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Home My WebLink About2024 uF`` RESOLUTION 2024-793 ADOPTED DOC ID: 20602 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-793 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON SEPTEMBER 10, 2024: 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 North Fork Country Club, for a fireworks display on Saturday, September 28th, 2024 at 9:30 PM(Rain Date: Sunday, Sept. 29th, 2024 at 9:30 PM) at 26342 Main Road, Cutchogue, New York subject to the applicant's compliance with any conditions and requirements of the Town of Southold policy regarding the issuance of fireworks permits,Notification of the Cutchogue Fire Department and compliance with all State codes on Firework Safety. j Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER:Greg Doroski, Councilman AYES: Doroski, Mealy, Smith, Krupski Jr,Doherty,Evans C �gC . C DENIS NONCARROW Town Hall,53095 Main Road TOWNCLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS . �.. V Fax(631)765-6145 MARRIAGE OFFICER " !�'� �'� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �►. ', south FREEDOM OF INFORMATION OFFICER LIVE® OFFICE OF THE TOWN CLERK A UG 3 0 2024 TOWN OF SOUTHOLD 1 APPLICATION PERMIT TO DISPLAY FIREWORKS Soil#hold Tow Clerk APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law of the State ofNew York, for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY;North Fork Country Club ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, PRINCIPAL OFFICE AT 26342 Main Rd Cutchogue NY 11935 DATE & TIME OF DISPLAY9/28/2024 na, avorox. 9:45 pm EXACT LOCATION OF DISPLAY Designated area North Fork Golf Course SUFFOLK COUNTY TAX MAP NUMBER FOR SITE1000-109-00-04-00-008-003 RAIN DATE& TIME 9/29/2024............................................................................................................. The following persons are to be in charge of the actual shooting of the fireworks: Name Richard Davin Assist-TBD Age: 55 Experience: 25 yrs Physical Condition: Fit (Additional names and information may he submitted on an attached sheet Number and type of fireworks is as follows:Main Body- 60-Asst A+36 3"color,36-4"6-1.4Gcakes ,3- 1,3Gcakes(1-for finalestart)Finale-,90-3"color,50-21/2"rapport.40-411brocade Manner and place of storage of fireworks, prior to.,display: Fireworks will be stored on licensed Santore's transport until loaded for the dispIay. Attached hereto and made a part of hereof is,a diagram of the grounds on which the display is to he 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. 0'0 Name of Organization Byl'10 Ili' Signature of Applicant 8/27/2024 Date of Application .I r r 1 a i fQY RESOLUTION 2010-474 ADOPTED DOC ID: 6016 THIS ISTO CERTIFY THAT THE FOLLOWING RESOLUTION NO.2010-474 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 29,2010: RESOLVED that the Town Board of the Town of Southold hereby adopts the following POLICY regarding the issuance of fireworks nermits: 1. The Town may grant a permit for the display offireworks by municipalities, fair associations, amusement parks,persons 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 he no time restriction if held on July 4. 4. No person shall engage in or allow the manufacture, assemhly, storage or display of any fireworks or pyrotechnics display without first obtaining a permit issued by the Town Clerk. A completed application for display offireworks must be received by the Town Clerk a minimum of30 days prior to the date of display. The permit application for any fireworks or pyrotechnics display shall he accompanied by the following _tf (a) a copy of a valid certificate of compi, supervising the firing of the display; (b) Certificate of Insurance naming the'I, coverage limits of$2,000,000 for put � 0�) damage; l (c) Detailed diagram showing location oil Ctivtn.q/" k Ij separation distances in accordance wi J �rJ�r�'` Section 405(2); kovrtcv-� /,-', -a(d) A copy of the contract with fireworks d o ti$, 74 (e) All applications shall require the appro which the display will take place and thl1�i5 approval by the Town Board. t� DENIS NONCARROWy4� ' �.y Town Hall,53095 Main Road TOWNCLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER 'S f` Telephone(631)765-1800 RECORDS.MANAGEMENT OFFICER 9�1 www.southoJdtowmy.gov FREEDOM OF INFORMATION OFFICER Y g 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 ofthe 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 inforination as the Southold Town Clerk may deem necessary to protect persons and property. Written permfssion 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 !east 30 days in advance of the date of the fireworks display. 12. All applications for a fireworks permit shall be subject to an alInlication fee in ao amount of S100.00. together with a nroccssiny fcc in an amount to he determined by the Town Board to cover the Town's costs for monitoring and enforcing compliance with the Penal Law. (The above instnictions are in accordance with the Pena!Law.Article 405-Licensing and other provisions relating to fireworks.) r Resolution 2010-474 Board'Meeting of June 29, 2010 5. All applications f6r a fireworks pennit shall be subject to an application fee in an amount of$100.00, together with a processing fee in an amount to be detennined by the Town Board to cover the Town's costs for monitoring and enf6rcing compliance with the Penal Law. Elizabeth A.Neville Southold Town Clerk RESULT: ADOPTED [UNANEVIOUS] MOVER: Albert Krupski Jr.,Councilman SECONDER:Vincent Orlando, Councilman AYES: Ruland, Orlando, Talbot,Krupski Jr.,Russell ABSENT: Louisa P. Evans Updated: 6/30/2010 10:43 AM by Lynda Rudder Page2 North Fork Country Club August 28,2024 To whom it may concern, North Fork Country Club has engaged Santore's World Famous Fireworks to provide us with a wedding fireworks display on September28,2024 with a rain date of 9/29/2024. Part of our arrangement is for Santore's World Famous Fireworks to obtain and complete all necessary applications and permits. They have our permission to process ali necessary paperwork for the event. If you have any questions or concerns, please contact us. nkyou, J � VIR", .'Pin ea General Manager P.O. BOX 725 • CUTCHOGUE, NEW YORK • 11935-0725 (631)734-7139 • FAs(631)734-9004 • nfccmail@aoptonline.net • www.northforkcc,com Alex�crione Gallery ■ o x j (~�� _ y +e'-,. \ Noah:Fork'Counu Club fig * . In F ` ;�• ,■ t , i~, :,, - 1, ( Poch Way j[jG �4 Olt country Club or country GIub,OP ' d u/ CY 1 Launch Site- • to IShells Audience Viewing Launch Site Cakes- 1.25" 0 Fallout Zone for Radius OFallout • IShells • Launch Site • I • Display • • North ForkCountry • 26342 Road, Cutchogue, All' 0 A� CERTIFICATE OF LIABILITY INSURANCE DATE 02'4"Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Acrisure, LLC dba Britton Gallagher PHONE FAx 3737 Park East Dr. STE 204 A/c No Ext:216-658-7100 A/c No):216-658-7101 Beachwood OH 44122 ADDRIESS: INSURER(S)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:270970116 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 MMI/DD/YYYY W MM/DD/YY A GENERAL LIABILITY Y Y S18ML00235-241 2/9/2024 2/9/2025 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE F-KI 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 T PRC- LOC $ CT A AUTOMOBILE LIABILITY Y Y S18CA00102-241 2/9/2024 2/9/2025 COMBINED SINGLE LIMIT Ea accident $1 000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident B UMBRELLA LIAB N OCCUR Y Y P-001-000074909-06 2/9/2024 2/9/2025 EACH OCCURRENCE $4,000.000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- I JOTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS i ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE F--1 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$ 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. Certificate Holder is named as additional insured.Coverage is provided on a