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o��gUffO�,�►�o ELIZABETH A.NEVILLE,MMC �� l/y Town Hall,53095 Main Road TOWN CLERK C* P.O.Box 1179 CA Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p . Fax(631)765-6145 MARRIAGE OFFICER y� a0� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD June 17, 2014 Peter Harris Greenport Fire Department Phoenix Hook and Ladder, Co. PO Box 58 Greenport,NY 11944 Dear Mr. Harris: The Southold Town Board, at its regular meeting held on June 3, 2014, granted permission to the Greenport fire Department to hold its Annual July 4 1 Fireworks on July 4 and 5, 2014. A certified copy of this resolution is enclosed along with the Fireworks permit. An insurance policy naming the Town of Southold as additionally insured has been filed with this office. Please contact Captain Kruszeski at the Police Department, as soon as possible, to coordinate traffic control. If you have any questions please contact me at the Town Clerk's office at 631-765-1800. Good Luck with your event. Sincerely, Lynda M Rudder Deputy Town Clerk enc o�oSUFFoc,�oo ELIZABETH A.NEVILLE,MMC �� l/y Town Hall,53095 Main Road TOWN CLERK o P.O. Box 1179 C4 Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p • .F Fax(631)765-6145 MARRIAGE OFFICERTelephone y� r- RECORDS MANAGEMENT OFFICER of �a0 FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov 765-1800 www.southoldtownny.gov 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 PHOENIX HOOK& LADDER CO. 1 &2 THIRD STREET,GREENPORT,NY 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 Friday,July 4,2014 and Saturday,July 5,2014(r/d TBD)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. ----------------------------------------------------- Elizabeth A.Neville, Southold Town Clerk Suffolk County,New York (Town Seal) Date: June 17,2014 THIS PERMIT IS NOT TRANSFERABLE Southold Town Board - Letter Board Meeting of June 3, 2014 RESOLUTION 2014-486 Item # 5.14 ADOPTED DOC ID: 9869 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2014-486 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 3, 2014: 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. I and Relief Hose Company No. 2 of the Greenport Fire Department, for a fireworks display on Friday, July 4th and Saturday, July 5th 2014, 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: Ghosio, Dinizio Jr, Ruland, Doherty, Evans, Russell Generated June 4, 2014 Page 33 �agu�Foc,�c ELIZARK"I'il A. NLVI.LLE, MMC; ��4 Town Hall.53095 Main Roa&--: — TOWN CLERK c _ P.U. Box .1179 co ar sonthold, Nt- York. I M71 Ph T2. (ASTRAR OF VTTAT.STATISTICS . (:ax(63 1)765-6 145 -ANRRIAGE OFFICER Telephone S63 t?766 1800 R1,100RD9 OF K41VAGEMENT OPPICT,JTt ��Oj � `�►� c�c,utholdto`tin.northfork.nct FRE EDOM OF INFORMATION OFFICER OFFICE. OF THE TOWN CI.ERK TO'WTl OF S010TIlOLD APPLICATION PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisions of Scction 405.00 of the Penal Law of the Statc of New York, for a permit to display fireworks as hereinafter specified: Relief Ho se DISPLAY IS TO BE SPONSORED BY Phenix Hook & Ladder Co. #1 & Co. #2 . PRINCIPAL OFFICE AT 3rd Street Greenport, NY 11944 DATE & TIME OF DISPLAY July 4 , 2014 @ Q PM. EXACT LOCATION OF DISPLAY Green port High School Athletic Field. SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE & TIME TBD-_ The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition John G. Rockwell 41 3+ Years Excellent (Additional names and information may be submitted on an attaclied sheet Number and type of fireworks is as follows: Approximately ( 398 ) 3" Aerail Shells . Manner and place of storage of fireworks prior to display: In a NYS Licensed Magazine @ Legion Fireworks Co. , Inc. 10 Legion Lane Wappingers Falls, NY . 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 coverage. NOTICE: Written permission, with signature of the Property Owner, must be submitted with the Application. 4 / �I FEE: $100 Name of Organization See policy for additional information a- 6, Signature o1'Applicant ate of A�� licatlon PP Off ELIZAB1,11i A. N°EVILLE,MMC ytg Town tl:�li, :;:;f1�in ;Ulain Rnad 'i'()WN C LERK � P.O. Lox 1.171) , o c �nm.hntrl,1Cmt li►rk 11971 HH(112TRAR OF VITAI..LYFA'I't8T1C:� '" �" r Q I't1:S il)rrl f ((itr FIi(i .IAvia, (im oppicEn Off` 1'vlc W1111►n ffi;t10 i;►- stint► R 1e(,'0 D.ei OF MANAGEMENT Ol�1,1Cb R �Q � i+'RE :llt)_VI OF 1N1+'OR-U 1'1()N OKKIC EH � '� � � �� ,:vutlxildto„n.northlurl:.:n:l OFFICE OP"I'HE TOWN CLERK TOWN oic so u,'1'HUI,i) APPLICATION PERMIT TO DISPLAY FIREWORKS 1S IlERE13Y MADE. pursuant to the provisions of Section 405.00 cif the Penal 1-aw offlu-, State (if New York, fora permit to display fireworks as hei-eina(ier sl)cc:ified: RelAor Hc) se DISPLAY IS TO BE SPONSORED BY Phenix Ilook & Ladder Co. #1 & Co. #2 . PRINCIPAL OFFICE AT 3rd .Street- Greenport , NY 11944 DA'I E & ` IMF OF D1SPI.AY July 5 , 2014 @ /d PM _ EXACT WCATION OF DISPLAY Green port High School. Athletic Field . SUFFOLK COUNTY TAX MAP NUM13ER FOR SITE RAIN DATE & TEME, TBD . The following persons are to be in charge of the actual shooting; of the fireworks: Name Age Experience Physical Condition John G . Rockwell 41 3+ Years Excellent Op. - - ( .W . �f� _ �� 37years _ Exce11'eu {Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Approximately ( 398 ) 3" - b" Aerial Shells . Nlanner and place of storage of fireworks prior to display: _ In a_ NYS Licensed Magazine @ Legion Fireworks Co. , Inc . 