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HomeMy WebLinkAbout2003ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o~suFFOt~-oo o~ ~~ ~ Z oy • ~~ ~~1 ~ Sao OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT for PUBLIC DISPLAY OF FHREWORKS Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax(631)76b-6145 Telephone (631) 765-1800 southoldtown.northfork.net 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, da hereby GRANT TO: MATTITUCK LIONS CLUB 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, JUNE 14. 2003 AT 10:00 P.M„ on the property of the COUNTY OF SUFFOLK, managed by THE TOWN OF SOUTHOLD, known as `STRAWBERRY FIELDS", Sound Avenue, Mat6tuck, New York ON CONDTCION 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 yeazs, competent and physically fit for the task, that there shall be at least two such operators wnstantly 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 kept at such widely separated points as possible within the actual area of the display. C A~~ ~~T~~k(F~ Elizabeth A. Neville, Town Clerk (Town Seal) Town of Southold Dated: June 4, 2003 Suffolk County, New York THIS PERMIT [S NOT TRANSFERABLE •- POI~IC~ D~Pt1I~TM~NT TOWN OF SOUTNOI,D Telephone Emergency Dial 911 MEMORANDUM CARLISLE E. COCHRAN, JR Chief of Police RECEIVED J U IJ 4 2003 TO: Elizabeth A. Neville, Town Clerk C'/ Southold Town Clerl FROM: Chief Carlisle E. Cochran, Jr. G DATE: June 4, 2003 RE: Request for Special Permit -Fireworks Permit for Strawberry Festival I have reviewed the above request for a special permit. I have no objection to the approval of this permit. 41405 Route 25 • P.O. Box 911 Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 Fas (631) 765-2715 ELIZABETH A. NEVII.I.E TOWN CLERK REGISTRAR OF VITAL STATISTICS MaitirinGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICEF ~~~0 V ~ CO~ = w oy • ~ x ~ ~-o! ~ ~ Sao OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Carlisle E. Cochran, Jr. From: Town Clerk Elizabeth A. Nevin Re: Fireworks Permit for Strawberry Festival Date: June 3, 2003 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631)765-6145 Telephone (631) 765-1800 southoldtr wn.northfork.net Transmitted is application for Fireworks display at Mattituck Lions Club Strawberry Festival on June 14, 2003. Permission for use of Strawberry Fields has perviously been granted by the Town Boazd. Please review this request and send me your recommendation in writing. Thank you. ~~ v Jti 3 '1003 •y .. A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER ~o~~-• - -~~ C~Gy~ ~+ x Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631)765-6145 Telephone (631) 765-1800 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Carlisle E. Cochran, Jr. From: Town Clerk Elizabeth A. Nevin Re: Fireworks Permit for Strawberry Festival Date: June 3, 2003 Transmitted is application for Fireworks display at Mattituck Lions Club Strawberry Festival on June 14, 2003. Permission for use of Strawberry Fields has perviously been granted by the Town Board. Please review this request and send me yow recommendation in writing. Thank you. . CERTIFICATE QF IN~aUItA~CE iss~llr ~n~ Apr{I & zeo3 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Brown and Hum hre Sur lus Lioes Insurance Brokers P Y P NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR LATER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Farallon Associates Insurance Brokers INSURERS AFFORDING COVERAGE 400 Montgomery Street Suite 500 San Francisco, CA 94104 mSURER A: Uederwriters, Lloyds of London 888-391-1053 INSURED mSURER B: Inc. Vineland Fireworks Co. , 1640 GardenRoad msURER C: NJ 08360 Vi l d ne an , mSURER D: COVERAGES THIS IS TO CERTIFY THAT THE POLICIEB OF INSURANCE LISPED BELOW NAVE BEEN ISSUED TO THE NAMED INSURED ABOVE FOR THE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WNICN THIS CERTIFIGTE MAY BE ISSUED OR NAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES INCLUDING, BUT NOT LIMITED TO THOSE FOLLOWING: LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CW1M5. ADDITIONAL CONDITIONS AND EXCLUSIONS: 1) TXE INSURANCE EVIDENCED BY THIS CERTIFICATE IS LIABILITY INSURANCE ONLY. IT IS NOT A BOND OR ANY FORK OF SURETY AGAINST WNICN SOMEONE OTHER AN °INSURED° MAY ASSERT A CLAIM OR BRING ANY ACTION. SUBJECT TO POLICY TERMS, CONDITIONS, DEFINITIONS AND EXCLUSIONS THE INSURANCE ONLY INDEMNIFIES AN INSURED AGAINST CERTAIN LEGAL LIABILITY. 