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Home My WebLink About1972~_ ram oP sooreiar.D Lrs~Ir Pan P®sLIC DISlLJ1Y or rlaanoRrzs I, ALDERI' N. RICHIWflD, Town Clerk of the Town t+f Southold, Suttol~ Connty, flew Yolk, being the officer duly designated by the Twrn board of the loan of Southold for the purpose. DO HsREdY a1Ufl'! IIfl?O ORIENT FIRE DISTRICT o A PSIt1lI7 rOa T1Q p111LiC DISlLJ1Y 01 /1RSM~8 by said organiz- ation in accordance with the prarisious of Section 1594-a o! the Penal Law O! `S.ho State o! Sea Yerk~ Ott July 4, 1972 Rain date: July 5, 1972. at the tiae and plaa~~ set forth in the applioatlon therefar. 8:30 P.M., Village Wharf, Main Street, Orient, N.Y, on condition that the bond (indesaity insmraace) required shall coatim~s in fall torce and wffeat in la~aar of the ?own of Wuthold. Dated at iouthol4, flee York, this 20th day of June , 1902 ~~~ ~~~~~ Albert N. llcaa~ad, tova ci .y. !'can of soachold, snfloik Connt,, Yew Yack. SEA L Named Insured and Address This endorsementformsapartot Policy No....1~Z..._.S.MP....~.~!.95... 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, N• Y• 11957 of said policy unless another effective date is stated herein. Effective date.....~1wY..4....~....~,C.~....~+A~ .............Effective hour is the same as stated in the Declarations of the Policy. THIS ENDORSEL~DiNT PROVIDES COVERAGE UNDER SECTION 405.00 OF THE PENAL LAW OF THE STATE OF NEW YORR. IN CONSIDERATION OF AN ADDITIONAL PREMIUM IT IS AGREED THAT COVERAGE UNDER SECT. II LIABILITY IS AFFORDED FOR A FIREWORK DISPLAY BY THE FIRE DEPARTMENT ON VILLAGE WHARF, MAIN STREET, ORIENT, NEW YORK IN BEHALF OF THE TfNrftd OF SOUTHOLD. AS RESPECTS THIS EVENT, THE TWN OF SOUTHOLD IS AN ADDITIONAL NAM® INSURED, IN TED; EVENT OF RAIN ON THE DAY, COVERAGE WILL BE AFFORDED FOR RAIN DATE: JULY 5 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 thisendorsement takes effect as of 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 Underwriters Insurance Company INSURANCE GROUP Hartford Accident and Indemnity Company Twin City Fire Insurance Company Citizens Insurance Company of New Jersey 'J MNRTFORD CONNECTICUT // ! Counkrsigsed by.,,CFA(r ~. ~:LL.~t¢... .~,t~ ...... ......... ......... .. %~/lrGlhorised Agcnt Form C-3240.0 A Printed iv U. 5. A. 2-'64 j CERTIFICATE O(F INSI!JRANCE .$ m Hartford Fir< Insurance Company ~4p ®N<w York Underwriters Insurance Company THE HARTFORD ~ m Hartford Accident and Indemnity Company 6 (TI Twin City Fire Insurance Company INSURANCE. GROUP wrrowo. ~owecr cur `s ®Citizens Insurance Company of New Jersey "Chis is to certify that the company designated herein by Co. Code has issued to the named insured Named Insured and Address the policies enumerated below. ORIENT FIRE DISTRICT 1J ORILHARD STREET ORIENT, N. Y. 11957 The policies indicated herein apply with respect to the hazards and for the coverages and limits of liability indicated by specific entry herein, subject to all the terms of such policies. Coverages and Limits of Liability Hazards Policy E1feC[IV¢ Expiration Bodtly Ivjury Lleblllty _ Property Damage Liablllty Number Dale Date *earb occurrence *eacb occurrence aggregate General Liability Premises-Operations-Elevators 12SMP303495 7~4~72 7 5 72 OCCURR $ SQQ ,000 $ ,000 $ ,000 $ 500000 IDdependent Contractors $ ,000 $ ,000 $ ,000 $ ,000 Coif ~ ed Operations; $ ,000 $ ,000 $ ,000 $ ,000 Products Aggregate: $ ,000 XXXX XXXX CJntractual (as described nelow> $ ,ooo $ ,ooo $ ,ooo $ ,ooo Automobile Liability Owned Automobiles _ _ $ ,000 $ ,000 $ ,000 XXXX Hired automobiles _ $ ,00 0 $ ,000 $ ,000 XXXX Von-Owned