10 Legion Lane Wappingers Calls, NY . 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 at certificate or policy of insurance coverage. NOTICE: Written permission, with signature of the Property Owner, must be submitted with the Application. �G�6tA .(���//I.�l�QK7q¢.—�!/G/��'rWL f.0 J �����V�/a•C.J FEE: $1 d0ngganizalion See policy for additional information 13 .__ -- Signaturc of:'Applicant -- c Application Federal Erplocl-,eS L?ce fit• Pr=-_!'L U.S.Department of Justice Bureau of Alcohol,Tobacco,Firearms and Explosives (18 Z:S.C CST via-am=aaraa�atlata calm; In accordance with the provisions of Title)CI.Organized C-m.L :- the activity specified in this license or permit within the':rr.itst_,. -.__cf-- expiration date shown. THIS LICENSE IS NOT I R.a NSF f:RA BLE L+_'gOE.R P'CFtt 5:56.5-', Direct ATF ATF-Chief,FELC Correspondence To 244 Needy Road Martinsburg,WV 25405-9431 Chief,Federal losives Licensing Cat" Name LEGION FIREWORKS CO INC Premises Address(Changes?Notify the FELC at least 10 da%s before the move.) 10 LEGION LANE WAPPINGERS FALLS NY 12590- Type of License or Permit 20-MANUFACTURER OF EXPLOSIVES Purchasing Certification Statement Mailing Address tC hanger- > :-t The licensee or permittee named above shall use a coPy ofthis license or permit to assist a transferor of explosivesto verify the identity and the licensed status of the licensee or pemmAtee as provided by 27 CFR Pal 555. 'Ihe sisnature oa each mm must be an original LEGION FIREWORKS G O INC s' e. A faxed,scanned or emailed copy ofthe license or permit with a signature amended to be an origi gd signature is acceptable. Thr signature m ud bathes ofthe Federal 10 LEGION LANE Explosives Ucertsee(FEL)oraresponsible person ofthe FEL Icertifythat this isatrue WAPPINGERS FALLS, NY 1259C- copy of a license or permit issued to the licensee or permittee named aboveto engage in the business or operations specified above under"Type of License or Permit." � �!— :/✓r- . �i",'.1 ��,'�/',/err-�•"`-:'/ Licensee/Permittee Responsible Person Signature Position Title Frank M. Coluccio Printed Name - Date Prwicm Edition is Obsolete u�Nawsantarnuao,uremnsnanseami�mi.anmwawnuxaer4nmae f•=�= c Federal Explosives License(FEL)Customer Sermice Information Federal Explosives Licensing Center(FELL) Toll-free Telephone Number: (877)283-3352 ATF Homepage: 244 Needy Road Fax Number: (304)6164401 Martinsburg,WV 25405-9431 Email: FELC@,atf.gov Change of Address (17 CFR 555.5d(a)(1)). Licensees or permittees may during the term of their current license or permit remove their business r ere^=:,:•vs t-a new location at which they intend regularly to carry on such business or operations. The licensee or permittee is required to give notification of the net.'::.,m.:_:s: c business or operations not less than 10 days prior to such removal with the Chiu Federal Explosives Licensing Center. The license or permit Ail_,be vaii'4-";r remainder of the term of the original license or permit. ([be Chielf;FELL,shay,if the licensee or permittee is not qualified,refer the request for amended ticerse or permit to the Director of Industry Operations for denial in accordance with§555.54.) Right of Succession (27 CFR 555.59). (a)Certain persons other than the licensee or permittee may secure the right to carry on the same expiosive ma:—_z-5 business or operations at the same address shown on,and for the remainder of the term of a current license or permit" Such persons are: or child,or executor,administrator,or other legal representative of a deceased licensee or permittee:and(2)A receiver or trustee in bsn;�ruptc�.it 2&- :ane Z., benefit of creditors. (b)In order to secure the right provided by this section,the person or persons continuing the business or operatitr permit for for that business or operations for endorsement of such succession to the Chiu FELC.within 30 days from the date or:u he carry on the business or operations. Cut Here X --------------------------------- Federal Explosives LicensdPetmk(FEL)Information Card I License/PermitName:LEMON FIREWORKS CO INC I I I I I Business Name: 1 I I I I License/Permit Number.6-NY-027-20.6C-00077 I � License/Permit Type_20-MANUFACTURER OF EXPLOSIVES I I Expiration: March 1,2016 1 IPlease Note: Not Valid for the Sale or Other Disposition of Explosives. STATE OF NEW YORK a DfVI;SOF DEPARTMENT OF LABOR f=' SAFETY AND HEAL70-4 LICENSE TO DEAL IN OR MANUFACTURE EXPLOSIVES Expires: r:2 4 Legion Fireworks Co., Inc. 10 Legion Lane THIS LICENSE MUST BE Wappingers Falls, NY 12590 POSTED IN YOUR PLACE OF BUSINESS Frank Coluccio License No D-2310 is hereby licensed to deal in or manufacture explosives in compliance with the requirements of,the Labor Law aoy Industrial Code Rules. Any change in the conditions under which this license is granted may cause it to be revoked. Eileen M.Franko,Acting Director FOR THE COMl1A1SSIONER OF LABOR Every person selling,delivering or giving away any explosives must keep at the principal place of business within the state,a record of each transaction,Including: 1) the NAME or TYPE and QUANTITY of explosives SOLD,DELIVERED or GIVEN. Note:No license is needed to purchase smokeless powder,or black powder in quantities not exceeding five pounds for use in firing antique firearms or artifacts or replicas thereof. However,dealers MUST post all such transactions on the"Dealer-Manufacturer Report of Explosives Transactions". 