primary non-contributory basis.North Fork Country Club,the hamlet of Cutchogue, the Town of Southhold,Suffolk County are named as additional insureds,but only in respect of liability caused by the negligent acts or omissions of the named insured,Subrogation waived to the extent required by the written contract. Fireworks Display date-wedding 9/28/2024 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Fork Country Club ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 725 Cutchogue NY 11935 AUTHORIZED REPRESENTATIVE United States 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD A� CERTIFICATE OF LIABILITY INSURANCE DAT8/281202'4"' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Acrisure, LLC dba Britton Gallagher PHONE FAX 3737 Park East Dr. STE 204 Afc No Ext:216-658-7100 A/c,Noy 216-658-7101 Beachwood OH 44122 ADDRIESS: INSURER(S)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: Schaghtico ke NY 12154 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:798750579 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 MMIDDIYYYY MMIDD/YYW A GENERAL LIABILITY Y Y S18ML00235-241 2/9/2024 2/9/2025 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMI E ( RENTED PREMISESS Ea occurrence) $500,000 CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERALAGGREGATE $2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY T PRO• LOC $ A AUTOMOBILE LIABILITY Y Y S18CA00102-241 2/9/2024 219/2025 COMBINED SINGLE LIMIT Ea accident $1 000 000 X ANY AUTO BODILY I NJU RY(Per person) $ ALL OWNED SCHEDULED tid P BODILY INJURY(Per accident)AUTOS AUTOS ( ) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident B UMBRELLA LIAB X OCCUR Y Y P-001-000074909-06 2/9/2024 2/9/2025 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DEO I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY L M If ER ANY PROPRIETOR/PARTNER/E(ECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 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. Town of Southold,Suffolk County,and The North Fork CC are named as additional insureds,but only in respect of liability caused by the negligent acts or omissions of the named insured.Subrogation waived to the extent required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Southold 53095 Main Rd. AUTHORIZED REPRESENTATIVE Southold NY 11971 TATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Zj'yo NERRK► Workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured SANTORE'S WORLD FAMOUS FIREWORKS LLC (518)664-9994 846 STILLWATER BRIDGE ROAD SCHAGHTICOKE,NY 12154 1c.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 472010297 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New York State Insurance Fund(NYSIF) TOWN OF SOUTHOLD 53095 MAIN RD. 3b.Policy Number of Entity Listed in Box 1a" POBOX 1179 DBL 6582 92-9 SOUTHOLD,NY 11971 , 3c.Policy'effective period 02/06/2024 to 02/06/2025 4.Policy provides the following benefits: ® A.Both disability and paid family leave benefits B.Disability benefits only C.Paid family leave benefits only 5.Policy covers: ® A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law Fj B.Only the following class or classes of employers employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage �aas described above. Date Signed 8/28/2024 By eAU �4 "'Off"''�"' &O54— (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (866)697-4332 Name and Title Kristin Markwica,Head of Disability Insurance Unit IMPORTANT: If Box 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board, DB Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200 PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4C or 5B of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) Certificate Number 804517 Additional Instructions for Form 1313-120.1 By signing this form,the insurance carrier identified in box "3"on this form is certifying that it is insuring the business referenced in box"1 a"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law.The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box "2". The insurance carrier must notify the above certificate holder and the Worker's Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in Box 3c,whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Disability and/or Paid Family Leave Benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or paid family leave benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand and twenty-one,the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein,,however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits, and after January first,two thousand eighteen,the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1 (10-17)Reverse NYSI F New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^"^" 472010297 SANTORE'S WORLD FAMOUS FIREWORKS LLC N.40 143 SUMMIT AVE BERKELEY HEIGHTS NJ 07922 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER 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 440758 02/07/2024 TO 02/07/2025 8/28/2024 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:IIVMW.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, 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 SU NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 542576776 U-26.3 flaw U.S.Department Eastern Service Center 1701 Columbia Ave. of Transportation Operations Support Group College Park,GA 30337 AN-E2 FIREWORKS DISPLAY NOTIFICATION Company Name* Santore's World Famous Fireworks LLC Email Address of Person Submitting Request- terisa@santorefireworks.com Cell Phone Number for On-Site Technician:Aob Mardorf 516-369-2107 Event Name: North Fork Country Club Display Date: 9/28/24 Rain Date. N/A n6,zIL=y C+art Tima• 9:15nm Duration of Fireworks nicplay- 15-20 min Max Height of Fireworks: 400 Feet Address,City and State: 26342 Main Road,Cutchogue, NY Latitude: 41 -nO'-1 6" (North) Longitude- 72 -29'-25" (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 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-Fireworks@,faa.gov Sincerely, c t1-- - Matthew N. Cathcart Manager, Operations Support Group r �'_._,.�.....-�.t'S1 NOTFOR ; NEON YC]6Z1� .1: .i,L FEDERAL w.I.JEv�i✓. COMMERCIAL DRIVER LICENSE PURPOSES h: ,t)161 229-777 oalaC, ��•� DAV1N_ • RICHA,RD,M P0.90X 541 MORICHES.NY 11955' 1 r HAZMAT�y 04100/2026 iq snr41 Po,y{51.11" [v�HAZ I uot:04/2211966 ` I _ . e;;,,u,.64/22/2025 r,...I t R ; r,'A'X ; _ryi D004/08/2021 STATE OF NEW YORK-DEPARTMENT OF,LABOR PYROTECHNICIAN CERTIFICATE OF COMPETENCE ,v i RICHARD-M DAVIN: i g,• CLASS-B �,.. NON PROXIMATE AUDIENCE ONLY THIS CARD 7MUSTBE CARRIED ki WHEN USING PYR0T--Ct61a`,RR-657 NYC N CERTIFICATIONS REOUIRED IN NYC CERTIFICATE ISSUED BY FDN_Y�� Qy GERTS' 6,a9,46'56 R dSSIJEL) 0i/0ffY2022 EXPIRES O£>t/O8/2023 NAME Ric:eiARDti lW'DAvlN NOT := HOME130X?�541. .-, C s.,...a ADDR.sMORIIiE FD NYS,'NY 14955 " `•7, 1a.. EMPLOYEE FFEE- $S CAT_E20 TYPE Fitness D,IES'C:'PYROTECHNIC FIREWORKS JamoLOYER';PYRO ENGINEERING y RICHAR l PO SO 17 r .f MGR ES �^ DA LICENS Q OVA '+ 1 11 W2D o.EXPIRATIOlJ a - t z3 Federal Explosives License/Permit U.S..Department of Justice �,�$ U,S;L; /ttl,�)tgY �o� Bureau of Alcohol,Tobacco,Firearms and Explosives n rnuiiw n nfleaar au+Ivuat,:r euin Iruur Iu accordance with the provisions of Title XI,Organized Crime Control Act of 1970,and the regulations issued thereunder(27 CFR Pall 555),you may engage in the activity specified in this license or permit within the limitations of Chapter 40,Title_13,United States Code and the regulations issued thereunder,until the expiration date shown. THIS I.ICEIVSE'IS'NOTTISANSrEltat:llLE:I11y'DEIt-22 Cl*It':545.�3:-._See"WARNINGS"and"NOTICES"on rcversc. Direct ATF ATF-Chief,FELC :i=LiccnseiPerm_ it Correspondence To 244 Needy Rand ;' r;. _ ;-,,Y.r Number' -.- Martinsburg,WV25405-9431,.. ;r:rr Chief.Federal Explosives Licensing Ccnte (FELC} ;1�!.' Expiratioh` F ' DateMarch 27 Name SANTORES WORLD FAMOUS FIREWORKS LLG Premises Address(Changes? 