HomeMy WebLinkAbout2014 o��S�FFO(,�co
ELIZABETH A. NEVILLE, MMC �� r/y Town Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
CZ
C* 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS p • Fax(631)765-6145
MARRIAGE OFFICER �� ��' Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER 0.( `1►a 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:
East End Seaport and Maritime Foundation
Third Street at the Ferry Dock,Greenport,New York 11944
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:OOPM,Saturday, August 30,2014(RAINDATE:I0:OOPM,Sunday,August 31,2014)
at Greenport High School Athletic Field, Front Street and Moore's Lane,Greenport, New York
11944;
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 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.
(Town Seal) Elizab A. Neville,Southold Town Clerk
Suffolk County, New York
Date: 8/27/2014
THIS PERMIT IS NOT TRANSFERABLE
RESOLUTION 2014-707
ADOPTED DOC ID: 10047
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2014-707 WAS
ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON
AUGUST 26, 2014:
RESOLVED that the Town Board of the Town of Southold hereby amends resolution#2014-
679, adopted at the August 12, 2014 regular Town Board meeting to read as follows:
RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a
fireworks permit by the Town Clerk to East End Seaport and Maritime Foundation, for a
fireworks display on Saturday, August 30, 2014 at 10:00 P.M. (Rain Date: August 31, 2014) at
the Greenport High School athletic field, Greenport, upon payment of a fee of$100 and subject
to the applicant's compliance with the requirements of the Town's policy regarding the issuance
of fireworks permits, as amended, and subject to the approval of the Town Attorney.
0�as4q.0404�&
Elizabeth A. Neville
Southold Town Clerk
RESULT: ADOPTED [UNANIMOUS]
MOVER: James Dinizio Jr, Councilman
SECONDER:Jill Doherty, Councilwoman
AYES: Ghosio, Dinizio Jr, Ruland, Doherty, Evans, Russell
Neville, Elizabeth
From: Neville, Elizabeth
Sent: Tuesday,August 26, 2014 10:54 PM
To: 'JMOddon@greenportvillage.org'
Cc: Rudder, Lynda
Subject: Emailing: East Seaport Maritime Fo_20140826214039
Attachments: East Seaport Maritime Fo_20140826214039.pdf
Importance: High
Hey Jeanmarie,
O000ps!! Delete that first e-mail. I sent you the Peconic Landing Fireworks Permit by mistake.
Here is the East End Seaport Maritime Foundation's Town Board Resolution and Fireworks Permit.
Betty Neville
Your message is ready to be sent with the following file or link attachments:
East Seaport Maritime Fo_20140826214039
Note:To protect against computer viruses,e-mail programs may prevent sending or receiving certain types of file
attachments. Check your e-mail security settings to determine how attachments are handled.
Neville, Elizabeth
From: Neville, Elizabeth
Sent: Tuesday,August 26, 201410:54 PM
To: 'JMOddon@greenportvillage.org'
Cc: Rudder, Lynda
Subject: Emailing: East Seaport Maritime Fo_20140826214039
Attachments: East Seaport Maritime Fo_20140826214039.pdf
Importance: High
Hey Jeanmarie,
O000ps!! Delete that first e-mail. I sent you the Peconic Landing Fireworks Permit by mistake.
Here is the East End Seaport Maritime Foundation's Town Board Resolution and Fireworks Permit.
Betty Neville
Your message is ready to be sent with the following file or link attachments:
East Seaport Maritime Fo_20140826214039
Note:To protect against computer viruses,e-mail programs may prevent sending or receiving certain types of file
attachments. Check your e-mail security settings to determine how attachments are handled.
i
00 01
FROM WAQ
A.M.
OF TIME P.M.
PHONE ❑ URGENT
AREA CODE NUMBER EXT.
