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PERMIT For PUBLIC DISPLAY OF FII2EWORkS I, ELIZABETH A. NEVILLE, 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: GREENPORT FII2E DEPARTMENT STAR HOUSE CO., THII2D STREET, A PERMIT FOR THE PUBLIC DISPLAY OF FII2EWORkS by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York at 10:00 PM on Sunday, May 26, 2013 (r/d 27th) on the property of GREENPORT HIGH SCHOOL Athletic Field, north side Front Street and east side Moores Lane, Greenport ,New York. ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feel from the nearest above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines; that all fireworks that fire a projectile shall be so setup that the projectile will go in the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore or a lake or other large body of water, then they maybe directed in such manner that the falling residue from the deflagration will fall in to such lake or body of water; that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task, that there shall be at least two such operators constantly on duty during the discharge and that at least two soda acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. Elizabeth A. Neville, Southold Town Clerk Suffolk County, New York (Town Seal) Date: May 9, 2013 THIS PERNIIT IS NOT TRANSFERABLE o~oSOFFOC,~~o ELIZABETH A. NEVILLE, MMC r/y Town Hall, 53095 Main Road TOWN CLERK C ~ P.O. Box 1179 y Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS p • .F Fax (631) 765-6145 MARRIAGE OFFICER y~ Ot` Telephone (631) 765-1800 RECORDS MANAGEMENT OFFICER ~j .IL ~a FREEDOM OF INFORMATION OFFICER T www.southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT For PUBLIC DISPLAY OF FIREWORKS ELIZABETH A. NEVILLE, Town Clerk of [he 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: GREENPORT FIRE DEPARTMENT STAR HOUSE CO., THIRD STREET, A PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York at 10:00 PM on Sunday, May 26, 2013 (r/d 27th) on the property of GREENPORT HIGH SCHOOL Athletic Field, north side Front Street and east side Moores Lane, Greenport ,New York. ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feel from the nearest above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines; that all fireworks that fire a projectile shall be so set up that the projectile will go in the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore or a lake or other large body of water, then they may be directed in such manner that the falling residue from the deflagration will fall in to such lake or body of water; that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task, that there shall be at least two such operators constantly on duty during the discharge and that at least two soda acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. rl-?'------------- Elizabe~le, Southold Town Clerk Suffolk County, New York (Town Seal) Date: May 9, 2013 TH[S PERMIT IS NOT TRANSFERABLE RESOLUTION 2013-390 ADOPTED DOC ID: 8806 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2013-390 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MAY 7, 2013: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a fireworks permit by the Town Clerk's Office to Star Hose Company of the Greenport Fire Department, for a fireworks display on May 26, 2013 (r/d 5/27/13), at Greenport High School's field, Greenport, New York upon the payment of a single fee of $100 and subject to the applicant's compliance with the requirements of the Town's policy regarding the issuance of fireworks permits and subject to the approval of the Town Attorney. ~Q Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Christopher Talbot, Councilman SECONDER: Louisa P. Evans, Justice AYES: Dinizio Jr, Ruland, Doherty, Talbot, Evans, Russell Cooper, Linda From: Fisher, Robert Sent: Tuesday, May 07, 2013 10:46 AM To: Cooper, Linda Subject: GFD Fireworks Linda I have no reservations about this permit. Bob Robert Fisher Fire Marshall robert.fisherLa~town.southold.ny.us (631) 765-1802 office (631) 786-9180 cell CONFIDENTIALITY NOTICE: This communication with its contents may contain confidential and/or legally privileged information. It is solely for the use of the intended recipient(s). Unauthorized interception, review. use or disclosure is prohibited and may violate applicable laws including the Electronic Communications Privacy Act. If you are not the intended recipient, please contact the sender and destroy all copies of the communication From: Cooper, Linda Sent: Friday, May 03, 2013 12:56 PM To: Fisher, Robert Subject: GFD Fireworks Hi Bob, Last week I emailed a copy of the GFD's application for Fireworks permit but have not yet received any comment from you. Do you have any objections to the permit being issued? Thank you. Linda Cooper t Cooper, Linda From: Flatley, Martin Sent: Thursday, April 25, 2013 2:38 PM To: Cooper, Linda Subject: RE: Linda, I havenn''n--o~~olIbj''ection to this permit being issued T""''~7 Chief of Police Southold Town Police Department 41405 State Rt. 25 Peconic, N.Y. 11958 631-765-3115 From: Cooper, Linda Sent: Thursday, April 25, 2013 2:09 PM To: Finnegan, Martin; Fisher, Robert; Flatley, Martin; Spiro, Melissa Cc: Chris Talbot (christotalColyahoo.com); Dinizio, Jim; Doherty, Jill; Louisa Evans (Ipevans06390Cwomail.com); Russell, Scott; W. Ruland (rulandfarmCalyahoo com) Subject: i Cooper, Linda From: Spiro, Melissa Sent: Thursday, April 25, 2013 2:12 PM To: Cooper, Linda; Finnegan, Martin; Fisher, Robert; Flatley, Martin Cc: Christopher M. Talbot -Forward; Dinizio, Jim; Doherty, Jill; Louisa Evans; Russell, Scott; William Ruland Subject: RE: This property is not preserved land. Therefore I am not reviewing or commenting. Melissa From: Cooper, Linda Sent: Thursday, Aprii 25, 2013 2:09 PM To: Finnegan, Martin; Fisher, Robert; Flatley, Martin; Spiro, Melissa Cc: Chris Talbot (christptalCalyahoo.com); Dinizio, Jim; Doherty, Jill; Louisa Evans (Ipevans06390Co?gmail.com); Russell, Scott; W. Ruland (rulandfarmCa~yahoo.com) Subject: 1 ` ~~gUFFO(,rC ELIZABETH A. NEVILLE, MMC h~~ ~Gy Town Hall, 53095 Main Road TOWN CLERK p ~ P.O. Box 1179 y Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS O ~ ~ Fax (631) 765-6145 MARRIAGE OFFICER ~'~O! Telephone (631) 76b-1800 RECORDS OF MANAGEMENT OFFICER * southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Martin Finnegan, Town Attorney Chief Flatley, Southold