Date of Application Waih in Orton i! Awl Laurel Lake Preserve q. .�� �� `} J� �.` ��1` 'y � L.. 4 .'fid j 't€ ';a '� ��. ktf - i t _-: Sal �,:•-�� m '1.i y.;� '''�"' - �,d' 'Fa t'Y �� ;\i1�� " �• t s.il. �;�, Ji•�� ",,,.; �',�,..� �+LaUre!LlXllkS�s (l= _� �,�:,t_ } tiT = � ." 't'. ... � - <�`� �}+�y�F �}.tq.yl A .:r� .T: �'•i�a+t.R'�",'S-'- � 'i�'��'T` � .�...i-..� E� __�s � �5t" S �,.' :. .. �� ,e._ Ma ,��F _ "• '� ^����' °���`�'�'�- .. fGountry C)ub�� � ��,�.�'. a Laurel,. -ake'P.ark. :- •- yyj ,, .` + ,9"' ` _r Bobs Clearnng a r� - 'Resto anon Servrc t • t� i { q o+ f�Y _ .. 1 � ' Vi�tt- (yy���� � ;� t��• tl.� +J t t @ S+. •.A zip E`' 7 ; f �` .� •i +� i '�v r-k �'♦ �� t 1' fir.;. 3'g,. *i{- �.- 44� - a •. 1f/ yy i • � � 1 i � i � s k .. ..,.....,,.......,..:. ....,.....w..--......,,.�..............._,•:r..o-w.^av:,?rr•,r.'era..+xt;;exp,,..wA.,....roe.•^7..w�'^!x�'• "Y`-"?'�44„':s;�'+�'^��:��f:':.»3+„"N.�;?.lp'"+enF� .w'�j=+•':x•,:,q:.. ..,en, .. ..�, w , , .. .. 1 STATE OF NEW YORK • ��� ` DIVISIGN OF DEPARTMENT OF LABOR d ; :.'. -SAFETY AICD HEALTH LICENSE TO'DEAL'IN OR'*MANUFACTURE•EXPLOSIi•►`ES' Expires: '11/31/•Z1)22. Santore's World Famoits.'Ffreworks,'LLC 846 Stillwater Bridge Rd THISt^10ENS'E MUST 8E ° Schaghticoke, NY 12154 POSTED.IN YOUR PLACE OF BUSINESS August.N. Santore,Jr..:- License b%b 5796 Is hereby licensed to desl.in Qr manufacture explosives.'n compliance,;withthe.requirements of the Labor Law and .Industrial Code Rvles.�Ariy.change in the condifians underwhich'this license is granted may-cau-4.1 to be revoked. Eileen M.J:r ko,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,•'includirig: 1) the NAME or TYPE.and QUANTITY of explosives SOLD,DELIVERED or'GIVEN. Note:No license is needed to purchase smokeless powder;or'black powder in quantities not exceeding five pounds for use in firing antique firearms or artifacts or replicas thereof.'.However,-dealers MUST post all such transactions on the"Deafer-Manufacturer Report of Explosives Transactions". 2) the DATE OF EACH SALE;DELIVERY.or GIFT. 3) the NAME, LICENSE NUMBER,and I bSINES5•ADDRESS'.ol:the,purchaser,donee,or person to whom the explosives were delivered and.tne f'rrn,"if ariy.,represented by skh'person. 4) the NAME,'ADDREFS,,and,-LICENSE,NUMBER of the persod.TAKING"THE EXPLOSIVES AWAY from the seller or'donor• SH-862(5-98) r . I U.S.Depat'ttnent of Justice Federal Explosives License/Permit • Bureau ofAlcohol,Tobacco,Fireanns and Explosives (18 U.S.C Chapter 40) n�xmat®raa®Imlm[ampmmla In accordance with the pro.•isions 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-4o,TitIr~18,United States Code and the regulations issued thereunder,until the ex-piration date shown. THIS LICENSE IS NOT TRANSFi'ERABLYUNDER' Z7 CFI Sa5•53 ,,See"WARNINGS"and NOECES"on reverse. DirectATF ATF-Chief,FELC License/I?ermif Correspondence To 244 Needy Road Martinsburg,WV25405-9431 Chief,Pederal Ex IOSNeS 1,20enSIng Cent (�C) F,xpiiation,:: Date 'March 1, 2024 Name SANTORES WORLD FAMOUS FIREWORKS;LLC s - Premises Address(Changes?Notify the-FELC at leas[;10 days before the move.)L*:.'. x: 846 STILLWATER BRIDGE ROAD", , SCHAGHTICOKE NY 12154- Type ofLicense or Permit ' 20-MANUFACTURER OF EXPLOSIVES . Purchasing Certification Statement :,' Mailing Address`{Ci=6;s?r Notify the FELC of any changes.) T'he licensee or permirteenamed above shall use a ccpy,of.ihis license or•:pennitio transferor of explosives to verify the identity and the•.liceased.status ofthe licensee of permittee as provided by 27 CFR Part 555. The simatufc on eacErctror most ti-,anDr)Mal ��ANTORES:,VtWORLD FAMOUS FIREWORKS LLC sienanrre. Afased,scanned or ziriailad copy ofthe liczi?