2) the DATE OF EACH SALE,DELIVERY or GIFT. 3) the NAME,LICENSE NUMBER,and BUSINESS ADDRESS of the purchaser,donee,or person to whom the explosives were delivered and the firm,if any,represented by such person. 4) the NAME,ADDRESS,and LICENSE NUMBER of the person TAKING THE EXPLOSIVES AWAY from the seller or donor. SH-862(5-98) n1 ,aco YY) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YY 5/2/2014 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 rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Britton GallagherFAX PHONE.Extiw21 M58-71 A/C N01:216-658-71 01 One Cleveland Center, Floor 30 E-MAIL 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURE S AFFORDING COVERAGE NAIC# INSURER A Axis SU[plUS Ins Company 26690 INSURED INSURER B:EVereSt National Insurance Company 10120 Legion Fireworks Co., Inc. INSURERC: 10 Legion Lane INSURER D: Wappingers Falls NY 12590 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1401959807 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 TYPE OF INSURANCE ADL UBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDIYDD YYY MM/ B GENERAL LIABILITY 18ML00116-141 /15/2014 /15/2015 EACH OCCURRENCE $1,000,000 DAMAGE ToRENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO-IJECT 7LOC $ B AUTOMOBILE LIABILITY S18CA00058-141 /15/2014 /15/2015 Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HI RED AUTOS X AUTOS Per accident $ A UMBRELLA LIAB X OCCUR EAU731294 /15/2014 /15/2015 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTHLIMII�S - ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space Is required) Date of Display:7/4/2014. Location of Display: Greenport High School 720 Front Street Greenport, NY 11944. Additionally Insured: Certificate Holder,Town of Southold,Village of Greenport,Greenport Public Schools,and Greenport Fire Department. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Phenix Hook&Ladder Co.#1 &Relief Hose Co.#2 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 58 3rd Street AUTHORIZED REPRESENTATIVE Greenport NY 11944 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ,4c R CERTIFICATE OF LIABILITY INSURANCE 5/2/22014014 D IDDM/YY) 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Britton Gallagher PHONE FAX 216-658-7101 One Cleveland Center, Floor 30 E-MAIL ac No 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A AXiS Surplus Ins Company 26690 INSURED INSURER B:EVereSt National Insurance Legion Fireworks Co., Inc. INSURERC: 10 Legion Lane INSURER D: Wappingers Falls NY 12590 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:276521984 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. 1EXP L7R TYPE OF INSURANCE N R POLICY NUMBER POLICY EFF MM/DD YY LIMITS B GENERAL LIABILITY 18ML00116-141 /15/2014 /15/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITYM R PREMISE Ea occurrence) $500,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO LOC $ B AUTOMOBILE LIABILITY S18CA00058-141 /15/2014 /15/2015 Ea actident) 1,000,000 X1x ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS x AUTOS Per accident A UMBRELLA LIAB X OCCUR EAU731294 /15/2014 /15/2015 EACH OCCURRENCE $4,000,000 X EXCESS UA13 CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS'LIABILITY Y/N LIMITS I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Date of Display:7/5/2014. Location of Display: Greenport High School 720 Front Street Greenport, NY 11944. Additionally Insured:Certificate Holder, Town of Southold,Village of Greenport,Greenport Public Schools, and Greenport Fire Department. CERTIFICATE HOLDER CANCELLATION. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Phenix Hook&Ladder Co.#1 &Relief Hose Co.#2 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 58 3rd Street AUTHORIZED REPRESENTATIVE Greenport NY 11944 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/06) The ACORD name and logo are registered marks of ACORD y � a ► �i?"t,� `M a` a�t,.. 3 � g,�i y� �R,� �3 t4�F "�" k.' S �'�43"� �¢¢:.�, a :2yr � �`":• e t "i.+1.` ury�r•!�,��: '�` l.,i � 'i. r,5,,y' �' �v��y`��' ..'C L�^i� _a's� "6'�5'.;, 9x' 't�h%m.° � ,,,.,�, P`" �4' �ts+�,` '� _br ;;.»jXrt x�_s� ��y �d'L, 4 3+ `tea 1y' Iry - p -yt _ °5 }_�"' ?b �r`' ` uz. .`dal..• �;:kx %�'¢� '� :t_ ,.yap �..:'. ,-p till�} 'k '`��` t����� � •(:� vh �'. iA N SIM W -0 i0yGoo Ic � � � } 2 �9- !