HomeMy WebLinkAbout2001ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
PERMIT
for
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
PUBLIC DISPLAY OF FIItEWORKS
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 FIIiE DISTRICT
PHOENIX, & RELIEF HOSE COMPANIES
A PERMIT FOR THE PUBLIC DISPLAY OF
FIItEWORI{S
by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the
State of New York on WEDNESDAY, JULY 4.2001 AT 10.00 P M (Raindate•
THURSDAY. JULY 5, 2001) on the property of the GREENPORT HIGH SCHOOL
GROUNDS, EAST SIDE OF MOORES LANE, GREENPORT, NEW YORK.
ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force
and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the
fireworks 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 feet from the neazest above
ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such
display shalt be restrained behind lines at least one hundred and fifty feet from the point at which
the fireworks aze discharged and only persons in active charge of the display shall be allowed
inside these lines; that all fireworks that fire a projectile shall be so set up that the projectile will
go in the air as nearby as possible in a vertical direction unless such fireworks are to be fired
from the shore or a lake or other large body of water, then they may be directed in such manner
that the falling residue from the deflagration will fall into 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 beheld
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 dischazge and that at last 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 Seal) Town of Southold
Suffolk County, New York
_~-~?~~11 ~-
Date
~~
POI,IC~ D~Pt1I~TM~NT
TOWN OF SOUTI~OLD
Telephone Emergency Dial 911
MEMORANDUM
CARLISLE E. COCHRAN, JR.
Chief of Police
JUN 1 2 2001
..,.yiY~u~d ~aly~rr 4~Erk
TO: Elizabeth A. Neville, Town Clerk
FROM: Lt. Martin Flatley
DATE: June 11, 2001
RE: Request for Special Permit - Greenport Fire Department
Fireworks -July 4, 2001
Please be advised that the above request is approved.
~~„
41405 Roure 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~~gUFFO(,~co
_~ ~~ Town Hall, 53095 Main Road
o - P.O. Box 1179
N
~y • ~~ Southold, New York 11971
Fax (631) 765-6145
~Ql y ~a~ Telephone (631) 765-1800
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Chief Carlisle E. Cochran, Jr.
From: Town Clerk Elizabeth A. Neville
Re: For your approval, request for fireworks permit
Greenport Fire Department, Wednesday, July 4, 2001
Date: 5/22/01
Please advise if this meets with your approval, and of any recommendations or
suggestions you might have for any conditions of granting this request before the
fireworks permit is issued. Thank you.
• UFFO(
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ELIZABETH A. NEVII T.F p~
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TOWN CLERK o= ~
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REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Dy •
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RECORDS MANAGEMENT OFFICER ~~
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
APPLICATION
for
•
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (616)765-1523
Telephone (516) 765-1500
RECEIVED
MAY 2 2 2001
Southold Town Clerk
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 ~ne.~tiK [t'~1.~ - \l21(~~Hr)CQ Cnwt,{~~^'eS
PRINCIPAL OFFICE AT r:~rewo~~cs (~ l ~ ~r~e ~id ~(/iKe~m~cl /l~J
Y_raido.ae I(p~Fo L.
DATE OF DISPLAY ~~~~ [~ , p I
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 Pnhysical Condition
-S ~ a~ /ea.S ~av
~ i o ~ ars God
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 ~C l~ l `vim
Na Ie of Organi on
B
Signature of Applicant
~~ao2,o/
ate Application
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PRODUCER
~ ~ THIS CERTIFICATE IS ISSUED AS A M R OF INFORMATION ONLY AND CONFERS
$rQW n and Humphrey SUrpl115 LIDOS IDSUrance BTOkerS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND,
F
ll
A EXTEND OR LATER THE COA'ERAGE AFFORDED B7 THE POLICIE6 BELOW.
ara
on
ssoaates Insurance Brokers
i
400 Montgomery Street Suite 500 INSURERS AFFORDING COVERAGE
~ San Francisco
CA 94104
, INSURER A: Underwriters, Lloyds of London
R88-391-1053
INSURED INSURER B: 5orema NA
Vineland Fireworks Co., Inc
T/A Fireworks by Girone INSURER C:
1640 Garden Rd.
i
Vineland, NJ 08360 INSURER D:
COVERAGES
THIS IS TO CERTIFY THAT THE POLICn:S OF INSURANCE LLrTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICTED,
NOTWTDISTANDING ANY REQUIREMENT, TERM OR GONDIRON OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFIGTE MAY BE
ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN LS SUB]ER TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
SUCH POLICIES INCLUDING, BUT NOT LIMITED TO, THOSE FOLLOWING. LIMrTS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. ADDITIONAL CONDITIONS
AND EXCLUSIONS: 1) THE INSURANCE POLICY EVIDENCED BY TNLS CERTIFIGTE PROVIDES LIABILITY INSURANCE ONLY, R TS NOT A BOND OR ANV OTHER fORM
OF SURETY AGAINST WHICH SOMEONE WHO IS NOT AN "INSURED" HEREUNDER MAYASSERT A CLAIM OR BRING ANY LEGAL ACTION. SUB]ECr TO ITS TERMS,
DEFINITIONS AND CONDITIONS, THE INSURANCE PROVIDED BV THE POLICY ONLY mDEMNIFIES AN "INSURED" FOR LEGAL LIABILITY IMPOSED UPON THE
"INSURED". ]) TNLS INSURANCE DOES NOT APPLY TO THE NAMED iNSURED'S SHOOTER (S), ASSISTANT (S) AND/OR ANV OTHER PERSON (S), INCLUDING ANV
VOLUNTEER (5) PARTICIPATING m ANY WAV IN THE SHOOTING AND/OR EXECUTION OF ANY DISPLAY OR SPECIAL EFFECT UNDERTAKEN BY THE NAMED mSURED
i OR "PROPERTY DAMAGE" TO PROPERTY OWNED, LEASED OR RENTED BY THE NAMED INSURED'S SHOOTER (S), ASSISTANT (S)AND/OR ANV OTHER PERSON'S
~ INCLUDING ANY VOLUNTEER (S) PARTICIPATING IN ANY WAY IN THE SHOOTING AND/OR EXECUTION OF ANV DISPLAY OR SPECIAL EFFECT UNDERTAKEN BY THE
~ NAMED INSURED.
' CO POLICY EFFECTIVE POLICY EXPIRATION
' LTR TYPE OF INSURANCE POLICY NUMBER DATE fMM/DD/YY) DATE lMM/DD/YY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
'.
A ®COMMERCIAL GENERAL
LIABILITY
DMGLB010018
05/31/01
05/31/02 FIRE DAMAGE (Any one fire) $ 50,000
^ CLAIMS MADE ®OCCUIL MEDICAL EXP (Any one per¢on) $ 5,000
i GEN'L AGGREGATE APPLIES PF,RSONAL & ADV INJURY $ ],000,000
LOCATION
GENERAL AGGREGATE $ 2,000,000
PRODUCTSCOMP/OPS ACG $ 1,000,000
I COMBINED SINGLE LIMIT $1,000,000
B
C AUTOMOBILE LIABILITY EXI2019-2000 IO/0~/()D 10/0~/OI (Ee accWent)
I
' ^ AN1'AUTO BODILY INJURY $
^ ANY OWNED AUTOS (Per pecan)
I ® SCHEDULED AUTOS BODILY INJURY
$
', ® ITIITED AUTOS
® NO:V-0WNED AUTOS (Per eaideny
PROPERTY DAMAGE $
(Per weident)
EXCESS LIABILITY EACH OCCURRENCE $q,000,000
i A ®occuB. pcLAIMSMADE
OTHER DMXSD010014 OS/31/01 05/31/02
®
THAN UMBRF,I,LA AGGREGATE $4,000,000
'
I
' WC STATU- OTH-
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ORRERS COMPENSATION
AND TORY LIMITS ER $
F.MPLOYF,RS'LIABILITY E.L.EACH ACCIDENT
$
E.L. DISEASE-EA EMPLOYEE $
E.L. DISEASE-POI.ICYLIMIT $
I OTHER
DF,SCRIPTION OF OPF.RATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDF,D BY ENDORSEMENT/SPECIAL PROVISIONS
~ 1) Phenix & Reliet Hose Company of Greenport Fire Department 2) Green Fire Department 3) Village of Greenport 4) Town of
Southold 5) Greenport Public School 6) Silver Dollar Shows are Additional Insureds as Respects a Fireworks Display on July 4,
~ 2001 (RD July 5, 2001) at Greenport High School Grounds, Grcenport Long Island, NY.
CERTIFICATE HOLDER CANCELLATION
i Phenix & Relief Hose Company Of SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
~. Green ort Fire De artment
P P THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL i0_ DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER N
MED'
~' 212 I{napp Place A
TO THE ,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY RI IPON HE COMPANY,iCS AGENTS OR R~PKI:' SENTATIVES
!i Grecnport Long Island, NY 11944 AUTHORIZED REPRESENTATIVE~`'.d ~~ ,{~ /~
t 'I~t_
.QCORD CERTIFICAT F LIABILITY INSU E DATE (MM/DD/YY)
05/10/2001
PRODUCER (g 56)694-2222 FAX (856) -2279
The Borelli Agency, Inc.
