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Home My WebLink About1976. ! ~ TOWN OF SOUTHOLD PERMIT FOR PUBLIC DISPLAY OF FIREWORKS I, JUDITH T. TERP.Y, 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 Midw~ Amusem~t Tnc ,_& Snvthnld F;rP ngrt, A PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Fenal Law of the State of New York, on Frid y, August 13. 1976 Rain Date: at l n~ n0 ~~~ 15^t„rrlr~ 0 ~ ~+ I ~ o~~ ~: n~T-pq._~ at the time and place set forth in the application therefor. ON CONDITION THAT the bond (i.ndemnity insurance) required shall continue in full force and effect in favor of the Town of Southol DATED at SOII'I'AOLD, New York, this 13th day of _A~st __ 1976. cJ~ G%ITH T. TERRY, To Clerk Town of Southold, Suffolk County, New York_ S E A L .~ ~ T0: TOWN OR VILLAGE CLERK: APPLICATION IS MADE HEREBY,PURSUANT TO THE PROVISIONS OF THE PENAL LAW, STATE OF NEW YORK, SECTION 1894-a, FOR A PERMIT TO DISPLAY FIREWORKS AS HEREAFTER SPECIFIED. THE DISPLAY IS SPONSORED: ~- WILL BE HELD ON AT (NAME ) (DAY) (STATE ub<~<.! ~. a M- (HOUR) THE COMPANY IN CHARGE OF FIRING THE DISPLAY IS N,Y, PYROTECHNIC PRODUCTS COMPANY INC, WITH ITS PRINCIPLE OFFICE AT BELLPORT, L,I. N,Y. THE PROPRIETOR IS FELIX GRUCCI, THE TWO MEN WHO WILL FIRE THIS DISPLAY ARE: NAME AGE EXPBRIENCE PYSICAL CONDITION NUMBERS AND TYPES OF FIREWORKS THE FIREWORKS WILL BE STORED IN A COVERED TRUCK PRIOR TO THE SHOOTING ON THE GROUNDS, DATE O " / -3 - AT bSO GLTLiO ~~ NEW YORK 1 RESPECTIVELY SUBMITTED(, l (NAME RGANI TIO L BY ,~~ ( { a CERTIFICATE OF INSURANCE Tbis la b eeMiy thof Ineuranee pelicbs lewd re~w ^ 1 • .. Certificate No.: 86 Contract Cost: roOn ?c? NETId YORK AND SPONSORS OR PROPERTY OWNERS OR MUNICIPALITIES•,AS••_ADDITZONAL•,INSUREDS, Lw.c..l C the numbare and •%piraflen dente el which ere 1{efed below, are In }area in thle Company as e} ............... ~rL'~....~.i.~.a....~.9.7.SJ....., w ...............! ............................................................................... coverlnp in accerdenp wlfh the ~me~fheroo} at 1M }ollowinp Iecetion ~%A:~::~'~''ti~'r"~~ ...... ............~.".:V'.:!~4...... ....................... ......................... Dj,sP..~BY... DBte.,'..............:~~ ...~...f~..e..... ~....~..../..... ....................... KIND OR POLICY C%PInAT10N urlTS or uAealTr POLICY NUraln DATE Bodily Injury Property Domage A-Workmen's Provided by werkm.n'e Subject to $100.00 Cempensatlon Cempen.eflon Law ffafa e} .......................................... Deductible per claim B-~Ir(enYEYetunrs ar Eech porcon f ............................ Eeeh aceldent f~~•~•~•~•••~~~~~~••~~~•~~~•~ ConlroNon Llobllit Eeeh accident 5 ............................ ApgrogNe 5........................... C-Owners or Conttaeten Eeeh parsers 5 ............................ Eeeh aeeidenr f............................ Protective Liablli Each accident f ............................ Aggreqete f............................ D-Owners, Landlords Eoch person f ............................ Exh accident f ••••~••••~~•~ ••••~• ~~ andTetwntsLlebill Eaehaeeldent ............................ E-Awomobl le Liability Each person f ............................ Eeeh aecldant 5~........................... (1) Owned Vehicles Each accident 5 ............................ Eech pereon f ............................ Eeeh eceident f............................ (]) Hlred Vahiciae Each occident f ............................ (3) Ofller Nonownad Each person 5 ............................ Eeeh eeeidenf f............................ Vehlelee Eech eeeidenf f ............................ F-Comptebenaive Each pereon f ............................ Eech sae idanf f............................. Liability (1) CempreMnelva Eoch eceident f ............................ ANemoblla Each pereon f ............................ ....! Eaeh accident f.................... (2) Celnprahenaive Each accident f ~ ................ ........... General AppregNe f ............................ Aggraqaro f............................ (3) Comprehenelre Each pereon f ............................ E«h accident f...........................! (eembined General Eech ac<Ident f ............................ and Aufemeblla) Assregafe f ............................ Aggrosate f............................ Fireworks Display Each pereon f ......... .. .. • ••••••~• • °• • Eeeh aeetlent f......** """""""" Liability GL19536 329/77 Eaeh accident f......~!'~!' ................ Insurance Aggnpote f ............................ AggroqNe f............................ • Properly damage esuaod by eallepea e} er atructurol Injury ro bYlidinga eneluled. }t dF$500 , 000 Combined 5lrigle • Properly dalaage Imdergnwnd eweed by meehanicel equlpwent a%etuded. Limit Thls GMI}leaf. b IuYad ae fha rogwN e}: y ~ /~ r Z' Named Sponsor: IYL[cQte;~Rt.. l_LrrLC.4.j,X.:z.1.v:~~:~.....~`.~^::`.~::.......75!.Yet[C/,c~tea'-:,..1,~'t-~:....'~:.~L~ .....:.......... ............... u7 (a y `~712L,!,l,C. "VI, 3t y~l'C<L ¢.Lte~ `-q--II L Addreee ..........................................~..............,............................................~........L f........ ro wham we will mall written netlea e( canealollen er en chatpee aHaetinq fhle Certilieeta. NOTE: In event rain or inclement weather HALLMARK INSURANCE COMPANY prohibit this display, coverage will apply `,. •~•.•} on subsequent date on which display is held, J,,~'_~f~ ~ - ~'' within the term of this contract. g /~iH.~•~l~a.i.r°r 3~~''4'!'~' '~fdl~) Cleanup and policing of display area are responsibility of the Sponsors. ••• AYfNMI[[ee ea NferlY[ DATE: