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HomeMy WebLinkAbout1977TOWN OF SOUTHOLD l~ ~ ~ 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 THE ORIEDIT 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 3, 1977 at 8:30 P.M. Rain Date: Jul 4 1977 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 II continue in full force and effect in favor of the Town of Southolc DATED at SOUTHOLD, New York, this 3rd day of June 197'x. JUDITH T. TERRY, To Clexk Town of Southold, Suffolk County, New York. S E A L 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~~e ~~ ~fie/(/Q f~~~o ~~ with principal office at /~~/~/n/~° /Y~ New York, and will be held on ~~ , ~/,L, ,(_, day Tmonth 19~' at ~,~C7 P.M. ~'y.-.. hour RAIN DATE: ,*~-~f LL ~(,~ / ~'~7 The following persons are to be in charge of the actual shooting of the fireworks: Name Experience /L_~ ~ Physical Condition ~.-tJ ©~ D b ~.L ©p ~_ Number and tyke of fireworks is as follows: PL ~, s ,~ ~ rs e i1Y2~ v..o ~.~-l . ~s~e ,C.C S 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. F Dated: at New York. Named Insured and Address r~.~ Orient Fire District Thisendorsement formsapart of Policy No...12....~...~.........~~!.9.~6...... Orchard St. n;sued by THE HARTFORD INSURANCE GROUP company or companies designated therein, and takes effect as of the effective date Orient, NeW York 11957 of said policy unless another effective date is stated herein. Effective date.........J~~...3~.~..d..~ .......................................Effective hour is the same as stated in the Declarations of the Policy. It is agreed that the "Persons Insured" provision is amended to include as an insured the person or organization designated below, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises designated below leased to the named insured, and subject to the following additional exclusions: - The insurance does not apply: 1. to any occurrence which takes place after the named insured ceases to be a tenant in said premisels; 2. to structural alterations, new construction or demolition operations performed by or on behalf of the person or organization designated below. S/S Orchard St. Orient, New York Town of Southold Incl Nothing herein contained shall be held to vary, waive, alter, or extend any o[ the terms, conditions, agreements or declarations of the policy, other than as herein stated. This endorsement shall not be binding unless countersigned by a duly authorized agent of the company or companies; provided that i(thisendorsement takes effect as o[ the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy by a duly authorized agent of the company or companies shall constitute valid countersignature of this endorsement. THE HARTFORD Hartford Fiee Insurance Company New York UnderwNters Insurance Company ' INSURANCE GROUP Hartford Accident and Indemnity Company Twin City Fire Insurance Company >, Citizens Insurance Company of New Jersey .. HARTFORD CONNECTICUT ~})O~ o - Counkrsigned by.........V~-.~~`~SOI,....~~~(/ eb ................................................. j / Authorized Agent Form G-3390-0 A Privted in U. S. A. 2 '64 Named Insured and Address ThisendorsementformsapartofPolicyNo12,.,SMP.307..5..26,,,,,,. Orient Fire District issued by THE HARTFORD INSURANCE GROUP company or Orchard Street companies designated therein, and takes effect as of the effective date Orient New York 1195? of said policy unless another effective date is stated herein. f Effective date......July 3rd ..........................................Effective hour is the same as stated in the Declarations of the Policy. This endorsement provides coverage under section 405.00 of the penal law of the •tate of New York. In consideration of an additional premium it is agreed that coverage under Sect. 1 liability is afforded for a firework display by tha Fire Department on village wharf, Pain Street, Orient, New York in behalf of the Town of Southold, As respects this event, The Town of Southold is an additional named insured, in the event of rain on the day, coverage will be afforded for rain date: July 4th. Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated. This endorsement shall not be binding unless countersigned by a duly authorized agent of the company or companies; provided that if this endorsement takes effect as of the effective date of the policy and, at issue of said policy, forms a par[ [hereof, countersignature on the declarations page of said policy by a duly authorized agent of the company or companies shall constitute valid countersignature of this endorsement. THE HARTFORD Hartford Fire Insurance Gompany New York Underwrltere Insurance Company INSURANCE GROUP Hartford Accident and Indemnity Company Twin City Fire Insurance Company -, Citizens Insurance Company of New Jeroey .. `. HERTFORD CONNECTICUT /)~' Countcrtigntd hy.......~ .... ......~(...?!...;1~~ .................................. .......... 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