� ■ r ��!F .4 r3•• §: % ~�o l,, IM gn>1 20f11!NeMw,�YMt.lb�IS� �. � ,��.! t 'f? * * * RECEIPT * * * Date: 05/28/14 Receipt#: 170688 Quantity Transactions Reference Subtotal 1 Fireworks 7/4-5/14 $200.00 Total Paid: $200.00 Notes: Payment Type Amount Paid By CK# $200.00 Greenport, Fire Departmetn Name: Greenport, Fire Departmetn Po Box 58 Greenport, NY 11944 Clerk ID: LYNDAR Internal ID: 7/4-5/14 Rudder, Lynda From: Fisher, Robert Sent: Tuesday, June 03, 2014 11:11 AM To: Rudder, Lynda Subject: RE: Emailing: grnpt fireworks_20140528131313.pdf Lynda I have no problems with this annual permit. Bob Robert Fisher Fire Marshall robert.fisher@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 -----Original Message----- From: Rudder, Lynda Sent: Monday,June 02, 2014 12:56 PM To: Fisher, Robert Subject: Emailing:grnpt fireworks_20140528131313.pdf Importance: High Please approve or disapprove this fireworks application 1 Rudder, Lynda From: Flatley, Martin Sent: Wednesday, May 28, 2014 4:57 PM To: Rudder, Lynda; Doroski, Melanie; Finnegan, Martin; Fisher, Robert; Kruszeski, Frank; Spiro, Melissa Subject: RE:July 4 - 5 fireworks Attachments: CA for GFD July 4th Fireworks.xls I have no objections to this event taking place, attached is my cost analysis. Martin Flatley Chief of Police Southold Town Police Department 41405 State Rt. 25 Peconic, N.Y. 11958 631-765-3115 -----Original Message----- From: Rudder, Lynda Sent: Wednesday, May 28, 2014 2:18 PM To: Doroski, Melanie; Finnegan, Martin; Fisher, Robert; Flatley, Martin; Kruszeski, Frank; Spiro, Melissa Subject:July 4-5 fireworks Please provide approval/disapproval for this fireworks permit 1 Town of Southold Police Department Special Event Cost Analysis -Event: '!Greenport-Fire Dept Fireworks Display1 --- I � { Date(s): July 4, 2004 Location: Greenport High School Grounds Patrol Allocatlttn for Event Reg Hours OT Hrs Hrly WageTotal Comments I I Police Offlctem, S.P.O Haase 1.5 $20.81 $31.21 - - -- -- 1 Special Patrol Reg Hours !OTHrs I Hrly Wage Total Comments CRU - Bicycle Patrol -9 Unlf - { Highway Patrol Marine Units t Traffic Control - 'Reg Hours OT Hrs Hrly Wage Total I Comments - 1.51 - _ -I $16.46 j $24.69 1.51 -i $16.46 TT $24.69 1 _ - Egulprnerit Costs Road Flares N - $40.00 -i i Total Department Cost for Event = $ $120.59 Prepared by Capt.M. Flatley 5/29/2014 Page 1 Rudder, Lynda From: Spiro, Melissa Sent: Wednesday, May 28, 2014 2:20 PM To: Rudder, Lynda Subject: RE:July 4 - 5 fireworks Greenport School is not Town of Southold preserved land. Since this is not preserved land, I have no comment on this application. Melissa -----Original Message----- From: Rudder, Lynda Sent: Wednesday, May 28, 2014 2:18 PM To: Doroski, Melanie; Finnegan, Martin; Fisher, Robert; Flatley, Martin; Kruszeski, Frank; Spiro, Melissa Subject:July 4-5 fireworks Please provide approval/disapproval for this fireworks permit Rudder, Lynda From: Rudder, Lynda Sent: Wednesday, May 28, 2014 2:18 PM To: Doroski, Melanie; Finnegan, Martin; Fisher, Robert; Flatley, Martin; Kruszeski, Frank; Spiro, Melissa Subject: July 4 - 5 fireworks Attachments: grnpt fireworks_20140528131313.pdf Please provide approval/disapproval for this fireworks permit 1 SUFFO(,(co 9- ELIZABETH A. NEVILLE, MMC h~ G.y Town Hall, 53095 Main Road TOWN CLERK p P.O. Box 1179 COD Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS p Fax (631) 765-6145 MARRIAGE OFFICER y~~l N. Telephone (631) 765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Martin Finnegan, Town Attorney Chief Flatley, Southold Town Police Department U~~d a z i Robert Fisher, Fire Inspector 010 #-d74V Melissa Spiro, Land Preservation A-I f V- 2-14 From: Linda J. Cooper, Deputy Town Clerk Dated: April 2, 2014 Re: Fireworks Permit for Star Hose Company, GFD Transmitted herewith is an application for Fireworks Permit for Star Hose Company, for May 24, 2014. Please advise if you have any objections to a permit being issued. Thank you. cc: Southold Town Board ELM4BErar A. M9VILLE, MIMIC Town Hall, 68095 Main Road P.O. Box 1179 TOWN CLERK Southold, New York 11971 REGISTRAR OF VITAL STATISTICS Fax (881) 766-6146 MARRIAGE OFFICER Qrf Telephone (881) 765-1800 RECORDS MANAGEMENT OFFICER wwwaoutholdtownnygov 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 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 Saturday, May 24, 2014 (r1d 25th) on the property of GREENPORT HIGH SCHOOL Athletic Field, north side Front Street and east side Moores Lane, Greeoport , 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 w 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. Elizabe Neville, Southold Town Clerk Suffolk County, New York (Town Seal) Date: April 8, 2014 THIS PERMIT IS NOT TRANSFERABLE RESOLUTION 2014-318 °®~''41 ADOPTED DOC ID: 9676 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2014-318 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON APRIL 8,2014: 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 24, 2014 (r/d 5/25/14), 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. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Robert Ghosio, Councilman SECONDER: Louisa P. Evans, Justice AYES: Ghosio, Dinizio Jr, Ruland, Doherty, Evans, Russell ~gyfi0(,4-cQ ELIZABETH A. NEVILLE, MMC Town Hall, 53096 Main Road TOWN CLERK ~j P.O. Box 1179 ra Southold, New York 11971 REGISTRAR OF V rAL STATISTICS O Fax (631) 765-6146 ,NChRRIAGE OFFICER RECORDS OFF MANAGEMENT OFFICER Telephone (631) 766-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION 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 24, _2014_ Time: 10:00 pm EXACT LOCATION-OF DISPLAY Greenport High School athletic field SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE & TIME May 25 , 2014 The following persona are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Christopher Racioppo dob: _ 5 years + Health: Excellent 9/16/89 assistants: tbd (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: 1.3G Fireworks 2-3 inch=424. Total Cakes=6. Manner and place of storage of fireworks prior to display: Storage at Westhampton facility. Product delivered day o 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 coverage, NOTICE: Written permission, with signature of the Pronerty Owner, must he submitted with the Application, Star Hose Company (Greenport FD) FEE: $100 Name of Organization See policy for additional information By Signature of Applicant Th~rz~/ z 7 z~ Date of Appiicatio ALLIED February 24, 2014 Greenport Fire Department 240 6th Ave Greenport, NY 11944 Re: Pyro Engineering, Inc. dba: Bay Fireworks Dear Sir/Madam: A Certificate of Insurance and Endorsement evidencing insurance for Pyro Engineering, Inc. dba: Bay Fireworks for the 2013/2014 term are attached. Updated documents will be provided once coverage is bound May 14, 2014. 