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HomeMy WebLinkAbout1997 ~ g~FFO(k~~ JUDITH T. TERRY ~' ~~ Southold Town Clerk ~.(~ ~~~ 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 Telephone (516) 765-1801 I, JUDITH T. TERRY, 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 here GRANT TO Mattituck Lions Club r; Fireworks By Girone A PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accord- ande with the provisions of Section 405.00 of the Penal Law of the State of New York, O N June 13 1997 and June 14 1997, between 9:30 P.M, and 10:00 P.M., on the property of Walter Gatz, south side of Sound Avenue, east of Cox Neck Road,Mattituck, the time and place set forth in the application therefor. 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 inactive 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 manner that the falling residue from the deflagration will fall into such lake or body of water; that any fireworks that remain unfired after the display is concluded shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual charge of firing 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. ith T. Terry, Town erk Town of Southold (TOWN SEAL) Suffolk County, New York Ma 30 1997 ate THIS PERMIT IS NOT TRANSFERRABLE b°ibb~7Ufl ~9 _ __ '97 ' 1[~~8~3aM~FIREl~24 SPRY GIP~iNE~~~EY _ ~ 669 697 955 _ KF 152 D@6 . CERTIFICATE OF fNSURANCE Oats; June 6, 1997 TiR01VNANDHUMP1iiREYSU;iiPLUS Thiscertiflcateidiaeuedssamatterotinformationonlydad 11(~}~ES__ IN$URADiCEHAOSI:RS ~ 500 B " ' camfenuori3htsuponshecertificateholder.'Ihecen~ete do aaffirdedb d d lt hecov t 0 RY t l SUITE SAN F>6tANCdSCO, CIS 9!104 y ,ett erag oesnotanwn an ta ari polbciea below. RED C NI AFFORDING COVERAGE' Fireworks By Girone Company CNA Mtsrnadonal Reinsurance Co 1 b40 garden Road Latter A 30.00% Participation Vfnaland, NJ 06380 Company Und®nwiters at Lloyd's, London Letters yo.oa% Panlc~ tiorr Ct7VER AGES thle e ro cerliPy thal the policies liatad below pave bam lraued to the imwed Gamed Glove for the polity period ladimrad~ Notvited4leding ouy rcgalremeN, lean, a coadltiop eE at7 eooaeel Ot oiler deeoateal with rWpaR W ehicb dd! eanlGcazs m+q' be iKtrA er msy pertain. the iasuredtx a8brdad the ' ' S deaert'led sereia' aul' et to all !area aul !!onl. cad Policy ' ion! of! IiriEB, Policy Uability limits In S 1000's ' Co Type Of Policy Effective Expiratlon Each Lir Insurance Numbsr Date Date Acrid®nt A r ate General Liability ClalaK Ldade Farm X pret4lsl~alOperstione SI & PD Comtaned 2,000, 4,000, A & X Contttaetval Liability X PtoduetalCoalpleted F97/4207/000 0*a/31I97 05/31 /08 B Pe~anal~Inaury 1 Personal ' N/A N!A 1a X Public I u ass LiabUity ~ Umlttella Form 81 do PD Otha9 an U Gila t:o d Coreca ge does ooa apply to iloday lalttry or Pegood Lljay te, Or lac, or d8mage lo, er Ivec eE two the ahooter(c), assietant(r). andlor any order ! . iaNUdc vela tee a in wa is the a:actdio o d'd r ial a ra Type of Display: FireNrorks Display Site of Display: Green Pastures Farm/Walter Gate Data of Dis la ; Jun®13 & 14 1987 Additional Insureds tMYh rerspect to the ebovo display only,• 1) MatGtuck Lions Glub 2) Town of Southhold 3) Mattituck Fire Department 4) SiIVBr Dollar Shows 5) Castle Rock Amusement NCELLAT N B) Gre®n Pastures FarmslW81t8f Getz Shoald angof the above policies be anceled beftue the ttl~irstlon data thereof, tits iasoi~as wmpaay tsftl tnai130 dsys arrittdn notice to tie oertitieate holder named to eha 1eR. ERTIPICA NOL ER Authorized epr@s®Ifiative: i ~ Mattituck Lions Club/Silver Dollar Shows ~ 212 Knapp Place ~ ,, ~ (~ Grtsenport, Long Island, NY y/(~ t JUDITH T. TERRY Southold Town Clerk ~p~~~U, ~ u~ `OG~ 0~0 ~o~ ~1 ~ r~ OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION for PERMIT TO DISPLAY FIREWORKS Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Telephone (516) 765-1801 APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 4050.00 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__L~ Q - ' %~~~~CS~.`_h~O~'/5_ 1~~J PRINCIPAL OFFICE AT J'ireGcJU +~ ~ i`S G`,i (Oir oH2~ ~5T Cxrc~lro ~~ U'~v~o,.,~ Iv,~ DATE OF DISPLAY ~~yti~ ~3 C..-v4C ~i{ ~~ S(p0 TIME OF DISPLAY 9, 3(~ / ~j~f RAIN DATE E TIME ~ / ~i'Je ~T / ,'S ~i~lP The following persons are to be in charge of the actual shooting of the fireworks: Name /~ ~~ H~:!i~Y2' S J~avlL~e~~ ~f~cr.'S Age Experience ~ as!s~P~~s ~~~rs ~f'C!r 5 Physical Condition ~O d Number and type of fireworks is as follows: ~l~lOrv ~~it~~ /7P lJ _ ~ ~f-i~~/ ~~ The fireworks will be stored in a covered truck prior to shooting on the grounds. Attached hereto and made a part 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. ~~ // 7't! l-v'o r KS ame ofpOr By Dom. Signature o1 n~ z o~ G~z ~'` I cZr v,1 Z ~e~or Gcg D~-- ~ goo ~Qe~ i/l Ql~ d~tec~;oks ~ ~ Gear cf ~~k;lA.,~ ~\ I~ .- r /\ ~~ Cen ~-er V rass t-r~e c.. wane G~ ~Z~h T ~ _ - R~. 