�or pennII with a signature ` untended to be an • igpature is acceptable- The sigiaw"reautsE be that ofihe Federal <• 143 SUM M l-r AVE'. ` E)Tlosives ' ensee(FE orarespomiblepaonofth-eFEL:;I•ertiB•ERK-fb Y_HEGHTS, NJ 07922- i A :egag-icopy li issued tothe licensee orpentitce,namedabvn -ve bu cs op rcxFs deed above under"Type of Lieease.or.Permit:'I> dt`••. ! ;.;r'�` r .t�:rt•' �.°' 'i - _ ,'f'I '•p_.✓:is�' -' ' Li use rm" Responsible rson Signature Pos • • �, �, P nted Name i17. �Previo olete . / aTFs�,:ssca.t�s3oe.ls�ant RevisedSeptm=bea2011 Federal Explosives License(FEL)Customer Service Information Federal Explos -s Licensing Center(FaC) Toll-free Telephone Number. (877)283-3352 ATF Homepage:www.atf.gov 244 Needy Road Fax Number. (304)616-4401 Martinsburg,WV 25405-9431 E-mail: FELCr@atfgov Change of Aldress (27 CFR j55-54(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 th ey 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 Iess than 10 days prior to such removal with the Chiei Federal Explosives Licensing Center. The license or permit will be valid for the remainder ofthe term ofthe original license or pormit. (The Chid FELL,shall,if the licensee or permittee is not qualified,refer the request for amended license or permit to the Director of Industry Operations for denial in accordance with§555.54.) Right of Succession (27 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 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 permittee;and(2),A.receiver or trustee in banuptcy,or an assignee for benefit of ereditors. (b)In order to secure the right provided by this section,the person or persons continuing the business or opera*ons shall furnish the license or pennit 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- Cut Here (Continued on reverse side) r Federal Explosives License/Perinit(FEL)Infozmation Card I License-TermiiName:SANTORES..WORLD FAMOUS FIREWORKS LLC l I ( I Business Name: 1 t I LicensePermit Number:6-NY-083-2D-4C-01080 1 I LicenscJPermit Typc-20-MANUFACTURER OF EXPLOSIVES [ 1 I +Expiration: March 1,2024 t I; 1 II I'Please Note: NOL Valid forthc Sale or Other Disposition of Erplosives. I ----------------------------------� A,GI CERTIFICATE OF LIABILITY INSURANCE DAT6I 6 022 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: Britton-Gallagher and Associates, Inc. PHONE FAX One Cleveland Center,Floor 30 arc No •216-658-7100 Arc No):216-658-7101 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC# INSURER A.-Everest National Insurance Company 10120 INSURED 18341 INSURER13:Axis Surplus Ins Company 26620 Santore's World Famous Fireworks LLC INSURER C: 846 Stillwater Bridge Road Schaghticoke NY 12154 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:360024692 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN 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. POLIINSR4GENERAL TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMMDY EFF PM/DD CY EXP LIMITS LTR A LIABILITY S18ML00235-221 2/912022 2(9!2023 EACH OCCURRENCE $1.000,000 D GE TO RENTED OMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE OCCUR MED EXP(Arty one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG 52,000,000 POLICYFRI PRO- LOC $ A AUTOMOBILE LIABILITY SIBCA00102-221 2/912022 219/2023 COMBINED SINGLE LIMIT Ea accident S1.000.000 X ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON OWNED PROPERTY DAMAGE $ X HIRED AUTO$ X AUTOS Per accident B UMBRELLA LIAR X OCCUR P-001-000074909-04 21912022 2/912023 EACH OCCURRENCE $4,000,000 XNEXCESS LIAB CLAIMS-MADE AGGREGATE $4000,000 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNER!EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPL OYE $ Ifyes,desc ibe under DESCRIPTION OF OPERATIONS below E.LEISEASE-POLICY LIMIT $ 1 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:7130122;rain date:7131122. Location-6600 Main Rd.,Laurel,NY Town of Southold and Suffolk County