Town Police Department Robert Fisher, Fire Inspector Melissa Spiro, Land Preservation From: Linda J. Cooper, Deputy Town Clerk Dated: April 25, 2013 Re: Fireworks Permit sponsored by Greenport Fire Department (Star Hose) Transmitted herewith is an application for a Fireworks Permit for Sunday, May 26 (r/d Monday, May 27) at the Greenport High School sports field. Please advise if you have any objections to a permit being issued. Thank you. cc: Southold Town Board ELIZABETHA. NEVII.I,E,IVIIVIC X00 ~y Taws Hall, 53095 Main Road TOWN CLERH ~ ~ P.O. Box 1179 Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS O ~ ~ Fax (631) 765-6145 MARRIAGE OFFICER O~ Telephone (631) 766-18qq~ RECORDS OF MANAGEMENT OFFICER j # ~O southoldtown.narthfark.AEtCEIVED FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK APR 2 5 ~U13 TOWN OF SOUTHOLD APPLICATION Southold Town Clerk PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law of the State of New York, for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY _ Star Hose Company (Greenport FD) PRINCIPAL OFFICE AT 240 6th Avenue Greenport, NY 11944 DATE & TIME OF DISPLAY May 26, 2013 Time: 10:00 pm EXACT LOCATION'OF DISPLAY Greenport High School SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE & TIME I a ~ ~ 13 i0 ' 00 P M The following persons are to be in charge of the actual shooting of the Tireworks: Name Age Experience Physical Condition Michael Garafalo dob: 5/8/76 5 years + Helath: Excellent assistants: tbd (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: 1.3G Fireworks 2 inch=352, 4 inch-51. Total Cakes=5 Manner and place of storage of fireworks prior to display: Storage at Westhampton facility. Product delivered day o i Attached hereto and made a part of hereof is a diagram of the grounds on which the display is to be held. Also attached is a certificate or policy of insurance wverage. NOTICE: Written permission, with signature of the Prooertv Owner, must be submitted with the Application. Star Hose Company (Greenport FD) FEE : Ito 0 Name of Organization See policy for additional information Signature o Applicant L/c"~ry ~ ~ bY~ Lt Zo~~ Date of Application i / / / i15 ~ ~~r... i 8 ~ P ~ ~ iyy r ~ ~ t Y y ~ Fes- a ~ #i ~ ~ . i "RR ~x'= ~ t Yx ~ 4 ~ ~ . . p ~ 00~ sni e~ E e, 1 'fly DEPARTMENT OF THE TREASURY -BUREAU OF ALCOHOL, TOBACCO AND FIREARMS LICENSE/PERMIT (1i1 U.S.C. CHAPTER 40, EXPLOSIVES) R CFR Part SS6~ as ~ ~isbna of 7Ne 7p. Oryenixed CAma Control An of 7970, ane Me reguleUOm ipwE Narcalgar (27 IY nay en9aga In Ne ceNvhy spsai8ed in tab sewaelWnnit wiMin the Iknibtlona d Chaptr <IA TAN 70, UnhW bYelr Cade snd the regubdOns 4swd thereunder, undl tla expiratbn dab shown. Sae'WARNINO• and'NOTN:ES' on heck. Christopher R. Reeves OVECr ArF Chief, Federal Expbaives U~eg Emebri~U~ t~p®sp 1 e~® rneardvanEArE Bureau d Alcohd, Totretxo. FL'eartt& ttpd funs ro 244 Needy Road gs,W,~ MetfhwbUtp, West Vhp9YS . IAYe 1 TelenMne• 1-877- Q°...If p~{ NN4 Prem~Addtew (7Y9ettEa7 Yaamm DBA BAY FIREWORKS &#NTNfL. f7V5i0 IMPORTER 400 BROAUN nolai uw FSOwlar t0o'pa Wawa me move (IPI) Ofd.©W ROAD, SUITE 3 M'fgMINALE, NY 11735- IyFeaurasEOSFEmar 57-IMPORTER OF FIR6V~Ptl($ 3b13PLAY+ a7EF. FroeAU Owu>awauc~ee R Reeves PURCHASING CEI4YffIr~ATION Ica Illet d11618etNe CnpylNg~ A~ ekeNd~aa YaamW mwyea FELL etIr910 data bebn Mahanea w me to engaea In Yre ~4'+ PYRO f~INE@RN+4Q INC tlBA 81A7Y 9RI(S 8 INTNTL PVRO IMPORTER (sIGnATUnE OF UCENSEFR fRgFipid-pW ROAD, SUITE 3 FAR , NY 17735- The icemeapemi0ae rwnlad herein atae uee a aYa ~ m b~~ ae gpy~d ibn The eprrture on each retvoductlon mwtbe en ORIGMsp#~e ATF F 5/00.7a1a000.16, Pan 1 (9A79) Eastern Service Center 17UI Columbia Ave. O.S. Dcpartincnt Opcratians Suppon Cnoup Cnllcge Park, GA 30337 of'1'ransponation A1V-E2 April 16, 2013 Pyro Engineering Dear Ms. Triolo, We received your letter regarding your proposed fireworks display for: Star Hose Co. 20132. Location of Show: Grceoport, NY Date of the show: May 26, 2013 Rain Date: May 27, 2013 Approximate Start Time: 10:00 PM Duration of Firework Display: !0 Mlaotes Height of Fireworks: Wfll not eaceed 400 feet Above Ground Level ATC POC: None Steps to be taken by Firework Comoanr Fireworks staff should remain vigilant [o ensure that no aircraft are in the area prior to beginning the fireworks display. Our office has no objection to this event provided all the above precautions are met. This letter disposes of the Federal Aviation Administration's interest in this matter but should not be construed as superseding or invalidating any existing rules or regulations promulgated by any other federal, state, county or municipal government, which may be required for this display. if you have any questions regarding [his event, please wntact John Kofler a[ (404) 305-6479 or john.kofler@faagov. Sincttely, Michael Vermuth / MenagerTacticalOperationsl'eam Eastern Service Aree Air Traffic Organization PR-595 Expires 6/30/15 «t ; ~ S ~ ` ra;V°C !~a vF' s ~ ~ 3~ ~ , 1~, I r~~~ x America's World Class Fireworks Leader Display Date: May 26, 2013 FIREWORKS DISPLAY AGREEMENT AGREEMENT made April 3, 2013 by and between Pyro Engineering, Inc., whose address is 999 South Oyster Bay Rwd, Suke 111, Bethpage, NY 11714 (hereinafter "PEI"); and Star Hose Company, 240 6''^ Ave., Greenport, NY 11944 (hereinafter "SPONSOR"). WHEREAS, PEI designs, produces, and conducts fireworks displays; and WHEREAS, SPONSOR wishes to engage PEI to design, produce and pertorm a fireworks display on the terms and conditions hereinafter set forth; NOW, THEREFORE, in consideration of the terms, conditions and covenants hereinafter set forth, the parties hereto do mutually agree as follows: f. FIREWORKS DISPLAY.• On, May 26, 2013 (hereinafter °the Display Date"), PEI shall provide the fireworks and equipment fa the display at the Fireworks Display location. The display will be under the supervision of a PEI !rained technician. It is agreed that PEI shall be tha sob fireworks supplier and producer for the event contracted forherein. (Note: The actual start and stop time of the display will be determined by the governmental authorities having jurisdiction over the display). ALTERNATE DATE: May 27, 2013 2. COSTAND PAYMENTS: FIREWORKS DISPLAY PRICE: s The total (Fireworks Display Price plus all other applicable charges) sum of ~ shall be due and payable as follows: a. The sum of Due and Payable on Night of May 26, 2013 Please Note: SPONSOR is responsible for the payment of all govemmental fees and taxes, including, but no[ limked to, sales, use, exclse, license, permit, emertainment, or other fees, taxes or surcharges imposed or otherwise applied to this exhibition. Also, please sea Section 18(c) below. 