Automobiles _ $ ,000 $ ,000 $ ,000 XXXX Workmen's Compensation and Employers' Liability Compensation -Statutory Employers' Liability - $ ,000 Umbrella Liability 12HU80006O 7~4~72 7~5~72 $ 3 ,000,000 *I(with respect to Automobile Liablllty the Policy Number entered above includes the symbol GB, AZ, MVP, MAG or PGB, the word "occurrence" is amended to read "accident". Location and description of operations, automobiles, contracts, etc. (For contracts, indicate type of agreement, party and crate.) COVERAGE IS AFFORDED FOR SETTING OFF A FIREWORKS DISPLAY ON VILLAGE WHARF', MAIN ST., ORIENT, N. Y. IF BY CHANCE THIS EVENT IS RAINED OUT, COVERAGE ~,TiLL BE AFFORDED FOR JULY 5, 1972. If policy is canceled, Towel of Southold written notice will be given to: Southold, N. Y. Date Co. Code r By..~.~~'...:?' ~- ~r.~ . - ~.~ t o>ized Re¢reseatative Form AL-13-a Printed in U. S. A. 7 '67 Named Insured and Address ThiaendorsementtormsapartotPolicyNo.....I,2...SMP._.30.34.9.5.. 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, N. Y. 11957 of said policy unless another effective date is stated herein. Effective date....JULY....~i....-....EACH...YEAR............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 STATE OF NEW YORK. IN CONSIDERATION OF AN ADDITIONAL PREMIUM IT IS AGREED THAT COVERAGE UNDER SECT. II LIABILITY IS AFFORDED FOR A FIREWORK DISPLAY BY THE FIRE DEPARTMENT ON VILLAGE WHARF, MAIN STREET, ORIENT, NEW YORK IN BEHALF OF THE TOWN OF SOUTHOLD. AS RESPECTS THIS EVENT, THE TbHN OF SOUTHOLD IS AN ADDITIONAL NAMED INSURED, IN THE EVENT OF RAIN ON THE DAY, COVERAGE WILL BE AFFORDED FOR RAIN DATE: JULY 5 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 i[ this endorsement takes effect as of 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. I1t111.1PVIlJ/ Hartford Fire Insurance Company New York Underwriters Insurance Company INSURANCE GROUP Hartford Accident and Indemnity Company Twln City Fire Insurance Company - '- _ Citizens Insurance Company of New Jersey 'Y MAFTFOflD CONNECTICUT ~~`f~~y'/~,'' .`~ may(, / _.. Couxterstignrd by..yC~~ J ./-..!/ .. l ...... ........ .. ~~~J7~fithorised Agent Form G-I]40-0 A Printed in U. S. A. 2= 64 CERTIFICATE O'N' INSURANCE .:, m Hartford Fire Insurance Company ° ®New York Underwriters Inmrance Company THEaHARTFORD ~ m Hartford Accident and Indemnity Company ~ m Twin City Fire Insurance Company r.errooo. cor~emwm '~ ®Citizens Insnrance Company of New Jersey s+ Co. Code This is to certify that the company designated herein by Co. Code has issued to the named insured Named Insured and Address the policies enumerated below. ORIENT FIRE DISTRICT ORCHARD STREET ORIENT, N. Y. 11957 The policies indicated herein apply with respect to the hazards and for the coverages and limits of liability indicated by specific entry herein, subject to all the terms of such policies. Coverages and Limits of Liability Hazards Policy Effective Expiration Bodny Injury LiaMlity Property Damage Llabltlty ~ Number Dale Date ~ °each occurrence *each occurrence aggregate General Liability :Premises-Operations-Elevators 12SMP303495 7/4/72 7/5/72 OCCURRE $ 500 ,ooo CE $ ,ooo $ ,ooo $ 500000 Independent Contractors $ ,000 $ ,000 $ ,000 $ ,000 Completed Operations, _ $ ,000 $ ,000 $ ,000 $ ,000 Products Aggregate: $ ,000 XXXX XXXX Contractual (as described below) $ ,000 $ ,000 $ ,000 $ ,000 Automobile Liability Owned Automobiles $ ,000 $ ,000 $ ,000 XXXX Hired Automobiles $ ,000 $ ,000 $ ,000 XXXX Non-Owned Automobiles $ ,000 $ ,000 $ ,000 XXXX Workmen's Compensation and Employers' Liability Compensation -Statutory Employers' Liability - $ ,000 