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~n~rrwriter~ ttt ~`il~a~~'s, ~'iun~-mt
(Nef Incorporated)
CERTIFICATION OF INSURANCE
This certifies that the following insurance has been effected with certain
Underwriters at Lloyd's, London:
NAME OF ASSURED Suffolk Novelty Fireworks Co., North Forg
AND ADDRESS Country Club, Cutchogne, New York, Township
of Southold.
PERILS OR TYPE Public Liability and Property Damage Liability
OF INSURANCE on Firework Exhibitions.
LOCATION(S) OR Grounds oY North Fork Country Club
OTHER SCHEDULES Display on or about July 7 1956.
LIMITS OR AMOUNTS PL10,000/25,000.00
Pd 2500.00
TERM OF COVERAGE ,July 13 1955 to July 13 1956
POLICY NUMBER 28459-8
This Certification of Insurance is issued at the request of:
North fork Country Club
Cutohogue, New York
Township of Southold County of Suffolk
and confers no rights to the holder which would not otherwise be conveyed to the
holder under the terms of the insurance; in the event of material change in cover-
age or cancellation of the insurance during the term thereof NEWHOUSE AND
HAW LEY, INC. , will endeavor to notify the holder, but neither Underwriters at
Lloyd'e, nor NEWHOUSE AND HAWLEY, INC. , accept any liability or reaponai-
bility for failure to do so.
Dated at Chicago, Illinois, -this
7 day of June 1956
THE TRAVELERS
aCrye ~rabelerg 3Jusuraure ~fuapanp
Frye aCrabeferg ~luDemnitp ~Companp
Certificate of Insurance
This is to certify that policies of insurance as described below have been issued to the insured named below
and are in force at this time. If such policies are canceled or changed during the periods of coverage as stated
herein, in such a manner as to affect this certificate, written notice will be mailed to the party designated below
for whom this certificate is issued.
Ime and address of party to whom this certificate is
Town of Southhold ~
- Southhold, NY
2. Name and
North Fork Country Club
SAS P°lain Rd.
Cutchogue,N.'Y.
L J
3. Location of operations to
Southhold, Suffolk Co., NY
4. Coverages for which insurance is afforded Limits of Liability Policy Number Policy Period*
Workmen's Compensation and Employers' Compensation-Statutory **
Liability in The state named in item 3 hereof
Bodily Injury Liability-excep} automobile **
$100, 000. each person
eX cluding Protective
---- ---- ------ - -------- --------- -- $ 00 000• each accident
3------~----- ------------------- SLG 8
3934 79 2
7- 7-55-5
Property Damage Liability-except automobile **
$ 25 , 000 • each accident
eX cluding Protective $ aggregate
**
Bodily Injury Liability-automobile $ each person
$ each accident
**
Property Damage Liability-automobile $ eachaccident
-roucy is ettective and expires at 12:01 a.ht., standard time at the address of the named insured as stated herein.
**Absence of an entry in these spaces means that insurance is not afforded with respect to the coverages opposite
thereto.
Description of Operations:
rr^ireworks,etc X3265
Liability for damage to property caused by ^ Blasting or Explosion, or ^ Collapse of or Structural Injury to
(Enter X in block aDDiicable)
any building or structure is excluded from operations classified as
The insurance afforded is subject to all of the terms of the policy applicable thereto.
This certificate is executed by The Travelers Insurance Company as respects insurance afforded by that com-
panyunder the policies designated above; it is executed by The Travelers Indemnity Company as respects insurance
afforded by that company under the policies designated above.
Mark tq. Flanagan
THE TRAVELERS INSURANCE
Branch Office Bklyn THE TR V RS I
Date 6/18/56 jb 4~~
C-5918r Rev. B-54 rxiurzo irv us.n. AfU Reb>e.