The URL can be used to link to this page

Home My WebLink About2014 o�os�FFo�,�oo ELIZABETH A.NEVILLE,MMC �� Gy Town Hall,53095 Main Road TOWN CLERKp P.O. Box 1179 CA Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 5 .F Fax(631)765-6145 MARRIAGE OFFICERy RECORDS MANAGEMENT OFFICER �� a0 Telephone 765-1800 www.southoldtldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD July 16, 2014 Cheryl Kraft C hief Fire Marshal Town of Southampton 18 Jackson Ave Ilampton Bays, NY 11946 Dear Ms. Kraft: This is shall serve as confirmation that the ']'own of Southold Police Department is aware and approves of Pyro Engineering d/b/a Bay Fireworks using a private loading location at 380 1" Street, New Suffolk from July 31, 2014 through August 2, 2014. A certificate of insurance has been tiled with the 'Town Clerk's office. If you have any questions or concerns please feel free to contact me. Sincerely, U�rn Lynda M Rudder Deputy Town Clerk Rudder, Lynda From: Jo-Anne Triolo <joanne@bayfireworks.com> Sent: Wednesday, July 16, 2014 8:58 AM To: Rudder, Lynda Subject: Re: FW: Sebonack GC fireworks display loading insurance certificate Thank you Lynda, FM Cheryl Kraft's email is ckraftAsouthamptontownny.gov. If you could please "cc" me as well I'd greatly appreciate it. Sincerely, Jo-Anne On Tue, Jul 15, 2014 at 5:08 PM, Rudder, Lynda<lynda.rudder cr,town.southold.ny.us> wrote: you are good to go. If you forward me Ms. Kraft email, I will type up something formal and send it to her and cc you. From: Flatley, Martin Sent: Tuesday, July 15, 2014 4:39 PM To: Rudder, Lynda Subject: Re: Sebonack GC fireworks display loading insurance certificate This is fine with me Lyn, they have been using this site safely for several years Sent from my iPad, Chief M. Flatley > On Jul 15, 2014, at 3:35 PM, "Rudder, Lynda" <lynda.rudderna town.southold.nus> wrote: > Does this work for you? > From: Jo-Anne Triolo [mailto:joanneabaytireworks.com] > Sent: Tuesday, July 15, 2014 3:33 PM > To: Rudder, Lynda > Subject: Re: Sebonack GC fireworks display loading insurance certificate > Hi Lynda, > Sorry to bother you again...Can you please confirm notice of the barge loading activity at the Belvedere Property Management location. FM Cheryl Kraft with the Town of Southampton is looking for confirmation, from your office that you are aware of the loading activity. I am going to contact the local FD as well and let them know. > I've attached a copy of the loading location site map and the letter of permission to do so. i > Thank you. > Sincerely, > Jo-Anne > On Tue, Jul 15, 2014 at 3:10 PM, Rudder, Lynda <Lynda.rudder(cr7town.southold.n�us<maiIto:lynda.rudderntown.southold.ny•us» wrote: > Thank you > From: Jo-Anne Triolo [mai Ito:Joanne2bayfireworks.com<mailto:joanne m,bayfireworks.com>] > Sent: Tuesday, July 15, 2014 2:14 PM > To: Rudder, Lynda > Subject: Fwd: Sebonack GC fireworks display loading insurance certificate > Hi Lynda, > Just forwarding this info for your records....thank you. > Sincerely, > Jo-Anne > ---------- Forwarded message ---------- > From: Jo-Anne Triolo <joannenbayfireworks.com<maiIto:joanne2bayfireworks.com>> > Date: Fri, Jul 11, 2014 at 12:09 PM > Subject: Sebonack GC fireworks display loading insurance certificate > To: "Cooper, Linda" <Linda.Cooperktown.southold.ny.us<mailto:Linda.Cooper2town.southold.ny.us>> > Good afternoon Linda, > As in years past Pyro Engineering Inc. dba Bay Fireworks will be using a private loading location at 380 1st Street in New Suffolk for the load in and load out dates of 7/31/14 -8/2/14.. I've attached a copy of the insurance which names the Town of Southold as additional insured. > Please confirm receipt of the insurance certificate and that we are good to go as far as the Town's