Dutch Mill Road
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Malaga„ NJ 08328 INSURERS AFFORDING COVERAGE
INSURED Vinel end FI reWOr KS CO., Int. INSURERA~ Liberty MMtDaI Insurance Co.
1640 E. Garden Road INSURER B:
Vinel Bnd, NJ 08360 INSURER C'
INSURER D:
INSURER E:
VVYGR/1V CJ
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. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDM/) DATE (MM/DD/VY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $
CLAIMS MADE ^ OCCUR MED EXP (Any one person) $
PERSONALBADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO PRODUCTS-COMP/OP AGG $
POLICY
LOC
JECT
AUT OMOBILE LIABILITY
B
IN
E
D
SINGLE LIMIT
ANV AUTO ~
tl
e
I
Ea a $
ALL OWNED AUTOS
BODILY INJURY E
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Pera¢itlenq $
PROPERTY DAMAGE
(Par atcitlenl) $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANV AUTO EA ACC
OTHER THAN E
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR O CLAIMS MADE AGGREGATE $
8
DEDUCTIBLE $
RETENTION S $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY C1-335-301113-010 04/01/2000 04/01/2002 TORY LIMITS ER
A E. L. EACH ACCIDENT $ 100,000
E. L. DISEASE-EA EMPLOYE $ 100,000
E. L. DISEASE-POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BV ENDORSEMENT/SPECIAL PROVISIONS
ispl ay Date: July 4, 2001
ain Date; July 5, 2001
~.crtrlrlVAle nVLUCrt I IpDDITIONAL INSURED; INSURER LETTER L•AmL.CLLAIIVP!
Phenix & Relief Hose Company of
Greenport Fire Deptartment
212 Knapp Place
Greenport Long Is., NY 11944
SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATON DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~_ DAYS WRITTEN NOTCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
~BUaT~eF'AILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
,ryl~nY! (!~ C~gL{T$/IGFNTC OR REPRESENTATWES.
.. ~
ELIZABETH A. NEVII.LE
TOWN CLERK
~ ~osuFFOt~-c
0~0 OGy~
N x
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r~
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
PERMTI'
for
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631)765-6145
Telephone (631) 765-1800
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 Boazd of the Town of Southold for this
purpose, do hereby
GRANT TO: GREENPORT FIRE DISTRICT
PHOENIX. HOOK & LADDER & RELIEF HOSE COMPANIES
A PERMIT FOR THE PUBLIC DISPLAY OF
FIREWORKS
by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the
State of New York on SATURDAY, JULY 7, 2001 AT 10.00 P M (Raindate• SUNDAY
JULY 8.20011 on the property of the GREENPORT HIGH SCHOOL GROUNDS, EAST SIDE
OF MOORES LANE, GREENPORT, NEW YORK.
ON CONDTITON 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 neazest building, public
highway or raikoad, 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
display shall be restrained behind lines at least one hundred and fifty feet from the point at which
the fireworks aze discharged 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 large body of water, then they may be directed in such 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 conducted shall be immediately disposed of in a
way safe for the particular type of fireworks remaining; that no fireworks display shall beheld
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 last 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 Seal) Town of Southold
Suffolk County, New York
_~7La~/_
POI~IC~ D~Pt1I~TM~NT
TOWN OF c~OUTtIOLD
Telephone Emergency Dial 911
MEMORANDUM
TO: Elizabeth A. Neville, Town Clerk
FROM: Lt. Martin Flatley
DATE: June 11, 2001
RE: Request for Special Permit - Greenport Fire Department
Fireworks -July 7, 2001
Please be advised that the above request is approved.
~~p
CARLISLE E. COCHRAN, JR.
Chief of Police
w. ~,vKn
JUN 1 2 2001
...rrr~aiu ~bwr. ti.lerk
41405 Route 25 • P.O. Bos 911 Pcconic, N.Y. 11958
Administratiae (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~OgpFFOL~(-CO~
a y~
H x
oy • ~~
~JOl ~ Sao
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Chief Carlisle E. Cochran, Jr.
From: Town Clerk Elizabeth A. Neville
Re: For your approval, request for fireworks permit
Greenport Fire Department, Saturday, July 7, 2001
Date: 5/22/01
CJ
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631)765-6145
Telephone (631) 765-1800
Please advise if this meets with your approval, and of any recommendations or
suggestions you might have for any conditions of granting this request before the
fireworks permit is issued. Thank you.
