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HomeMy WebLinkAbout20021 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER h~o~0$UfFO(~-cOG ~ y~ O ~H x Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1500 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT For PUBLIC DISPLAY OF FIREWORKS I, ELIZABETH A. NEVILLE, Town Clerk of the Town of Southold, Suffolk County, New York, being an officer duly designated by the Town Board of the Town of Southold for this purpose, do hereby GRANT TO: GREENPORT FIRE DEPARTMENT PHOENIX HOOK & LADDDER & RELIEF COMPANIES by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York at 10:00 p.m. on Thursdav..iuly 4. 2002 and Cat„~dav r,.I„ ~ ~nm. nauma~e: ~a~uraav, .IU-y a, ~ooz dz ~unaay lulu 7 2UU2 at lU•00 P M on the property of GREENPORT PUBLIC SCHOOL, north side Front Street Greenuort New York ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at ]east two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feel from the nearest above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are dischazged and only persons in active chazge of the display shall be allowed inside these lines; that all fireworks that fire a projectile shall be so set up that the projectile will go in the air as nearby as possible in a vertical direction, unless such fireworks aze to be fired from the shore or a lake or other lazge body of water, then they may be directed in such manner that the falling residue from the deflagration will fall in to such lake or body of water; that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task, that there shall be at least two such operators constantly on duty during the dischazge and that at least two soda acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual azea of the display. Elizabeth A. Neville Town Clerk Town of Southold Suffolk County, New York (Town Seal) Date: July 2, 2002 THIS PERMIT IS NOT TRANSFERABLE t POIaIC>a DI'aPt1RTMl'aNT TOWN OF SOUTtIOI~D Telephone Emergency Dial 911 MEMORANDUM TO: Elizabeth A. Neville, Town Clerk FROM: Chief Carlisle E. Cochran, Jr. ~~/ DATE: July 1, 2002 CARLISLE E. COCHRAN, JR. Chief of Police RE: Request for Special Permit -Fireworks -Phoenix H&L Relief Company July 4 and 6, 2002 I have reviewed the above request for a special permit. I have no objection to the approval of this permit. cc: Lt. Martin Flatley 41405 Route 25 • P.O. Box 911 Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 • Fax (631) 765-2715 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER ~~~OaV `^ C~Gy +~ z ~y • ~`~` ~ot ~ Sao OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Carlisle E. Cochran, Jr. From: Town Clerk Elizabeth A. Re: Fireworks Permit for Phoenix & L Relief Company sponsored by Vineland Fireworks, Date: June 26, 2002 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631)765-6145 Telephone (631) 765-1800 southoldtown.northfork.net Please review the above request and advise me, in writing, of your recommendations. Thank you. Page 1 of 1 Neville, Elizabeth From: Neville, Elizabeth Sent: Wednesday, June 26, 2002 3:52 To: Harris, Peter Subject: GFD Fireworks Apl. Peter: You left off two (2) applications for fireworks permits today. However, the one for the FD did not have a map attached. If you wish me to copy the one from last year, I have to have a signed request to this effect. You can e- mail me, and then put the actual signed request in the inter-dept. mail. Thanks Betty 6/26/2002 ELIZABETH A. NEVII.LE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER =`2~~v V 1 C~G Town hall 53095 Main Road y , p ~ P.O. Box 1179 y a; Southold, New York 11971 O ~ y~ ~ O! Fes (516) 765-1825 Tele hone (516) 766-1800 O! ~ ~~ p OFFICE OF TIDE TOWN CLERK TOWN OF SOUTHOLD APPLICATION for 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 PRINCIPAL OFFICE AT ~ no ~.. . DATE OF DISPLAY ,\I„~~ TIME OF DISPLAY RAIN DATE E TIME ~. ,, ,~ („ ~ The following persons Name C :S cC~S C~'{~ ,~ ~sr S are to be in Age ~~ _ ~~ -_ Number and type of fireworks is as follows: The fireworks will be stored in a covered truck prior to shooting on the grounds. 