acknowledgement of this activity (no permit needed). > Thank you very much. > Sincerely, > Jo-Anne > Jo-Anne Triolo > New address and phone number: > Pyro Engineering Inc. dba Bay Fireworks > 999 South Oyster Bay Road, Suite 111 > Bethpage, NY 11714 2 > 516-597-5500<tel:516-597-5500> Phone > 516-597-5507<tel:516-597-5507> Fax > Jo-Anne Triolo >New address and phone number: > Pyro Engineering Inc. dba Bay Fireworks > 999 South Oyster Bay Road, Suite 111 > Bethpage, NY 11714 > 516-597-5500<te1:516-597-5500> Phone > 516-597-5507<tel:516-597-5507> Fax > Jo-Anne Triolo > New address and phone number: > Pyro Engineering Inc. dba Bay Fireworks > 999 South Oyster Bay Road, Suite 111 > Bethpage, NY 11714 > 516-597-5500 Phone > 516-597-5507 Fax > <New Suffolk loading location 8-1-14.pdf> Jo Anne Triolo New address andThone number: Pyro Engineering hm.dha&ry Fireworks 999 South Orster Ba r Road,Suite 111 Bethpage,NY 11714 516-597-5.500 Phone 516-597-5507 Fax 3 A11%. R ® CERTIFICATE OF LIABILITY INSURANCE 07/11/2014mm 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(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 certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCERCONTACT Allied Specialty Insurance,Inc. NAME: AX 10451 Gulf Boulevard AJPHONE c ..... _. ___...._. LceJ. Treasure Island,FL 33706-4814 Qgss_ 1.800-237-33$$ - _,.,-.___- __. INSURERS)AFFORDING COVERAGE ___ __—_ NAIC k INSURERA:,T-H-E„Insura_nc_e_ Company 12866 INSURED Pyro Engineering, Inc. INSURER B-- dba: Bay Fireworks INSURER c;__. _.__._ ................__ INSURER D:--— — . .... 999 South Oyster Bay Rd.,Suite 111 —....--- ......... . - — - INSURER E: Bethpage, NY 11714 IN F: 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. T INSR TYPE OF INSURANCE..-... .. lAl)OL'ISITt3 .".. '-_........___--- ....-..............- 10 IF” POLICY LTR POLICY NUMBER M D DIV V LIMITS A GENERAL LIABILITY ! EACH OCCURRENCEI�1, 000 I CPP0101284-040511412014 105114/2015 0 �y - —+ - 1 X COMMERCIAL GENERAL LIABILITY ! �$Elsdt.$.�$tEtL.GSILpAS41 T s.100�01]0 ! CLAIMS-MADE X OCCUR ! MED EXP(Ann one peraon__�$ _ [PERSONAL&ADV INJURY 'trs1,000,000 ! GENERAL AGGREGATE I GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOP AGG $2,6 00,000 PRO• —_.. ......... .....- .. .�......, _.. POLICY LOC I $ A AUTOMOBILE LIABILITY ! COMBINED SINGLE LIMIT 1,000,000 CPP0101284-04 05/14/2014 105/14/2015 McOriliAlIntL. .,_$ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURYPer accident; AUTOS X AUTOS i ( ) $ X HIRED AUTOS X. NON-OWNED PROPERTY DAMAGEAUTOS S _i�cJ4ent) 3 A UMBRELLA LIAR X j OCCUR ! s4,000,000 I ELP0010292-04(VL) 05/14/2014 05/14/2015 :EACH OCCURRENCE_— _ X EXCESS LIAR i CLAIMS-MADE; `• I ,AGGREGATE $4,000 OQO DED RETENTION ! $ A WORKERS COMPENSATION ! j WC STATIM 0TH• AND EMPLOYERS'LIABILITY YIN I WC144166I 05/14/2014 05/1412015 --I4RY_Lltd¢5.........__ER ANY PROPRIETORIPARTNEWEXECUTIVE EL.EACH ACCIDENT $1,000000 OFFICER/MEMBER EXCLUDED? El NIA �� j i .....,. -...... ,- Mandatory In 11 yes.describe under E L DIS....E—A..S.E EA EMPLOY_ . 000,000 _!:_ �. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 E 1,0001000 ..,_._._ A EXCESS LIABILITY/OCCUR IELP0010296-04(GL) 105/14/2014 05/14/2015 !EACH OCCURRENCE$9,000,000 AGGREGATE$9,000,000 i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 191,Additional Remarks Schedule,If more specs is required) Date: 07131/2014.08102/2014 Rain Date: 08/08/2014 Location:New Suffolk,Southold,NY RE:General Liability,the following are named as additional Insured In respects to the operations of the named Insured only:Belvedere Property Management,LLC;Robins Island Holdings,LLC and their Respective Owners;Town of Southold,NY and their respective owners,officers,directors, members,employees,agents,volunteers or other representatives,successors and assigns Hold Harmless agreement per contract between the named Insured and the additional Insured applies CERTIFICATE HOLDER CANCELLATION Belvedere Property Management,LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1251 Avenue of the Americas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 17th Floor ACCORDANCE WITH THE POLICY PROVISIONS, New York,NY 10020 AUTHORItED EPRESENTAT 4 Cert#1629C /// ©1988-2010 ACORb CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD FIREWORKS DISPLAY HOLD HARMLESS AGREEMENT Between Belvedere Property Management, LLC, Robins Island Holdings, LLC and their Respective Owners and PYRO ENGINEERING, INC. (Contractor) WITNESSETH: 1. PYRO ENGINEERING, INC. (Contractor) agrees to indemnify and hold harmless Belvedere Property Management, LLC,Robins Island Holdings, LLC and their Respective Owners from and against any loss, damage or liability, including reasonable attorney's fees and expenses incurred by the latter entities and their respective employees,agents,volunteers or other representatives arising out of the installation, firing or disassembly of pyrotechnic equipment or device and/or the supervision and presentation thereof. 2. The applicant has furnished the Certificate of Insurance with limits of liability described below: Workers Compensation/Employers Liability: $1,000.000 per occurrence. General Liability: $1,000,000 per occurrence Automobile Liability: $1,000,000 Umbrella/Excess Liability: $9,000,000 per occurrence A true copy of the Certificate of Insurance is attached indicating the member entity and applicable associations,recreations or committees formed by the member entity to organize the"event"must be named as additional insured on all liability policies. 3. The facilities will be used for the following purpose and no other: EVENT: Fireworks loading location DATES: 7/31/14 - 8-2-14 Dated 7 o hy Signed (Contractor) Witness: RIDER Contractor hereby releases, discharges and promises not to sue Belvedere Property Management, LLC, Robins Island Holdings, LLC, including their respective owners, officers, directors, members, employees, agents, volunteers or other representatives, successors and assigns, including, the owners estate, executors, administrators and legal representatives (collectively, the "Owners") from any and all causes of action, claims, demand, liabilities, judgments, losses, damages, injuries, costs or expenses of every kind that relate to personal injuries or property damage arising out of or in any manner relating to the manufacture, installation, firing or disassembly of any pyrotechnic equipment or device and/or the supervision and presentation thereof. It is my intention to release all claims against the Owners, whether now existing or arising in the future and whether for compensatory or punitive damages. Contractor hereby agrees to indemnify and hold harmless the Owners from and against any claims, including cost of litigation, attorney fees and reasonable expenses in connection therewith that may be brought against the Owners by me, on my behalf, or otherwise relating to me in connection the manufacture, installation, firing or disassembly of any pyrotechnic equipment or device and/or the supervision and presentation thereof. Event: Fireworks loading location Dates: 7/31/14-8/2/14 Dated: Signed- (Contractor) Witness: 999 South Oyster Bay Road 9 Suite 111 Bethpage, NY 11714 T: 516.597.5500 • F: 516.597.5507 E N G I N E E R I N G www.peifx.com www.bayfireworks.com World Class Productions RECEIVED FAX: 631-765-6145 J U L 1 4 2014 [j[sle, Avrilr Date: 7/11/14 p,5- Southold Town Clerk Office of the Town Clerk Town of Southold Ull`9 s 0.rpin(��Pesvi Town Hall 53095 Main Road Southold,NY 11971 Dear Linda, Major Sporting Events The Sebonack Golf Club is holding their annual fireworks display on August 1"in the Town of Southampton,but the loading of the barge will be at a private dock in the Town of Southold just as we did last year. I'm enclosing an insurance certificate naming the Town of Southold as additional insured. IVIajor league baseh.-Al U's.01villpir calnlitlez If you require any further information please let me know. '.aliunal Footbail Im.,ip Thank you. fftici [eaq je Basehah PGA'L11CP ,,00dwA Ga r-;s Sincerely, Concert Tours-Close Proximity Jo-Anne Triolo Ultra Music lest Mau Electric Katy FP l, One oireCllo; Ahte Cooper Swed,3h Horse S!;,owm SlEge,cancul" lleatrlcai Enlits NATIONAL: 800.606-3716 //NY CT PA IVID VA SC GA FL TX NV CA ,ace CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 110.� 07/11/2014 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). ACT PRODUCER Allied Specialty Insurance,Inc. -NAME: 10451 Gulf Boulevard PHONE FAX --- A/C No, Treasure Island, FL 33706-4814 ADDRIESS: 1-800-237-3355 INSURERS AFFORDING COVERAGE _T NAIC# INSURER A:T.H.E.Insurance Com an 12866 INSURED Pyre Engineering, Inc. INSURER 9: dba: Bay Fireworks INSURERC___ 999 South Oyster Bay Rd., Suite 111 INSURER 0: INSURER E: Bethpage, NY 11714 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ]AD-,-OL UBR POLICY EFF POLICY EXP - ----- LTRPOLICY NUMBER MMIOD MM/DD/YYYYI LIMITS A GENERAL LIABILITY EACH OCCURRENCE $1,00_0,0_00 CPP0101284-04 05/14/2014 05/14/2015 DAMA ETO ENTED — --- X COMMERCIAL GENERAL LIABILITY PRE ISES(Ea occurrence) $100,000___ CLAIMS-MADE a OCCUR MED EXP(Any one person) $ PERSONAL BADV INJURY $1,000,000 ----_-_-- -_—__-- -- GENERAL AGGREGATE $ - I GEN-L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 - POLICY 1 -11 PRO- LOC - a ------ ------ A AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT 1 000 CPP0101284-04 ;05/14/2014 105/14/2015 caident)____ __._ r O 00 Eaa ANY AUTO j 1 BODILY INJURY(Per person) 1$ 1 �------ -.. __ ----- -- _ -- ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS .)(. AUTOS ( )� --- - X HIRED AUTOS X gUOT SWNED ! PROPERTY DAMAGE 3 i- (Per accident)____ $ ITO A i UMBRELLA LIAB X OCCUR X' EXCESS LIAR ELP0010292-04(VL) 05/14/2014 05/14/2015 EACH OCCURRENCE $4,000,000 �-—T _ CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ A WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N WC144166 05/14/2014 05/14/2015 ----- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000 000 OFFICER/MEMBER EXCLUDED? ❑ N/A _ _ , (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $1 x000,000 If yes,describe under -__ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A EXCESS LIABILITY/OCCUR ELP0010296-04(GL) 05/14/2014 05/14/2015 EACH OCCURRENCE$9,000,000 AGGREGATE$9,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) Date: 07/31/2014-08/02/2014 Rain Date: 08/08/2014 Location:New Suffolk,Southold,NY RE:General Liability,the following are named as additional Insured in respects to the operations of the named Insured only:Belvedere Property Management,LLC;Robins Island Holdings,LLC and their Respective Owners;Town of Southold,NY and their respective owners,officers,directors, members,employees,agents,volunteers or other representatives,successors and assigns Hold Harmless agreement per contract between the named Insured and the additional Insured applies CERTIFICATE HOLDER CANCELLATION Belvedere Property Management,LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1251 Avenue of the Americas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 17th Floor ACCORDANCE WITH THE POLICY PROVISIONS. New York, NY 10020 AUTHO ED PRESENTAT, Cert#1629C / J ©1988-2010 ACOCORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD RD