846 STILLWATER BRIDGE'ROi4D_. SCHAGHTICOKE, NY 12154 Type ofLieense or Permit - 23-IMPORTER OF EXPLOSt1%ES' "' F Purchasing Certificatioii,StalenfeittL �' Mailing Address(Chatiges'1 Notify the FELC ofany changes.) 'flee licensee or perinittee named above shall rise a-copy ofiliis license orPerin to'as%st a transl-ror of e\plosives to verify the identity and the lic-�ised'siatus oftlie licensee or;` _ pennittee as provided by 27 CFR Part 555. Tlie siiarattttre tnreridi cwriiitst besn'oriainah '' ANTORES VUORL'D'FAMOUS FIREWORKS LLC si stare. Afased,scaimed or e-mailed copy ofthe'iicc�isc or•-pentiit�tillt a sigliatirre" = intended to be an original signature is acceptable. The sig'latiire must.l that ofthe Feder al 143 SUMMIT`AVE Explosives Licensee(FEL)or a responsible person oftlTe FEL;I;ccttifyth,tt this is a true BERKE"E`4 EIGHTS, NJ 07922- copy of a li"nige or permit issued to tree licursea ar pennittet nauied:ibopc to�mgage urtlte- - :_,:'. ,•t busniess or opeatioas specified above muds•"Type of License or•Pciittif:"._.w._ «'- - ✓„ { _ Licensee/Pennitlee Responsible Person Signature Positioni'I'ille, '--*"-", .w_.. _._-._______. .-.___Print::JNaiuC - --'^-• -I�atC..,.____..____.._.._.._..._n_...,____._..-___�._____. �._......_.-__..i1LFI�btifiStOU:]��S�FOD:15FiutI"__.__-.-- Previous Edition is Obsolete SAWORES WORLD rAr4OJSFIRER'ORKSLM17RBTIUWATEARPtRnEPOAu Y151&YT-UpJ-7&7C-07CS1:WerN1,231717d14PoRTCROFE%FEOSIAS Revised September2011 Federal Explosives License(FEL)Customer Service Information Federal Esplosives Licensing Center(FELC) Toll-free TeleplioneNumber: (977)293-3352 ATF Homepage:wwmatCgov 244 Needy Road FaxNumber: (304)01G-1401 Martinsburg,WV 25405-9431 E-mail: FL'LC t atf oov Change ofAddress (27 CFR 555J4((r)(1)). Licensees or permittees may during the terul of their current license or permit remove their business or operations to a new location at which they intend regularly to cam,on such business or operations. The licensee or pennittee is required to give notification of the nety location of the business or operations not less than 10 days prior to such removal with the Chief.Federal Esplosives Licensing Center, The license or permit%ill bevalid for tile remainder of tite term of the original license or pennit. (The Chief,FELC,shall,if the licensee or pennittee is not qualified,refer the request for amended license or permit to the Director of Industry Operations for denial in accordance vrilh§555.54.) Right of Succession (27CM 555.59). (a)Certain persons other than the licensee or penmittee may secure the rinlit to carry on the same explosive materials business or operations at the sane 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 license-,or permittee;and(2)A receiver or trustee in bankruptcy,or an assigner,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.FBLC,within 30 days from the date on which the successor begins to tarn'on the business or operations. (Continued on reverse side) Cut Here 5--- Federal Explosives License/Permit(FEL)Information Card � I License/Permit Name:SANTORES WORLD_ FAMOUS FIREWORKS LLC I I I BusinessNaine: I 1 License/Perinit Number:6-NY-083.23.7C-01081, I 1 LicenselPermit Type:23-IMPORTER OF EXPLOSIVES I Expiration: March 1,2027 I 1 1 Please Vote: Not Valid for the Sale or Other Disposition of Explosives. I I I Expires: 1/31/2025 SH-862(3122) WE ARE YOUR DOIL DIVISION OF SAFETY HEALTH' THIS LICENSE MUST BE LICENSE AND CERTIFICATE UNIT Uopap (Department POSTED IN YOUR PLACE OF Of Labor STATE OFFICE CAMPUS,BLDG. I BUSINESS, ALBANY,NY 12226 License No. D-6796 LICENSE TO DEAL IN OR MANUFACTURE EXPLOSIVES Santore's World Famous Fireworks, LLC 846 Stillwater Bridge Rd Scliaghticoke, NY 12154 August N. Santore, Jr. -is hereby licensed to,deal In or manufacture explosives in.compliance with the requirements,of the Labor Law and-Industrial Code Rules,Any change in the conditions under which this license is granted may cause It to be revoked. Every person selling,delivering or giving away any explosives must keep at the principal place of business within the state, a record of each transaction,including: 1) the NAME or TYPE and QUANTITY of explosives SOLD,DELIVERED or GIVEN.Note:No license is needed to purchase smokeless powder,or black powder and quantity Is not exceeding five pounds.for use In firing antique firearms or artifacts or replicas thereof.However,dealers MUST post all such transactions an 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. the NAME,ADDRESS,and LICENSE NUMBER of the peison TAKING THE EXPLOSIVES AWAY from the seller or donor. Amy Phillips,Director FOR THE COIN/INUSSIONER OF LABOR SH-862(5-98) N -Sky Productioris'LL 001121'ht P.O.Box•697 . ! Stillwater,New York 12170 DATE-, - s` wza `i. ' l . " _ -T1OTHE:�PAY ORDER F c U A'3•/ f t - ��},�� Y �4.L - - i' n �T C � Ir # c +• :'� '::'� :.'fir.,.,. �t �Y. f,t s'f~ T9 F - `:t'`i o - o -7 t ';:r•.; --MEMO .4 Oy `:•�:��,W AIlTHOFUZED SIG ATURE - `tQ"'t•f• O':^�!. 4 - .•.ter'.:;y., I,• , I _ G • O•' O.- i. �v t':11 4�30.�-:�2,8;." [�(1i Noncarrow, Denis To: fireworks Permit Cc: Johnson, Benjamin;Schlachter,Amy (amys@southoldtownny.gov); Mudd,Jennifer; Sabrina Born (sabrina.born@town.southold.ny.us); Franke, Diana Subject: Fireworks App. NFCC 9/28/2024 Attachments: NFCC fireworks_20240830114929.pdf Please review and let us know. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.raov denisn@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. 1 Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 08/30/24 Receipt#: 334635 Quantity Transactions Reference Subtotal 1 Fireworks 9.28.2024 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#001121 $100.00 North Fork Country Club Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: North Fork Country Club 26342 Main Rd Cutchogue, NY 11935 Clerk ID: DENISN Internal ID:9.28.2024 Noncarrow, Denis From: Verity, Mike Sent: Tuesday, September 3, 2024 9:55 AM To: Noncarrow, Denis Subject: RE: Fireworks App. NFCC 9/28/2024 Denis, I have no objection to the fireworks display, provided it is in compliance with all State codes,Town codes and is conducted in a manner that is safe to other persons or their property. Best, Mike From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent: Friday,August 30, 2024 11:49 AM To: Lillian<McCullough>; McCullough, Lillian <lillianm@southoldtownny.gov>; DeChance, Paul <pauld@southoldtownny.gov>; Grattan,Steven<sgrattan@southoldtownny.gov>;Town Att;Verity, Mike <Mike.Verity@town.southold.ny.us>;Visser III, Fredric<fredv@southoldtownny.gov> Cc:Johnson, Benjamin<benjaminj@southoldtownny.gov>;Schlachter,Amy<amys@southoldtownny.gov>; Mudd, Jennifer<jennifer.mudd@town.southold.ny.us>; Born,Sabrina <sabrina.born @town.southo Id.ny.us>; Franke, Diana <dianaf@town.southold.ny.us>; McCullough, Lillian <lillianm@southoldtownny.gov> Subject: Fireworks App. NFCC 9/28/2024 Please review and let us know. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.aov denisn@southoldtownny.pov 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 Noncarrow, Denis From: Grattan, Steven Sent: Tuesday, September 3, 2024 11:56 AM To: Noncarrow, Denis Subject: RE: Fireworks App. NFCC 9/28/2024 I have no objections to this event. Steve From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent: Friday,August 30, 2024 11:49 AM To: Lillian<McCullough>; McCullough, Lillian<lillianm@southoldtownny.gov>; DeChance, Paul <pauld@southoldtownny.gov>; Grattan,Steven<sgrattan@southoldtownny.gov>;Town Att;Verity, Mike <Mike.Verity@town.southold.ny.us>;Visser III, Fredric<fredv@southoldtownny.gov> Cc:Johnson, Benjamin <benjaminj@southoldtownny.gov>;Schlachter,Amy<amys@southoldtownny.gov>; Mudd, Jennifer<jennifer.mudd@town.southold.ny.us>; Born,Sabrina <sabrina.born@town.southold.ny.us>; Franke, Diana <dianaf@town.southold.ny.us>; McCullough, Lillian<lillianm@southoldtownny.gov> Subject: Fireworks App. NFCC 9/28/2024 Please review and let us know.. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownnv.aov denisn @southoldtownnygov 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 UFF01/r , DENIS NONCARROW �� Gy Town Hall,53095 Main Road TOWN CLERK p= P.O.Box 1179 y Z Southold,New York 11971 REGISTRAR.OF VITAL STATISTICS Q � � Fax(631)765-6145 MARRIAGE OFFICER 'y RECORDS MANAGEMENT OFFICER �0,� .�� Telephone oldt nny.gov FREEDOM OF INFORMATION OFFICER www.southoldtownny.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: North Fork County 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, September 28th 2024 at 9 :45pm. Rain date is Monday, September 29th. Exact Location is 26342, Main Road, Cutchogue, New York, 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 firi e fireworks shall be over the age of eighteen years, competent and physically fit for the task, that the sha be at lea two such operators constantly on duty during the discharge and that at least two soda-ac' or of er approv d type fire extinguishers of at least two and one-half gallons capacity each shall be kept at suc i ely separ a oints as possible within the actual area of the display. 11171 117 enis Nonca ow, Town Clerk Town of Southold Suffolk County,New York (TOWN SEAL) Date: September 11,2024 THIS PERMIT IS NOT TRANSFERABLE i 0--f-J"640 RE OLUTION 2024-322 ADOPTED IOC ID: 20134 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2024-322 1 VIAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON APRIL 9, 2024: RESOLVED that the Town Board of the Town of Southold hereby approves the issuanc of a Fireworks Permit by the (Town Clerk t Santore's Fireworks on behalf of the North Fork 1 ountry Club, for a fireworks display on Saturday, July 6th, 2024 at 9:15 PM (Rain Date: Sunda September 1st, at 9:OOPM) at 26342 M3.in Road, Cutchogue, New York upon payment o single fee of$100.00 and subject to the applicant's compliance with any conditions and requirements of the Town of Southold olicy regarding the issuance of fireworks permits Denis Noncarrow Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Anne H. Smith, Councilwoman SECONDER:Brian O. Mealy, Counci man AYES: Doroski, Mealy, Smith, rupski Jr, Doherty, Evans I i t DENIS NONCARROW Town Hall,53095 Main Road TOWN CLERK ® P.O.Box 1179 ZZ"" Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p ® Fax(631)765-6145 MARRIAGE OFFICER �Q �'• Telephone(631)765-1800 RECORDS.MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK ; TOWN OF SOUTHO_LD 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 BY North Fork Country Club PRINCIPAL OFFICE AT 26342 Main rd. Cutchogue NY 11935 DATE & TIME OF DISPLAY 7/6/2024 , EXACT LOCATION OF DISPLAY North Fork Country Club-designated area on Golf Course SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE &TIME 9/01/2024 The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Gregg Kotasek 53 10+ Active-Fit (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: 1.3G cakes- 19. , 2-3" Shells -4.12 , 4"shells.-102 Manner and place of storage of fireworks prior to display: On a licemed lranspnrt 1 intol loade for 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 Pmerty.Owner,,must be submitted with the Application. Santore's World Famous Fireworks LLC FEE: $100."0!0 Name of Organization By Te.-i ya aofl� Signature of Applicant 3/07/2024 Date,of Application 1 DENIS NONCARROW Town Hall,53095 Main ad R o TOWN CLERK A: � P.O.Box 1179 too . :m Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ` Fax(631)765-6145 MARRIAGE OFFICER ', ®. ��` Telephone(631)765-1800 , RECORDS.MANAGEMENT OFFICER wwwsoutho�dtowanygov 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. 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 dislilay. 4 12. All applications for a fireworks permit shall be subject to an aptilication,fce in -an amount of$1,00.00, together with a processing fee in an,amount to be deterntined lsy 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.) 1 ' North Fork Country Club i i f i March 18, 2024 t ! To whom it may concern, I North Fork Country Club has engaged Santore's World Famous Fireworks to provide us with a fireworks display on July 6, 2024 with a rain date of July 7,2024. Part of our arrangement is for Santore's World Famous Fireworks to obtain and complete all necessary applications and permits.They have our permission to process all necessary paperwork for the event. If you have any questions or concerns, please contact us, TIZ�Ink you, �L Pin ea General Manager P.O. BOX 725 CUTCHOGUE.NEW YORK • l 1935-0725 (631)734-7139 • r•Ax(631)734-9004 • nfcc mail Cooptonline.net www.northforkcc.com r � r� U.S.Department Eastern Service Center 1701 Columbia Ave. of Transportation Operations Support Group College Park,GA 30337 AJV-E2 FIREWORKS DISPLAY NOTIFICATION Company Name* Santore's World Famous Fireworks, LLC Email Address of Person Submitting Request: terisa@santorefireworks.com Cell Phone Number for On-Site Technician:_Gregg Kotasek 631-803-0429 Event Name: North Fork Country Club Display Date: 7/6/24 Rain Date:--9/1/23 Display Start Time: _9:15ym Duration of Fireworks Display: 15-20 min Max Height of Fireworks: 400 Feet Address,City and State: 26342 Main Road,Cutchoeue, NY Latitude: 4100' 16" (North) Longitude: 72 29'25" (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 l 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-Fireworks a,faa.gov Sincerely, Matthew N. Cathcart Manager, Operations Support Group Goggle Maps North Fork Country Club 10 : t 'F A S ' \ 911M ,. 350 Ft 4• a • • • Measure distance Total distance:350.63 ft(106.87 m) Launch Site up to 4 Shells -Audience Viewing Launch Site - = Cakes - 1.25" Fallout Zone for Cakes- 150' Radius Fallout Zone for 4" Shells-350' Radius Launch Site Lat/Long: 41o00' 16" N/72 29' 25" W Display Location: North Fork Country Club, 26342 Main Road, Cutchogue, Southold, NY SA ' -WOR1.1)UAMOU5- FI RE WORKS AC RO " CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDD/YYYY) `� 317/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Acrisure, LLC dba Britton Gallagher&Associates PHONE FAX One Cleveland Center, Floor 30 A/C No Ext:216-658-7100 WE,No:216-658-7101 1375 East 9th Street ADDRIESS: Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Everest National Insurance Company 10120 INSURED 18341 INSURER a:AXIS Surplus Ins Company 26620 Santore's World Famous Fireworks LLC 846 Stillwater Bridge Road INSURERC: Schaghticoke NY 12154 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:753580453 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 ADD S BR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MMIDD/YYW A GENERAL LIABILITY Y Y SIBML00235-241 2/9/2024 219/2025 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE Pil 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/OPAGG $2,000,000 POLICY X PRO- LOC $ CT MBINED SINGLE LIMIT A AUTOMOBILE LIABILITY Y Y S18CA00102-241 2/9/2024 2/9/2025 CO Ea accident $1 000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ B UMBRELLA LIAB X OCCUR Y Y P-001-000074909-06 2/9/2024 2/9/2025 EACH OCCURRENCE $4.000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4.000,000 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY YIN O Y LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A 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 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. Certificate Holder is named as additional insured.Coverage is provided on a primary non-contributory basis.North Fork Country Club,the hamlet of Cutchogue, the Town of Southhold,Suffolk County are named as additional insureds,but only in respect of liability caused by the negligent acts or omissions of the named insured,Subrogation waived to the extent required by the written contract. Fireworks Display date-7106124 Rain date-7/7/2024 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Fork Country Club ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 725 Cutchogue NY 11935 AUTHORIZED REPRESENTATIVE United States ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Y workers CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured SANTORE'S WORLD FAMOUS FIREWORKS LLC (518)664-9994 846 STILLWATER BRIDGE ROAD SCHAGHTICOKE,NY 12154 1c.