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. , I ln~ a~I ,rewd.~S ~,~ By ~k N3Tne of Orga 'za SignaLftrure of Applicant ~o ~Y ~o~~ Date of Application :harge of the actual shooting of the fireworks Expe`/r~~ie/V~(ncn~fe',p/r~ Ph/y/s'~ical Condition f U `('e~rC ~ „d ~ s~~~J~~~ C'~oa d ~S l¢GrC ~~pd s CERTIFICATE OF LIABI ACORD DATE IMMIOTNY YI LITY INSURANCE os/o9/zoo2 ~, PftODQCER (41$) 391-1013 FAX (415) 391-4514 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Farallon Assoc Ins Brokers HOLDER. THIS CERTIFICATE DOES NOT AMENp, EXTEND OR Street omer t ALTER THE COVERAGE AFFORDED BV THE POLICIES BELOW. y g 4p0 Mon SO~te $00 INSURERSAFFORbINGCOVERAGE San FranCTSC°, CA 94104 nd F reWOr S CA. INSURER A' Royal SYrp1Y3 Lines Ins. Co. INSURED Vlne a den Road 0 G wsuRERe: Sorema NA ar 1fi4 N7 08360 eland Vi INSURERC AISLIC , n wSURER D: INSURER E: GVYetN~A~c° 7Hbi POLICIES of INSURANCE LL9TED BELOW VE BEEN ISSUED TO 77iE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHS NTRACT OR OTHER pOCUMENT WITH RESPECT TO WHICH THIS CERTIFlCATE MAY BE ISSUED OR ANT REQUIREMENT, TERM OR CONDITION OP ANY CO 9 DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN, THE INSURANCE AFFORDED BY THE pOLKIE AS . EGATE LMrtS SHOWN MAY HAVE BEEN REDUCED BY PAID CW G R POLICIES. AG I ~ TYPE OF INSURANCE POLICY NUMOER PO FEOTIVE OL Y LIMIT S 000 1 03085 0$/31/2802 05/31/2003 EACH OCCURRENCE , s . DENERAL LIABIIJTY FIRE DAMAGE (My ene fire) E $0, DD caMMERCIAL GENERAL VABILITY MED E%P (Myone lKron) f non CLAIMS MADE OCCUR PERSCINAL b AOV INJURY i 1 OOO 00 A WTE = Z OOO OO GENERAL AGGRE O P 00 D00 9 2 YOP AG PROCU0T9~CONI , , GENL AGGREGATE LIMB hPPL1E6 PER: POLICY jEC07 LOG ~ X12290-2002 04/20/2002 04/20/2003 COMBINED SINGLE LIMIT E pui DMOBILE LIABILRY (ES eccklent) 1, 000, DD ANr AuTo ALL OWNED AUTOS BDOll.Y INJURY (Pcr pnrcan) E X BCHEDDLED AUTOS B X HIRED AUTOS DOOILY INJURY (PerawidenU y NON-oW NED AUT05 PROPERTY DAMAGE f (Par aoaianQ AUTO ONLY • EA ACCIDEM Y DARAGE LIABILRY EA ACC HER THAN 3 ANY AUTO OT AUTO ONLY: qG0 9 EACH OGGVFtRENCE 9 4,000.0 EXCESS LWBIUTY E 4 DOB 0 AGGREGATE X COCUR OclA/MS MADE E1398108F40 0$/31/2002 0$/31/2003 s C f DEDUCnDLE s RETENTION E T LRAITS ER 'NM1NtHERS COMPENSATION AND .EMPLOYERS UABNiv EL. EACH ACdOEM 9 UMn IPTK)y OF OPERATIQNS40GATION.4iVEHICLESrExcw wnwuucu nr cnw_.xincnuxc..w..~~.~~~~ henTx & Re1Teg Hose Company o Greenport Fire Department 2) Green Fire Department 17illage of Greenport 4) Town of Southold $) Greenport Public Schools 6) Silver Dollar Shows Additional Insureds as Respects a Fireworks Display on 7uly 4, 2002 Rnd luly6, 2002) at enport High School Grounds Greenport Long Island, NY. CERTIFICATE HOLDER I (ADDITIONAL INSURED; INSURER LETTER T.wwcLVAnvrr Phenix & Relief Hose Cortpany of Greenport & Relief Department 222 Knapp Place Greenport Long Island, NY 11944 bHOULD ANY OP THE ABDVR OESGRIBED POLICIES BE CPNCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY LyILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICgTB HOLDER NAMED TO THE LEf T, BUT FAILURE t0 MAIL sUGH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Dp pryv