3. POSTPONEMENT/RESCHEDUL/NG: kthe display of the fireworks is postponedlrescheduled by reason of inclement weaMer or by determination by the govemmental authorty having jurisdiction, a for any other rwson beyond the control of PEI, same shell be re- scheduled to the Attemate Date set forth above. In the event a postponemenUrescheduling is necessary due to indemant weather or by determination by the govemmental authority having judsdictian, or for any other reason beyond the contrd of PEI apostponement/ rescheduling fee wis be based on the table below. Descri lion y° of Fireworks Dis a Price Additbnal Costs If notified b 12:01 AM on Oti/26h3 5% An 3ntl Pa Vendor Bc enses If notMed after 12:01 AM on 05/Z6/13 15% An 3b Pa Vendor eases Once Ba Fireworks Techs Arrive on Site 20°h An 3'^ P Vendor ses Any request made by SPONSOR for rescheduling/canceling shall be directed to help@bayfireworks.com or by phone (516) 233- 4132. It is understood and agreed that PEI shall have no obligation to reschedule a display except as required by inclement weather or reasons beyond the control of PEI. 4. SPONSOR'S AGENT: Mr. Ken WhHe Jr. CELL PHONE: ~ .S ~ ~ Tshall be designated as SPONSOR'S agent to whom all questions and inquiries shall be relayed. Sponsor's agent shall be the only agent of SPONSOR authorized to make decisions on behalf of SPONSOR or to request rescheduling of the fireworks display on the part of SPONSOR. Please initial each page. Initial here: / ~ Sponsor 1..~. ALLIED Apri124, 2013 RE: Pyro Engineering, Inc. dba: Bay Fireworks Dear Sir/Madam: A certificate evidencing insurance for Pyro Engineering, Inc, dba: Bay Fireworks for the 2012/2013 term is attached. Since they do not renew until May 14, 2013, an updated certificate will be issued as soon as the renewal policy number is assigned. Pyro Engineering, Inc. dba: Bay Fireworks is in good standing with our company and has always been very professional. We are very pleased to have the privilege of representing them. Should you have any questions, or require anything further please feel free to contact me directly at (727) 547-3038. Thank you for your cooperation regarding this matter. Sincerely, Tarrwr~ Catt~toT Tammy Catterton Account Representative Enclosure(s) ,aco d CERTIFICATE OF LIABILITY INSURANCE oaiZ4iZa;3 THIS CERTIFlCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFlCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATNE OR PRODUCER, AND THE CERTIflCATE HOLDER. IMPORTANT: H the cartlflesb hdder is an ADDITIONAL INSURED, tlls pdiry(ies) must be endorsed. If SUBROGATION IS WANED, subject to fhe bans and condHlons of the pdiry, eerbin pdicles may requlro an endoroenwnt A sbbment on fhb ceRHitab does not wMer ri ghb b the rsrtifleab holder In Ifeu of such endoroameM s . PRODUCER glHed Specialty IrnUrerrce, IDC. NµE: 10451 Gulf Boulevard PHONE FAK AIC. NOI: Treasure Island, FL 33708.4614 E~s 1-500.2373355 INSURERS AFFORDING COVERAGE _ Nuc. xlsuRERA: T.H.E. Insurance ComparN 12866 INSURED Pyro Engineering, Inc. xuuRERa: _ dbe: Bay Fireworks INauREac: 999 South Oyster Bay Road, Suite 111 INSURER°: Bethpage, NY 11714 INSURER E: INSURERF: 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. N0TIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E%CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE a INSURANCE POLICY NUYBER POD EW PO EItP IIYITS A GENERALLIALRLITY CPP0107284-02 D5H4I20t2 o5N4120t3 EACHOCCIXiRENCE 61,000000 X COMMERCIAL GENERAL LIABILITY EM a S1D9,999 CLNMSMADE a OCCUR MED E%P Nr,r one Darwnl S PERSONALa AOJ IKAXiY 61,000,000 GENERALAGGREGATE a 2 OOO OOO GENL A(%JREGATE UTAT APPLIES PER: PRODUCTS-COMP,OPAGG r2,000,OOO POLICY pR0. LOC 3 A AUTOMOBILEUAeILm CPP0101284-02 DS/t4/2ot2 os/t4nota Ea.~wnean ° L~ 1,000,000 ANY AUTO BODILY INAIRY (P®Peraml S AUTOS ED X SCH~DUlEO BODILY INIURY (Par avfEeriO a X HIREDAUTOS X pUfON~OKNEO PROPERTY DAMAGE P Lb S S A UMBRELULIAB X OrFUq ELP0010296-02 0511412012 05/14/2013 EACH OCCURRENCE s 9,000,000 J( E%CE68 LUe DWMS#1ADE AGGREGATE i9 D(19 DDD DED RETEMN)Ni S A EYPLpYERe:O~~ X VYC STATU- OTH~ nx WC723842 OSN4/2012 OSH4l2073 ~FIC~EO%URMEMEIARCWTNE~ CUTNE? NIA E.L. EACH ACGOENi 31,000,000 pyar1n~ E.L. DISEASE-EA EMPLOYE 51r00D,090 DESCRIPTION 6OPERATIONS Oebw E.L DISEASE-POLICY LIMIT 51,000,000 DESCRIPTION OF OPa]iATON1I LOCATIONSIVCi11ClFa (AeitlI ACORO 101,AMMaW Wexflu BNWIM,Nmga apxaMrapuhal DISPWY DATE: 5/26H3 RAIN DATE: S/27H3 LOCATION: Greenport High Schwl, Greenport, NY RE: GENERAL LU161LITY, THE FOLLOWING ARE NAMED AS ADDITIONAL INSURED IN RESPECTS TO THE OPERATION OF THE NAMED INSURED ONLY: Star None Company; Graenport Fira Dept; Village of Greenport, NY; Town of Southold; 3uT(dk Coumy; Greenport UFSD. Hold Harmless nwnl per ewtract between fM Named insured and the Addldonal Insured applies. The above Cormlerclal General Lbbilily pdiry aROres bodity Injury d property damage IWbillly coverage arising dirodty from a flrawoHU display, however, no Marine, Hull & Machinery, PEI or PWltrtion Liability coverage b afforded under mis CGL Polley artaing from iM use LTf any barge, docks, piers, wharves or flosUng platforms. CERTIFICATE HOLDER CANCELLATION Greenport Fire Department Thirty (30) Days Notice of Cancellation Applies. BHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 240 6th AVBnMe THE EXPIRATION DATE THEREOF, NOTICE WILL BE, D IN Greenport, NY 11944 ACCORDANCE WITH THE POLICY PROVISIONS. PROVIDED AS EVIDENCE OF INSURANCE Aunl AnvE UPDATED CERTIFICATE PROVIDED AT RENEWAL 'mil/ ACORD 25 (2010/05) The ACORD name and logo are registered marks of2ACORp ~ CO ORATION. All rights reserved. RESOLUTION 2010-474 ADOPTED DOC ID: 6016 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION N0.2010-474 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NNE 29, 2010: RESOLVED that the Town Boazd of the Town of Southold hereby adoats the followine POLICY reeardin¢ the issuance of fireworks aermits: 1. The Town may grant a permit for the display of fireworks by municipalities, fair associations, amusement pazks, persons or organizations of individuals. Penal Law Section 405.00(2). 