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 472010297 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New York State Insurance Fund(NYSIF) NORTH FORK COUNTRY CLUB 26342 MAIN RD 3b.Policy Number of Entity Listed in Box 1a" POBOX 725 DBL 6582 92-9 CUTCHOGUE,NY 11935-0725 3c.Policy effective period 02/06/2024 to 02/06/2025 4.Policy provides the following benefits: ® A.Both disability and paid family leave benefits B.Disability benefits only C.Paid family leave benefits only 5. Policy covers: ® A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 2/21/2024 By eAt4iYrl (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that Insurance carrier) Telephone Number (866)697-4332 Name and Title Kristin Markwica,Head of Disability Insurance Unit IMPORTANT: If Box 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board, DB Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200 PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4C or 5113 of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. D113-120.1 (10-17) Certificate Number 775983 Additional Instructions for Form D13-120.1 By signing this form,the insurance carrier identified in box "3"on this form is certifying that it is insuring the business referenced in box"1 a"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law.The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box "2". The insurance carrier must notify the above certificate holder and the Worker's Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in Box 3c,whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Disability and/or Paid Family Leave Benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or paid family leave benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carver is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand and twenty-one,the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits,and after January first,two thousand eighteen,the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1 (10-17)Reverse NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE r .0 A A A A A A 472010297 SANTORE'S WORLD FAMOUS FIREWORKS LLC �~ , 143 SUMMIT AVE BERKELEY HEIGHTS NJ 07922 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SANTORE'S WORLD FAMOUS NORTH FORK COUNTRY CLUB FIREWORKS LLC 26342 MAIN RD 143 SUMMIT AVE CUTCHOGUE NY 11935 BERKELEY HEIGHTS NJ 07922 POLICY NUMBER CERTIFICATE NUMBERT POLICY PERIOD DATE A2353 260-9 217844 02/07/2024 TO 02/07/2025 2/21/2024 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:INMW.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: 178225882 U-26.3 SH-862(3f22) Expires: 1/31/2025 WE ARE YOUR. I3OL DIVISION OF SAFETY .HEALTH THIS LICENSE MUST BE Sun LICENSE AND CERTIFICATE UNIT "`Y' 10 oparrment POSTED IN YOUR PLACE OF �of Labor S TATE OFFICE CAMPUS,BLDG. 1 BUSINESS ALBANY,NY 12226 License No, D-5796 LICENSE TO DEAL IN OFF MANUFACTURE EXPLOSIVES Santore's World Famous Fireworks, LLC 846 Stillwater Bridge Rd Schaghticoke, NY 12154 August N. Santore, Jr. Is hereby licensed to deal In or manufacture explosives in compliance with the requirements of the Labor Law and Industrial Code Rules.Any change in the conditions under which this license is granted may cause it to be revoked. Every person selling,delivering or giving away any explosives must keep at the principal place of business within the state, a record of each transaction,Including: 1) the NAME or TYPE and QUANTITY of explosives SOLD,DELIVERED or GIVEN.Note:No license is needed to purchase smokeless powder,or black powder and quantity Is 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 r' from the seller or donor. )/ 11,111le Amy Phillips,Director FOR THE COMMISSIONER OF LABOR SH-862(5-98) U.S.DepartnentofJustice Federal EiMlosives License/Permit Bureau ofMcohol,Tobacco,Firearms andFacplosives (18 U.S.G Chapter 40) saratasaaaaataalmunar�nto�suat In aocordame with the provisions of TWc RI,OtganizW Crime Control Aat o€1970,and the regulations issued themnder(27 CFR Part 555).you may engage in the activity specified in this license or permit within the limitations of Chapter40,Tide 18,United States Code and the regulations issued thereunder,until the cx l�ratloll date sham THIS LICENSE IS NOT TRANSFERABLE UNDER 27 i5.53. Sec"WARNINGS"and"NOTICES"on reverse. Direct ATF ATF-Chief:FF_LC Lieensa'Permit Correspondence To 244 Needy Road Number o : E 1 081 Martins ,WV 25405-9431 Chief.Federal EsplosivesL'cesnsingCen (FELC) F_.piration Date March 1 , 2024 Name SANTORES WORLD FAMOUS FIREWORKS LLC Prendses Address(Change'.?Notify the FELC at least 10 days befarethe move.) 846 STIL LWATER BRIDGE ROAD. SCHAGHTiCOKE,NY 12154- Type ofNcense or]?mtt 23-IMPORTER OF EXPLOSIVES Purchasing Certification Statement Mailing Address(Changes? Notify the FELC of any cbanges.) 7heliemsworperruirtee named above dmmuseacopy ofthis•lioemscorpa=11to assist a transferor ofeaptosivesto verifpthe identity andthe 0-censed.stams ofthe licensee or pmnttoeasprovidedby27CFRPmt555. Thee: txwaaneacbmoymuctbean.oeieiW SANTORES WORLD FAMOUS FIREWORKS LLC si atone A faced,scanned or e.nsat'led copy ofthe Hearse or permit with a signature intftded to be an original signs twe is nmaptable. Thu dehi are must betbat cf the Federal 143 SUMMIT A V E EaplasivesIaeentta(FEL}orampoas�blepersa�toftheFEL Iemifytbdtthisisatsue BERKELEY HEIGHTS, NJ 07922- copy of a license or permit ismed to the licensee or poaaidee unmed•aboveto•eagage in the business or operations specified above undar'T}pe of License or Permit." LiaenseoPermittee Responsible Person Signature Positionrlitle Printed Name Date ATFFarm ctoo W/5900.15 Part I previonEaign is Cbsmlete u*awi Rveised September 2011 Federal Explosives Ucense(FEL)Customer Service h&—anon Federal Explosives Licensing Center(FELC) TollA a Telephone Number. (877)283-3352 ATF Homepage:www a3£gw 244 Needy Road FaxNurmber. (304)616.4401 Martinsburg.WV25405-9431 E-marl: FELCOWfgov C tango of Address f27 CFR 553.54(a)(1)). Ueensees or perminew may dwingthe term of their cm. license or permit remove their business or operations to a new location at which tiM intend regdatly to carry on sueb business or operations. The iiamme or psrmittee is required to give notification ofthe new location ofthe businms or operatiams trot I=than 10 days prior to sash mulovitl veith the Chic$Falmd ExpWiM Liccasiag Center. The licanso or permit will be valid for the remainder ofthe term oftbe original license or permit. (Me ChK FELC,shall,if the licensee or perreittee isnot quaned,refer the request for amended Hemw or peml to the Director of bides Operadons for dmW 3n zcwrdancc wide§33S54) Right of Succession (27 CM SSS.59). (a)Certain persons otherthan the licensee or permittee may secure the right to Carty 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 perrrdt. Such parsons are: (1)The surviving spouse or child,or executor,administratar,or ather legal representative of a deceased.Geeasee or pennitteq and(2)A receiver or trustee in bankcruptcy,or an assignee for benefit of creditors. (b)In order to secure the tight provided by this section,the putt m or pwsons continuing the business or operations shall furnish the license or permit for forthat business or operations for endorsement of such succession to the Chits FELC,within 30 days from the date on which the successor begins to raq on the business or operaliom fC'ondwed on revww side) tttttHt'ze,�:---- ———— ------ Federal FA-plosives LicensddPemdt(FEL)Information Card I License?emit Name:SANTORES WORLD FAMOUS FIREWORKS LLC 1 1 1 t I BusinessName: I 1 I t License/Permit Number.6-NY-W3.234C-01081 1 I LicensePermit Type:234MPORTER bF EXPLOSIVES t r Expiration: March 1,2024 { t I I Please note: Not Valid for the Sale or Other Disposition of&\plosive¢.