2) THE INSURANCE DOES NOT COVER CLAIMS FOR BODILY fN]URY O0. PROPERTY DAMAGE OF THE NAMED INSURED'S SHOOTER(S) ASSISTANT(S) OR ANY OTHER PERSON(S) INCLUDING ANY VOLIfTEER(S) PARTICIPATING IN ANY WAY IN ANY DISPLAY OR SPECIAL EFFECT PERFOIINED OR EXECUTED BY THE NAMED INSURED. 3)COVERAGE DOES NOT APPLY TO CLAIMS FOR BODILY INJURY OR PROPERTY DAMAGE ARISING OUT OF THE INSURED'S FAILURE TO FOLLOW NFPA OR OTHER APPLICABLE POST DISPLAY OR SPECIAL EFFECT SEARCH RE UIRENENTS OR RECOMMENDATIONS. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER GATE (MM/DDA'Y) DATE (MM/DD/YY) LIMITS GENERAL LLYBILITY EACH ACCIDENT $ 1,000,000 CLAIMS MADE 3 MEDICAL EXP An ooe ersoo $ 5,000 p DMGLW020004 07/08/2002 07/08/200 FIRE LEGAL LIABILITY $ 50,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTSLOMP/OPS AGC $ 1,000,000 COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) ^ ANY AUTO BODILY INJURY $ ^ ANY OWNED AUTOS (Per P°^0°> ^ SCHEDULED AUTOS BODILY INJURY $ ^ HIRED AUTOS Per anidem ^ NON-0WNED AUTOS PROPERTY DAMAGE $ Per attidevt EXCESS LIABILITY EACH ACCIDENT $ FOLLOWING FORM AGGREGATE $ WC STATU- OTH- WORKERS COMPENSATION TORY LIMITS ER $ AND E.L.EACH ACCIDENT $ EMPLOYERS' LIABILITY E.L. DISEASE-EA EMPLOYEE $ E.L DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONSRDDED BY ENDORSEMENT/SPECIAL PROVISIONS 1) Mattituck Lions Club 2) Lewis J. Newton & Sons 3) Town of Southold 4) Mattituck Fire Department are additional insured as respects a fireworks display on June 14, 2003 at Mattituck Strawberry Festival Grounds, Mattituck NY. CERTIFICATE HOLDER CANCELLATION Mattituck Lions Club/Lewis J. Newton & Sons SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ]0 DAYS WRITTEN NOTICE TO THE 212 Kna p Place F CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO Greenport Long Island, NY 11944 OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES y AUTHORIZED REPRESENTATIVE /~ ~-t ~..-{ ~, ,1"a; `La. LL ' ACURD CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD/YVYY) ,e 04/07/2003 PRODUCER ~g 56)694-2222 FAX (856)694-2279 The Borelli Agency, Inc. Dutch Mill Road THIS CERTIFICATE IS ISSUED ASAMATTER OF INFORMATION 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 NAIC # IN$uRED yi nel and Fireworks Co., Inc. INSURERA Liberty Mutual Insurance Co. 1640 E. Garden Road INSURERS: Vineland, 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. NOTWITHSTANDIN 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 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 NSR TYPE OFINSURANCE POLICY NUMBER DATE MM/DD/YV DATE MM/OD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ CLAIMS MADE ^ OCCUR MED EXP (Any one parson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ee eccitlenq ANV AUiO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per eccidem) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANV AUTO OTHER THAN EA ACC $ AUTO ONLY: qGG $ EXCESS/UMBRELLA LWBILITY EACH OCCURRENCE $ OCCUR O CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC7-335-301113-013 04%01/2003 04/01/2004 TCRY LIMITS ER EMPLOYERS' LIABILITY ANV PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 A ' ! OFFICER/MEMBER EXCLUDED E.L. DISEASE-EA EMPLOYE $ 500,000 tt yes, Describe under SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATONS / LOCATONS /VEHICLES / E%CLUSIONS ADDED BV ENDORSEMENT /SPECIAL PROVISIONS i spl ay date; June 14, 2003 ain date; To be determined (`FRTIFIf:ATF Nfll nFR CANCELLATION SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~_ DAYS W ^^RITTE~ N TfCE f+--^'F GE T~#i HOLDER NAMED TO THE LEFT, M atLitDCk Lions CI Ub ~ BUT FAILURETb MA~L St/7CH°r1U12E'SA LL )MPOSE NO OBLIGATION OR LIABILITY Leis J. Newton & Sons p ~ 212 Knapp Place , ' UAa.$+THE~I RER, IT EN OR REPRESENTATVES. OF ANV KId G teen port Long Is., NY 11944 AUTHORIZED MEPR ENTATI$/E ` ACORD 25 (2001/08) ~ ©ACORD CORPORATION '1988 r ~~ SUFFO(~=c~~ y' ELIZABETH A. IVEVIi.LE = y< TOWN CLERK o REGISTRAR OF VITAL STATISTICS N x ~ O~ y'h RECOR S MANAGEMENT OFFICER O ~ ~a FREEDOM OF INFORMATION OFFICER `tea ~ 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 BE SPONSORED BY PRINCIPAL OFFICE DATE OF DISPLAY TIME OF DISPLAY RAIN DATE E TIME The following persons are to be in charge of the actual shooting of the fireworks: ~i~l a Age Experience Physical Condition %~ ~_ /~ TPlirt_ Number and type of firew rks is a follows: The fireworks will be stored in a covered truck prior to shooting on the grounds. Attached hereto and the display is to be coverage. made a part of hereof is a diagram of the grounds on which held. Also attached is a certificate or policy of insurance ~~~ ~ ~d, aod3 to of pplication