2. An "organization of individuals" is a religious, civic, or comparable organization. Op. Atty. Gen No. 2007-3. 3. Fireworks permits shall indicate that the display must be concluded by 10:00 p.m. if held Sunday-Thursday, 11:00 p.m. if held Friday or Saturday, and there shall be no time restriction if held on July 4. 4. No person shall engage in or allow the manufacture, assembly, storage or display of any fireworks or pyrotechnics display without first obtaining a permit issued by the Town Clerk. A completed application for display of fireworks must be received by the Town Clerk a minimum of 30 days prior to the date of display. The permit application for any fireworks or pyrotechnics display shall be accompanied by the following: /(df a copy of a valid certificate of competency as a pyrotechnician for the individual supervising the firing of the display; Certificate of Insurance naming the Town of Southold as additional insured with coverage limits of $2,000,000 for public liability and $2,000,000 for property damage; Detailed diagram showing location of fireworks dischazge and minimum sepazation distances in accordance with the applicable requirements of Penal Law Section 405(2); (dJ A copy of the contract with fireworks display company; and (e) All applications shall require the approval of the Fire Chief of the District in which the display will take place and the Fire Mazshal before being presented for approval by the Town Board. Resolution 2010-474 Board Meeting of June 29, 2010 5. All applications for a fireworks permit shall be subject to an application fee in an amount of $100.00, together with a processing fee in an amount to be determined by the Town Board to cover the Town's costs for monitoring and enforcing compliance with the Penal Law. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Albert I{rupski Jr., Councilman SECONDER: Vincent Orlando, Councilman AYES: Ruland, Orlando, Talbot, Krupski Jr., Russell ABSENT: Louisa P. Evans Updated: 6/30/2010 10:43 AM by Lynda Rudder Page 2 GREENPORT PUBLIC SCHOOLS '720 Front Street Grompart, NY 11944 APPLICATION FOR USB OF SCHOOL FACILITIES The Admioistratim is responsible far the use of al! school facilities is order that they may omsider your request for suds use, kindly complete the following: I. Facilities Use Request the use of~~~ N1~ „ F /JT~~C pir!- f'P~tsat Caaapat Public Schools for thePiaPoseof~ i.PO `L,o.~~~ ~iSf -d m 2C . 2- v I ~ at (time) l~ Will activity be to the public? Y./ ~ f Admissim of ~a~ , will be charged; proceeds will be used far Does applicant egret to submit fiomcial records fqr emminafim open rem? c~~. . .Does applicant agree to ebnfarm to the regulations ofthe Board of Educatim and all laws regulating to the use of sdrool property including Sxtim 414 printed m the reverse sid~e .o/f ~tbis applicatim? Ye C ~l2.cf i f,~t i~~ ? ~ Z Ya ~ 7'i? ~ rrr° B^' ~ eo .A.. s --A~ ~ Name ,4ddr~ ~T Talephme # ~ 7 ? ~ 7 ~~_of the persm respmsible m this oceevm. II. Igstaance Infirmatim _ A certifieaze of insueance of ai least 51,000,000 public liability Pe' ocanrrnce and 52,1)00,000 _ aggregate liability insurance and S50,000 property damage shall be submitted at least three days in advmce of the event and must designate both the using agenizetim and the Gremport Unim Free School District with ISO eudoraemmt CG2026. The absence of such a certificate will preclude use of the &cility. The policy must contain a 30~ny guarantee notice of cancellatim. The user agrees to indemnify ' the district for any applicable deductibles. = IIL Rules Governin¢ Use of Fari1~es A. No smoking is allowed m the building or m the gramds. The argmiratim using the facility is responsible far mfarcemeat B. No drinking of alcoholic beverages is permitted C. Activity shall be restricted to that area far which permissim is granted. D_ Activity shall not wrtend beyond hours approved by district. E. Progams shall not interfere will regular school schedule. F. Organiratim shall be respmseble for moving its equipment into and nut of the building. G. The supervisor of the activity shall be presort before it is due to start and remain with the - group until all have left ~ A In the absence of admiois[ramve personnel, the custodian is charged with the ~ respmsibility of the building. I. School authorities must have fm access to all rooms at all times I. A careful examinatim will be made after use of the area by the applicant who will P~PfiY make good m any lass err damage, which might have acmrred. K No school property err equilmrent is to be altered err removed from the premises. L. This license is revocable at any time by school authorities. M. No resa'vatim will be made unffi this applicatim is caromed and approved by the district's Chief School Administrator. IV. Rental Fees Other Fees or Conditions: Auditorium for performance 5100 Auditorium for practice 5 50 Gymnasium for performance 5100 Gymnasium for practice 5 50 Whm m approved activity takes place outside the normal hours of school operation, the arganizatim will be charged 540.00 per hour far paamnel arrvicen for a minimum of 4 hours. This all must be pain seven days in advance and is not refundable unleiea the district receives notification of cancellation at least 48 hours in advance. V. I ages oo behalf of the abovamentianext organization that all members and guests will observe the regulations and that we, individually, and as an.organizatian, will assume all fmaadal responsibility fm any sect all damages done W the Oreeapor[ School property during the above• indicated period of use. We also ogee that our organi~tian will at all tomes hereafter urdemnify the above-named school against any lass, damage or eacpmse of any lend, which said sdrool may sustain err inax because of the use of the above-mentimed Mrildmg by av organization, and we furlha will hold said school harmless for loss of any kindm amrex;tion herewith. Signed: 7~... ~ ~ ( Date: ~e~,,~ ~ Zo l ~ Granted Died ~ 2 Superintendent of S Dols / c bails of Use: E7t:CERP7'S FROM SECTION 414 OF THE EDUCATION LAW "...The Board of Education of each district may...permit the use of the school house and rooms therein, and tiro grrnmds and other property of the district, when nd in use for adrool purposes, far any of the following purposes: 1. For the purpose of insnvctiaa in any branch of education, learning a the arts. 2. For hold'mg social, civic and re¢eatiaoal meetings and mtettainments, and other issues pertaining to the welfare of the community, but audr meetings, eMertaimnent and uses shall be n~-exch~sive and shall be open to the gareral public. 