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Home My WebLink About1981 r~~/ TOWN OF SOUTHOLD PERMIT FOR PUBLIC DISPLAY OF FIREWORKS I, JUDITH T. TERRY, Town Clerk;of the Town of Southold, ORIENT FIRE DEPARTT4ENT ~-1~ / ~~ h~// ' `JUDITH T. 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 organizati in accordance with the provisions of Section 405.00 of the Pens Law of the State of New York, on July 4, 1981 at approx. 8:.30 r Rain date: July 5, 1981 at approx..-8:30 A.M. at the time and place set forth in the application therefor. ON CONDITION THAT the bond (indemnity insurance) required shal] continue in full force and effect in favor of the Town of Sou t} DATED at SOUTHOLD, New York, this 1st day of July 1481. is i I:t:~;[.7I-'731LT:T:UL"E" e~~~ ~y • -- ... '1:U1/il.'.Idyllif:~l7:f.L7:ipla:iiil;dp•/7:7:[Haurn:T.t~.~aii:ra~nXrar~y_ui~r.~_a_acr:. _ _ - - - __ __- NAME ANU ADDRESS OF AGLNCV Roy H Reeve ;ency Inc I=Iattitucl, i]Y 11952 NAME AND ADDRESS OF INSURCD Orient Pire District Orc1_.ard St. Orient NY 11957 COMPPNV I FTr ER y COMPANY D LCTTfR COMPANY C LETTER L This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. N~ of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by terms, exclusions and conditions of such policies. lt, term or canditiad is subject to all the CGMPANV PO~ICV Limits of Liability in Thousands ( 060) - I FiTER TYPE OFINSUHANQ POIICV NUMHER [xPIRAT ON JATF EACH _ OCCDRRFNCE AGGREGPTL GENERAL LIABILITY h30DILY INJURY $ 1 ~~~ $ 1 ~~~ ~]°OMRRENFNSI~E °ORM 650-608E159-~1-IPTD-80 9/26/81 , , ^ PREMISES-OPERA rIONS PROPER rV DAMAGE $ $ ^ E%Pt OSION ANC COLLAUSL HAZARD ^ UNpERGROUND HAZARD - I -'- ^ PHODUUSJCOMPI FTH~ I OPERAilONS HAZARD HOUILV INJU RY AND ^ CONTRACTUAL INSURANCE PROPERTY DAMAGE $ $ ^ HROAD FORM PROPERrV COMBINED ^ DAMAf.F INDf PCNOFNT CONTRAC10R5 ___ ___ _ ^ PERSONAL INJURv PERSONAL IN JURY $ AUTOMOBILE LIABILITY RoDILV wJUev renal RERSOw $ ^ COMPRCHCN F M SN IOH BODILY INJURY $ ^ (EACH ACCIDENT) OwNEU ^ HIRED PRO PERIY UAMAGE $ ^ BODILY INJURY nND NON-OWNED PROPERTY DAMAGC $ _..._ ___. COM HINFD EXCESS LIABILITY ___ _._-- ~ - - ^ UMpRCIIA FORM Bw!LV INJURY AND THERI A M ^ PROPERTY DAMAGE $ $ H O N U HRCIIA COMBINED FORM WORKERS' COMPENSATION sraruroav and --- EMPLOYERS' LIABILITY ___.__ _ $ OTHER -. __.. _--- DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLFS I'ireworla display, Saturday 7/4/81, rain date Sunday 7/5/81 £rom the property of I-r. John Tuthill of Villa„e bane Crient STY 11957 Cancellation: Should any of the above described policies be cancelled before the expiration date thereof. the issuing com- pany will endeavor to mall days written notice to the below na med. certificate holder, but failure to mall such notice shall impose no obligation or liability of any kind upon the company. COMPANIES AFFORDING COVERAGES COMP""Y A Travelers LETTER COMPPNY LETTER NAME AND ADDH[55 OF CERr IHCATE HOLDER. Town o£ Southold Main St. Southold ~1Y 11971 ACORD 25 (1-Z9) DATE ISSUE 6/2 9/8 1 r A A Ar1GE 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 Orient Fire Department ,.with principal office at Orchard St., Orient, N.X. New York, and will be held on 4th ~ July day month 19 81 , at a rox P.M. hour RAIN DATE: July 5, 1981 The following persons are to be in charge of the actual shooting of the fireworks: Name Awe Experience Robert J. Douglass 57 34 years Robert G. Douglass 34 13 years Physical Condition Good Good Linten Duell _ 30 5 ~.aarc __ ~^~ Number and tyre of fireworks is as follows: Night aerial display by Vitale Firewoods Co. - 150 shpts 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, Orient name of organization BY ~ s,1a Co issioner Dated: July 1, 1981 at Southold New York. 415.E ~i .~/~/ ~~-~-~ JUDITH T TERRY NOTARY PUBLIC, State of New York No. 52-0344963 Suffolk Count Commission Expires March 30,~