❑ TELEPHONED ❑ CAME TO SEE YOU ❑ RETURNED YOUR CALL
� s
7€€kk
it,
N Board Meeting of August 12, 2014
IN 2014-679 Item # 5.6
'TED DOC ID: 10018
VING RESOLUTION NO. 2014-679 WAS
)F THE SOUTHOLD TOWN BOARD ON
if Southold hereby approves the issuance of a
nd Seaport and Maritime Foundation, for a
4 at 10:00 P.M. at the Greenport High
of a fee of$100 and subject to the applicant's
policy regarding the issuance of fireworks
of the Town Attorney.
A. Neville
'own Clerk
RESULT: ADOPTED [UNANIMOUS]
MOVER: James Dinizio Jr, Councilman
SECONDER:Louisa P. Evans, Justice %NrN
AYES: Dinizio Jr, Ruland, Doherty, Evans, Russell
ABSENT: Robert Ghosio
Generated August 14, 2014 Page 12
• ' f
ELIZABETH A. NEVILI.E,:&MC �\C2 Yv Town Hall,53095 Main Road
TOWN CLERK � P.O.Box 1179
Southold,New York 1,971
REGISTRAR OF VITAL STATISTICS ` Fax(631)766-6145
MARRIAGE OFFICER Telephone{631)765 1800
RECORDS OF MANAGEMENT OFFICER �./ '�� southol one(6 1)76 o 1 net
FREEDOM OF INFORMATION OFFICER
RECEIVED
1Y1a, An • 1(etn\•J h i 4{�J'lFFICD OF TTS TO VIN CLElUl-
Ave TOWN OFSOUTHOLD AUG - 1 2014
Gor
r np+ PERMIT TO DISPLAY FIREWORKS
Southold Town Clerk
APPLICATION IS IiEREBY 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 8E SPONSORED BY East End Seaport R. Maritime Foundation
PRINCIPAL OFFICE AT Third Street @ the Ferry Dock,_Greenport, NY 1.1944__
DATE& TIME OF DISPLAY _ 8/30/14 Time: 10:00 pm
FXk CT LOCATION-OF DISPLAY Greenport High School athletic field
SUFFOLK COUNTY TAX MAP NUMBER FOR SITE
RAIN DATE cox TI1KE30/14 @ 10:00 pm Rain date: 8/31/14
The following persons are to be in charge of the actual shooting of the fireworks:
Nance 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. Calces=6.
Manner and place of storage of fireworks prior to display:
Storage at Westhampton facility. Product delivered day o lsp
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 Pranerty Owner, must be submitted with the
Application.
East End Seaport & Maritime Foundation
FEE: $100 Name ofOrgarizatior.
See policy for additional information
By
Signature of Upplic�anl ���-
Date ofApplicati/on
�r,'""•a� RESOLUTION 2010-474
revADOPTED DOC ID: 6016
THIS IS TO CERTIFY:' THAT THE FOLLOWING RESOLUTION NO. 2010-474 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 following
POLICY regarding 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);
XA 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.
,eco d CERTIFICATE OF LIABILITY INSURANCE 10711712014
THIS CERMRrATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CENTFIGATE HOLDER.THIS
CERTFICIITE DOES NOT AFFIRMATNEL.Y OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES
BELOW. THIS CEtTTFr ATE OF MISURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUNG IINSURER(316 AUTHORIZED
REPRESgTTATNE OR PRODUCER,AND THE CERTIFICTE HOLDER.
IMPORTANT: Q the c I'll rA- holder is an ADDITIONAL.INSURW,the panh►(be)mast be endorsed. N SUBROGATION IS WANED,md*d to
Vw farms and candMiorrs of the palay.oertairr poiais racy n qWm an eudorawmnt A afatament on this c IMT, I doss not on d rights to the
-m lift efe ILolder In Neu Of such andarsmandloA
PRODUM Allied Spechft Insuranrx,Inc.
10461 Gtdf Bordelrard FM
Treasure isiand,FL 33706.4814
1402:17.3355 AuraCW*VPAW HMO
NNLNLBtA:T.H.E.btstNamx ConVanY 12866
aSURED Pyro Engineering,Inc. NISURERe:
dba:Bay Fireworks Nva:
NISURE lD
999 South Oyster Bay Rd.,Suite 111 ofox RH::
BeStpage,NY 11714 RnW
MF-
COVERAGES CERT94CATE NUMOM REVISION NWS
THIS IS TO CERWY THAT THE POLKAS OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAKED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWRHISTAHIOM ANY REST.TERM OR CONDITION OF MIY CONTRACT OR OTHER DOCUMENT 111TH RESPECT TO VWHICHH THIS
CERTIRQKTE MAY BE ISSUED OR MAY PERTAIN.THE eBINiANCE AFFORDED BY THE POLICIES DESCRIBED MEN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POS.LMYTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMIS.
N� TVPEOFNNNLANCE POLIt:YraNB®L LNa7a
A ""' ' N 000,000
CPP0101294-84 4M4 05MAI is O=W-m +cE t1,
X CeraMCIAL OEM R L LLL urY $100,000
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pmsowLaAD wmw $1,000.Q00
6ENEWLAaGRE6ATE $
6Bn.AL,RE"TEUWrMWUMPBt PROODUCrs-CorLP/OPAee $2,000,000
Poicy PRo- LAc $
Lur A ALLr°r10� upin 1f' CPPOID1284-84 4 WM40MS ,000.000
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RELENT ms $
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A AND e OVERVUAMLUY YIN 44166W 4n"s E.L.EACNAcaDENr ER $1,000.000
oTFLCF .M pi 161 MLUD®n
NIAJ E.LO -EADV $1,000,000
N ����OPFRATM]NS4.Mir E1.ONlEABE-POL1CYLeef 51.000000
A ExcEss uABNJT1fx)ccuR ELP0010296.04(GL) MM4 105M42"S JEAM OCCUR$11,aDoAN
AGGREGATE$11ANN000
DESCI!?LDNOFOPNRMLCNCILOCA7=nlVOYCIE$_ m-11AC0RDj*%A&MpwWft - 1 dwdul%r�ape lm4
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DATE:SSI30M4 RAMI DATE INIMM4 LOCATION:Gr*w*wt H e A9116 a FUtd,GreenportNY
RAL LIABILITY,THE FOLLOWING ARE NAMED AS ADDITIONAL MSD IN RESPECTS TO THE OPERATION OF THE NAMED INSURED
stEndSeaportSI- 'll Le Feumk m.VLMageefGriee*W%TownofSoudwKSepti#County; enGreportUFSD.
hvdess Agr*@nm*Par Cantr*d betwear the ruened insured and the addltia"kwAumd spp%&
CERTIFICATE HOLDER CANCELLAT10N
Thirty(30)Days Notice of Cancellation Applies.
East End Seaport 9.Nwith- Foundation SHOULD ANY OF THE ABOVE DESCRB®FIDIJ et BE CANCELLED NEFORE
Third Street Q the Ferry DOCK THE E>PNIATION DATE THEREOF. NaTICE YMJ- BE DBZA9= IN
ACCORDANCE VKM THE POLN:Y PROVISIONS.
Greenport NY 11044
AurR w /j
Cert#1735
0 11188 2010 ACOJO CORPORATION. AM rigfrts re:nrved.
ACORD 25[2010x00) The ACORD mane arrd Logo are regi m l 'norks of ACORD
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TIFICATIONS REQUiRED IN NYC
America's World Class Fireworks Leader Display Date:August 30, 2014
FIREWORKS DISPLAY AGREEMENT
AGREEMENT made May 30,2014 by and between Pyro Engineering, Inc., whose address is 999 South Oyster Bay Road,Suite
111, Bethpage, NY 11714 (hereinafter"PEI');and East End Seaport&Maritime Foundation,Third Street @the Ferry Dock,
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
hereinafter set forth;
NOW,THEREFORE,in consideration of the terms,conditions and covenants hereinafter set forth,the parties hereto do
mutually agree as follows:
1.FIREWORKS DISPLAY: On, August 30,2014 (hereinafter"the Display Date").PEI shall 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
shall be the sole fireworks supplier and producer for the event contracted for herein. (Note: The actual start and stop time of the
display will be determined by the governmental authorities having jurisdiction over the display).
