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Home My WebLink About1965_~ s ~~ J.L., - ~ t. J': ~,. . ._~~ '~ ,~, ~, ++Ar. ~1r... I. AS.~! M. IIiC1iMi~. 'lwlr CIN~'1t •f tl1~ 'Ywrai OY •entAald, b!'i~s11t ~A+MA7/. Mr 1fatlt. 1s11r1 f9w nifi9ns Mfr MGM 1r t~ SM+w M~td at tas Twiw ~! s~tlreld bs UiN ~rp~s. ~ ~~ ~i1! ~p Tne or: ant Flre De artme~,t Ro ert ,,. Douglass, C ief ~ ~t2? 19111 'A!i 1C~2C 02i1t~r f~' 1?yR~f'fN~i ~ sairi law iw NM/'~11iM ~M t~ /s'a1rla~MwM vt MKlAw 3g4-a s! Rw hwsi i~lt at tlM /f+1Rr os ~~ ~,~ a J u 1 y 4 . 196 5 ~ ~ *~ «~ r~ rZ~a :, tease of rain, July S, 1965.) Mt Et~tl1 #i i~ ap~l>+nasl.~w f~!'AN~• 8:~0 P.M. ®w t~owrlti,Aa tBnt. !1M rio~- {laNwltr iras~l s'+tit'+r d~ali fw toil lfotc~ Md Ittlio! is trnres ~! ~ !ww o! M1~w~i,~. 9stM K ~Q. ~ Yrnrlt. f~11~ 1~... ar o! ~ ui~e ltte,,~• ~t r• a ~Mw !' R lrMlw ~ . •IIt~+M1A ~r~ i^AL 1M-~k • Y` lr.. ~ #~-.64 la ct. 1~F11tY/'f This endorsement forms a part of Policy No .......... ........... .....:. issued by THE HARTFORD INSURANCE GROUP company or companies designated therein, and takes effect as of the effective date of said policy unless another effective date is stated herein. Effective date......... ~/ ~~~.... _ ................. Named Insured and Address ~! tIk! DIi'l~2~! {~ ~ ~S ........Effective hour is the same as stated in the Declarations of the Policy. ~~ ;~ ~ ~~~ ~~ T C~A~SiPI~"it~ ~ ~ EI 9A ~, EI Pl9~t ~!f nc- ttua~ 39.gk S.~o 39.2 5.~8 HISTP?A!~-~41~~ S tip ~.Y. htlEa?xt~t ATs YILLAICE fM1tF, lf~ft 3?..O~TIIR, 1~.Y. ~ Yt. ~ LiSB IIGT l9lt~CT 1rf Vi'i' RIiT! ~I,NBD~1'! S`[iIS tbr>~AC.6 CL~S Yt3 ~BpI.Ys JAY 5s 1965 1~ ~oat~9nl~d Q~vera~e shall a~~ly on day activity is held. Nothing her to nta~n s a e he to vary, atve, a ter, or exten any of [he 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. 160175 ~.oYa F. 1Cl~G,Jlt. 6,l16/ntyasc ~ ~ THE HARTFORD Hartford Fire Insurance Company New York Underwriters Insurance Company INSURANCE GROUP Hartford Accident and Indemnity Company Twin City Fire Insurance Company "~...~._ ~. Citizens Insurance Gompany of New Jersey HARTFORD CONNECTICUT - {.! Countersigned 6y.......s~~/.'. ~.~.~.........~ ... _lj. . ............................. ~~~ Autho>ized Agent Form G-2290.0 A Printed in U. S. A. 2-'li4 LIABILTFY ^' ' ~ ~DI~'I~~L Dpy~TiY ~$ a$6 (For use with C, CL, LFX, LGX and OTS Policies) ADDITIONAL INSURED -- LESSOR This endorsement formsapart of Policy Na1Q...W' ih4o73 issued by the HARTFOR D EI R E I NSURAN CE COM PANY GROUP company or companies designated therein, and takes effect as of the effective date o(said policy unless another effective date is stated herein. Effective date 7/~/D~ _.__. _...... Named Insured and Address ORIENT FIRS DiS17tIC? ORIENT, NEG1 y01tx ...... 12:01 e1 M., standard time at the address of the named insured as stated herein. It is agreed that such insurance as is afforded by the policy for Bodily Injury Liability and (or Property Damage Liability applies to the person or organization designated below, as insured, but only with respect [o liability arising out o[ the ownership, maintenance or use of that part of the premises designated below leased by said person or organization to the named insured, subject to the following additional provisions: "the insurance does not apply: (ll to accidents which occur alter the named insured ceases to be a tenant in said premises; (2j to structural alterations, new construction or demolition operations performed by or (or said person or organization. 'hhe exclusion in the policy relating to liability assumed by contract is replaced by the following with respect to the insurance afforded to said person or organization: "Po liability assumed by said person or organization under anv contract or agreement, but this exclusion does not apply to the following [vpes of written agreements relating to the premises: (1) any easement agreement, except in connection with a railroad grade crossing, (2) any agreement required by municipal ordinance, except in connection with work for the municipality, (3) any elevator or escalator maintenance agreement, or (d) any lease or premises agreement. SCHEDULE Designation of Premises (Part Leased to Named Insured) Name of Additional Insured VILI,LQS titARF, 11AI11 ST. QtIEMT, NBW YORx TOi1N OF EOUTNDLD 81piTIigLD, NEW Y0~ 3.92 .