--------------------------------- t l I U.S.Department of Justice Federal Explosives License/Permit Bureau of Alcohol,Tobacco,F (�S U.S.C. C1tQp�eY 4©)irearms and Explosives unimmumiluittinnariummcnm In accordance with the provisions of Title 7ff,Oreanlzed Crime Control Act of 1970,and the regulations issued thereunder(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 e:;ttiration date shrnyn. 'I'M4 I.1g N rQP.rC N�YnT Tit t.NCI'!:PA.Ri 1"UND it'll?7 Crr Sec 111%ARXTDJ091'—.4 IWOTTCrS° Direct ATF ATF-Chief,=- C License Pearhif Correspondence To 244 Needy Road Number 6-NY-083-20-4C-01 080 Martinsburg,WV 25405-9431 Chief.Federal Explosives Licensing Conte (FELC) Expiration_ Date March 1, 21024 Name SANTORES WORLD FAMOUS FIREWORKS LLC Premises Address(Changes?Notify the FELC at least 10 days before the move.) 846 STILLWATER BRIDGE ROAD . SCHAGHTICOKE NY 12154- Type of License or Permit 20-MANUFACTURER OF EXPLOSIVES Purchasing Certification Statement Mailing Address(Changes'?-Notify the FELC of any changes.) The licensee or pennittec named above shall use a copy ofthis license or permit to assist a transfwor of explosives to vcrify the identity and tfie licensed status ofthe licensee or pe mittee as provided by 27 CFR Part 555. 'Me signature an each cony inust be ari brieinal SANTORES,WORLD FAMOUS FIREWORKS LLC signature. A faxed,scanned or e-mailed copy of the license or permit,with a signature untended to bean original signature is acceptable. The signature must be dial of the Federal 143 SUMMIT AVE" Explosives Licensee(FEL)or a responsible person ofthe FEL..I certify that this is a true BERKELEY HEIGHTS, NJ 07922- copy of a license or permit issued to the licensee or perntittee mmned•ab6ve to-e_n-a�e in the - business or operations specified above under'Type of License or Permit." LicenseeTermittecResponsible Person Signature Position,'Title Printed Name Date ,177-'Gcrm 54nn WfLIuQ IS Para I 1'reviow Edition isObsolete "AMES WC4LD F410jr rmtwcrisucx+smttuAmtoncmi Revised September2011 Federal Explosives License(FEL)Customer Sen•ice Information Federal Explosives Licensing Center(FELC) Toll-free Telephone Number. (877)283-3352 ATF Il:omepage:aurmatfgov 244 Needy Road Fax Number. (304)616-4401 Martinsburg,W1i 25405-9431 E-mail: FELCa,atfgov Change of Address (27 CFR 555.S4(a)(1)). Licensees or permittees may during the term of their current license or permit remove their business or operations to a now location at which they intend regularly to cam on such business or operations. The licensee or permittee is required to give notification oftbe new location ofthe business or operations not less than 10 days prior to such removal with the Chie&Federal Explosives Licensing Center. The license or permit«ill be valid for the remainder of the 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 tsith§555.5.1.) Right of Succession (27 CFR 355.59). (a)Certain persons other than the licensee or permitter may secure the right to carry an the same explosive materials business or operations at the same address sho-wn on,and for the remainder of the term oL 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 porn»nee:and(_)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,IT-LC,within 30 days from the date on which the successor begins to carry on the business or operations. Cut Here !Continued on reverse side) — t Federal Explosives License/Permit(FEL)Informarion Card I I I License?ertltitName:SANTORES WORLD FAMOUS FIREWORKS LLC I I I 1 I 1 BusincssNamc: t I i I I I License!Permit Number:6-NY-083-20.4C-01080 i I 1 1 LicensePermit Type:20-MANUFACTURER OF EXPLOSIVES 1 Expiration: March 1,2024 I I I t Please yule: \ot l'alid for the Sale or Other Disposition of Explosives. 1 I i Dl.A1.,*%WfJN I F,ST OF.1 C,,,T Ic E 4 SANT WLS MIMI INAW WS FIREWORKS UA' 901091):MI-I"SN'R 143 SUNMHT AVE qgt�? BEJO ! 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",ii I cc Akv I lav'!liot coa Ip 4:1vki 'Il I I.;it pI icniiovt. l0I 't'llp IC:j cop ol,I hi I:1 Ic I lo,'Ih L!., I 13C rill lot.111,:next six i,,l tlniid v.c,colllplvi4: ,[I aI. 11,111,11 oc.:111,ill lhan Illoildis)J, 1:VidCrILC Of \I I It F I❑IS;:,!1)VI I I I;I I ed ,tans,- If k-,v hoot I I('!c'!Ill plctvd 2 1.,E onr;Ipplic:aios) 1�,-1-,:IILnka I'A-i I h ill i% olk,I I Ih, C1.11 IlIC Lkl][c of ihi:,jellcr,vve ie JI stmd you anouh�i Icticr. kvilich„ill he v;tlid 1,;'r w: I1lt,nsL,(of uJI61 III C CoillpleTc ztkliolf on Y"111 if that occur, ill k�,, 01a[1 six i� of coul'�t: ccnuiu cnt ulpoll your rrlll,tillurw cluitictf t",2 I,tllllial4e 'Ilvr:llon,ufllli,l yoltr C:lllcltl P io'l,c J irvcl qulc,tiol I or COIIL!erll.> to Siiy:tn t iairi- ."JA" Z Noma I hward ,VIT "I":1,addre� - - --- - - -- - - -- - - - - - I, i � • i I 61RE60RY KOTASEK I NON PROXIMATE Al-.' )IEr �`_ r y Aq THIS CARD MUST BE CAI � WHEN USING PYRO T NYC & NYS CERTIFICATIONS REQUIRED IN l�fllll �,�� + +11�i�itl Ilff I .0 �vi • Af' M ai ♦ � � 7 w I " ter- ' w ►. . �r"i ' '�` ! 5wa "46 PA Al . ';:V 7A 4� A bf - .,r.. �}1C•�'�:•' � '� e..�� rai;,r I �•/wV � hF'� ^C� .f.Y-€�,. ':h..�"V iiM'.'a �•'�!' ` =��' �'�tl �qyx� a ' Resolution 2010-474 Board Meeting of June 29,2010 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. • 0 2 Elizabeth A.Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Albert Krupski Jr., Councilman SECONDER:Vincent Orlando, Councilman AYES: Ruland, Orlando,Talbot,Krupski Jr.,Russell ABSENT: Louisa P. Evans Updated: 6/30/201010:43 AM by Lynda Rudder Page 2 RESOLUTION 2010-474 ADOPTED DOC ID: 6016 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO.2010-474 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 29,2010: RESOLVED that the Town Board of the Town of Southold hereby adopts the following. POLICY regarding the issuance of fireworks permits: 1. The Town may grant a permit for the display of fireworks by municipalities,fair associa{ions, amusement parks,persons 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: 4 (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. �oseo + FIREWORKS DISPLA Y AGREEMENT Display Date:07/06/Z024 i AGREEMENT by and between Santoro's World Famous Flreworks, LLC whose address is 846 Stillwater Bridge Road,Schaghticoke, NY 12164(hereinafter"Santore");and North Fork Country Club (hereinafter"SPONSOR"). WHEREAS,SANTORE conducts fireworks displays;and forth; WHEREAS,SPONSOR wishes to engage Santore to perform a fireworks display on the terms and conditions hereinafter set NOW,THEREFORE,in consideration of the terms,conditions and covenants hereinafter set forth,the parties hereto do mutually agree as follows: f.FIREWORKS DISPLAY. On,July 06,2024,(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: 7/07/2024 COST AND PAYNENTS:Permits are not inctuded in the pricing FIREWORKS DISPLAY PRICE: The total(Fireworks DisplayP(ice plus all other applicable charges)sum of $7,400.00 shall be due and payable as follows:. a.The sum of($7?400:1)O upon;executioii= a dldexliveryaofrthir,,, nlraGt,Paid by a Check;remit to:i,SaritoTe's PO Qpx 887,cStillwater Ny1,21i7�fl = _- r-- 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. 2. POSTPONEMENT/RESCHEDULING:7/0T/2024 if show Is postponed as per below. Description I %of Fireworks Display Price Additional Costs If notified by 6:01 AM on 71ffi 024 1 $1,500.00 Any 31d Party Vendor Expenses When fireworks tech leaves facility I $2,000.00 Any 3 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. 