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) 547-3085. Thank you for your cooperation regarding this matter. Sincerely, Kathleen Jones Commercial Lines Attachments ALLIED SPECIALTY INSURANCE, INC 10451 Gulf Boulevard, Treasure Island, Florida 33706.727 387- 6900 ' 1 800 235-8774 • Fax 888 345-1588 85 N.E. Loop 410, Sufte. 600, San Antonio, Texas 78216.210 341-1321 ' 1 800 235.8774 • Fax 210 341-2050 ~co,ed CERTIFICATE OF LIABILITY INSURANCE d EjMMDO"YY" 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: N the certificate holder to an ADDITIONAL INSURED, the policy(kw) must be endorsed. M SUBROGATION is WAIVED, subject to the terms and conditions of the policy, certain policies may require an andorsenwnt A statement on this arl8cate does not confer rights to the certificate holder In Ileu of such eedo s . °fl001°d1 Allied Specialty Insurance, Inc. aWT CT 10451 Gulf Boulevard E sAn. FAX Treasure Island, FL 33708.4814 om- NNC f 1-900-237.3355 INSURE a AFFORDING COVERAGE INWRIMA: T.H.E. Insurance Company 12888 INSURM Pyro Engineering, Inc. INSIMIERD, dba: Bay Fireworks INaun C: 999 South Oyster Bay Rd., Suite 111 WIRER°' T INSURER E: Bethpage, NY 11714 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. 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. INaR r OF INSURANCE L'rR POLICY N UNIB A _GENERAL LMOLm CPP0101284-03 61142013 061142014 FACH OCCLRRENCe $1,000,000 X COMMERCIAL GENERAL UABARY I:Tdll $100,000 CINAE:MADE I OCCUR MED EXP ow sent) f I.J PERSONAL A ADV INJURY $1000,000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE uMn A es PER PRODUCTS -COMMOP AOG 62,000,000 Palcv PRO' F-ILOC S A i Mrr0m ELEUAEun CPPOIC1284-03 OSM412013 051142014 u 1,000,000 ANY AUTO BODILY INAIRY (PKp ) S lJro X jSLIA~DULEO BDOILYINAA V PYatoOrq $ X RIREOAUT05 X NONE EO PROPERrv 3 _ f A uNeseuJm LNe X OCCUR ELP0010292-03 (GL S VL) 061142013 0511412014 EACH OCCURRENCE. s4,000,000 X c=saLNa CIAIMINAM AGGREGATE 0,000,000 $ WORKERS CONPOISATIGN STATLL OR4 YIN WC134166 61142013 0611412014 ~OFFICJ:RARBAER FX0.UDEDT NIA EL EACH ACCIOENT f1,000,OOO IWna ANryNMI EL. DISEASE-EA EMPLOY $1,000,000 ° RP;s i y T M EL.asEASE-POUCYuwr s1,000,000 A !EXCESS LIABILITYIOCCUR ELP001029MII (GL) 061142013 OW142014 EACH OCCURRENCE $6,000,000 AGGREGATE 56,000,000 DEBCPoPTIDN OF DIRMlM1Ne1LOC11T10NS 1YENiCLES UMAM, ACORO teI, AEpepglRmulu EN1AGY,NNen epAw b,~puYM) Display Date: 524114 Rain Date: 626114 Location: Greenport High School Athletic Field, Greenport NY RE: General Liability, the folkWAng are named as additional Insured in respects to the operations of the named insured only: Star Hose Company; Greenport Fire Department, Village of Gnanpo,%KY; Town of Southol ; Sutfolk County; Greenport UFSD Hold Harmless Agreement per contract between Named Insured and Additional Insured applies. The above Commercial General Liability policy affords bodily Injury S property damage liability coverage arising directly from a ffraworks display, however, no Marine, Hull S Machinery, PSI or Pollution Liability Coverage is afforded under this CGL policy adeing form the use of any barge, docks, plers, whams or floating plafforma. CERTIFICATE HOLDER CANCELLATION Greenport Fire Department 30 Day Notice of Cancellation applies SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13EFORE 240 5th Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Greenport,NY 11944 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR AT1Y): PROVIDED AS EVIDENCE OF INSURANCE / CERTIFICATE UPDATED AT RENEWAL D ISM2010 ACO CORPORATION. All rights reserved. ACORO 25 (2010/05) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK - DEPARTMENT OF LABOR ECHNIGIAN (<k,RTIFICA TV- C W ("'OMPETENCE CH RACIOPPO 1. EAR, E CARRIED TECHNICS YPIR 07110 NYC & NYS CERTIFICATIONS REQUIRED IN NYC T~ NYM,w'YWwm T ~^4 kY~~ I@3S J ~ I ~ ~ Y :pI t Mob u 0J/21/2014 12:56 FAX 9002 i ENGINEERING America's World Gass Fireworks Leader Display Date: May 24, 20f4 FIREWORKS DISPLAY AGREEMENT AGREEMENT made February 11, 2014 by and between Pyro Engineering, Inc., whose address is 999 South Oyster Bay Road, Suite 111, Bethpage, NY 11714 (heminefier "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 perform a fireworks display on the terms and conditions hereinater set forth; NOW, THEREFORE, in consideration of the terms, conditions and covenants hereinafter set forth, the parties hereto do mutually agree ae follows: 1. FIREWORKS DISPLAY.