• ~~S~FFO(,I'~, •
ELIZABETH A. NEVII.LE o~0 GGyC
TOWN CLERK ~
y x
REGISTRAR OF VITAL STATISTICS ~y • ~~
MARRIAGE OFFICER O
RECORDS MANAGEMENT OFFICER ~Ql ~ ~a
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
RECEIVED
Ir1AY 2 2 2001
Southold Town (lark
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 shooting of the fireworks:
e Age Experience Physical ,Condition
r ri, S~~ d ~ ~CG rc ~aa c~
a~ to . nodd
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.
ii~ ate, l/ /
Date Application
/ ~d~ ~~~~
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GRA~IJ~ s7'r4-N~
Gt~EN~aRY
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ACt:?RD CERTIFICATE F LIABILITY INSURA CE F DATE (MM/DD/YY)
'" 05/10/2001
PRODUCER ~g 56)694-2222 FAX (g56) -2279
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
The Borelli Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Dutch Mill Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Malaga„ N] 08328
INSURERS AFFORDING COVERAGE
INSURED Vineland Fireworks Co., Inc. INSURER A: Liberty Mutual Insurance Co.
1640 E. Gerdes Road INSURER B:
Vinel end, NJ 08360 INSURERC:
INSURER D:
INSURER E:
COVERAGES
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 ANV CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/OD/YY) DMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any ona fre) $
CLAIMS MADE O OCCUR MED EXP (Any one person) $
PERSONAL BADV INJURY S
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMB APPLIES PER:
PRO PRODUCTS-COMP/OP AGG $
POLICY
LOC
JECT
AUT OMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANV AUTO (Ea amitlant)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY
$
NON-OWNED AUTOS (Per actltleM)
PROPERTY DAMAGE
P
iE $
(
er am
enry
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANV AUTO EA ACC
OTHER THAN $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR ~ CLAIMS MADE AGGREGATE $
DEDUCTIBLE
$
RETENTION $ y
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY C1-335-301113-010 04/01/2000 04/01/2002 TORY LIMITS ER
A E. L. EACH ACCIDENT $ 100,000
E. L. DISEASE-EA EMPLOYE $ 100,000
E. L. DISEASE-POLICY LIMB $ $00,000
OTHER
DESCRIPTON OF OPERATONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BV ENDORSEMENT/SPECIAL PROVISIONS
i spl ay Date; July 7, 2001
sin Date; ]uly 8, 2001
CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER CANCELLATION
SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATON DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
DAYS WRITTEN NOTICE TO THE CERTFlCATE MOLDER NAMED TO THE LEFT
10
Phen1X & Reliet Hose Company of -
,
Greenport Fire Department B
UT FAILURE TO MAIL SUCN N071CESNALL IMPOSE NO OBLIGATION OR LIABILITY
212 Knapp Place e
~
''T~A OR REPRESENTATVES.
Greenport Long Is., NY 11944 A RIZE REPRESE TVE
•
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~~ ~ERTI' +~A'I'E
~
~ ~ ~
~ C]~F IN~URAN~E su~nn~rl±
i4fay1la 31~i
PRODUCER THI6 CERTIFICATE 1616SUED AS A M OF INFORMATION ONLY AND CONFER6
BTDwn And Humphrey SUrpIUS Lines InsHrance BlOkerS NO RIGHTS [LYON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR LATER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Farallon Associates Insurance Brokers
400 Montgomery Street Suite 500 INSURF,RS AFFORDING COVERAGE
n Fr
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i
CA 94104
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, IN
URER A
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London
I INSURED INSURER B: Sorema NA
I Vineland Fireworks Co., Inc
I T/A Fireworks by Girone INSURER C:
~I 1640 Garden Rd.