RING VPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. _ AUTHORIZED REPRESENTATIVE GlDlill. C1'ilTJ (ILIH1741Tn LIJ76~TP Jll /T lHl.l ,ti- ,, . o~Og~FFO(,~c~ G ELIZABETH A. NEVII.LE ti`l` y TOWN CLERK ~ o= ~ N x REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER ~y • ~~ RECORDS MANAGEMENT OFFICER ~a~ ~Q~ FREEDOM OF INFORMATION OFFICER ~ OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION for Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516)765-1823 Telephone (516) 765-1800 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 B PRINCIPAL OFFIC DATE OF DISPLAI TIME OF DISPLAY RAIN DATE E TIM The following persons are to be in charge of the actual Name Age c :s ~ ~c~s ~79 ~~ tl,>l.~~is:~ ~ shooting of the fireworks: Experiencf~e/ Ph/yslical Condition t~~ /2Cc~5 l ~,a~ ~S ~-Pa~S ~-~00 G rs Y~~.<< C'~od ~ The fireworks will be stored in a covered truck prior to shooting on the grounds. 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. i11~~G~Ic 'I"~r2uJor~ e of Orgar~izati By l /.~cti. W ~ Signature of Applicant J~~ ce ,~ Sl a~2 Date of Application cs Number and type of fireworks is as follows: DOT I~G~-lI ~`~~~ .•~ GRa~ryD s7'r~-+y~J Gt~EN ~aRY ,W~~ s: z~ o~ s~~ l ~ ~ ~~~, ~5 j ~ / zd N ee ILK/ m, n i r~u~ d,2S}0.~nc~2r 5 0o Y-I- ?.,~~ ~~(2C.~dV1 S ` `, oo~tS ~~-N r ELI7ABETH A NE O~0 u-. - -_n C~~ G . VILLE TOWN CLERK hi. = ,y o REGISTRAR OF VITAL STATISTICS y Z ~ MARRIAGE OFFICER O ~ ~ y~ O~ FREEDOM OF IN ORMATION OF ICER ~ ~ ~a OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT For PUBLIC DISPLAY OF FIREWORKS Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 I, ELIZABETH A. NEVILLE, Town Clerk of the Town of Southold, Suffolk County, New York, being an officer duly designated by the Town Boazd of the Town of Southold for this purpose, do hereby GRANT TO: GREENPORT FIRE DEPARTMENT STAR HOSE COMPANY NO. 3 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. Mav 25, 2002; Raindate: Sunday, Mav 25, 2002 at 10:00 P_M. on the property of GREENPORT PUBLIC SCHOOL, north side Front Street, Greenport ,New York. ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks aze to be fired shall be at least two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feel from the nearest above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are dischazged and only persons in active chazge of the display shall be allowed inside these lines; that all fireworks that fire a projectile shall be so set up that the projectile will go in the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore or a lake or other lazge body of water, then they may be directed in such manner that the falling residue from the deflagration will fall in to such lake or body of water; that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particulaz 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 chazge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task, that there shall be at least two such operators constantly on duty during the discharge and that at least two sodaacid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. - --- - C.! - ------ ElizaNeville Town Clerk Town of Southold Suffolk County, New York (Town Seal) Date: May 22, 2002 THIS PERMIT IS NOT TRANSFERABLE ~.