ALTERNATE DATE: August 31, 2014
2. COST AND PAYMENTS:
FIREWORKS DISPLAY PRICE:
The total(Fireworks Display Pnce lus all other applicable charges)sum shall be due and payable as follows:
a.The sum of� Due and Payable on Night of August 30,2014
Please Note: SPONSOR is responsible for the payment of all governmental fees and taxes, including, but not limited to, sales,
use,excise,license,permit,entertainment,or other fees,taxes or surcharges Imposed or otherwise applied to this exhibition. Also,
please see Section 16(c)below.
3. POSTPONEMENT/RESCHEDULING:If the display of the fireworks is postponed/rescheduled by reason of inclement weather or by
determination by the governmental authority having jurisdiction,or for any other reason beyond the control of PEI,same shall be re-
scheduled to the Alternate Date set forth above. In the event a postponement/rescheduling 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.
Description I %of Fireworks Display Price Additional Costs
If notified by 12:01 AM on 08/29/14 1 5% Any 3rd P rty Vendor Expenses
If notified after 12:01 AM on 08/30/14 1 15% Any 31d Party Vendor Expenses
Once Bay Fireworks Techs Arrive on Site 20% 11 ny 31d Party Vendor Expenses
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 White CELL PHONE::
� T shall 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.
Plewa initial each page.
Initial here: /<«-)
Sponsor
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Eastern Service Center 1701 Columbia Ave.
U.S.Department Operations Support Group College Park,GA 30337
of Transportation AJV-E2
REQUEST FOR FIREWORKS DISPLAY
5/30/14
Company Name: Pyro Engineering- 999 South Oyster Rd, Suite 111 - Bethpage,NY 11714
Email Address of Person Requesting the Show: joannena bavfireworks.com
Event Name: Eastend Seaport Maritime Museum
Display Date: August 30,2014 Rain Date: August 31,2014
Display Start Time: 10 PM
Duration of Fireworks Display: 8 minutes
Max Height of Fireworks: 300 Feet
City or Town and State (Physical Address):
Greenport,NY
Latitude: 41-06-19 N(North) Longitude:072-22-20 W (West)
List the Closest Public Use Airport Within 25 Nautical Miles of the Display if the Fireworks
Will Reach or Exceed 500 Ft. :Mattituck Airport=10 miles
Location or Special Notes:
Greenport HS Athletic Field
Front St.&Moores Lane
Please email your request to:
9-ATO-ESA-OSG-firewo rks Ca)-faa.q ov
* * * RECEIPT * * *
Date: 08/01/14 Receipt#: 176027
Quantity Transactions Reference Subtotal
1 Fireworks 8/30/14 $100.00
Total Paid: $100.00
Notes:
Payment Type Amount Paid By
CK# $100.00 East, End Seaport& Marine
Fdn.
Name: East, End Seaport& Marine Fdn.
P.o. Box 624
Greenport, NY 11944
Clerk ID: LYNDAR Internal ID:8/30/14
Rudder, Lynda
From: Martin Finnegan Forward
Sent: Friday, August 01, 2014 11:49 AM
To: Rudder, Lynda
Subject: Re: Emailing:fireworks_20140801095536.pdf
Looks ok to me.
Sent from my Whone
> On Aug 1, 2014, at 10:56 AM, "Rudder, Lynda" <Ivnda.rudder@town.southold.nv.us>wrote:
> Please approve/disapprove the attached.
><fireworks_20140801095536.pdf>
1
Rudder, Lynda
From: Flatley, Martin
Sent: Friday, August 01, 2014 12:29 PM
To: Rudder, Lynda; Doroski, Melanie; Finnegan, Martin; Fisher, Robert; Kiely, Stephen;
Kruszeski, Frank; Spiro, Melissa
Subject: RE: Emailing: fireworks_20140801095536.pdf
I have no objections to this fireworks display taking place.