Vineland, NJ 08360 INSURER D:
'COVERAGES
THIS IS TO CERTffV THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICATED,
NOTWRHSTANDING ANY REQUIREMENT, TERM OR CONDIRON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTffICATE MAY BE
ISSUED O0. MAY PERTAIN, THE INSURANCE AFFORDED 8Y THE POLICDiS DESCRIBED HEREm L5 SUWECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
SUCH POLICIES mCLUDING, BUT NOT LIMITED TO, THOSE FOLLOWING. LIMITS SHOWN MAV fUVE BEEN REDUCED BY PAID CLAIMS. ADDITIONAL CONDITIONS
AND EXCLUSIONS: 1) THE INSURANCE POLICY EVIDENCED BV THIS CERTIFICATE PROVIDES I reBILrIV INSURANCE ONLY, IT IS NOT A BOND OR ANV OTHER FORM
OF SURETY AGAINST WHICH SOMEONE WHO IS NOT AN "INSURED" HEREUNDER MAYASSERT A CLAIM OR BRING ANV LEGAL ACTON. SUBJECT TO ITS TERMS,
i DEFINITIONS AND CONDITIONS, THE INSURANCE PROVIDED BV THE POLICY ONLY INDEMNIFIES AN "INSURED" FOR LEGAL LIABILITY IMPOSED UPON THE
'
"INSURED". 2) THIS INSURANCE DOES NOT APPLY TO THE NAMED INSURED
S SHOOTER (S), ASSISTAM (S) AND/OR ANV OTHER PERSON (S), DVCLUDINC ANV
VOLUNTEER (S) PARTICIPATING IN ANY WAY IN THE SHOOTING AND/O0. EXECUTION OF ANY DISPLAY OR SPECIAL EFFECT UNDERTAKEN BY THE NAMED INSURED
OR "PROPERTY DAMAGE" TO PROPERTY OWNED, LEASED OR REMED BV THE NAMED mSURED'S SHOOTER (S), ASSISTANT (S)AND/O0. ANY OTHER PERSON'S
INCLUDING ANY VOLUNTEER (S) PARTICIDATING IN ANY WAY IN THE SHOOTING AND/OR E%ECUTION OF ANV DISPLAY OR SPECIAL EFFECT UNDERTAKEN BY THE
NAMED mSURED.
f.0 POLICY EFFECTIVE POLICY EXPIRATI0IC
~
L
TR 'CYPE OF INSURANCE POLICY NUMBER DATE (MM/DDM') DATE (MM/DDM') LIMITS
r
-
I
', GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
'
A ®CONIN[ERCIAL GENERAL
LIABILITY
DMGLBO10018
05/31/01
05/31/02 FIRE DAMAGE (Any one fire) $ 50,000
MEDICAL EXP (Any one person) $ 5
000
I ^ CLAIM6 MADfi ®OCCUR ,
II GEN'L AGGREGATE APPLI FS PERSONAL & ADV INJURY $ ],000,000
LOCATION
GENERAL AGGREGATE S 2,000,000
PRODUCTS-COMP/OP6 AGG 52,000,000
COMBINED S[NG1.E LIMIT $],000,000
~ ALITO]IOBII,F LIABILITS' EX12019-2000 lU/0~/00 10/07/01 (Ee accident)
^ ANY AUTO BODILY INJURY $
' ^ AN5' OWNED A[ITOS (Per Perron)
® SCHEDULED ALrTOS
BODILY INJURY
$
® HIRED AUTOS (Per .ceidenq
® NON-0\VNED AUTOS PROPERTY DAMAGE $
'.
mo- (Per occident)
I EXCESS LIABILITY EACH OCCURRENCE
$4,000,000
A
®occoR. ^cLA[MS MADE
llMXSD010014
05/3)/01
05/31/02
I ®OTHER THAN IiMBRELLA AGGREGATE
$4,000,000
4.
WC 6TATU- OTII-
I, WORKERS COMPENSATION
N TORY LIMITS ER $
i A
D
YMPLOYERS' LIABILITY E.L.EACn ACCIDENT
$
I E.L. DISEASE-EA EMPLOYEE $
E.L. DISEASE-POLICY LIMIT $
OTHER
I DF;SCRIP'1'ION OF OPERATIONS/LOCA'fIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSF,MENT/SPECIAL PROVISIONS
L 1) Phenix & Relief Hose Company of Greenport Fire Department 2) Green Fire Department 3) Village otGreenport 4) Town of
Southold 5) Greenport Public Schools ~ Silver Dollar Shows are Additional Insureds as Respects a Fireworks Display on July 7,
!, 2001 (RD July 8, 2001) at Greenport High School Grounds, Greenport Long Island, NY.
I C'ER'fIFICATF. HOLDER CANCELLATION
PheniX & Relief Hose Company of SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
Green ort Fire De artment
P THEREOF, THE ISSUING COMPANY WILL ENDFAVOR'CO MAI L_30. DAYS WRITTEN NOTICE TO THE
'
'
'
P CERTIF
ICA
/
F; HOLDER NAMED TO THE~,EFT, BUT FAILURE TO MAIL SllCA NOTICE SHALL IMPOSE NO
! 212 Knapp PIBCe OBLIGATION OR LIABILITY OF ANY KI(~ UPON THE COMPANY,.LTS AGENTS OR Fy!PRESENTAT[VES.