~ , POI~IC~ DEPt1RTM1'aNT TOWN OF SOUTFIOLD Teleph~E~~~cy Dial 911 MAY 1 6 2002 MEMORANDLTly1 Southold Town Clerk TO: Elizabeth A. Neville, Town Clerk FROM: Chief Carlisle E. Cochran, Jr. ~~~ DATE: May 15, 2002 CARLISLE E. COCHRAN, JR. Chief of Police RE: Request for Special Permit -Fireworks Permit of Greenport Fire Department I have reviewed the above request for a special permit. I have no objection to the approval of this permit. I recommend that a representative from the Greenport Star Hose Company No. 3 contact Lt. Flatley at least ten (10) days prior to the event to coordinate traffic control. cc: Lt. Martin Flatley 41405 Route 25 • P.O. Box 911 Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 Fax (631) 765-2715 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o~OgpFFO(,~Co o~ Gy< N x oy~ol * ~~0~ W • `~ OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief of Police Carlisle E. Cochran, Jr. From: Town Clerk Elizabeth A. Nevin Re: Fireworks Permit of Greenport Fire Date: May 14, 2002 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631)765-6145 Telephone (631) 765-1800 southoldtown.northfork.net Transmitted is application of Star Hose Company No. 3 of Greenport Fire Department for a fireworks permit for display on May 25, 2002. Please review this request and send me your recommendations in writing. Thank you. Town Board Town Attorney ELIZABETH A. NEVII.LE TOWN CLERI{ REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER =~o~~gUFFO~~-c ye G o - y = ~W ~1p• ~ Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1500 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION for 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 SPONS/O~RED BY PRINCIPAL OFFICE AT Vs^ePN,~ DATE OF DISPLA TIME OF DISPLA' RAIN DATE E TI The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition r ,-, .~ ~.~f J z2 a 9 S~~,-s odd Number and type of fireworks is as follows: The fireworks will be stored in a covered truck prior to shooting on the grounds. 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. N ~~ ~~~ ate o~ Application 0~0~.. •n CMG ELIZABETH A. NEVII,LE h`Z` yam, TOWN CLERK o= ~ VJ = REGISTRAR OF VITAL STATISTICS ~ • MARRIAGE OFFICER y~ 0~ FREED MOFINFORMATiON OFFCER o ~ '~ ~ ~~ OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION for Town I-Tall, 53095 Main Road P.O. Bnx 1179 Southold, New York 11971 Fax (516)765-1823 Telephone (516) 765-1800 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 SPONS/O~RED BY~7 PRINCIPAL OFFICE AT G('CpvLGh r-~- f-;r DATE OF DISPLAY a/T TIME OF DISPLAY //J /~/!7-~ RAIN DATE E TIME ,~//rinh.fi L~~e The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition r t ~, .~ a~ aeo/ ,~ J z~ /o ~~s ~~o~ Number and type, of fireworks is as follows: The fireworks will be stored in a covered truck prior to shooting on the grounds. 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. e o/~s ' aviC N me/~of~O g 'zation B ~/- Signature of Ap licant ~f 6 ,~a~.Z ate o Application ~~ mnv ~ o .nom an e t nom vTn,n nnin cTOn.inovc 1 LI'(.34. ltlx yuK 9A ~y~~i f s. ( \ ~t YSi 1 ~;t ~,~ 4 1 ~ h: ,E~.~1~' ~ ~. S .M4` A• ~ ~~ ' { ( ~I~ ~. ' ~ ~~ x ( ~-~Y I' x E j~[,'S~~ .~~CE~~IT ^(AW H }~y; LSD, j'Y{~~y !S;M I~ jt{ K,~ },7 'C~ jIpS~y~ ~ Fa., S'Ya+M k i3.ii. y ~';. QRa }pTrCnv F1 t. &{ P t Yb '2 9 'S'f ~~ x Y~ . . i u L b ~, M~1 i 1 Y 1 C S ,~ Z ~Y\t . i h1 '~. 4. xiDYl _33: ~Y~,S E.: Ykt~a{.I .E~., ) t ~ s'.. Yls:' L ~ t au f ilil 1 y . ,n.v 4 .. Yb ~ % .±P a ~~~ ~{' ~L.PB7s t Eli_sns _.c.NYI 11..1?`4+... :^.~ f.x, x . i _ . . , e ., , 3 . 5.i. 1 . YIi15 CERTIF1CATfi IS LSSlJElI AS A MATTS1i OF INry`ORMATION ONLY AND CONFEaS PRODUCER NORIGHTBUPONTRECERnnCATHHOIDHRTIIISCSATIFICATE]H)HSNOTATW.ND, Brown andAum hre Su IusLinesInsuranceBrokerB p y rP PCTENP OH LATHR THE COVRRAGE AFFORn%11 BY THH POLiCniS aHLOW. Farallon Associates Insurance Brokers H(S(~ggS AFFORDING COVEP.AGE 400 Montgomery Street Suite 500 San Francisco, CA 94104 INSURER A: UDderwriters, Lloyds of LondoD 888-391.1057 INS[)RED INSURER B: SoT'ema NA Co Inu k Fi ., s rewor Vineland I T!A Fireworks by Girone INSURER C: 1640 Garden Rd. V'uteland,NJ 08360 INSURER D. COVERAGES SURANCE LISTED BELOW HAVE BElN 15fiUED TO THE INSURED NAMEP ABOVE FOR THE PERIOD WDICATED, THL4 LS TO CERTIFY TRAY THE POl1CIE9 OF IN NOTWITHSTANDING ANV REQU~UE iCE AFF OORp¢o BV THCNppIICYIES DESCRIBED HEREIN 195~8)ECT ALL THE TLRMS WHEXdL6IOP15 AND F~NDETION OF EE ' RN ISSUED OR MAY PERTAIN, TH IONa LIMIT6 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDITIONAL CONp17 THOSE FOLLOWING TO LIN E , , TF O SUCH POL1C2E5 INCLUDING, BUT NOT EVIDENCED BY THIS CERTIFICATE PROVIDES LUBq.ITY IN6URANCE ONLY, IT 6 NOT A BOND OR ANY OTHER FORM AND EKCWSIONS: 1) YNE INSURANCE POLICY OP SURETY AGAINST WHICH 60MEONE WHO IS NOT AN "IN6URED" HEREUNDER IMY ASSERT A CLAIM OR BRING ANY LEGAL ACTION. SURIfLT TO rT57C0.1YSSr OSED UPON THE " FOR LC6K LIABnSTY IMP DEFINTTIOI45~ANP CONDITIONS, THE INSURANC¢ PROVIDED BY YHE POLICY ONLY INDEMNIFn'S AN ^INBORED Y TO BODILY IN]U0.Y TO THE NAMED 7NSUREbti 6HOOTER (6), ASSISTANT (S)AND/OR ANY OTHER PERSON (!<), "INSURED^. 2) THI9 INSURANCE DOES MOT APPL INCLUDING ANY VotnMEER (6) PART2CiPAT1NG IN ANY WAY ql THE BHOOTPNG AND/OR E)(ECTTTION OF ANT DISMJxY OR SPECIAL EFFECT UNDERTAKEN BY THE O0. ANY AND / NAMED IN6URED OR "pROPERri DAMAGE" TO PROPERTY OWNED, LEASED OR RENTED BY THE NAMED INSWIEDT: SHOOTER (S), ASSISTANT (S) NY WAY 1N THE fiH0077NU AND/OR EXCCUYION OF ANY DLSPLAY OR 6PECIAL EFFECT OTHF0. PERSON'S INCLUDING ANY VOLUNTEER (S) PARTICIPATING iN A UNDERTAKEN 0Y THE NAMED IrySIMED. POLICY EPFRCTN6 PDLICY EIP[MTI017 CO LTR TVPC OF MJURANCC POLICY NUMBER PATH MR) DATC E LIMIT9 LIBILITY GT IVERAI I 8A OCCl7RATUVCB $ ]000,0 . . , ®COMMRRCLU, GENERAL BDAMAO% A "ne 0re B S0, A LTAHILITY DMGLB010018 (15/31/01 U5/31/0¢ MRDICALEIiP(Myone peno") S 3,808 ^ CLAIMS MADE ®OCCUR PF.RSONAL& ADV INJURY $ 1,000,0 GFN'L ALGA%OATK APPLIES PItR POLICY GHNERAL ACGRECATH 5],000, PRODUCTS-COMP/OPB AGG 52,000, COMBATED bLYOLH LTMTr $2,800, }1 AUTOMOBILEL1ABtLITY ERI2019-2001 10/0~//Ol lam/o2 - ~'""N"") ^ ANY AUTO BODILY IN.NRY $ WNED AUTOS CP°~ ^ pNy O BODILY INJURY $ ® SCHEDULED AUTOS , ® IID2HD AUT09 w ka7 ® NON~OWNHO AUTOl: PROPHRTY PAMAGH $ RradA~q HACH OCCURRrNCE $4,000.0@8 EACESS LLLBIITTY AmraMwE ®occmL ^cl D010014 05/31/01 05131/02 A . ®OTHER THAN 11M1UtHL1.A DMXS A(KdREGATR 31,000 0 WC $TATU. OTS S COMPSNS ATION WO H TOIIY LIMTTB HR $ . R AK ANP $LXAC]l ACCIDENT S HMPLOYRRS'LIABILITY E.L DISFAB&EA HNIPLOYIE $ &L D248ASH.POLICY YJAf1R 3 OTHER OCATIONSM1'BHICLES/F.XCLI1610NS ADDH.n BY ENDORSEMENT/SPECIAL PROVISION& ' ION OF OPfiRAT10N8/I . DESCRIPT 1) Star Hose Co No 3 of GneeDnnrt Fire Department 2) Greenport Youth Aetivlties 3) Vblage of GreeDport 4) Town of Sogtho~d 5) Greenport Public Schools 6;HIIE~fimreseme~~s, q) GI'Cenport FiF'e Department are Additional Insureds as Respects a Fireworks Dlaplay on May 25, 2002 (RD May 26, 2002) at GreenpoR High School Grounds Greenport Long Island, NY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OP THH ABOVH PESCR[BED POLICIRS HECANCHIYHP BHRORE THE EATIHATION DATE Star HOSC CGm an No.3 p Y THCISSIJINO COMPANY WILL BNDEAYOR TO MAH. JB DAYS WRITTENNOTICH TO THH THFRHOF O(GreenpDMFireDepartment , CERTTSICATEHOLDERNAMEDTOTEOII,YET, BUT FAILURE TO MAILSU~INOTICEBHALLIMPOBEIVO IGATION OR LIABILITY OF ANY IOND UPON THE COMPANY,178 ACHNTS OR REPrtRSYNTATIYHS Place 212 Kna OBL pp Greenport Long Island, NY II944 AVTIIOAIZHD REPRESENTATIVE ~ I°IFiT ld ctK~i"iriirA`i Ic ur ~i BILITY INS RANCE ACORL? r DATE (MMIDDIYY) os/os/aoaz PRODUCER (856)694-2222 FAX (858)894-2279 The Boralli Agcncy, Inc, Duch Mill Road ONLY AND CONFERS NO:RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOE6 NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 9ELOW. Malaga „ N7 08328 ' INSURERS AFFORDING COVERAGE INauaeD y; ne7 and Fi roworks Co., Inc. WSURER A: Liborty Mutual Insurance Go. 1640 E. Cardon RoaA INSURER B: Vineland, N] 08360 INSURER C: INSURER D INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN6URED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. OIWITHSTANDI ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE 166UED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I6 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LYIL TYPE OF INSURANCE POLICY NUMBER 017E Y DATE M ~ LIMITS aENERpI upBIL1TY EACH OCCURRENCE t COMMERCIAL GENERAL LIABILRY FIRE DAMAGE (Pny orle Ore) i CLAIMS MADE OOCCUR MED EXP (/Try O11P pBreml d PERSONALBADV INJURY d GENERAL AGGREGATE d 6EML AOORELiATE LIMI7APPLIEB PER. PRODUCTS•COMP/OP AOO d ' POLICY jE~Y LOC pul OMOBILE LuBluTr COMBINED 81NOLE LIMIT 8 ANV AUTO (Ee acCMariO , ALL OWNED AUTOS BODLY INJURY t SCHEDULED AUTOS (Per peram) HIREb AUTOS BODILY INJURY NON-0WNEO AUT08 leer accwent) PROPERTY DAMAGE i (Pw eccwwNj GARAGE LUawn AIpo ONLY ~EAACCIDENT t ANY AUTO OTHER TWW EA ACC t AUTOONLY: AOO t EXCESS UABILITY EACH OCCURRENCE d OCCUR ~ CLAIMS MADE AOOREOATE 6 t DEbucnBLE s RETENTION S t ~ WORKERS COMPENSATION AND C7-335-301113-013 04/01/3002 04/01/2009 TRY a71 R ETAPLOVERS' L4BIDTV E•L EACH ACCIDENT d 508,000 A E.L. DISEASE-EA EMPLOYE d SO ,000 E.L D18EA8E•POLICY LIMR i SO ,000 OlHfifi DESCRIPTION OF OPERAHONSILOCATIONaNEHICLE&EdCLU61ONd AOOEO BY N E PRO 1610N6 ' ispl ay date? May 25, 2002 sin date; May 26,2002 CERTIFICATE HOLDER ADDInONAL INSURED; INSURER LETTER GANGELLgTION 6HOULD ANY OF THE ABOVE DESGi1BED POLICES BE CANCELLED BEFORE THE EXpIRATON GATE THEREOF, THE ISSUING COMPANY WILLENDEAVOR TO TAIL 1D-DAYS W1IRTEN NOTICE TO THE CERTFICATE MOLDER NAMED TO TNS LEA, Star Hose Creenport CO . No . ; o f Fire Dept. EUT FAILU CE 1 PO NO OBLIGATION OR LUUNLIT'( 212 Knepp P1 ece OFpMf KINOU N fi00MP NY, ITS G b RESENTpnVE& Greenport Long Ys., NY 11944 AurHORIaEDa s am ..~._.m ~.. ~,~____._.... MtaY 13 '02 04~a6PM VINELRND FIREWORKS, `~ U.S. Departrnerrt at TrcnapoAOnon federal AWaRlon AdrrliNs.4allon Naw Yprk Autamafed Inlamatlonal Fllg ,t Servtoe BtatNm 16D ArrNal Avenue Ronkonkoma, NY 17779 May 13, 2002 Mrs. Rose Paeitto Vineland Fireworks Company, b.rc, 1640 Garden Road Vineland, NI 08360-1867 Dear Mrs. Paciltto: ~ ' I . Our office has no objections to the proposed (reworks display scheduled for the (ireenport High School, Greenport, NY. "Lhe time ol'the '3isplay will be approximately 9 p.m. on May 25, 2002 fora 20-22 minute duration, with u scheduled raindate of May 26, 2002. lt, should be noted that no shell shall exceed 600 feet and the following conditions must also be met. 1. Contact the Supervisor of the New York TRACON at (516) 683-2984 at least two hours poor to your display, if the display occurs within 5 miles of an airport, to negotiate any altitude limitations or timc frame restrcfions, if they are required. 2. Contact the New York mated Int;:snational Flight Service Station at (631) 471- 7394 at least six hours prior to the scheduled detonation of the fireworks display to effect the issuaace of a Notice to Airmen Advisory (NOTAM). This letter disposes of the Federal Aviario.