HomeMy WebLinkAbout1979/9~j
TOWN OF SOUTHOLD
PERMIT FOR PUBLIC DISPLAY OF FIREWORKS
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 HEREBY GRANT TO ORIENT FIRE DEPARTMENT
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 4 1979 at 8:30 P.M.
Rain date: July 7, 1979 at 8:30 P.M.
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 Southo
DATED at SOUTHOLD, New York,
this 27th day of July 1979.
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JUD/ ITH T. TERRY, own Clerk
Town of Southold, Suffolk
County, New York.
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FLOYD F. KING JR 120175CHANGE ENDORSEMENT
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THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW:
1 Form MP-20
(Ed.7-11)
EFFECTIVE DATE COMPANY POLICY NUMBER
7-4-
TERM FROM TO FORM NUMBERS AND EDITION DATES
3 YRS 9-26-77 9-26-80 SAME
INSURED'S NAME AND MAILING ADDRESS AUTHORIZED REPRESENTATIVE'S NAME AND MAILING ADDRESS
ORIENT FIRE DISTRICT
ORCHARD STREET
ORIENT, SUFFOLK CO. , NY `-t ~~ `~- I~,Ln"C~~ ~~~ Fk~
SIGNATURE
POLICY CHANGES
UNDER SECTION II
IN CONSIDERATION OF AN ADDITIONAL PREMIUM TBE FOLLOWING CODE IS HEREBY ADDED:
OLT 794615 FIREWORKS ERHIBITION "FLAT CHARGE FOR FIREWORKS DISPLAY AT
VILLAGE LANE, ORIENT, NY."
ADDITIONAL INSURED: TOWN OF SOUTHOLD TO BE HELD WED JULY 4, 1979; RAINDATE
JULY 7, 1979
SECTION I-PROPERTY COVERAGE p,,,s,~, *,
LIMITS OF LIRBILITY PREMIUMS
Coverage
Description Loc.
No. Bldg.
No,
Previous Limn
New Limit Old
Rate New
Rate
Old Premium
New Premium ^ Rdd'I
^ Return
E S E E E
s s E s E
SECTION II-LIABILITY COVERAGE
PREMIUMS
COYERRGE LIMITS OF LIRBILITY Old New ^ Rdd'I
Prem. Prem. ^ Return
Bodily Injury and Property Previous Limit New Limit
Damage Liability Form MP-200 E ea. Occurrence E ea. Occurrence S E E
Combined Single Limit
E re ate E r ate E S E
Premises Medical Payments S ea. Person E ea. Person E S E
E ea. Accident E ea. Accident S S E
^ Forms other than MP-200: B.I. S ea. Person S ea. Accident E S E
Specify Coverage Part
] Revised Dual Limits MP-201 P.D. E ea. Occurrence E Aggregate E E E
Premises Medical Payment
S ea. Accident S E S
S ea. Person
INSTALLMENT PAYMENT PREMIUMS Total E
\J
LCT 6-~
Previous Revised Rdditional Return PREMIUM
Installments Installments Premium Premium DUE FOR THIS
ENDORSEMENT
Dates of subsequent 2. E E E E S ®Additional
installments: 3. $ E E E ^ Return
Date of Change: 7-7-79 165
.
NEPC
a CT~al4dT~mainder of policy term:
S
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Agency, By
Form MP-20 (Ed. 7-77)
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 specifi Q~
The display is to be sponsored by ~J ~~~/[/ // q~~
/j~e J~,P~D ~ with principal office at ~~ei(/ //
New York, and will be held on / y ?f/
day month
1g~~, at ~.~ ~ ~ P.M.
hour RAIN DATE:
The following persons are to be in charge of the
actual shooting of the fireworks:
Awe Experience Physical Condition
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,mss .y~-a
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Number and type of fireworks is as follows:
.~ - v~~~ ~ P ~~~~. ~~,~~ ~ air, ~ ~ ~ ~ - ~
-s_ - Ut T~1 ~ P ~ P ~ 1,4 /_ ,~/.Q~ W ~,,P ~S -- 7 d~ - ~
The fireworks will be stored 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.
Re ectfully submitted,
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Dated: ~, '
at /~~c~`' New York.
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