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. "Phis endorsement shall not be binding unless countersigned by a duly authorized agent of the company or companies; provided that it this endorse- ment takes effect as of the effective date of the policy and, at issue of said policy, formsapart 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. HARTFORD FIRE INSURANCE COMPANY GROUP Hartford Fire Insurance Company New York Underwriters Insurance Company Hartford Accident and Indemnity Company Twin City Fire Insurance Company Citi I C f N Jer e zena neurance ompany o ew s y 16oi75 FLOYD F ICING JR Wi4/nr/cac ~~)) ~ a ~ Countersigned by....~~G~.e~~.~l''y~..L _...... _. .'. ,,~/- .r//// ////// Authorized Agent Form L•2476 3rd Rev. Printed m U. S. A. i-'61 1 . t ?Ds ALBERT N. RICBMOIIDt TCMIf C~RXe '!'~ i~' SQ~THOLD AspLICATiA1i s HEREBY ltRtlEt pursuant to the provisions of Section 189ha of the penal Lar of the State of xer York, for a perasit to display firerorks as hereinafter specifiedt The display is to be sponsored by mt,P Orient Fire Department a rith principal office at Orient xew York, and rill be he18 en 4th a Ju~v ,186_ (dayj (aonthj at 8:30 p.M.. Rain Date -July $ 1965 8:30 p.m. (ho~j The following persons are to be in charge of the actual shooting of the firarorks: BAlIE AOE EXp~ = PHYSICAL CA~IDITION Robert J. Douglass 42 Military Good A. Rosa Norklun ~ R4ilitary Good Lloyd E. Terry ~1 3~rs. Dynamite Good Number and type of firarorks is as follo++st Vitale Fireworks MfK• CoyInc_ -Aerial Dis~l~_No.,6~8 ,~_~_,~~ _.,~....~..,,.._~rN - - ...~_~..~_~._..~~.»~ -------------~---~--fr__....-..-.._---- _Ni~ht~ork~ Sh~lwl Assortment ~~__~_,.__,.,,.,,,_.~~..--~-~-~-------- ____ r..ww.w___________r.. rw-__.n_____r.~_~.___N_.r_-____w_r The firerorks rill be stored in a covered truck prior to the shooting on the grounds. lttached hereto and made a part hereof is a diagram of the grounds on which the display is to be held. Also attached i• the certif- icate or policy of insurance coverage. Respectfully subaitted, T,~e Orient Fire Depar*mAn+ (Woos of organisation) / e-,-~iC- _ Chief Dated .r,,,,a ~n~55 ~ rwoasy as at Orient + New York. CERTIFICATE OF INSURANCE ' .$ Ifl fl5ceford Fu! Insurance Company ~ ®New York Underwriters Ivaumnce Company THE HARTFn~- cS m Hartf°rd Accidcat and Indemnity Company , ®Nor[hwestero Uuderwriten of Cidunc Insurance Company of New Jersey IN3[tkANCf: GItO ~ ®Citizene Insurance Co ~pany of New Jersey ~ CD Twin City Fire Insmance Company This is to certify that the company designated cO' ceae herein by Co. Code bas issued to the named insured the poltcies enumerated below. Named Insured and Address I) ORIENT FIRS DISTRICT SOUTH SIDE ORCHARD ST. ORIENT, N.Y. 2) TOWN OF SOUTHOLD, SOUTHOLD, N.Ye 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 N b Effective D t Expiration te D god{{y [niury Liablllty Property Ilamage L{ablllty er um a e a each pereov each eMdent each aetldent aggregate __ _ General Liability Premises-Operations 0 CL 1la1i073 9-26-64 9-26-65 100 $ ,000 300 $ ,000 5 $ ,000 25 $ ,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 $ ,000 $ ,000 XXXX Workmen's Compensation and Employers' Liability Compensation -Statutory Employers' Liability - $ ,000 Umbrella Liabidty $ ,000,000 Location and description of operations, automobiles, contracts, etc. (For contracts, indicate type of agreement, party and - date.) - VILLAGE WARF, MAIN ST. ORIENT, N.Y. FIRE WORK HISPLAY If policy is canceled, written notice will be given to: TOWY1 OF SOUTIIOLD SOUTHOLD, NEW YORK 6-9-65 Js Date Form G-2/06-3 Printed in U. S. A. fi '64 ~/ ~~~ Authorized Representative