5~8' ~ 05i19i97 16:31 W,M.DU~CA.BROWNBHUMPHREY ~ 609 697 9557 N0.051 D02 CERTIFICATE OF INSURANCE Date: May 19, 1997 P BROWN AND HUMPHREY SURPLUS Thu certif~teieissuedasamatterofiuforntationo and LINES INSURANCE BROKERS confetsnorietttsuponthecerti5cateholder.Thece k 000 bdONTG0111ERY ST, SUITE SOO dcesnotamead,exlendoraltertbemveraeeaBordedbytb SAN FRANCISCO, CA 90101 poliaas beknv. INSL/RED MPAN/E /N O Fireworks By Girone Company CNA /ntematYona/ Reinsurance Co 1640 Garden Road Letter A 30.Ot7% Pardcipa6on Vineland, NJ 08360 Company Underwriters at Lloyd's, London Letter B 70.00% Par6ci ation COVER A chic is to tenil'y slut the polieiu listed beltw Mve bem iswad W tha insured named sbow for the pdiry Road indicated. 1Votwitlutaading aay repuiremeol. term. or mnditioa or eny mnttact or ocher dmumem with rcapect b wbieh lhu eati6eate may be issued of may pertain. the iosarattae aftarded b the lido described herein is sub'eet to tJl terms. ertlwioot. and emd itbnc of such lieu. Policy Policy Liability Umits In $ 1000's Co Type Cat Policy Effective Expiration Each Ltr Insurance Number Dat® Date Accident A r ate General Liability Ckims Idade Form X Premises/Operations BI & PD Combined 2,000, 4,000, A X Contractual Laabdity 8 X Prodncts/Compteted F97/4207/000 05/31/97 05/31/98 B Operations pe~~ Injury Personal ' N/A N/A X Pnblic D' la u Ia Excess Liability Umbrella Form BI & PD Other Than Umbrollr Combined Coverage doa not apply to Badtly Injury Or lbnooal Injury to, or last. M damage to, a last OI use Of the rhoaer(e), assiataas(s), aadlor any otLsr t ,inel teluatee t 'i ti is w ins abm' md/ar ereeutim of dic ors cal etFesl ype of Display: Fireworks Dlsplay Site of Display: Gres„ Meadow ~arwts - (,Je,.1~-{r ()~z Date of Dis la : June 13 814, 1997 _ Additional Insureds witri respect to the above display only.' 1) Mattituck Lions Club 2) Town of Southhold 3) Mattituck Fire Department 4) .tk.Ll+efG~z 5) Silver Dollar Shows AN ELLATI 6) Castle Rock Amustllttent Should any of the abtm policiiea be eanoeled before the e~iration date theteof, the iasning ~titpsny X71 mar730 days written notice to the eorti[feste Lolder named to the left. CERTIFICATE HOLDER Authorized epresentative: Mettituck Lions Club/ Silver Dollar Shows 212 Knapp Place Greertport, Long Island, NY .~ ~~` ~- JUDITH T. TERRY Southold Town Clerk ~g~FF~G{~~0 ~O~,y,, ~ `~`I ~ ~~~ Town Hall, 53095 P~1ain P. O. Box 1179 Southold, New York Telephone (516) 765-1801 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. 3. The exact location planned for the fireworks display. 4. The age, experience and physical characterics of the persons who are to do the actual discharging of the fireworks. 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. A diagram of the grounds on which the display is to be held, showing the point at which the fireworks are to be discharged, the location of all buildings, highways and other lines of communication, the lines behind which the audience will be restrained and location of all nearby trees, telegraph or telephone lines or other overhead obstructions. 8. Such other information as the Southold Town Clerk may deem necessary to protect persons and property. 9. An indemnity insurance policy with liability coverage and indemnity protection of $1,000,000.00 per person for bodily injury; $1,000,000.00 per accident; $1,000,000.00 property damage. 10. The Town Clerk of the Town of Southold must have the insurance policy in her possession before fireworks permit is issued. The named insured must read: TOWN OF SOUTHOLD. 11. Application for a fireworks permit must be made at least five days in advance of the date of the fireworks disolav. Road 11971 (The above instructions are in accordance with the Penal Law, Article 405 - Licensing and other provisions relating to fireworks.) JUDITH T. TERRY Southold Town Clerk O~QcuFF01,Y~oG ~ ` O ~ ~ ~Ol ,Y. ~~'~~ OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION for PERMIT TO DISPLAY FIREWORKS Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Telephone (516) 765-1801 APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 4050.00 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 ~a-fTi~cGr j,,b,s GLtrQ PRINCIPAL OFFICE AT ~/'~n.S Q~N , ~ytr777ficc~ /J,q-/!ik YJ,.117t, c,~ ' /N~''^' /t A. /4/Y/ri ~1'vc4 DATE OF DISPLAY J:/,vL/ / 3 r /Cl ~ / ~~7 TIME OF DISPLAY `7 3~ ~~- RAIN DATE & TIME The following persons are to be in charge of the actual shooting of the fireworks: Name Age ~£"'TZ/ ~~~R~' f ~ Z Experience Physical Condition Number and type of fireworks is as follows: ~° ° (~C,/+Jf j~ ~ ~ ~j GrL..b2ks Cr/~~1 ifir~IYT- The fireworks will be stored in a covered truck prior to shooting on the grounds. ,~~~; ~~ yes Attached hereto and made a part 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. 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