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HomeMy WebLinkAbout2012ELIZABETH A. NEVILLE, MMC TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS OF MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 .Southold, NewYork 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.nor th fork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD June 28, 2012 Attn: Jo-Anne Bay Fireworks 400 Broadhollow Rd, Ste 3 Farmingdale NY 11735 Dear Jo-Anne, As I stated on the phone this morning, you do not need an actual permit for the loading of fireworks from a private dock in New Suffolk, but the Town of Southold did need the information and insurance coverage. Since no permit was necessary, returned herewith is your $100 check no. 5613. As always, it is a pleasure dealing with you and your company. Very truly yours, Linda J. Cooper Deputy Town Clerk Eric. CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer righta to the certificate holder in lieu of such endoresmsntlsI. CONTACT PRODUCER Allied Specialty Insurance, Inc. NAME: FAX 10451 Gulf Boulevard ~A~C..o. Treasure Island, FL 33706-4814 ADDRESS: 1-800-237-3355 INSURERIS) AFFORDING COVERAGE NAIC · INSURER A; T.H.E. Insurance Company 12866 ~.SURED Pyro Engineering, Inc. ~NSURER B: dba: Bay Fireworks INSURER C: 400 Broadhollow Road, Suite 3 INSURERE: Farmingdale, NY 11735 ~.SURER ~: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANy CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ~*DDL 3UBR POUCY EFF POLICY EXP LTR TYPE OF INSURANCE I~1~~ POUCY NUMBER iMM/OD/yyyytiMM~OD/%~tyyt LIMITS A GENERALLIABILIT~ CPP0101284'02 ;)5/14/2012 05/14/2013 EACHOCCURRENCE $1,000,000 DAMAGE TO RENTED ~- COMMERCIAL GENEF~L LIABILITY PREMISES lEa occurrencel$100,000 I CLAIMS-M~DE [] OCCUR , MED EXP(Anycnepemon) $ PERSONAL & ADV iNJURY $ 1,000,000 GENERAL AGGREGATE $2~000~000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/DP AGG $2,000,000 PRO- COUS~NE~ S~NOLE LtU~ $1,000,000 A --AUTOMOBILEUABlUTY CPP0101284-02 D5/14/2012 05/14/2013 IEaacck~entl $ UMSRELLA LIAB t~ OCCUR ELP0010296-02 05114/2012 05114/2013 F-~CH CCCURRENCE $9,000,000 A ~ EXCESSLIAB~ CLAIMS-MADE AGGREGATE $9,000,000 A AN D E MPt. OYERS' UABILITY YiN WC123842 05/14/2012 05/14/2013 TORY LIMITS OTH- ANY pRO pRIETOR~PARTNEPJEXEC UTIVE E.L. EACH ACCIDENT $ t 1000,000 (Mandatmy I. NH) E L D~SEASE - EA EMPLOYEI $t,000,000 D~SC RIPTIDE OF O PEPJ~TIONS below E L DISEASE - ROLICY LIMIT $ lt000t000 DISPLAY DATE: 716112 RAIN DATE: 7/7rt2 LOCATION: NEW SUFFOLK, SOUTHOLO, NY. RE: GENERAL LIABILITY, THE FOLLOWING ARE NAMED AS ADDITIONAL INSURED IN RESPECTS TO THE OPERATION OF THE NAMED INSURED DNLY: BELVEDERE PROPERTY MANAGEMENT, LLC; ROBINS ISLAND HOLDING, LLC AND THEIR RESPECTIVE OWNERS; TOWN OF SOUTHOLD, NY;. Hold Harmless Agreement per contract between the Named Insured and Additional Insured applies. The above Commercial General Liability policy affords bodily Injury & property damage liability coverage arising directly from a fireworks display, however, no Marine, Hull & Machinery, P&I ~r Pollution Liability coverage Is afforded under this CGL policy arising from the use of any barge, docks, piers, wharves or floating platforms. CERTIFICATE HOLDER CANCELLATION Belvedere Property Management, LLC 1251 Avenue of the Americas, 17th Floor New York, NY 10020 CERT #1863B (Revised 6/15/12) ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAllON DATE THEREOF, NO~CE WlLLLL BE, DELIV. ERE~BBE, DELIV IN ACCORDANCE WITH THE POLICY PROVISIONS, , r H UI~.E D ~'R E S E.N~ Tire /' © t988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RECORD~ OF MANAGEM~qT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P,O. Bax 1179 ~]outhold. NwwYork 11971 Fa~ (631) 75~6145 'I~ephone (~D 7~18~ ~u~ld~.n~ork.n~ OFFICE OF 'l'~ ~: TOWN CLERK TOWN OF .qOUTHOLD PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisibns of Section 405.00 of the PcnaJ Law of thc State of New York, for a permit to &splay fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY PRINCIPALOP~'ICEAT 1350 Avenue o_~ the Americas, Suite 2300, New York., NY 10019 DATE & TIM~ OF DISPLAY 7/6/12 "LOADING 0NL¥' Private Dock located at the end of EXACT LOCATION'OF DISPLAY SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE & TIME The following persons are to be in charge of the actual Ihooting of the fireworks: Name Age Experience Physical Condition Hichael Lam~n 27 years 5 yeara + Health: Excel. Zeno Robert Ceely 26 yeara 5 yeara + lteelrh: Excellent (Additional names and inform**ion may be subnd~/on a~ a~ached sheet Number and Wpe offlrewor~ ~ ~ follows: 1.3G Firauorks 2-3 inch=520, & Inch-168, 5 inch=208, 6 in~90~ 8 inch-48. Manner and phce of storoge of fireworks prior to display:, Delivery to loading site day of display. Attaeheni hereto and made a part of hereof is · diagram of fine grounds on ~ich tbe dhplay is to ~ hdd. ~o a~ch~ h a ~fl~te or ~fl~ of~su~n~ ~vera~. Pyro Engine~rln~ Inc dba Bay S~ ~llcy for additional information / ~o Si~t~ o~Appli~t D~te o~App]i~don BELVEDERE PROPERTY MANAGEMENT, LLC June 15, 2012 To whom it may concern, This letter is to confirm that Pyro Engineering, Inc dba Bay Fireworks has my permission to use the loading facility located at 380 1~ St, New Suffolk, NY 11956 to load and unload fireworks on July 6, 2012 (rain date will be July 7, 2012). Regards, Controller [251 A~*'enue of the Arrterh:'it~, J. Tth Floor New Yoek, New Y~yek 10020 STt~TE OF ~EW YORE - DEPARTMENT OF LAJ~O~: NYC & NYS CERTIRCAT~ONS REQUIRED ;N NYC STATE OF NEW YORK - DEPARTMENT OF LABOR NYC & NYS CERTIFICATIONS REQUIRED IN NYC