^. Administration's interest in this matter, but should not be construed tts superseding cr invalidating say existing rules or regulations promulgated by any ottrer federal, stag, county or munieipa! goveramcat, which may be required for this display. i Sincerely, ' ' II e ~ ~ ii C~~ ~~~~%~i[~LI ~I Ron Napurano ~ Manager, New Yotk A1F33 ~ I ~j '~. t•d ea oue.tndeN uoa Bt+ErTT zo et Feu boo -~ i~~..l ~ ~~ e.~~ I GRaNa s7?Q-+iJ~ GII ~E~N fPIa R ~' ~; I .. j-t.~' rl lei lZ.~iG { 11~0' ;W es~- s: ~z of JCY~oa p ~ ~F'r~''S m~nirnuuh d,s~-a~c~ Soo r+ zawe~ Q~~ ~;rec,~-;ons ooh tS ~~-N r ;. .~ ., , < ) ~, FROM Greenport Fire Dept Michael Comanda Secondary Principal Thomas L. Babbitt Guidance & Spccral Education Dtrector FRX ND. 631-477-4012 May. 23 2002 08:47RM P1 Greenport Public Schools 720 F7ont Street Greeriport:, iVec¢ Rork .1194.4-1599 Barbara H. Claps Pboae: 833Y477.1950' Fax: 831 /.477.2164 Elementary Prtnelp:d Charles Sonora Babette Corrine Supcrlntendent Dlslrlct Clerk May 7, 2002 Mr. Ken White Jr. .3r1 Street Star Hose Co./Greenport Fire Department Greenport, NY 11944 Re: Carnival Parking & Fireworks Dear Mr. White: Robert Coatanttnl Athletlo Director Your request, on behalf of Star Hose Co./Greenport Fire Department, Io use our parking lot on Thursday, May 23 -Monday, May 27, 2002,and back field for fireworks on Sunday, May 2h, 2002at I0: 00 p.m. has been approved. There is no fee for this usage. A certificate of insurance of at least X1,000,000 public (iabiliry per occurrence and $2,000.000 aggregate property damage insurance shall be submitted at least three days in 4dvance of the event and must designate both Star Hose Co./C:reenpnrt Fire Department and Greenport Union Fiee School District with ISO endorsement CG2026. The absence of such a certifxate will preclude use of the facility. In the event that the premises needs to be used by the school, you will be notified 48 hours in advance of the d3,strict's event, which will take precedence. Please accept my best wishes fora .successful program. Sincerely, ~~~~~~` Charles Kozora Superintendent of Schools CK/pc cc: Mr. Szczygiel FROG1 Greenport Fire Dept FRX NO. 631-477-4012 May. 23 2002 08:48RM P2 iiREENPORT PUBLIC SCHOOLS ~ . 720 Front Street Greenport, NY 11944 APPLICATION FOR USE OF SCIIOOL FACII_ITIES ~ ,. /' >> . ~, ~ \ ~~ ~' The Administratim is responsible for the use of all school Cacilities in order that they m y ~t(sider your request for such use, kindly complete the following: L Fra~ci~li~ties Use Reeuest ~ ~ (~~m) .S/A~~QtP ~ ~r~~P ~7~G/C/ /IRP ~'O/ TOGufStS the use of ~i9? l~..r~ ~y~~S/L~ /~ ~< ~o~C CCS-at Caempo<t Public Schools for the purpose of L.g.a iw ,~i9I2/l.uG y~~C~ L.,/rt/~l~S" m /ilAy L3 TO /~Aya7 (date) - ~ t 6 at (time) ~1~~~ Will attiviry be open to the public? v Admission of will be charged; ptoaoods will be used for Does applicant ogres to submit financial records for rim open requests? 1 ~- Does appli®rtt agez to conform to the regulatims of the Board of Edur~Yim and all ]au%s regulating to use of school property including Sectim 414 printed m the reverse side: of this apPlicstim? ya c Name Address Telephme # ~~L`~f ~ -9~d I ofrheperson responsible on tlus ocwsim. IL Insurance tnformatim A certificate of i^~~.,~ of ai least 51,000,000 public liability per ootatrtmoe aced 52,000,000 aggegate property damage insurstce shall be submitted at least three days in advazttz of the event and must designate both the using organizatim and the Greenport Unim Free School Distritt with [SO enders®mt CG2lyL6. The absence of such a certificate will preclude use of the facility. The policy must rnnmat a 30day guarantee notice of canoellatim. The user agrees to indemnify the district for eery appGeable deductibles. [II. Rules Govemme Use of Facilities A. No smoking is allowed in the