- On, May 24, 2014 (hereinafter She Display Datel, PEI shag provide the fireworks and equipment for the display at the Fireworks Display location. The display will be under the supervision of a PEI trained technician. It is agreed that PEI Mail be the sob flrsworRS supplier and producer for the event contracted for herein. (Nota: The actual start and atop time of the display will be determined by the governments[ authorities having jurisdiction over the display). ALTERNATE DATE: May 25, 2014 2. COST AND PAYMENTS: FIREWORKS DISPLAY PRICE: The total (Flrewods Diapl PrIa6 lus all other applicable charges) sum of t~ shall be due and payable as (allows: a The sun cf : t~ Due and Payable on Night of May 24, 2014 Please Note: SPONSOR Is responsible for the payment of all governmental fees and taxes, inducting, but not limited to, sales, use, excise. license, permi6 entertainment or otter fees, taxes of surdueges imposed or otherwise applied to this exhibition. Also, please we Section 16(c) below. 3. POSTPONEMENT/RESCNEDUUNG: If the display of the fireworks is poatpored/resc eduled by reason of inclement weather or by detemiketlon by the govemmadal sutrodly having Jurisdiction. or for any other reason beyond the control of PEI, same shall be re- sehedubd to the Attemale Data set forth above. In the event a postponernanUrearheduling Is necessary due to inclement weather or by determination by the governmental authority having jurisdiction, or for any other reason beyond the control of PEI a postponement/rescheduling fee will be based on the table below. Dwcri on % of Fireworks Display Price A=V ional Casts rxMified 12:01 AM on 06123/14 5% An 3 P Vendor Expenses. If noMM after 1291 AM art 0414 15% An 3 Party Vendor Expenses Once Bev Flrewarks Tells Arrive on Site 20% An 3 Party Vandor Experises Any request made by SPONSOR for reschoduiin 9kanceling shall be directed to help®bayfireworks.com or by phone (516) 233- 4132. R 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. Bift Bogardus. CELL PHONE: 31 _~J,` ! 7 (d- ,24m shall be designated as SPONSOR'S agent to whom all questions and Inquiries shag be relayed. Sponsor's agent shag be the only agent of SPONSOR authorized to make decisions on behalf of SPONSOR or to request rescheduling of the fireworks display an the part of SPONSOR. Plena in" aam papa Idut het: Spun p PE U.S. Mpanmcnt Pastern Service Center of Operations Support Group 1701 Columbia Ave. "1"rnnsportati0n C011c0e Park. NV-E2 GA 30337 February 18, 2014 Pyro Engineering, We received your letter regarding your proposed fireworks display for : I. Congers Fire Department 2014', 2. Hempstead Golf Club 2014, 3. North Sea FD 2014, 4. Star Hose Company 2014, 5. Village of Maybrook. Date: As per Fireworks Display Request Form Physical Locatin: As per Fireworks Display Request Form POC at ATC Facility: Steps to be taken by Firework Company: + Fireworks staff should remain vigilant to 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 notifications and 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. Please be sure to include on all future display request accurate locations or longitude and latitudes for display. If you have any questions ~concerning this event, please contact David Phillips at (404) 305-5574. Sincerer i~'G~~e r' 1,5~` rchae Manager Tactical Operations Team Eastern Service Area Air Traffic Organization CHIEF W MANWARING (631) 477.9801 - STATION 1 1vASS C F HARRY BREESE (631) 477.8261 - STATION 2 2W ASS, IEF WAYNE MILLER (631)477-1943-CHIEFS OFFICE (631) 477-4012 - FAX CHAPLAIN C. KUWIAN THIRD STREET • P.O. BOX 58 TREAS/SECRETARY J. KALIN GREENPORT, NY 11944 IMP Email: gfdfiregoptonline.net www.greenportfd.org Organized 1845 March 30, 2014 RECEIVED Town Clerk Elizabeth Neville APR 1 2014 Southold Town Hall 53095 Main Road Southold Town !'Ier1i Southold, NY 11971 Re: May 2014 Carnival Fireworks Dear Ms. Neville: The Board of Wardens of the Greenport Fire Department at a regular meeting in December 2013 approved the Star Hose Co. #3 request to hold a Carbival at the Polo Grounds on Mooreslane from May 22, 2014 to May 26th, 2014 with Fireworks to be held on May 24, 2014 at 10:00 pm, with a rain date of May 25, 2014 same time. Attached are copies of fireworks contract, permission letter from Greenport School allowing us to utilize property on their North Athletic Field, and the necessary insurance. If you wish to discuss this event with me or have any questions, please do not hesitate to contact me. I can be reached at 445-0204. Ree ull VAyde Manwaring Chief Greenport Fire Department P.ECEIVED GREENPORT PUBLIC SCHOOLS 720 Front Street Greenport NY 11944 APR 1 2014 APPLICATION FOR USE OF SCHOOL FACILITIES The Admmish'ation is responsible for the use of all school facilities in order that they 4i4yth"4Wxyptylerk request for such use, kindly complete the following. 1. Facilities Use Request ~ (Organization) ..n JAQ &.,f Ca. (c,Eg-s-Aw xr rp requests the use of No f IrN A is r IQ g [t at Greenport Public Schools for the purpose of K Ir W!, t'-r% bps P4 y on (date) SRt1r~4 r , ------*(time) 10 (?r1. Will activity be open to the publi Y a S Admission of N Ow will be charged, proceeds will be used for Does applicant agree to submit 5nancial records for examination upon requests? Yts Does applicant agree to conform to the regulations ofthe Board of Education and alf laws regulating to the use o school properly mclu¢m Section 414 printed an the reverse side of this application? ds wAS T =nwg 92s 4cc4A4k L9.rr ~vrduP.•rNy//0V 'Ed Name Address i Telephone k 4-I7.3-O q7 ofthe person responsible on this occasion. U. hLShasnce Information A cartificate of insurance of at least $1,000,000 public liability per occmreneo and 52,000,000 aggregate liability insurance and $50,000 property damage shall be submitted at least three days in advance of the event and must designate bath the using argmiZEAtim and the Greenpat Union Free School District with ISO endorsement t',02026. The absence of such a certificate will preclude on of the 18m*. The policy must contain a 30-day guarantee notice of cancens4aL The user agrees to indemnify the distant for any applicable deductiVes. HL Mas Governing Use ofF 7' Ira A. No smoking is allowed in the building or on the grounds. The organization using the fihcility, is responsible for enforcement B. No drinking of alcoholic beverages is permitted. C. Activity shall be restricted to that area for wtkich permission is granted. D. Activity shall not extend beyond hours approved by district E. Programs shall not Interfere will regular school schedule. F. Organization shall be responsible fir moving its equipment into and out ofthe buhldiq& G. The supervisor of the activity shall be present before it is due to start and remain widh the group until all have left. H. In the absence of admioisfts ive personnet the custodian is charged with the responsibility of the building I. School sudhoities must have free access to all moms at all times J. A cweU examination will be made after use of the area by the applicantwho will promptly make good on any loss or damaM which might have occurred. Ic No school property or equipment is to be altered or removed from the premises. L. Ibis license is revocable at any time by school authorities. K No reservation Will be made until this application is returned and approved by the district's Chief School Admmistator TV. Rental Fees Other Fees or Conditions: Auditorium for performance $100 Auditorium for practice $ 50 Gymnasium for performance $100 Gymnasium for practice $ 50 When an approved activity takes place outside the normal hours of school operation, the organization will be charged $40.00 per hour for personnel services for a minimum of 4 hours. This all must be paid seven days in advance and is not nfimdeble unless the district receives notification of cancellation at least 49 hours in advance. V. I agree on behalf of the above-mentioned organization that all members and guests will observe the regulations and that we, individually, and as an otgeoizotien, will assume all financial _-responsibility-fer=any and all4ismages-done-to the *aabove--_ indicated period of use. We also agree that our arganimtim will at all times hereafter indemnify . the above-named school against any lass, damage or expense of any kind, Which said school may sustain or incur because of the use of the above-mentioned building by our organization, and we firther will hold said school harmless for toes of any kind in connection herewith Sign Data: h ad Granted Denied Date Stiperioterhdent o s c Details of Use: EXCERPTS FROM SECTION 414 OF THE EDUCATION LAW "...The Board of Education of each district may...permit the use of the school house and roams therein, and the grounds and other property of the district, when not in use for school purposes, for any of the following purposes: 1. For the purpose of instruction in any branch of education, leamuhg or the arts. 2. For holding social, civic and recreational meetings and eotdlamments, and other issues pertaining to the welfare of the community; but such meetings, entertainment and uses shall be non-wiclusave and shall be open to the general public. 3. For meetings, entertainments and occasions where admission fete an charged, when the proceeds thereof are to be expended for an educational or clharitable'purpose, but such use shall not be permitted if such meetings, entertainments and occasions are under the exclusive control, and the said proceeds are to be applied for the benefit of society, association or organizations of veterans of the military, naval and marine service of the United States and organizations of volunteer firemen." Revised 9/1/2001 For Profit OreanizOm Auditorium $150 per hour = hour(s) X rate = Custodial $40 per hour Monday - Friday = hout(s) X rate = Custodial $60 per hour Saturday & Sunday = hour(s) X rate = Technical (sound & lights) $60 per hour = hour(s) X rate = This all must be paid seven days in advance and is not refundable unless the district receives notification of canceliationat least 48 hours.in advance, V. I agree on behalf of the above-mentioned organization that all members and guests will observe the regulations and that we, individually, and as an organization, will assume all financial responsibility for any and all damages done to the Greenport School property during the above- indicated period of use. We also agree that our organization will at all times hereafter indemnify the above-named school against any loss, damage or expense of any kind, which said school may sustain or Incur because of the use of the above-mentioned building by our organization, and we further will hold said school harmless for loss of a kind in connection herewith. Applicant