3. For meetings, ®tertainments and ocasions where admission foes are duaged, what the proceeds tha+eof are to 6e expanded for an educational or dcaritable purpose; but sorb use shall not be permittal if suds medings, mtertaiomeats and occasions aro ands the exclusive antral, and fhe said proceeds aro to be applied fax the benefit of society, assodation err arg®izatians of veteasns of the military, naval and marine service of the United States and organi7atims of voluntear firemen" Revised 9/1/2001 _ _ o~~gUfFO[,r~~G ELIZABETH A, NEVILLE,IVIlVIC y Town Hall, 53095 Main Road TOWN CLERK p ~ P.O. Box 1179 H 2 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS p ~ .F Fax (631) 765-6145 MARRIAGE OFFICER yty~l ~aQ`' Telephone (631) 765-1800 RECORDS MANAGEMENT OFFICER ~ www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT For PUBLIC DISPLAY OF FIREWORKS I, ELIZABETH A. NEVILLE, 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: GREENPORT FIRE DEPARTMENT THIRD STREET,GREENPORT A PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York at 10:00 PM on Wednesday. July 3, 2013 and Saturday. July 6, 2013 on the property of GREENPORT PUBLIC SCHOOL, on the athletic field, Greenaort ,New York. ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feel from the nearest above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active chazge of the display shall be allowed inside these lines; that all fireworks that fire a projectile shall be so set up that the projectile will go in the air as nearby as possible in a vertical direction, unless such fireworks are to be Fred from the shore or a lake or other lazge body of water, then [hey may be directed in such manner that [he falling residue from [he deflagration will fall in to such lake or body of water; that any fireworks that remain unfired after the display is conducted shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual chazge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task, that there shall be at least two such operators constantly on duty during the discharge and that at least two soda acid or other approved type fve extinguishers of at least two and one-half gallons capacity each shall be kept at such widely sepazated points as possible within the actual area of the display. o - ` j------------ ElizabethC~, Southold Town Clerk Suffolk County, New York (Town Seal) Date: June 18, 2013 THIS PERMIT IS NOT TRANSFERABLE RESOLUTION 2013-478 ADOPTED DOC ID: 8894 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2013-478 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NNE 18, 2013: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a fireworks permit by the Town Clerk to Phoenix Hook & Ladder Company No. 1 and Relief Hose Company No. 2 of the Greenport Fire Department, for a fireworks display on Wednesday, July 3`d and Saturday, July 6~' 2013, at Greenport High School's field, payment of a fee of $200, subject to the applicant's compliance with the requirements of the Town's policy regarding the issuance of fireworks permits and subject to the approval of the Town Attorney and the Fire Marshal. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER: William P. Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Talbot, Evans, Russell * * * RECEIPT Date: 06/12/13 Receipt: 152307 Quantity Transactions Reference Subtotal 2 Fireworks 7/3 8 6/2013 $200.00 Total Paid: $200.00 Notes: Payment Type Amount Paid ey CK #1202 $200.00 Greenport, Fire Dept Name: Greenport, Fire Dept Phoenix Hook & Ladder Co C/o Peter Harris 212 Knapp PI Clerk ID: LINDAC Internal ID: 7~3 & 6/2013 CHIEF WAYDE MANWARING (631) 477-9801 -STATION 1 1sT ASST. CHIEF HARRY BREESE (631) 477$261 -STATION 2 (631) 477-1943 -CHIEFS OFFICE 2N0 ASST. CHIEF WAYNE MILLER (631) 477-4012 -FAX CHAPLAIN C. KUMJIAN THIRD STREET • P.O. BOX 58 GREENPORT, NY 11944 TREAS/SECRETARY J. KALIN Email: gfdfireCoptonline.net r ~ r r' www.greenportfd.org Organized 1845 June 9, 2013 RECEIVED Chief Wayde Manwaring Greenport Fire Department P.O. Box 58 JUN 1 0 2013 Third Street, Greenport 11944 Southold Town Clerk Deputy Town Clerk Linda Cooper Southold Town Hall Main Road, Southold 11971 Dear Ms. Cooper I have been requested by the members of the Phenix Hook & Ladder Co. #I and Relief Hose Co. #2, to give permission for two fireworks displays to take place on Wednesday night .Iuly third and Saturday night July the sixth at the Greenport High School athletic field off of Moores Lane in Greenport. At this time I am giving permission for these fireworks displays to take place.I am Also with the understanding that there are no rain dates at this time. Our department will provide fire protection for these events. Sincerely yours, Wayde Manwartng Chief Greenport Fire Department Cooper, Linda From: Flatley, Martin Sent: Tuesday, June il, 2013 12:46 PM To: Cooper, Linda Cc: Blasko, Regina Subject: RE: Fireworks appl. Hi Linda, I have no objections to this fireworks display being held, but please let us know the exact dates for the show(s) so we can plan accordingly since there seems to be a discrepancy in the paperwork. Thanks, ~t~ ~ Chief of Police Southold Town Police Department 41405 State Rt. 25 Peconic, N.Y. 11958 631-765-3115 From: Cooper, Linda Sent: Tuesday, June 11, 2013 11:40 AM To: Finnegan, Martin; Fisher, Robert; Flatley, Martin; Spiro, Melissa Subject: Fireworks appl. I received the attached fireworks application from Peter Harris. Although he only show one date on the application he did submit a $200 fee with is the fee for 2 nights of fireworks. Unfortunately Peter is away and I haven't been able to reach him. The letter from Manwaring gives 2 dates for fireworks. So although the application only shows 1 date, I will ask Peter for an amended application and am going ahead with the process. So I will need you recommendations. t Cooper, Linda From: Spiro, Melissa Sent: Tuesday, June 11, 2013 12:18 PM To: Cooper, Linda; Finnegan, Martin; Fisher, Robert; Flatley, Martin Subject: RE: fireworks appl. This is not preserved property so I have no comment. Melissa From: Cooper, Linda Sent: Tuesday, June 11, 2013 11:40 AM To: Finnegan, Martin; Fisher, Robert; Flatley, Martin; Spiro, Melissa Subject: Fireworks appl. I received the attached fireworks application from Peter Harris. Although he only show one date on the application he did submit a $200 fee with is the fee for 2 nights of fireworks. Unfortunately Peter is away and I haven't been able to reach him. The letter from Manwaring gives 2 dates for fireworks. So although the application only shows 1 date, I will ask Peter for an amended application and am going ahead with the process. So I will need you recommendations. t -'LEGION FIREWORKS Co Inc PHONE N0. 