3.SPONSOR'S AGENT:Raluca Pintea 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. REC'D FEB 7 2024 4. EXHIBITION PLANNED"CHECKLIST: It is understood and agreed by the parties hereto that the Fireworks"Qisplayshall be contingent upon the stridt 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 Santoro within the time limits therein set forth shall be deemed to be an event of default of SPONSOR'S obligations hereunder, 5.SECURiTYMAFETY: SPONSOR shall provide and maintain sufficient Security before,during and after the Fireworks Display until the.pyroteehnfcian in charge.declares the area clear. Security"shall be:deemed to include',.but not'timited to;be sll,security iines,.palice protection,snow fencing,:rope lines,baricades 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 ear's and spectators with'a minimum radtus.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 set up by or on behalf of SPONSOR shall be in.accordance with the current edition of NFPA 1123-and under the direct supervision of the Santoro4echnician in charge.Any such inspection Shall not in any way Interfere,with-the safety,setup or schedule of the preparation for and dlsassernaly 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. S.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. 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 orregulatory restrictions,labor disputes of whatever nature,power lass,telecammunicattons failure,;acts of G,od;or any othercause beyond its. reasonable control. In the event SANTORE is unable to d Aver the Fireworks Displayon'the.De,,livery-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. T.CONTRACT SUBJECF.TO GOVERNMENT REGULATION:"This Agreement and Santore obligations hereunder are subject to all applicable Federal,State,.Munidpal 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,rul%j.egulation orordinance shall be enacted'which in any way prohibits,`limits or restrlcts the sale,performance or aperation"of.the ezhibitiori°of.the Fireworks'Display or in the''event SPONSOR'S permit in anyway 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,fuB contract price. 8. GENERAL PROVISIONS: a) This agreement constitutes the entire agreement'between the parties relating to the subject-matter hereof and may not,be changed,rnodltiod,renewed or extended exceptbya"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 agreeme.rit be held or,declared,to be:votd or illegal for:any.reason,all otherclauses,sections, or parts of this agreement which can be effected without such illegal clause,section,or part shall.nevertheless continue in full forceand 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 requite 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/FDIFM 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 3D days from the date of cancellation to request Santore to reschedule the Fireworks. 4 I 4 ' k F Display. Fireworks Display shall take place no later than six months from originally scheduled Fireworks Display and may not be rescheduled WWI—7/4.of any,year Without.express consent of Santore. f t) Santore agr`oes to procure liability insurance on Behalf of SPONSOR,and'to indemnify SPONSOR,to the extent thereof,for i. all claims arising out of Santore negli9ence. Any additional insurance.that is required that incurs a cost will be the SPONSOR'S responsibility., t 9. SPONSOMS DEFAU LT,.• In the event SPONSOR fail to pay.'any=sum when due`under the:ternis of this contract;SPONSi)R:shall pay,.'In addition td sudh,amourtl,interest at the rate df 1.5%per month on the,.unpaid armourif frdm hei-original due.date,SPONSOR does."further agree'tttatif hdlt pay'Santore reasonable attorney fees and otFie'r coats.In,'the event Santore shaii.cornmence,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. 10.LIQUIDATED DAMAGES: It agreed by and.between the parties hereto that in the event of SPONSOR'S default hereunder$antore 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 Santoro will have.sutfiered damages due to;$ponsoles default.The dama Ass,suf idr d by Santoro as a result of Sponsors default will be substantlal,f but incapable of determination with'mohemaGcat precision:It is„thaiefore;.agreed bythe`par.s that;the ameuntdue.: Santore is not a penalty,but rather a mutually beneficial and reasonable estimate of the damages suffered by Santore. 11.SUBSTITUTIONS: Santore shall have the right,at its discretion,to substitute any fireworks it deems necessary provided same does not'datract fmrn the aesthetic value or quality of the program,This includesi but is not limited to,shell sizes,quantities,types and brand`names: Any substitutions shall in noway result In or entitle SPONSOR to a reduction or,abatement of the full contract price, 12.ARS17RATION: 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 attomeys'fees.The award of.the arbitrator shall be final,and binding and judgment may be entered thereon in any court of competerif jurisdiction.The arbitrator sitting in such controversy shall have,no power to°alter or modify anyetip"ress provision of this Agreerrrcnt,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.remedyin aid.`of'a"rbitratlon,includingi1lbut:not,linrited.to,injunction,,attach e:d ment or replevin;pending thetermination of any 6i6im or controversy in arbitration. Anyand all.disputes,controverstes,�actions,claims,. causes ofaction,or proceeding - rising under;.out of Orin-connectloh with orrelatinA'.to the•terms'ofthis'Contraat,and ariy 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. 13.BINDING EFFECT:This contract shell not be binding on Santore until executed by SPONSOR and Santore and Santore Is In receipt of the down payment required hereunder. 14. EXHIBITION PLANNER CHECKLIST(EPQ: a. FIREWORKS.DISPLAY PERMIT:, (Nate: The actual start and stop time of the display will be determined by the governmental authorities having jurisdiction over the display). SPONSgR'S.RF�.SPONSIBILITY: it,is:Sponsbe*.responsibility tor-call your State,City,County,Town',Borough,or Village Fire h/larshator:other.approprtate:authacity to Ole far and ghtaiii ihe•Fiireworks;Display'permit. Santoro will prepare the paperwork for the pemft apo.11 tign'gn SPONSOR!$behW(.-..U6on receipt of your perink,you must-send the permit'to'our office foraur., records no'lateir than 3b da s orior to your dlanlaV dAte. .Fa I re tada so.could sorloust opoLdize'ypufdldolay. You must obtain information on: - 1, Flung 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 pian'to the display site. Fax us a copy of the route instructions from the nearest US Interstate to the display area.(appraved by the fire marshal or other authority,if necessary), 5., Notify FAA on.the day of your display,according to.the instructions imthe FAA Letter of Approval,which will be forwarded:to you prior to your display. b.COAST'dUARl70l2 MITS11w6dir0r6QuI69d-r 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. c.SPONSOR RESPONSIBILITIES ANO EXPENSES Cf he follov%inci servic®s ne0d to bo provided and paid for bV the SPONSOR In addition to the Fireworks Display:Price. 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 MAY BE FOLLOWING THE REQUIRED FIRST LIGHT DUD,SEARCH ON THE.MORNING AFTER THE DISPLAY. d.INSURANCE: Please list below the additional insured,as they should appear on the insurance certificate: q, 3. 2. 4. Name of Sponsor: Date . Santora a Data North Fork Count . B : Raluca Pintes. . Signed by on behalf'of so . ign tore) Print Nam0. .� �i ar�+ 88i�82 . Title of authorized rep esentati4ve'.of Sponsor Yl� t18 In "mem er r • r ■ ■ r ■ ■ .• • ,■ r r t r, ■ •' 0 ■, • ■ r ■, a it ■ a • .s • .• a r ■ ■ ■ a r a r • ■ • r it San,tote DISPLAY SITE PLAN QUESTIONNAIRE t. AIN6MS listed beldw.are subject to all governing Federal State Municipal and local laws,rules,ae ordinances,regulations and codes,now or hereinafter in effect and to the conditions and limitations contained In th6 permits required of t 'b 6btaln6dl by Spo t nsor. SPONSOR: Display Date July 06,2023, Rain Date:july-1.2024 Budget: $t406.00 Display Location: North Fork Country Club Grounds Time of Display-`Approx.9-1S p.m (Note: The actual start and stop time of the display will be determined by the governmental . authorltles having Jurisdiction.over the display). IMPORTANT: PLEASE,PROVIDE A SITE PLAN FOR YOUR EVENT LOCATION,INDICA77NG WITH AN X THE EXACT SPOT WHERE FIREWORKS ARE TO BE SET-UP. Local Fire Marsh6f, Telephone No: Call Phone No. 'Z;;W Contact Person; Telephone No: Call Phone No. The Following Inionnation Is necessary In order for us to provide your community or organization with a display that conforms.with fireworks saffly Mulattons and for the issuance of your Insurance certificate. 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, ETCJ....: ...... TEMPORARY.EVENT SET-UPS(CONCESSIONS,TENTS,ETC.)........................... MAINPARKING AREAS.................................................................................. HIGHWAYS OR ROADS..............................................................! OVERHEAD OBJECTS(POWER LINES,LIGHT.POLES,TREES,ETC....... ....... FUELSTORAGE............................................................................................. PLEASE PROVIDE DIRECTIONS FROM NEAREST INTERSTATE,TO DISPLAY SITE. A MAP WOULD ALSO BE HELPFUL. Local Motels/Hotels: Telephone Nos. Title. ... .... It A" ad, Date INVOICE • SANTo . 240706-P -WORLD FAmous- FIREWORKS\ PURCHASE ORDER:#._ TERWIS.. „DATE',SHIPPED :,SHIPPED.VIA F.0.6. DATE Upon Receip : 7/06/2024 Santore's•V1lorld.Famous Fireworks LLC .` 3/18%24 SHIPPED DESCRIPTION UNIT PRICE AMOUNT PAID Fireworks Display-permit application fee directly ;Town of Southold $100.00 �'P ''ecejVed RECT MAR 1 024 0�,(U'Q"tv0K ty OK 04 OK Ace SIGN "A U�,� Total $100.00 Due: Please make check payable to :the Town of Southold and remit payment to: Town of Southold ` Office of the Town clerk 53095 Main Rd ME Po box 1179 Southold NY 11971 AI t SHTC Southold Town Clerk Mar 21/24 Check No. 050092 050092 Invoice No Inv.Date PO Number Reference Audit No Gross Amt Disct/HB Net Amt 240706P Marl8/24 N/A PJ2230 100.00 0.00 100.00 Distribution: 01-1300-00 Southold Town Clerk 100.00 100.00 0.00 100.00 �c'Q tit r r 1 IX y North Fork Country Club Detach Before Depositing - Vf f. Y T _ _ r-;t a 4-'Ct'M - t«f, nI. •'S s ': 6 4. rth ® C I� . �50 66/21 tk,hU ue . ._.._ .952 U= f t�! {,p 'h:y;),`;<i, III' � � • �:� •F ti +l v. ;tt .1 e' . ,. '., .,- - 'ten i..'�v::......:�:"-:..,.•,.....:' •d'-t': - 050 092 3224 ••n 7 a{� .anr.�2 «Lis j v _ _V - - E .CTL A - t: is It.'a ki vo AT TH +.1•t '�i,:+x:.'..:� .:_ rt. -'1 �.1 .•tl r ::^ORDE Southold-Towii":Clerk ' .' ^r' 'rZ R 179_w -_ Ole sit. ............ .�ot�thold_NY._._Owv ,}j r h- 't 9 - AUTH RI ED S161J.TURF lie 5009 2no 1:0 2 140666 5000 20 76 L 5n' I I Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 03/29/24 Receipt#: 324832 Quantity Transactions Reference Subtotal 1 Fireworks 7.6.2024 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#50092 $100.00 Country Club, North Fork Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Country Club, North Fork Pob 725 Cutchogue, NY 11958 Clerk ID: DENISN Internal ID:7.6.2024 Noncarrow, Denis From: Visser III, Fredric Sent: Friday, March 29, 2024 2:37 PM To: Noncarrow, Denis; Flatley, Martin; Ginas,James; Lillian; McCullough, Lillian; Spiro, Melissa;Town Att;Verity, Mike Subject: RE: North Fork Country Club Firework Permit No opposition. Fredric Visser, Fire Marshal Town of Southold Phone: (631)765-1802 Web: https:Hsoutholdtownny.gov/1736/Fire-Marshal Email: Fredv@southoldtownny.gov PO Box 1179 54375 Main Road Southold, NY. 11971 From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent: Friday, March 29, 2024 11:29 AM To: Flatley, Martin<mflatley@town.southold.ny.us>; Ginas,James<jginas@town.southold.ny.us>; Lillian<McCullough>; McCullough, Lillian <lillianm@southoldtownny.gov>;Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>;Town Att; Verity, Mike<Mike.Verity@town.southold.ny.us>;Visser III, Fredric<fredv@southoldtownny.gov> Subject: North Fork Country Club Firework Permit Please see attached and respond. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.gov denisn@southoldtownny.pov 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. Noncarrow, Denis From: McCullough, Lillian Sent: Monday,April 1, 2024 9:03 AM To: Noncarrow, Denis Subject: RE: North Fork Country Club Firework Permit Thanks, Denis! No Comments from me—neither the display, nor its blast radius are on or adjacent to preserved land. Cheers, Lilly From: Noncarrow, Denis<denisn@southoldtownny.gov> Sent: Friday, March 29, 2024 11:30 AM To: McCullough, Lillian <Iillianm@southoldtownny.gov> Cc: Noncarrow, Denis<denisn@southoldtownny.gov> Subject: FW: North Fork Country Club Firework Permit Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.pov denisn@southoldtownny.pov_ 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. From: Noncarrow, Denis Sent: Friday, March 29, 202411:29 AM To: Flatley, Martin <mflatlev@town.southold.nv.us>; Ginas,James<jginas@town.southold.ny.us>; Lillian <McCullough,Lillian<lillianm@southoldtownnv.gov_>>; Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>;Town Att; Verity, Mike <Mike.Verity town.southold.nv.us>;Visser III, Fredric<fredv@southoldtownnv.gov> Subject: North Fork Country Club Firework Permit Please see attached and respond. Thank you Denis Noncarrow Southold Town Clerk. Town of Southold, New York www.southoldtownny.pov 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 1 V Cc -F SA 't' t i -WORLD FANIOUS- FIRFWORKS Dear Town Clerk of Southold; Good Tidings, We have been contracted to perform a Fireworks Display for the North Fork Country Club. Please find the supporting documents and application in this correspondence.The North Fork Country Club( 26342 Main Rd Cutchogue NY 11935) Will remit application fee ($ 100.00) directly to the Town . If you have any questions or need anything further, please do not hesitate to reach out. Kind regards, Terisa At Santore (Terisa Clothier) , 518-664-9994 office 518-706-7673 cell Remittance :PoBox 687 Stillwater NY 12170 Facility address: 846 Stillwater Bridge Rd. Schaghticoke NY 12154 RECEIVED MAR 2 9 2M Southold Town Clerk North Fork Country Club March 18,2024 jTo whom it may concern, North Fork Count ryClub has engaged Santore's World Famous Fireworks to provide us with a fireworks display on July 6, 2024 with a rain date of July 7, 2024. Part of our arrangement is for Santore's World Famous Fireworks to obtain and complete all necessary applications and permits.They have our permission to process all necessary paperwork for the event. If you have any questions or concerns, please contact us. nk you, '`Pin ea General Manager P.O.BOX 725 • CUTCHOGUE,NEW YORK 11935-0725 (631)734-7139 • rAx(631)734-9004 • nfccmail@optoniine.net www.northforkcc.com J - DENIS NONCARROW �� Gy Town Hall,53095 Main Road TOWN CLERK _ p P.O.Box 1179 ti 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O Fax(631)765-6145 MARRIAGE OFFICER A Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �0.� `j►a www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER 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: North Fork 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 Tuesday, July 6th 2024 at 9:15 P.M. (Rain Date: Saturday, September 1st, 2024 at 9:00 P.M.)-at-26342 Main Road, Cutchogne, 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 reaoo velocity of more than thirty miles per hour; that all persons in actual charge of firing the fireaoint ovZ e of eighteen years, competent and physically fit for the task, that there shall be atpenstantly on duty during the discharge and that at least two soda-acid or other approtinof at least two and one-half gallons capacity each shall be kept at such widely separs f6le ' in he actual area of the display. DkDXNon ow,�-Town Cler Town of Southold Suffolk County,New York (TOWN SEAL) Date: April 9th,2024 THIS PERMIT IS NOT TRANSFERABLE