building of an the Bounds The organiz9tim using the fa©lity is respmsible for enforcement B. No dtidting of alcoholic beverages is permitted. C. Activity shall be restricted to that area for which petmissim is gamed. D. Activity shall no[ extend beymd hours approved by district. E. Programs shall not interfere will regular school schedule. F. Orgattuatim shall be responsible for moving ifs equipment into and out of the building. G_ The superrisor of the activity shall be present before it is due to start and remain with the soup ~attil all have left_ H. in the absence of adminiffirative personnel, the custodian is charged with the responsibility of the building. I, School authorities must have free access to all tnonLS az all times J. A careful exammatim will be made aRer use of the area by the applicmrt who will promptly make good on any loss or damage, which might have occurred. K No school property or equipment is to be altered or removed from the premises. L. This license is revocable at any time by school authorities. M. No teservatim will be made until this application is rettutted and approved by the distritt's Chief School Administrator. . ~ FROM Greenport Fire Dept FRX N0. 631-477-4012 May. 23 2002 08:48RM P3 ~ar lV. Rental Fees Other Foes or Conditions: Auditorium for performaace' 5100 Auditorium for praciiw S 50 Gymnasie~ for perfmmatace 5100 Gymnasium for practice S 50 When an approved aQivity takes plaoc outside the normal haul of school operation, the arganizerioa will be ~atged 540.00 pet' hour for petrsaquel setvitxs far a minimum of 4 hoots. This all must be paid seven days in advrQt¢ and is noc refundable unless dte dislrct receives ootifimtion of eanallaaoa at least 48 hours in advance. V. I agree on behalf of dte abovesmattioned organimtion that all members and guests will observe dte regulations and that we, individually, and as an organization, will assume all financial responsibility far any and all damages done to the GreenpoR School ptvpety during the above- ineii®ted period of use. We also agree that our orgarti~tion will at alt tomes hereafter Qtdemnify the above-rammed school againa arty loss, damage or expense of any kind, which said srltool may setstain or inaa because of the use of the above-mrntioned build'mg by our organization, and we feather will hold said school harmless for leas of any kind in c~rteetionhaewith. signed: ~-r<...,~~ d~~~ ~/1_ Date: S 6 6 licant Gutted Denied ~D~ Date: ~ 7 O Superintatdrn°o~Sehools txcifie Derails of Use: EXCERPTS FROM SECTION 414 OF'If1E EDUCATION LAW `.__Tbe ]3eard of Education of each district may...permit the use aFthe school house and rooms therein, and the grounds and other property of the district, when noc in use for sdtool purposes, far any of the following purposes: I. For the purpose of instruction in any brands of edumtioq leambtg a the arts. 2. For holding social, civic and recreational meetings and rntertaurmrnts, and other issues patHining co the welfare of the oommeatity, but suds meetings, enterfairmien[ and rises sha11 be non-exclusive and shall be open m the grneral public. 3. For meetingx atteAautments and occasions where admission fees are charged, when the procceds thereof are to be expended for an educational or dra[itable propose; but suds use shall not be permitted if such meetings, entertainments and ocasions are tinder the exclusivt control, and the said proxedt are to be applied for the benefit of soatiery, association a orgattiations of vetermts of the military, naval and marine service of the United States and organi~tims of volunteer firemen,^ .,, Revised 9/1l200t