845 838 3476 Sun. 07 2013 10:25RM P2 O~~pF sopTyO BLIZASETH A. NEViLX,E ~ ' `O ' Town FIatl, 550fl> Main Rcud TOWN CLERIC ~ P,O. Box ili9 REGISTRAR OP VITAL 9'fATIS'[2(:S ~ ~ ~e Soutlroid, New York 111)71 MARRIAGE OFFICER I'nx i631)7G5~G 193 RL•'CORASIrL4N.4GE[dEN'fOFPICER O~yC ~ Toleplior.e((i;l.l7Gt~-1&OU k`R1iF.UOM OF I~FORb1AI'tO~OFFICF,R southoldto~:n.ncuthfock.nek OFFICE OF THE TOWN CLEEtI{ TOWN.OF' SOLtT.H()LD APP~C:ATION PEI2Nli'1' TO IITSPLr#Y FTT2EWOItKS APPLICATION IS IU;REI3Y MAbE, pursuant to the provisions of Section 405.00 of the Penal Law of the State of New York, fir a pemut to display fireworks as hereinaftersptccifird: p DISPLAY T$ TO $E SPbNSOTt`ED BY ~ L1~(T~Ic 5 I.,oc~~ar ,~1 rs? ,t5a~ ~cr.~ r -~,r:b PItTNCTPAL OFFICE AT ~ . r 1 DATJ? & TIME 4P' DISPLAY , - ~ . ~ ii'i' U ; -72-~-he~5 EXACT LOCATION OF DISPLAY ~,r~~kt.;~~nf`~' ,~,s,~ ~r ~~dr1 f - ! . I"; SUFFOLK COUNTY TAX MAP NI1M13EIt FOi2 SITE ~ort+ .~.,r,,r~ /~,.L,/, ~ .~~ed ~ ~ ~i I2AIN~DATE & TIME T P)T~ The foilon'iny persons are to be is chargaof the actltai~,shooting of the fireworks: .Name Age Experience Physical Condition x Chris IY~~ob2v~is ~ 5 ~.vs _ ( ~ _ - _ X ..Mvl(~ _ ~l(1D 3 ~ : VAS Q~'Q' (Ad'ditioliai aalnes and information may.lie'submitted o~ an aitaclied sheet Number aAd type of;firewnrks-is.as:Yollows: ..~~pYQ.~'rraa7'o~ ~1~ 3;2~_ 5p ~ineM aQr~~1 ^~41~. Manner and place of storago of fireworks prior to display: ~ ~ = Y ~ ' + • ~Ofe L2 ior~ . Attached hereto and made a part of heceof is a diagram of the grounds on which the display is to beheld, Also attached is a certif5cate or pulley of Insurance coverage. NOTICE: Wr[tten pcrttilssion, with signature of ffie Pronerty Owncr: must be submitted with the Application. / ' / ~,,yaritcofOrgmtirauon ~ • Signature of Applicant llate of Application M CERTIFICATE OF LIABILITY INSURANCE I DATE MM,DD YYY,lz/ZO/2OlZ THIS CERTIFICATE IS ISSUED AB A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER TH~S 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(ies) 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 cediflcate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER CONTACT 3oseph Cherepowi ch NAME: NcMann Price Agency, [nc. PHONE I [~C, NO):631'477'8930 (~vc, No, E~): 631. 477. 1680 828 Front Street E-M^~L da.mcmannprice~hamptons.com ADDRESS: P.O. BOX 2065 PRODUCSR 00001901 CUSTOMER ID #: Greenport, NY 11944-0876 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA; Arch Tnsurance Company Village of Greenport Fire Department INSURERS: PO Box 58 INSURERC: Greenport, NY 11944-0058 INSURERO: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 122012DA 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 I ADD[ SUBR POLICY EFF POLICY EXP LTRI TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) {MMIDD/YYYY) LIMITS , GENERALUABIUTY MEPK06726907 06/0112012 0610112013 EACH OCCURRENCE $ 1,000,00(~ DAMAGE TO RENTED ~~COMMERCIAL GENERAL LtABILITY~ I PREMISES lea occurrence) 100 ~ 00(~ ~ CLAIMS-MADE ~ OCCUR I MED EXP (Any one person) $ 5100(~ A ~ PERSONAL & ADV INJURY $ 1, O00,00(~ GENERAL AGGREGATE $ 10,000,000 ' GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/dP AGG $ 10 ~ 000 j 000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT -- (Ea accident) $ I ANY AUTO ~'ODiLY INJURY (Per person) $ : ALL OWNED AUTOS ~ SODILY INJURY(Per accident $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) ~ NON-OWNEDAUTOS I $ ~X UMSRELLALIAB X~ OCCUR MEIJM06473407 06/0112012 06101/2013 EADHOCCURRENCE $ 5,0001000 A/EXCESS LIAB j ] CLAIMS-MADE AGGREGATE $ 5 i 000 ~ 000 Ii RETENTION $ $ WORKERS COMPENSATION I TORY LIMITS I ~ith reBpeCt to the Washington'B Birthday Parade and Celebration to be held on 2/16/1:1. CERTIFICATE HOLDER CANCELLATION Town of Southold PO Box 1179 Soqthold, NY 11971 ACORD 25 (2009109) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. /.~/AUTHORIZED REPRESENTATIVE~/~ ~.,~ ~ ~ 198~ACORD C~ORA~IO~. ~ righ~ rese~ed. The ACORD name and Iog~are registered marks of ACORD -- FROM :t LEGION FIREWORKS Co Inc PHONE N0. 845 838 3476 Jun. 07 2013 10:26RM P3 DATE Alweurcrr q ,ac R CERTIFICATE OF LIABILITY INSURANCE snnD,s THIS CERTtF1CATE I5 ISSUEO AS a MATTER OF 1NKOt4MAT70N ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATVELY OR NEGATIVELY AMEND. EIriENp OR AFTER THE COVE7tAGE AEFOROEO BY AUTHORIZED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: M the wWNcete 1lelder is an ADDITWNAL. INSURED. tfle pogcy(ISa) mwt ~ endGrled' N SUBROGATION IS WANED, >wbJed to cafpin policies tDa ulrc an erMaraeme4d. A staiema7lt on Mis certfAeate does not roller rights to MC Me terms>md coiYYTatioi7s of tIM potty, Y re9 CCrtillnata Flotaar M lreu Of aurJr eDdOree s . °"ONE 1_rr55~7.SIlD-.. s^ ~ 1.83>S~Z10L. Bd~ ~elgnd~~Cent~. FlDat 30 ~E+'" 1375 East 9tl1 Street ~IpQ1(yl ACFOROe1D co9EAADE _ ruw s geveland OH 4g11A wsure~YA3JewteJD;iir~-Ca 1 NS{aeL ~ . - NEUPF.a a 3dew H3b1D°han Ins. nCe Co. Legan Fireworks lA., Inc. R/sleER. C~' IJS.ID$-C/MID~C4y. . iQ LeglOfl Lane W9VReR,D_. _ Wappingers Falls NY 12590 weue~Ye; e1si1RLRF COyg=q CERTIFICAT'E NUMBER: 2055266615 REVISION NUMBER: THIS 6 TO CERnFY THAT THE pq.IC1E5 OF INSURANCE USTID BELOW HAVE BEEN ISSUED TO THE INSIFIED NAMED WtIH TO INkiICH TH{S INDICATED. N07Y'ATHSTANDING ANT REOl11REMENT, TERM OR CONbrt1ON OF ANY CONYRAT-'T OR OTHER OOCL9AENT CFItTIFlCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDmONS OF S11C1I POLICIES. LIMrTS SHOWN MAV HAVE BEEf1 REDUCED BY PAip CLAIMS. ..vOIJGY ETM POUCV Ei~ L TYPE DF YIBIIR/JIGE P'OUCY RIA®0Y CB+~LIABl1R 399-01 15!2019 5/2014 EACH OCCVPIZEN~ f1,00D,DOG X wM~canLCERER~A~o.euTY PReuasES .emrrn,ml., s5oo9D ~ L 1 MED ExP Wm'~aPaaAV s PEROpnK6ADV wxWY f1000.D00 _ GERERAI-AafiREGAIE f2 000.000 D017. peGREW7E UMT APPtRB PEr+: PRODUCr$-OO1MlOP AGG f2,000000 PDUCY x ~O' roc t AIRONDBIIE weer. CA938387911 15/2013 5x2014 E7~000 pp0 X ANYAVYO sornty lNAlrN(Fer oerml f ~ Avrsal~Enu1~ amav wxrRr lP.aoae.9 s wR®AV1os X AD7D - i i C Ie1BRH.r.AUAe X rxcUR EA1f/31296 152019 512014 EA~10 y,,Opp,Opp , X E%CtS9DAe GMJSNAOE AGGREGATE f4.DOD,000 _ DFD RETENnONS ~ i NoW~CDIMdKATgN WGSrA11A 0714 AMl91NJyYEtS UABMY IX7 QrrrvE~ R/A EL FaCH ACCIDENT f YQ~IyyeMeyyIaIMMyF MII El OISEME-FA E7B1. i CESaOPf~ION DP~DA@i/1ipR,4 blur El owEAeE-PODGY LWPT S eF.iCNPl10N OFOPERATIONS/LOCATKaVe/yfllpx,EB (ApYen ACORD 1D1. Adaead as:u:ks SaAeLNw Mean sPKr bragdnd) Date of 7/3/2013. Rain Date: 76D. Lecatibn Display: Greenport High Schod Athletic Field Greenport,NY_ dOlorralry Insured: Certificate Holler, Greerlport Public School, Yllage of GresnpOrt, Greenport Fire DepartrneM, and &ue Sky Amusements d, 611ertainmeM, Ltd. Cl?RTIF7CATE HOLDER CANCEtLATiON SHOULD ANV OF THE ABOVE DESCRIBED M4G1E8 BE CANCELIID BEFORE 7NE EIIPQtAT10N BATE THEREOF, NOTICE MALL BE DELIVERED Ut Town of Southold AccoRDANCE M/tT}I THE POtJCY PROwslor7s_ PO Box 1179 Southold NY 11971 umloq®~csNrwTNa 7f'~°~~ ®198&2010 ACORD CORPORATION. AN rights reserved, ACORD 25 (2070/051 The ACORD runre and logo are registered marhe of ACOItD -s' ' F~~ ~x _ , ~ r . w ~ a 6 # TIL ~Y ~ tl ~ , Y a r. ~ M , _ Y ~ ~ ~!S i~ ~ ~ e~ ~ ~ ~~{~C f~ ~!4 G~ `S ~ r. M ~ 1" 4 e ~ ~ i >a, ~ s ~ a s • ~ z4 , . y ~ P} " ~ ynY J ~ b~ A S Y J ~ ~4 ~ ~ r ~ ~ a G . ,~3 Maw f ~t e $100 permit fee ~syEEOf~~ ELIZABETIi A. NEYLT.LE ~ Town Hall. b9096 Main Road TOWN CLERK p F.O. IIOx 1,I7-9 y ¢ Southold, hew Xork 11971 AEOL4TRAR OF VITAL STATISTICS ,r A7 MARRIAOE OFFICER ' ® Fax (531) 765.&145. RECORDS MANAGEFfENT OFFICER y~f Telephone (691) 7GS-1800 FREEDOM'OF INFOAMATEOTI~OFFECEA .soutlwld2ow++nnrtti.{prk.net RECEIVED OFFICE OF THE TOWN CLERH TC)ViTN t3F Sf~UTHOLI3 J()N ~ 20~ APPLICATION PERMIT TO DISPLAY FIREWORIGS Southold Town Clerk APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law of the Stara otNew YoEfc, for a-peFmit to-display fireworks as hereulafrer speci£led: DISPLAY IS TO BE SPONSORED BY Greenport Phenix Hook & Ladder & Relief Company PRINCIPAL OFFICE AT 236 3rd Street, Greenport, NY 11944 ~ _ IYATE i4c TIl1$: OF I9ISPLAY July b', 2013 ee 1U;()0 pm EXACT LOCATION OF DISPLAY Greenport High School RAIN DATE & TIME N/A The following persons are to be in charge of the actaal shooting of the fireworks: Name Age Experience Physical Condition William_Lotterhos dob~5./.26/13 S years + Health: Excellent Assistants=tbd (Additional dames and infomlation maybe submitted on an attached sheet Number and type of fireworks is as follows: 1:3G Fireworks 2-3 inch=352, 4 inch=51 Total Cakes=5. Manner and place of sforage of tire~vorks prior to display: Delivery of fireworks day of display. Attached hereto and made a part of hereof is a diagram of the grounds on which the display is to be held. Also attached is a certificate or policy of Insurance coverag Name r ti u ~ By Signature;ofApplicant.. Date of Application I Amp CERTIFICATE OF LIABILITY IFISURANCE ~ os,osz~ 01"~' TTIf5~75YSSFIEQ7t5 RYAA~PI~R^'OFitN4"JItMAMION^CNL°1' 7kN6^C9NPERS~1iE!-RI9FR~S ~dPBrF?FIE-BERTIfi@#T~E 1i6bBER. filiiG 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 Ills certHigle holder is an ADDITIONAL INSURED, the policy(ies) moat be endorsed. H SUBROGATION IS WAIVED, subject to the terms and'conditions oTille pdnLy, cerlaNl polf@les may regNie an entlbrsemedt. A slalamelROrr'gns cerdfcllFO does~nDtcoNferrtgl7ts'(othe certificate holder in Ilea of such endorsemen a . ~RraDMCEa. ,Inc: wale 10451 Gulf Boulevard PNONE ~ Ne Treasure'tslarn?, fL SSF066-~t~~ xaL 1-800-237-3355 INSUR AFFORDING COVERAGE NAKa :.I u F l.S,•~^^ 72866 asuRER e INSURED Pyro Engineering, Inc. dba: BSy FlyeworRs •11i1°ER~ 999 South Oyster Bay Rd., Suite 111 RISURERO: Joel Ran E Bethpage, NY 11714 wsuRERF: CDYERA[:FC CERTIFICATE NUMBER: REVISION NUMBER: THIS IS 70 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTNATHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MATH RESPECT TO WHICH THIS EERdJFIC.4ZE •AIAY BE ISSUED.-0&MAY FERSBJII;. THE INcI IRe.~rc ?FF9RDEQ_aY 771E I c nccre,PCn .NERFJWIS SUBJECT TJIAL.L 7JiE. TERMS,. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHONM MAY HAVE BEEN REDUCED BY PAID CWMS. INSR TYPE OF INSURANCE POLICY NUMBER NM EFF POLICY EXP lJN1rS A cENERALtJAenm CPP0 7 01284-03 OSH4Y1013 05114/2014 EACHOCCURaExcE s1000000 1t DMIAIERCIALGENERAL LN&IJTY 1 F,p a ce s 100,000 CWMS-MADE ~ OCCUR MED EXP (Am/ane penan) S PERSONALb ADV INXIRY 31,666,666 GENERAL AGGREGATE S 2 666 666 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPXW AGO s2,000,OOO POLICY PRR LOC f q AvrdeoelLE Luaxm CPP0101284-03 0§/14/2013 OS/14l2014 COMBIN ep SINGLE LIMIT 1 666 600 ANY ALTO BODILY INJURY {Per psmonl -S ALL OVMED SCFa:DUICn fiODILY INJURYIMrectlaen0 S AUTOS AUTOS 1r: HIRED AUTOS 1< ~NONONNEO ER S S A X °ce'm ELP0010292-03 (GL & VL) 05/1412013 05/14/2014 EADx occuxaENCE s 4,009',068' X. EXCESS UA6 ~~.µq~ AGGREGATE 54 666 666 DED ~ RETENTIONS S WORNERa GOMPEN3AT10r/ MA; STATLL OTi4 A AND EMPLOY6r3•tIABILRY YIN WC134166 05/14/2073 05/1412014 X F~ ED~i NIA E.L EACH ACCIDENT S1',666'j666' (bleMaWry In rrlr) E.L. dsEASE-EAEMPLDYE f1,66/6L,666 NDEe9E~RiPT1OF~OPBRAi1dJ3-below E.L E.P000YVMm s1ry00v1006~ A EXCESS LIABILITY/OCCUR ELP0010296-03 (GL) 05/14/2013 05114/2014 EACH OCCURRENCE 55,000,000 AGGREG4TE~S5,000,000 oESrBIPPTIdi~ oeFJrATloxs/ LncAnDNS/ VENICI.Ea uulbcb.ACnRn Tai,.AeaNlo„M.R.o,.rrssrJ,.as.,n,I,or...R.ral><nawrml. DISPLAY DATE: 7/6113 RAIN DATE: NONE LOCATION: Greenport High School, GreenporL NY RE: GENERAL LIABILITY, THE FOLLOWING ARE NAMED AS ADDITIONAL INSURED IN RESPECTS TO THE OPERATION OF THE NAMED INSURED ONLY: Village of Greenport; Town of Southold; Blue Sky Amusemems; Greenport UFSD; Suffolk County Greenport Ffre District; Greenport FD Phenix Hook 3 ladder 8 Relief Company. CERTIFICATE HOLDER CANCELLATION ISreenpartFD~Phenlx FiBtt arnYRelieftorrtparry Thirty (30~Days Notice of CanDellatina.A{Jplies SHOULD ANY OF THEABOVE DESCRIBED IN)UC 6E CANCELLED BEFORE 236 3rd Street THE EXPIRATION DATE THEREOF, NOTICE MILL eE, DELI IN G7e9r1p0TT, NY' 1't94TT ACCORDANCE WITH THE POLICY PROVISIONS. CERT #2296 Auer ATrvE ®1988-2010 ACORD CO PORATION. All rights reserved. ACORD 25 (2010/OS) The ACORD name and logo are registered marks of ACORD - ~ - r i i ~ - ~ - e,, _ ~ . s tt Ff. ~ ~ ~ . . , f , ~ r ~ ~ ~ ~ ~ ® ~ ~ ~ ~ ~ 4' 3 S'S~ ~ a T ~ w-. 4 c}~` r o~ok~ c~i` Ladde.