are additional insureds,but only in respect of liability caused by the negligent acts or omissions named insured. Subrograticn 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. Laurel Links Country Club 6400 Main Road AUTHORIZED REPRESENTATIVE Laurel NY 1194$ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD t S N New York State insurance Fund PO Box 66699,Albany, 12206 I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE Chi':-v* p A A A A IA A 472010297 SANTORE'S WORLD FAMOUS FIREWORKS LLC 143 SUMMIT AVE SCAN TO VALIDATE BERKELEY HEIGHT NJ 07922 AND SUBSCRIBE POLICYHOLDER I! CERTIFICATE HOLDER SANTORE'S WORLD FAMOUS TOWN OF SOUTHOLD FIREWORKS LLC 53095 MAIN RD. 143 SUMMIT AVE SOUTHOLD NY 11971 BERKELEY HEIGHTS NJ 07922 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2353 260-9 581792 02/07/2022 TO 02/07/2023 6!1612022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER OOLICY 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 INIfiHE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEN{ 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:I/WWW.NYSIF.COMICERTICERTVAL.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, PRIbR 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 UPO(V THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT S711*2 NCE FUND T DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:396422630 I L7RR MYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AA AA AA ? 472010297 � SANTORE'S WORLD FAMOUS FIREWORKS LLC ■ y.+p" , 143 SUMMIT AVE BERKELEY HEIGHTS NJ 07922 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SANTORE'S WORLD FAMOUS LAUREL LINKS COUNTRY CLUB FIREWORKS LLC 6400 MAIN RD 143 SUMMIT AVE LAUREL NY 11948 BERKELEY HEIGHTS NJ 07922 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2353 260-9 16854 02/07/2022 TO 02/07/2023 6116/2022 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. 1 i I I NEW YORK STAT SUR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:81450744 Noncarrow, Denis From: Spiro, Melissa Sent: Friday, June 24, 2022 7:17 AM To: Noncarrow, Denis Subject: RE: Firework app 7/31/22 This is not Town preserved land. Melissa From: Noncarrow, Denis Sent:Thursday,June 23, 2022 3:38 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@town.southold.ny.us>; 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> Subject: Firework app 7/31/22 Please review Firework app from Laurel Links Country club. Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.south oldtownny.gov denisn(a)southoldtownny.aov 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. i Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/23/22 Receipt#: 301802 Quantity Transactions Reference Subtotal 1 Fireworks .30.2022 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#15.458 $100.00 Club, Laurel Links Country Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Club, Laurel Links Country 6400 Main Road Pob 307 Laurel, NY 11948 Clerk ID: DENISN Internal ID: .30.2022 t Noncarrow, Denis From: Flatley, Martin Sent: Thursday, June 23, 2022 3:43 PM To: Noncarrow, Denis Subject: RE: Firework app 7/31/22 I have no objections to this display being approved 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. 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From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent:Thursday,June 23, 2022 3:38 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@town.southold.ny.us>; 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> Subject: Firework app 7/31/22 Please review Firework app from Laurel Links Country club. Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisn@southoldtownny.go_v 631-765-1800 CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. It is solelyfor 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.