~ i, ~.
' GrfenpOrl Long Island, NY 11944 Al1THORIZED REPRESENTATIVE , - u/
I~ERT _ ~X'I'Ei OF INSIIRP~NCE - u~ Iz~rlr Marv 1t>r z~i
PRODUCER THIS CERTIFICATE IS ISSUED AS A "i ~ dR OF INFORMATION ONLY AND CONFERS
Brown and Hum hre Sur IHS Lines Insurance Brokers
P Y p NO RIGHTS UPON THE CERTIFICATE 1.~6LDER THIS CERTIFICATE DOES NOT AMEND.
EXTEND OR LATER THE COVERAGE AFFORDED BY TAE. POLICIES BELOW.
Farallon Associates Insurance Brokers
400 Montgomery Street Suite 500 INSURERS AFFORDING COVERAGE
San Francisco, CA 94104 INSURER A: Underwriters, Lloyds of London
888-391-1053
INSCRF,U INSURER B: 5orema NA
Vineland Fireworks Co., Inc.
T/A Fireworks by Girone INSURER C:
1640 Garden Rd.
Vineland, NJ 08360 INSURER D:
I C'OVH;RAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L15TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PERIOD mDIGTED,
it NOTWITHSTANDING ANV REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFIGTE MAY BE
ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
THOSE FOLLOWlNC. LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDITIONAL CONDITIONS
BUT NOT LIMITED TO
SUCH POLICIES INCLUDING
,
,
AND EXCLUSIONS: 1) THE INSURANCE POLICY EVIDENCED BY THLS CERTIFIGTE PROVIDES LIABILITY INSURANCE ONLY, IT IS NOT A BOND OR ANY OTNER FORM
OF SURETY AGAINST WHICH SOMEONE WHO LS NOT AN "INSURED" HEREUNDER MAY ASSERT A CLAIM OR BRING ANY LEGAL ACTION. SUBJECT TO ITS TERMS,
DEFINITIONS AND CONDITIONS, THE INSURANCE PROVIDED BV THE POLICY ONLY INDEMNIFIES AN "INSURED" FO0. LEGAL LIABILITY IMPOSED UPON THE
i "INSURED". 2) THIS INSURANCE DOES NOT APPLY TO BODILY INJURY TO THE NAMED INSURED'S SHOOTER (5), ASSISTANT (S)AND/OR ANY OTHER PERSON (S),
INCLUDING ANV VOLUNTEER (S) PARTICIPATING IN ANV WAY IN THE SHOOTING AND/OR EXECUTION OF ANY DISPLAY OR SPECIAL EFFECT UNDERTAKEN BY THE
NAMED INSURED OR "PROPERTY DAMAGE" TO PROPERTY OWNED, LEASED OR RENTED BY THE NAMED INSURED'S SHOOTER (S), ASSISTANT (S) AND/OR ANY
OTHER PERSON'S INCLUDING ANV VOLUNTEER (S) PARTICIPATING IN ANY WAY IN THE SHOOTING AND/OR E%ECUTJON OF ANY DISPLAY OR SPECIAL EFFECT
UNDERTAKEN BY THE NAMED INSURED.
CO POLICY EFFECTIVE POLICY EXPIRATION
I:I'R TYPE OF'INBL'RANCE POLICY NUMBER DATE (MM/DDA'YT DATE (MM/DD/Yl~ WMTrB
i, GENERAL LIABIl.I'1'1' EACH OCCURRENCE $ 1,000,0011
®COATMF.RCIAL GF.NF.RAL FnLE DAMAGE (Any one fire) $ 50,000
A LTABn,TTY DMGLB000018 05/31/00 05/31/01 one person)
MED[CAL ExP (An $ 5
000
i ^ CL VMS MADE ®OCCUR. y ,
' GEN'L AGGREGATE APPLIES PERSONAL & ADV INJURY $ 1,000,000
LOCATION
GENERAL AGGREGATE $ 2,000,000
PRODUCT$COMP/OP5 AGG $2,000,000
i COMBINED SINGLE LIMIT $7,000,000
B AU'IOIDIOBILELIABiL[TV EX12019-2000 10/07/00 10/07/01 (Eseceidenq
^ ANY AUTO BODILY INJURY $
' ^ ANY OWNEU AUTOS (Per p.rm")
® SCHEDULED AUTOS BODILY INJURY $
® AIRED AUTOS (Per sccidrnq
® NON-0NNED AU70S PROPERTY DAMAGE $
(Per rrr~de"q
'~ EXCESS LIABILITY EACA OCCURRENCE $4,000,000
~
A ®occuR ^CLAIM6MAUF, DMXSD000014 05/31/00 05/31/01
I
I ®O'1'HER THAN UMBRELLA AGGREGATE $4,000,000
WC STATU- OTA-
'. WORKERSCOhIYENSATION TORY LIMITS ER $
AND
' F.LEACA ACCIDENT $
EMPLOYERS
LI,IBILITT E.L. DISEASE-EA EMPL01'EE $
! E.L. DISEASE-POLICY LIMIT $
!~ OTHER
i DN;SC'R[P'CION OF OPF,RATIONS/LOCATIONS/1'EIDCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
11) Star Hose Co. No. 3 of Greenport Fire Department 2) Greenport Youth Activities 3) Village Of Greenport 4) Town Of Southold
S) Greenport Public Schools 6) Silver Dollar Shows 7) Greenport Fire Department are Additional Insureds as Respects a Fireworks
on 05/26/01 (rd 05/27/01) at Greenport High School Grounds, Greenport Long Island, NY.