~ Ca. ~ . , i a, f Y L <ii. 4 Date: 6/6/13 SPONSOR: Greenport FD Phenix Hook & Ladder & Relief Company Fireworks Company Pyro Engineering, Inc. 999 S. Oyster Bay Rd-, quite 1.11 Bethpage, NY 11714 Show Date(s): 7/6/13 Rain Date(s): none tnratinn• Greenport.l4iigh.Schoolfield 1. Total number of Class B shells being used is: 2-3"=3~2, 4"=51. Total Cakes = 5. Sizes between: 2 inches and 4 inches in diameter. 2. All shells are DOT approved. 3. Display will be fired manually. 4. Delivery to site will be at approximately ]2:00 Nnon. Set up will take approximately 4-5 hours. 5. All displays will comply with all requirements as set forth in NYS Penal Code 405 and NFPA 1123, 1124. 6. Pyro Engineering, Inc. has complete understanding of all rules and regulations goverrtirtg prtblic Fmwor}cs displays and this display will be in accordance with those rules and regulations. 7. Personnel representing fireworks display company: Lead: William Lotterhos (Pyrotechnic license attached) 8. Technician(s): tba Signe L-~-2~s21~~ /e~yi~ Ftre rks Company Representative 4 o N b I I i 1 i STATE ~ NEW YORK. - DEPARTMENT OF LABOi~ PYROTECHNICIAN CERTIFICATE OF COMPETENCE WILT-!AM A LOT~ERHOS ~r Ct:A~S: B NO?~ PROXIMATE 14UDIENCE ONLY TI~tiCARD MUS7{{E CARRIED 11VFiE2N lTECHNICS CERTN PR-4$ EXPIRES 10/15 1 NYC & NYS CERTIFICATIONS REQUIRED IN NYC w 0 U.S. Depettirseat of Justice a s-us-a ua uafsavoa r w uawaaow a w suss Bureau ofAlcohol, Tobeao, Firearms and Explosives (l8 U.S. G ChRptCT 40) naru.umatraaa~sw'sa In accordance xtth the provisions of Title XI, Organized Crime Control Act of 1970, and the regulations issued thereunder {27 CFR Pea 555), you may engage in the eaivity spaei6ed in this license or permit within the limitations of Chapter 40, Title Ig, Unitrxl States Code and the rcguletions issued thereunder, until the expiration daft shown. TH[S LICENSE IS NOT 7'Ri ~ SFL+Rg~LF TINDER 27 CFR 555.53. See "WARNlNOS" sad "NOTICES" on reverse. Direm ATF ATF-Chief, FEI:C LtrasaelPemtit Correspondence To 244 Needy Road Namba • ~ • ~ ~ ~ • Martimburg, W V 25405.9431 Chief, Federal losives Licensing Center (FFJ, Expnahon r ~ • Data ® ~ Name 14.9'C DBA BAY FIREWORKS &INTNTL PYRO IMPORTER (IPI) Premises Address (()tangs? Notify the FELC at (east 10 days before the move ( 999 SOUTH OYSTER BAY RD SUITE 111 FARMINGDALE NY 11735- Typ< nfLicense or Permit 57-IMPORTER OF EXPLOSIVES Purohesing Certification Statemem Mating Address (Chmgea~ Notify the FELC of any changes.) The liomxe a petrnittae nmord above dta0 use a Dopy ofthr6licmx a ponnil to stain a trattdaar of e~bdvsto verily Ilea idemity atdtlte Geetrsed states ofthe Itemxa a petmhtee as provided by 27 CFR Part 555. The aitstlu[e m atA ceov mug be n ai®tal simsM. Afized, acaoneda e-mailed copy oftlte liaox or pertnnwhh asippanrce PYRO ENGINEERING INC intended to be an arigmel eigpmtre is eaeplabk. Thesignabue must bethat otWe F'edaal DBA BAY FIREWORKS&INTNTL PYFlO IMPORTER EtWloaivs Licensee (FEL) a a reapmsiblaperaon dihe FEL I cmAV Ihri this is s we (IPI) copy of a license a permit issued to the licensee a pumrttee named aboveto engage n the 988 SOUTH OYSTER BAY' RD SUITE 1 11 business a apaatias sped above coda °fype d License a Pamst." FARMINGDALE, NV 17735- LicenseePermittx Responsible Person Signature PositiotstTiUe Printed Nemc Date n7p rmn sws.tastoo t? Pw i Prwlau L•dnian isObsolate mevrraeaenenmerrnawa>tmntatm.now,au.rva,,,.rwruansmrmwns Rmiwd(]a~v 2011 Federd Fplosives License (FEL) Cuatgner Serv(ce InformaGm Fedeal Explosives I.iratsing Comer (FELC) Toll-free Telephone Number: (877) 283-3352 ATF Itomepage: www.atfgw 244 Needy Road FexNumber: (304) 6161401 Meainsburg, WV25405-9431 E-mail: FF,I.Ct~atfgw Clrenge of Address (27 CPR JJ3.34(aJ(p). Liunseea or permittees may during the term oftheir current license or permit remove thtir business w operetions to a new location at which they intend regularly to carry on such business w operations. The licensee or perming is required to ghro notification of the new location of the 6usineas or opaatioas.oet less than 10 days.prioria such re®oval wG}s the Chief Federal Errploaiuas Liaaasing Caster. The tisanes w permit wiliba valid fwthe remainder of the term of the original license w permit. (Ilse Chief FELC, shall, ff else Nemsee or petmittee is not qualified, refer flro request for amended ticrose or permit to the Director oC Industry Operations for denial in accordance with ~ 55554.) Right of Succession (77 CF72 SSS.39). (a) Certain persons other than the lieenset or pertnittee mry amore the right to carry on the same explosive matcdals businesswepertlionsRtlsc inns addre~sahavrn an, and far the remahsderoftltetennvf,acmTeraticzrtsnm partnSt. Sueh pasonsue: (1)'llu surviving spousa or child, w execmw, administrator, or oiha Iegel rcpresentetive of a deceased Geensa or permittee; and (2) A receiver or frusta in baniwptcy, w an assignee for benefit of uWrtors. (b)In order to secure the right provided 6y this 's.~~n,the{tarsanwtaersuae ~~^~•~~tLahuaivgaorahall farrtieh iks liaanae ar permit for for that business w operations for endorsement of such succession to the Chief, FELC, wthin 30 days Crom the date on which the successor begins to carry on the business w operations. IConhnued on revarre ride) Cut Here I__________________________________.l I Federal Expletives LfuoedPermlt (FEL) lafotmatioa Card l I l t License/Petm¢ Neme: PYRO ENGINEERING INC t I r I , I Business Name: DSA BAY FIREWORKS &INTNTL PXRO r ~ IMPORTER (IPI) l I Liccnse/Petmit Number. ti-NY-059.514E-00129 ~ I I I ~ Lieense/Petmit Typa:6t-IMPORTER OF ERPLOSNES I t Expiration: Msy 1, 2074 t I 1 I I Please Nale: Not Valid fa the Sale a Otha Disposhim of E~losivw. I Eastern Service Center 1701 Colttttibia Ave. U.S. Department Operations Support Group Coliege Park, GA 30337 oFTransportation AN-E2 REQUEST FOR FIREWORKS DISPLAY 6/6/13 Company Name: Pyro Engineering 400 Broadhollow Rd. Suite 3 Farmingdale, NY t 1735 Email Address of Person Requesting the Show: 'oanne ba fireworks.com Event Name: Greenport FD Phenix H&L 2013 Display Date: July 6, 2013 Rain Date: N/A Display Start Time: lOPM Duration of Fireworks Display: 8-10 minutes Max Height of Fireworks: 400 Feet City or Town and State (Physical Address): Greenport, NY Latitude: 41.06.11 N (North) Longitude: 072.22.20 (West) Location or Special Notes: Greenport High School 720 Front St Please email your request to: 9-ATO-ESA-OSG-fireworksCa~faa qov