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Home My WebLink About1967ran or sarraa.D oar~r TaR lODLIC DISPL7-Y O! TIRENORICS I, 11LDiA'! N. AICfAtOIID, town Clerk of the Town of Southold, Suffolk County, Hew York, being the officer duly desigaated by tha Town Soard of the Iowa of Southold Par the purpose, DO H~SY ~ QYrO OYS'PER PONDS CHEMICAL CO (C:anr~ro C .a`ham~ ChlE A ?AAlIIr 1011 THS PEnI.IC DISlLAY W 3ItsNatRD by said orgaaiz- atioa in accordance with the prari.ioas of Ssctlon 169-a of the Psnal Lahr of the State of liew York, on Julv 4, 167 830 at the tics aad place set forth in the application therefar. Perni~c gran ~.ee on condition that the bond (indemaity insurance) required shall continw in loll force aad effect in favor of the town of ieathold. Dated at iontheid, Blew Yuck, ~ ~, this 27th daT of June , 19~ 7 ~~~~ _~ 1-lbert N. tewa cle~tk town of Southold, Suifelk OwntY. Sfew York. Stl-L r .vPPLiCATlON TO: ALBERT W. RICHMOND, "CadN CLERK, TDATN OF SOUTH OLD APPLICATION IS HEREBY MADE, pursuant to .he pro- visions of Section 1894-a of the Penal Law of the State of New York, fee a permit to display fireworks as hereinafter specified: The display is to sponsored by ~~s°Tc°G~ PDiY~~ ~/~ /~/L~,L (~ n , , with principal office at v~ /~/(// New York, and will be held on ~ /y , ___y~~c.~_~ (day) month) 196_, at b'.'3 O _ P.M. -. '7N chour) ~~i~i~' PR'Te ~~~ ~ 9 /l6~ The following persons are to br. in charge of the actual shooting of the fireworks: Name Age Experience Physical condition ~ 6P~ a. Tabu r:,c,vss~`~ _.~~~-o . ~' o v /~ L'Nie~' d~eoiPF~ ~,Cr~TN.gicq ~`/ /°~ Number and type of f eworks is 60o P as follows: The fireworks will be stored in a covered t%uck prior to the shooting on the grounds, A'.:taC'lled hPS'etU and made a par', r,ereot is a c3iayracn of the grounds nn which the d.isp.ay is to b'- held. A:. so attachCo is the certificate or polio, ~f i.nsuza:lcc r_o~~e;aye. Resaectfuliy submitted, OYsT~~ PaAlps CH=_~_~cq_~ e_o (name of organization) llated:_G~N,,,~ t~_I q ~ ~ _-_____ at (q , New Yor};. _-.___. ~~ ~~ c..~ o R ~3 ,o~S ~~ti ~' ~l~~ j9d ? ~w~y~ ~~ ~° `' a ~ ` ~~ a 0 I ~ o T i t I r ~ ~ r ~ p0 ~ ~-f~' 1'A-R 1 ~ri~r G- i '~. ,C3~9 ~ f:- S '~ ,-~ e e ~' S ~ ~R v y--W - ~.~o w - r„~~- ~ rC . ~ ~ 0 ,, N~ pe/~s~NS ~r,~nwcA 01Y vj~-~-~G-c w ~r~lRr ~ ~~~~~~~ ~, N~ ~A- ~ L' c~~'~~' ~ .~ -~ ~' CERTIFICATE OF INSURANCE F ~pa, c ~ m Hartford Fire Iasurmce Company 4 ®New York Uoderwrit<rs Iusunace Company j ~ THE HARTFORD' ~ m Fiartfard Accident and Indemttity Company , ®Nor[hwes[em Underwriters of Citizens Inaurance Company of New Jersey INSURANCE GROUP " ®Citizens Insunnce Company of New Jersey ~ m Twin City Firc Insurance Company ..a..o„ ~e...~.,r. LMM This is to certify that the company designated Co. CWe herein by Co. Code has issued to the named insured ~ Named Insured and Address the policies enumerated below. ORIENT FIRE DISTRICT b OYSTERPONDS CHEMCIAL CO., <r TOWN OF SOUTHOLD FLOYD F. KING, JR., 16-0175 ORCHARD STREET ORIENT, NEW YORK 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. Coveragea and Limitg of Liability Hazards Policy Number Effective Date Expiration Date wily [vjury Llablllty AN Property Damage Liability •aMlla/aaaM paalliaC1116Pi eaal\a6LidaYL