I
C'F,RTIFICATE BOLDER CANCELLATION
Star HOSe Company No
3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BF CANCELLED BEFORE THE EXPIRATION DATE
.
Of Greenport Fire Deparhnent THEREOF, THE ISSUING COMPANY WILL F.NDF.AVOR TO M,UL 3.0 DAYS WRITTEN NOTICE TO TAE
LL IMPOSE NO
UC
NOTICE
H
212 ICllapp place fT
A
H
CERTIFICATE HOLDER NAMED TO THE LEF , BllT FAILURE TO MAIL S
Og1,IGATION OR LIABILITY OF AN1' KIND N THE COMPANY, IT GENTS OR R RESZ+.NTATIVES.
!I Greenport bong Island. NY 11944
I AUTAOWZED REPRESENTATIVE
CERTIFICAT F LIABILITY INSURA~E
ACORD DATE (MM/DD/Y1')
GS/1B/2DB1
PRODUCER (g 56)694-2222 FAX (856)694-2279
The Borelli Agency, Inc.
Dutch Mill Road
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Malaga „ N] 08328 INSURERS AFFORDING COVERAGE
INSURED Vineland Fi reWOrkS Co., Inc. INSURER A: Liberty Mutual Insurance Co.
1640 E. Garden Road INSURER B:
Vinel Bnd, NJ 08360 INSURER C:
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOiNATHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAI/v1S.
LTR TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDM') DATE (MMIDD/YY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one 9re) $
CLAIMS MADE O OCCUR MED EXP (Any one parson) $
PERSONALBADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $
POLICY PRO LOC
JECT
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
$
ANV AUTO (Ea accitlaM)
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS (Per parson)
HIRED AUTOS
BODILY INJURY
$
NON-OWNED AUTOS (Per ettidam)
PROPERTY DAMAGE $
(Par acddant)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANV AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR O CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND C1-33S-301113-010 04/01/2000 04/01/2002 TORY LIMITS ER
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
100,000
A E. L. DISEASE-EA EMPLOYE $ 100,000
E. L. DISEASE-POLICY LIMIT $ $00,000
OTHER
DESCRIPTON OF OPERATONB/LOCATIONSNEHICLES/E%CLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
isplay Daie: May 26, 2001
ain Date: May 27, 2001
CERTIFICATE HOLDER I ADDITIONAL INSURED; INSURER LETTER CANCELLATION
SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILLENDEAVOR TO MAIL
~_ DAYS WRITTEN NOTGE TO THE GERTFIGATE HOLDER NAMED TO THE LEFT,
Star Hose Co. No. 3 of
eUT~iu UCN I NO OBLIGATION OR LIABILITY
Green port Fire Department L
212 Knapp Place OF IND UPON THE C
OMP ,I GEN EPRESENTATNES.
Creenport Long Is., NY 11944 RUTH E SENTA !
/'~~
AGOHD Z65 (7/97 V l'JP1liVRU liVRrVrvillVrv "IDOa
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
~~gOFFO[,~C
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OFFICE OF THE TOWN CLERK
TOWN O~~L~THOLD
for
PUBLIC DISPLAY OF FIREWORKS
own 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,
N.ew York, being an officer duly designated by the Town Board of the Town of
Southold for this purpose, do hereby
GRANT TO: GREENPORT FIRE DISTRICT
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, MAY 26, 2001 AT 10:00
P.M., (Raindate: SUNDAY, MAY 27, 2001) on the property of the GREENPORT HIGH
SCHOOL GROUNDS, EAST SIDE OF MOORES LANE, GREENPORT, NEW YORK.