Umbrella Liability 12HU800060 7/4/72 7/5/72 $ 3 ,ooo,ooo -u wrtn respect to Automobile Liability the Policy Number entered above includes the symbol GB, AZ, MVP, MAG or PGB, the word "occurrence" is amended [o read "accident". Location and description of operations, automobiles, contracts, etc. (For contracts, indicate type of agreement, party and crate.) COVERAGE IS AFFORDED FOR SETTING OFF A FIREWORKS DISPLAY ON VILLAGE WHARF, MAIN ST., ORIENT, N. Y. IF BY CHANCE THIS EVENT IS RAINED OUT, COVERAGE WILL BE AFFORDED FOR JULY 5, 1972. If policy is canceled, written notice will be given to: Date Form AL-12-0 Printed in U. S. A. 7-'67 Town of Southold Southold, N. Y. r By .~~. ///~ of%zed RepresertiaEive ApgL2G1'MOIa I TOE ALeEaT ol. AxCffi401AD, '1'AfBi Ci.~R, TOWN OP 80~06D -, APyLICA'1'I03~ i0 NETdaBX Mi1pa, pnrenaat to the ~~ vieioae o! 8eatioa ~-a o! the lead Lear o! the 6tate o! New York, tear a paarwit to 4isply+ lirevoaeka as heareiaaltes aapaoilted~ The diarplay is to apoasaa; ed Ay , ~ ~? ~ ~ `T 2 ~~ 1~P',(; . , ~, with pa" iaas,pai o!lioe at ,_~e ~ ,~T ,,,,, New York, aad will be held on ~k ~,,, ~ v 1 ~^ 19~ y at ~ ~ 3r..~ ~ ._. N.M. , (honr~ The lollowiag pessosae are to be is charge o! the aatnal aahootiag o! the !lrewaacka~ Name Args E~+x srieacs Phs-sica],Laoatdition t 26Mi ~~Zti~ ~tl~ .. ^... w~3. ~~r~ t i~.~,.~s ww~ wY ~~~ /~ r~ r , 1C.DCz„R' i ~~iQO'2 ...+... ~1~. .~I `~ 'r.~~~ ..,.... C'. BG:JI~. leaabear and type o! lirewarkr ie as lollewa~ ,w~ ~e~,u Ss ecL N Qo 5NN«5 ~ ~~A ~~ T'he lireMOOrks will bs aatosed A..n a aovere4 tsnak parlor to the ahootiag oa the gronada. Attached heareto ead sade a part Mseo! is a diagram o! the gronada oa which the display ie to be held. Also attached ie the cestilicate or po3icy o! iaearaaas aovm~age. ieapsetlnlly suaaltted, F~l2t~N ~ ~.g~ l~~s~r Ca+~e of (aa~r~panieaef.on) /) ®' sy ~..l.C,~ 1'1~.2AD~Ctca (ro1L.n./ G~+. , 'rah ~ .n.1 s..i '+:N _.^^. ,. t; .. ~ ..1 .M. ~ ,., . NeM Yozk. ~L. f AYYLtG1TIOtl( TOs ALBBRT 1P. R2cEIl[CEID, '1'CMl1 C7sRR, TG1Di 0!' 60i1?HOLD AYBLICINI"jq/ IS ~AEBY M#DS, pursuant to the pso- ~S.~~a •isians of potion s of the penal Lar of the state of Ater Yark, tar a perwit to display firerasks as hereinafter specitieds 1'he display is to sponaasad bat ,~ ,2,~~L r - 2~ I ~ ~ T , rith principal office at ~„~z~r,o ~ bier flask, and trill he held as ~ ti J ~ ~ !d y as th) l~_~, at ~ ~ 3 O ~ M Y.M.. (hour) '!'he lolla-ing persons ue to lse in charge of the actual shooting of the firarorlus looms ~ mcpsglience Yhi-sical aonditlas Q04iCr ~ w~,iy3 N~ a7 5 ~QS ten l~ D SS iU orE/vnJ P' 3 (o r ~p ~r~ ~ c o D Y~oc~~tS ,1.gaort y~- iy ~ C~egn Mvaber and type of firerarks ie as foliawss e c/d27 "'~ 5 `~ ,ere. ..~,. ~ia~~viDe2.- t/tr`LC ~..~.,~ ~ s r/B S w~..rr+r.w.~~ ~ w~wwww 'l9se tirerorks rill be stared in a covered truck priar to the shooting oas the grounds. Attached hereto and wade a put hereof is a diagram o! the grounds on rhiab the dirplay is to be hold. Also attached is the certificate ar policy of insarance cororage. kespectfully subeittsd, ~(,~NT riRc- /~6PT (name of ornganisation) ,Q_gL' . D-er York. _arr~ rr~ a#M'7;~'ti:, ~ Ay".*~'. ° .°~~}'~"p F i w ~J SAro~~ may..... :si=r~« ~~~TM"°$ur"w"'e` ,-r) '~/ ~ r r~ fit' ~~ D X /:`) ~ i ~ ~- •- `~- l ! *... ,. _s : .. ~R`~~ ~~ ~ ~~~ Y { f, :`' r ~, i r ~ + t 4 I r '..+ ' ~ ~ ~ '~ ~ ~ F ~ ~ ~ ~ ~ ~ " ~''' ! ~ ' t > ;. ~_~~ . ~ ~tt/~ Fi4~r.~~7lLS ~~ r ,~39 ~..f~ S 7-R e c. q-s r-c%, ~ i-~~ r~ C1 ~1 ~~- r . ,, 'OK ,. vl~-~-g~6-e ~ ~gRr- ,~ X•C.cr f'T laC~ .~T' t~//i'f t/ Cr p c''~s o.q ~ ~C. ~~ " T ,.._~ .,. ~-a ~,~~~ ~ ~~ l~ ~ ~~ ; ~ i ,