aggregate General Liability Premises-Operations 10 SMP 104620 IF 6 4 6 0 $ 300,0 CURRENC $ ,000 $ ,000 $ 00,000 Elevators $ ,000 $ ,000 $ ,000 XXXX Independent Contractors $ ,000 $ ,000 $ ,000 $ ,000 Products-Completed $ ,000 $ ,000 $ ,000 $ ,000 Operations 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 E ,000 $ ,000 XXXX Workmen's Compensation and Employers' Liability Compensation -Statutory Employers' Liability - $ ,000 Umbrella Liability $ ,000,000 Location and description of operations, automobiles, contracts, etc. (For contracts, indicate type of agreement, party and - date.) - COVERAGE IS AFFORDED FOR SETTING OFF A FIRE WORKS DISPLAY ON VILLAGE WHARF. MAIN ST., ORIENT, N.Y. IF BY CHANCE THIS EVENT IS RAINED OUT COVERAGE WILL BE AFFORDED FOR JULY 9,1967. IE policy is canceled, 10 DAYS written notice will be given to: Date JUNE 20,1967 Form G-3106-3 Prieted io U. S. A. 6 '64 TOWN OF SOUTHOLD SOUTHOLD, NEW YORK I3y....... ~~~~~~.. - .............................................. Authorised Representative F,L~OYD F-. KING,JR 16-0175 6/20/LMM ORIENT FIRE DISTRICT ~ OYSTERPONDS CHEMICAL CD. Assnrea,_ 12 SMP 104620 HARTFORD INSURANCE GROUP Attached to and forming Part of Policy No. ______ __ ___ ____________ of the__________________________________________________. ORIENT, NEW YORK __________ ______________Insurance Company, issued at its _____________________________ _- _ -______________. A4ency. 7 x+•67 (City or Town) (State) Effective Date 1N CONSIDERATION OF AN AD COVERAGE UNDER SECTION II WORKS DISPLAY BY THE FIRE STREET, ORIENT, NEW YORK, _- 19 ..._. _____________________________________________________. A9eni POLICY TERMS 9.26.65 • 9.26.68 ~tTIONAL PREMIUM, IT IS AGREED THAT LIABILITY IS AFFORDED FOR A FIRE DEPARTMENT ON VILLAGE WHARF, MAIN IN BEHALF OF THE TOWN OF SOUTHOLD. AS RESPECTS THIS EVENT, THE TOWN OF SOUTHOLD IS AN ADDITIONAL NAMED INSURED. 1N THE EVENT OF RAIN ON THIS DAY, COVERAGE WILL BE AFFORDED FOR THE RAIN DATE JULY 9,1966. THIS ENDORSEMENT PROVIDES COVERAGE UNDER SUBDIVISION 5, OF SECTION 1894•A PENAL LAW OF THE STATE OF NEW YORK. ADDTTIONAL PREMRJM DUE HEREWITH 196 196 $ 73.15 INSTALLMENT INSTALLMENT TOTAL $ 73.15 RETURN PREMIUM PREVIOUS INSTALLMENTS REVISID INSTALLMENTS $ All other terms and coudiHone of this policy remain unchanged. ~'~~~ . APPLICATIQB T0s ALBEitT if, RICHMOND, T~ili CLERK, TOWN OF SOUTHOLD APPLICATION IS HEREBY MADE, pursuant to the pro- ~isiona of Section 1894-a of the Penal Law of the State of New York, fas a permit to display fireworks as hereinafter specified: The display is to sponsored by ~~ j ~~ ~~ S ~TS/PM/[ A-L N o , with principal office at ~Rj e N j Nw York, and will be held on TI~f c~Lt~L ~'' (day) ~ (month) lsfi_~, at ~f: ~D) P.M.. Qg~~ ~l9'Te c11.~,1.~' ~~yG7 (hoar !~ The following parsons are to be in charge of the actual shooting of the fireworkss Nacre Age Experience Physical condition ~.6Cfi'% cJ ~o6c.. - ~Q ~c C~ .~ o ~ ~A~s.s /Yo.4~u~y -L ,~ ~ ~~ G- o 0 0~ -~-- (~N/PF--(~. ~®~ls'' (° ~: ,C q%fl9r ~~ type df ~fir(~arks °is as foll~ s= ~ p 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. Respectfully submitted, O`/STP~ 96NAS C~f:M~G,q~ Cp (name of organization) Dated: (~~,s,,,,.A ~, ~- 1 q 47 at ~' ~,,,~ , New York.