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TOWN OF SOUTHOLD
PERMIT FOR PUBLIC DISPLAY OF FIREWORKS
I, NDITH T. TERRY, Town Clerk;of the Town of Southold,
Ol? IPP?T FIRE DEnAR "~"F.NT
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JUD~ TERRY, To Clerk
Town of Southold, Suffolk
County, New York.
Suffolk County, New York, being an officer duly designated by
the Town Board of the Town of Southold for this purpose,
DO HEREBY GRANT TO
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 July 3, 1932 at annrox. 9:.00 n.b?..
Rain date: July 4 1932 at annrox. 9:00 P.A4,
at 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 Southol
DATED at SOUTHOLD, New York,
this lst day of July 1932;
S E A L
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•. u:aaria:>ra~~aa7ica~Tiia3nar~:r~rlalnrmay~[.y~a.>.aacm:_
NAME AND ADDRESS OF AGENCY
Roy H, Reeve Agency Inc, COMPANIES AFFORDING COVERAGES
sin Raad PO Box 54
Mattituck, New York 1195 ~°nEe"Y A Travelers Insurance Company
2R~CEIVED _ _ _ -
NAME AND ADDRESS OF INSURED
Orient Fare District
Orchard Street
Orient, New York
11957
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ma[ pouaes m Insurance la[ea ceww nave ceen Issues m me msurea names aoove ano are In rorce an
or other document with respect to which this certificate may be issued or may pertain, the insurance
TY PE OF INSURANCE ~ PD LICV NUM BER
GENERAL LIABILITY -_ -
E_p.COMPREH ENSIVE FORM 650-608E159-A-IND-80
^ PREMISES-OPERATIONS
^ F%PLOSION AND COLLAPSE
HAZARD
^
UNDERGROUND HAZARD
^ PRODUCTS/COMPLETED
OPERATIONS HAZARD
^
CONTRACTUAL INSURANCE
^ HROAD FORM PROPERTY
^ DAMAGE
INDEPENDENT CONTRACTORS
^ PERSONAL INJURY
AUTOMOBILE LIABILITY
^ COMPRCHfN51VE FDRM
^ OWNED
^ HIRED
^ NON-OWNED
LIABILITY
^ UMBRELLA fORM
^ OTHER tHAN UMBRELLA
FORM
and
EMPLOYERS' LIABILITY
OTHER
POLICv
EXPIRATION DATE
9/26/82
Notwithstanding any requirement term or condition
d by the policies described herein is subject to all the
__ Limits of Liability in Thousands (000)
EACH gGGREG ATE
~CC URRENCE _
BODILY INJURY $ $
1,000 1,000
PRO PE RTY DAMAGE $ $
BODILY INJURY AND
PROPERTY DAMAGE b b
COMBINED
PERSONAE INJU RV ~ b
BODILY INJU RV
(EACH PERSON)
BODILY INJURY
(EACH ACCIDENT)
PRO PE HTY DAM AGF
BODILY INJU RV AND
PRO PERTY DAMAGE
COMBINED
DO DILY INJURY AND
PRO PERfV DAMAGE
COMBINED
STATUTORY
b
b
$ $
s
I til ~ A,:<.Inr Hn
DescRIPTION of oPERATIONSTEOCgnoNSroEHICEES Fireworks display Saturday 7/3/82, Rain date Sunday 7/4/8
from Orient Wharf off Village Lane, Orient, New York
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing co m-
pany will endeavor to mail days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERT IF IC AT E HOLOE R.
Town of Southold
Main Street
Southold, New York 11971
ACORD 25 Q-09)
DATE IS June 17. 1982
AUT~RIZED REPRESENTATIVE
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`. APPLICATION ~ •
T0: JUDITH T. TERRY, TOWN-CLERK, TOWN OF SOUTHOLD
APPLICATION IS HEREBY MADE, pursuant to the pro-
visions of Section 405.00 of the Penal Law of the State of New York,
for a permit to display fireworks as hereinafter specified:_
The display is to be sponsored by ~2 1 c,.~~ve ~?fj97` ,
with principal office at (~~e ~vo ~ ~T. ~Y.,`f,~7`
New York, and will be held on ~ ~ ~ ~u~
i9/~k~;~, day month
19~=, at ~' : OG~ P.M. ~ ,
hour RAIN DATE: Ju r~ ~~'.0'~t~'
The following persons are to be in charge of the
actual shooting of the fireworks:
Name Awe Experience Physical Condition
n PS., Tab?~~
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Number and ty~ve of firewo rks is as follows:
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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.
By
Dated: (~ ~.3a~ ~~
at
JOSEPH L'. TOWNSEClD, JR.
NOL'„,v PU" '^, StcM of New York
ri 96335
Q~ ~ ; County
Si0fllmis,^.i;.,, E. ;,:. _> rnarch 30, ;1.~,~
~._
R~CE.1_VE_D.
JuL 11982
fi9wn Clerk Southold
Respectfully submitted,