ON CONDITION THAT the bond (indemnity insurance) required shall continue in
full force and effect in favor of the Town of Southold, and PROVIDED that the
actual point at which the fireworks are to be fired shall be at least two
hundred feet from the nearest building, public highway or railroad, or other
means of travel, and at least fifty feet from the nearest above ground
telephone or telegraph line, trees or other overhead obstruction; that the
audience at such display shall be restrained behind lines at least one
hundred and fifty feet from the point at which the fireworks are discharged
and only persons in active charge of the display shall be allowed inside
these lines; that all fireworks that fire a projectile shall be so set up
that the projectile will go in the air as nearby as possible in a vertical
direction unless such fireworks are to be fired from the shore or a lake or
other large body of water, then they may be directed in such manner that the
falling residue from the deflagration will fall into 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 beheld during any wind
storm in which the wind reaches a velocity of more than thirty miles per
hour; that all persons in actual charge of firing the fireworks shall be over
the age of eighteen years, competent and physically fit for the task, that
there shall be at least two such operators constantly on duty during the
discharge and that at last two soda acid or other approved type fire
extinguishers of at least two and one-half gallons capacity each shall be
)dept at such widely separated points as possible within the actual area of
the display.
_Cly.~yG ~-----
Elizabeth A. Neville, Town Clerk
(Town Seal) Town of Southold
Suffolk County, New York
~_a~_a_/__~U_QI_
Date
POI~ICI'a DI'aPt1RTM1'aNT
TOWN OF SOUTFIOLD
Telephone Emergency Dial 911
DECEIVED
MaY ~ a 200
,.,~moiu yawn Clerk
MEMORANDUM
TO: ELIZABETH NEVILLE, TOWN CLERK
FROM: CHIEF CARLISLE E. COCHRAN, JR. G ~''
DATE: MAY 17, 2001
RE: REQUEST FOR SPECIAL PERMIT - GREENPORT FIRE
DEPARTMENT -MAY 27, 2001
Please be advised that the above request is approved
cc: Lt. Flatley
CARLISLE E. COCHRAN, JR.
Chief of Police
41405 Route 25 • P.O. Box 911 Peconic, N.Y. 11958
Administrative (631) 765-2600/2601 Fas (631) 765-2715
^ f
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
• o~SOffO(,~co •
~~
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
To: Chief Carlisle E. Cochran, Jr.
From: Town Clerk Elizabeth A. Neville
Re: For your approval, request for fireworks permit
Greenport Fire Department, Sunday, May 27, 2001
Date: 5/16/01
Please advise if this meets with your approval, and of any recommendations or
suggestions you might have for any conditions of granting this request before the
fireworks permit is issued. Thank you.
fl~
MAY 1 7 ?Otl(
o~~gUFFOt;,~coG
y~
y x
cy ~ ~~ ,
°1 #~ ~~~
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Chief Carlisle E. Cochran, Jr.
From: Town Clerk Elizabeth A. Neville
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
Re: For your approval, request for fireworks permit
Greenport Fire Department, Sunday, May 27, 2001
Date: 5/16/01
Please advise if this meets with your approval, and of any recommendations or
suggestions you might have for any conditions of granting this request before the
fireworks permit is issued. Thank you.
ELIZABETH A. NEVII.LE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
~OSOFFO(~-co
ono Gy<
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y~ol ~ ~ao~
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516)765-1823
Telephone (516)765-1800
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 ~3
PRINCIPAL OFFICE AT ~ +
DATE OF DISPLAY c> +
C+ a ~~+~°
TIME OF DISPLAY
RAIN DATE E TIME_ Suyl~,~• I~Y)Q,,/ ~}j , /Q,O~
ELI7.ABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
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:
~~gUFFO(~-co
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DISPLAY IS TO BE SPONSORED BY ~~
PRINCIPAL OFFICE AT a~~o
DATE OF DISPLAYS ` ~',i)iir
TIME OF DISPLAY
RAIN DATE ?; TIME SLt/1 ,i• mQ./ ~~J - /Q,O/!7
,~
The following persons are to be in charge of the actual shooting of the fireworks:
Name Age Experience Physical Condition
~ a~ ~~d
~ /D G~J
Number and type of fireworks i
fnllnwc
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. / p
i/~G.kJ/(~.1' PSIIQ~s~
me of~ rJganiz on
BY ~.~i W - .~i
Signature of Applicant
s-lG- ~dl
Date of Application
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