Signed: Date: -41 Superintende Granted Denied Date:%~~y Specific Detal EXCERPTS 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 the grounds and other property of the district, when not in use for school purposes, for any of the following purposes: 1. For the purpose of instruction in any branch of education, learning or the arts. 2 For holding social, civic and recreational meetings and entertainments, and other issues pertaining to the welfare of the community; but such meetings, entertainment and uses shall be non- exclusive and shall be open to the general public 3 For meetings, entertainments and occasions where admission fees are charged, when the proceeds thereof are to be expended for an educational or charitable purpose, but such use shall not be permitted if such meetings, entertainments and occasions are under the exclusive control, and the said proceeds are to be applied for the benefit of society, association or organizations of veterans of the military, naval and marine service of the United States and organizations of volunteer firemen." ACORQ CERTIFICATE OF LIABILITY INSURANCE F01/14/2014 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 MEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES aELOW. THIS CERTIFICATE OF 04SURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: If the conliiola hoklm is an ADDITIONAL INSURED, the polay(im) met he endorse. S SUBROGATION IS WANED, rAjed to the terms and condltlore C<DIe poky. cerhdil poTides m" !agora m wldolswnwN. A stat meat m Ws omWm does Let mdw ripM®b the ewnnoste holder In flea of such m dorsemae(s): PRODUCER MAcowrp= INE: Joseph Cherepowich McNann Price Agency, Inc. 631.477.1680 1:631.477.8930 828 Front Street c jc.mcmianpricesharrptons-caw P.O. Box 2065 `D 00001901 cuarommo; Greenport, NY 11944-0876 INGURR" AROImwG COVERAGE NAICI msUREO OMOMRA: Arch Insurance Company Village of Greenport Fire Departm n# 1014 tea, PO BOX S8 INSURER C: Greenport, NY 11944-0058 r NBURERD: INSURER E• NIRa®!F: COVERAGES CERTIFICATE NU1d6ER: 011414DA - REVI81014 NUIMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD - INDICATED. NOTWITHSTANDING ANY.REQUIREMENI, TERM OR CONDITION OF-ANY CONTRACT OR OTHER-DOf.IAiENT WHH 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. INOR LTR TYPE OF INSURANCE tN18R WVD POLICY NLNIM POLICY OFF OCCURRENCE s 1,000,000 0E M; LYI8 ommmm GENERAL LIABILITY - 14EPK0672690 06101=113 0610112014 IC~OMRPMSINGLEUNFT X CONIERCW. GENERAL LIABILITY - s 100, fEm CIAWSWADE OOCCUR A,ya,spwwrq s S A X L&ADVIJRY s 1,000, AGORECATE $ 10,000, GENL AGGREGATE UNIT APPLES PER S-CU PAPAGO s 10,000, POLICY MO" Lac s 17 AUTOMOBILE LMMnY ANY AUTO (EN ealuNq s XLYINAI2Y(Psrpegl) S All SCHOWNED EDULED tfrot txN AUros tmDLY INAArr (Pw.oda.~q s aclEEO HIRED AUTOS p+pr DAMAGE )s RON-OWNED AUTOS s $ X UMWALLALNG OCCUR MEUM06473 06!01/2013 06/01/2014 EACH OCCURRENCE s 5,000,000 A EXCESS Lee CLAIAGAteDE AGGREGATE H s DEDUCTIBLE - s X RETENnO N S NI s WORIUM WINBWTION A AND w PLawmar LNMUfY YIN ANY IATOPPoE70RIPARTIERIEXECUTNEO ACCIDENT s OFPN:ERNB,6E+ExCLUD®Y NIA ELtJ1CH ACCDBi (NNbaNrY in mq ELDISEASE -EA Iw1PR E.L. OBEL9E-POLICY Lltef s DESCRWTM OF OPERATIONS I LOCATIONS I VEHICLES (nIAaI ACORD Iw, AddeaW R,mrte SeMaM, Ne,an ~P+a b npuV~Iq ith respect to Carnival from S/zz/14 to S/z6/14 CERTIFICATE HOLDER CANCELLATION FAX: 631.477.2164 SHOULD ANY OF THE ABOVE DFSCRmED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Greenport Union Free School District REM 720 Front Street G port, NY 11944-IS99 ® A CORPORATION. AN rights nerved. ACORD 25 (2008106) The ACORD name and RW are registered marks of ACORD fi~ RESOLUTION 2010-474 ~~v ADOPTED DOC ID: 6016 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2010474 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 29,2010: RESOLVED that the Town Board of the Town of Southold hereby adopts the followine POLICY reeardin¢ the issuance of fireworks permits: 1. The Town may grant a permit for the display of fireworks by municipalities, fair associations, amusement parks, 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: 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 discharge and minimum separation distances in accordance with the applicable requirements of Penal Law Section 405(2); (d) 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 Marshal 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. l Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Albert Krupski Jr., Councilman SECONDER: Vincent Orlando, Councilman AYES: Roland, Orlando, Talbot, Krupski Jr., Russell ASSENT: Louisa P. Evans Updated: 6/30/2010 10:43 AM by Lynda Rudder Page 2 * * * RECEIPT Date: 04/02/14 Receipt#: 166748 Quantity Transactions Reference Subtotal 1 Fireworks 5/24/14 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK #1309 $100.00 Star, Hose Company Co #3 Name: Star, Hose Company Co #3 Greenport Fire Department 240 6th Ave Greenport, NY 11944 Clerk ID: LINDAC Internal ID: 5124/14 * * * RECEIPT Date: 04102/14 Receipt#: 166748 Quantity Transactions Reference Subtotal 1 Fireworks 5/24/14 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK #1309 $100.00 Star, Hose Company Co #3 Name: Star, Hose Company Co #3 Greenport Fire Department 240 6th Ave Greenport, NY 11944 Clerk ID: LINDAC Internal ID: 5/24/14