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HomeMy WebLinkAbout1967 r a, ws.~s N. azcrs~a~, rorw clock or tt,. roo.A of ao•tkold, ptlolk Co~uatr, sw rick. 1ai,.q tho atiicws daiq aaaipatM ~ tAa swa foosa of taa rarw of ~tlwela tac tl~a ricpoaa, !o ~i! ~/~! ~!0 F9.s,,e~:s Islam Fire Devart:nenc A l~II'! !N !O !l16IC 1IN'iA! N lIAN~ ~ aala ac~ia- atiM is aaeacYwaa »ith t1n ~aw-iaiaaa of Nati•a lAlha •! W lowal Lr •[ t1N •tata •! •aw riek~ oa J'.,J_y -i, 1067 9:00 at W tina asi )lava aat iortl~ la tA• a~pli@atioa tlwrof«r. P,, .._ a w eaaaitiea that tAa LoM (iiaaasitl laaaraaoa) rKairaa email o..ti.a. iw lrll iarao awt aitoat la :a..c •i tAa Tara •i aata•1a1. Nqa at Matfa<l~a, wn liwCk, N1ir 27 t.h aq of Sune ~ 1N ~ . ~'11~ar! •• • tw •~-~ sww ~ raottiala. wttialk ~~ !aa rick. ~ s A L IPM :Y APPLiCATSCiv TO: LI.BSRT W. RICHl1Q~ID, TQ~IN CLERK, TQ9N DE' SOOTHQ.D APPLICATION ZS HEREBY MADE, pursuant to the pro- visions of Section 1894-a of the Penal Law of the State of New York, for a permit to display fireworks as hereinafter specified: ~p.~,The display is to sponsared by --r~--M1-~.-~ -~ ~~-~. ~-~^E~~ , with principal office at ~~~^~-M ~a - v1.. Ter York, and rill be held on ~ , © (day) (m nth) 19i~_, at / ~ ~ ~ P.M.. (hour) The following persons are to be in charge of the actual shooting of the firewarks: 11ana 7-ge ESCperience ~~ ~~~.. ~ ~ ~ 3 ~v `\ Number and type of firewar a is as follows: The fireworks will be stored in a covered truck prior to the shooting on the grounds. Attached hereto and made apart hereof is a diagram of the grounds on which the display is to be held. Also attached is the certificate or policy of insurance coverage. Respectfully submitted, ~~~„ ama of organizatio ) BY ~ -`-`-Qn-i-~ ~~ ~ ~ -- Dated: /~ - ~ `~-+ , 19 b_ Z at ~,,.n ley New York. ~ v Physical condition .. ~ tra wm~ n..at.~. r.., >t. y. tore. - ` ~] us ta. laekw N•d., Cdesw, m. rant ~OwN AND ~ fn LGY• Il1C. A-10 ^ tns twerrw u.. sa®ts, a.. rota sans ao ^ w s. etwa. th«., t.. aw.t... cma. rector N~LMORANDUM OF II~i3URANCE CONTRACT COST $300.00 THIS IS TO CERTIFY that the insurance hereinafter described hm bees elfeded with INTERSTATE FIRE & CASUALTY COMPANY & LLOYD'S OF LONDON IDSUred ATLAS DISPLAY FIREWORKS, Jaffrey, New Hampshire It is understood that for the Display shown, the owners of property, or sponsoring committees, or organizations shall be included as insureds under the terms oP the policy. Display V,'est Harbor, Fishers Island, New York Date: July 4, 1967 PaoPesrr oa aocanoN tNSOSaD aIND OPINBUMNC~ Fireworks Display Public Liability Insurance Pouex No. U143-11710 & GNY-20776X8 ,,,,,,ti or ~~~ Ba ao 1 (a) & 1 (b) & 2 wec.~w rests: erPecma One tesu nO1, May 1, 1967 ~ May 1, 1968 ~n subs equent date on which the Disalay is he la . within the term oY this contract. soaax mbar accts or $ 40 $_SO .000.00 each person .000.00 each acddent S 10.000.00 B 20.000.00 each person each aeddeat fi_ aggregate S aggregate PaOParY DAMAa6 ExCaHB OP S ___~ach aeddeat S 5 000.00 each aeddeat S aggregate $ aggregate TOTAL LIMITS: $50/100,000 Bodily Injury3- $50,000 Property Damage a S *Fishers Island Fire Dept. and the Town o3 Southold, Fishers Island, New York a ^~.Ot~'.: ~"07..1CV C!)Vf rS >U ~~)^i V.-i.Sil~n S O~ JF'.C1;]nY: 1=.ylb_~ _~aY7~l ]..'; ;, OF t11P ~t~.te ofi ~ae~? Yor'~- The insurance described above is sub)ed to endorsement alteration, traaafer, assignment or cancellation with- out notice to the bolder of this Memor®dum. Thin Memorandum comers no rights to the holder thereof and is given only as a matter of information regard- ing the inew®ce above described It is expressly uadentood sad agreed by the Assured that Brows sad Hawley is sot an Insurer hereunder and shag not be liable in any way or to any extent whatever for say loss or claim, but that the Insurer hereunder is named above. tesueDro *(See Above) $R~ ~ AND ~ W Y, C. asraD>.r Chicago, Illinois ,~,, 14 ,,,,.d June is 67 sx acts ta... sro) 1 (a) BODIi.Y INJURY 1(b) PBOI?ERTY DAMAGE (Subject to $100 Deductible per Claim) APPLICATION TO: ALBERT W. RICHMOND, TOWN CLERK, TOWN E)E' SOUTHUI,D APPLICATION IS HEREBY MADE, pursuant to the pro- visions of Section 1894-a of the Penal Law of the State of New York, for a permit to display fireworks as hereinafter ~ c~ The display is to sponsared by ~-~-~ ~I ~'~~ , with principal office •-+-y. New York, and will be held on `~ _ , _ (day) 196 ~ • at e/~.0 ~ P.M..- (hour ) specifie~~ffd: ~~ ~ yp N]~h.M~=I ~Y~' W+" at ~ i-e-~'~.'.~' ~~'0 ~v, (wont ) The following persons aze to be in charge of the actual shooting of the firewarks: Name Number and The fireworks will be stared in a covered truck prior to the 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 the certificate or policy of insurance coverage. Respectfully submitted, .+ /f-(~ ame of organization) By ~, ~~-~---, ; I -~, ~,. Dated: ~k`^-~p-~6_ ~~ ~ , 15 ~ i at ~~~-T..-~ ~.la~°- , -~, ~ ., New York. Ex erience Ph sical condition 1 p y,~.~,~~ ~ CT~~^~--' --~ ape of fireworks is as follows: .~ ~U ~_ 30