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: Friday, August 01, 2014 10:57 AM
To: Doroski, Melanie; Finnegan, Martin; Fisher, Robert; Flatley, Martin; Kiely, Stephen; Kruszeski, Frank; Spiro, Melissa
Subject: Emailing:fireworks_20140801095536.pdf
Please approve/disapprove the attached.
1
Rudder, Lynda
From: Doroski, Melanie
Sent: Friday, August 01, 2014 1:25 PM
To: Rudder, Lynda; Finnegan, Martin; Fisher, Robert; Flatley, Martin; Kiely, Stephen;
Kruszeski, Frank; Spiro, Melissa
Subject: RE: Emailing:fireworks_20140801095536.pdf
I have reviewed the applications for Fireworks Permits for:
East End Seaport & Maritime Foundation 8/30/14 (RD 8/31/14), at the Greenport High School Athletic Field.
Greenport School is not Town of Southold preserved land.
Since this is not preserved land, the LPC has no comment on this application.
-----Original Message-----
From: Rudder, Lynda
Sent: Friday, August 01, 2014 10:57 AM
To: Doroski, Melanie; Finnegan, Martin; Fisher, Robert; Flatley, Martin; Kiely, Stephen; Kruszeski, Frank; Spiro, Melissa
Subject: Emailing: fireworks_20140801095536.pdf
Please approve/disapprove the attached.
1
CHIEF HARRY BREESE (631)477-9801 STATION 1
1sT ASST.CHIEF WAYNE MILLER (631)477-8261 STATION 2
2ND ASST.CHIEFJEFFREY L.WEINGART (631)477-1943-CHIEFS OFFICE
CHAPLAIN C. KUMJIAN (631)477-4012-FAX
TREAS/SECRETARY J. KALIN THIRD STREET• P.O. BOX 58
GREENPORT, NY 11944
Email:gfdfire@optonline.net
I t www.greenportfd.org
Organized 1845 RECEIVED
AUG - 4 2014
Southold Town Clerk
August 2, 2014
To whom it may concern;
The Greenport Fire Department is aware that the East
End Seaport & Marine Foundation will be holding a
fireworks display on Saturday, August 30" with a rain date
of Sunday, August 315 at 10:00 pm in conjunction with their
carnival fundraiser. We will have apparatus on hand to
stand by during this event.
Res ectfully yours;
G�
Harry Breese
Chief of Department
" - GREENPORT UFSDg '`� J
� a
RECEIVED 720 Front Street J41-1
P J
Greenport, NY 11944 / �/ 1�
AUG - 4 2014 APPLICATION FOR USE'OF SCHOOL FACILITIES
S0uARi!dr@*n is responsible for the use of all school facilities in order that they may consider your
request for such use, kindly complete the following:
1. Facilities Use Request: (Organization), �14GG�reennort
requests
the use of�� �� Public Schools for the purpose of:
.SAgai fe
on(date), o.' a u ' / at(time)
Will activity be open to the public? (Circle one) Yes. No
Is this a For Profit Organization?(Circle one) Yes (00
Admission of A-10 A f C /� will be charged; proceeds will be used for
L e � Zt'/►l�i,4„� ,�L(C,
Does applicant agree to submit financial records for examination upon requests? .E
Does applicant agree to conform to the regulations of the Board of Education and all laws regulating to
the use of school property including Section 414 printed on the reverse side of this application? 50',e.V
Name : �1 �. 1J,!/rl eef /���� Address: Zgf a c�!
Telephone#
of the person responsible on this occasion.
II. Insurance Information
A certificate of insurance of at least$1,000,000 public liability per occurrence and$2,000,000 aggregate
liability insurance and$50,000 property damage shall be submitted at least three days in advance of the
event and must designate both the using organization and the Greenport Union Free School District with
ISO endorsement CG2026.The absence of such a certificate will preclude use of the facility.
The policy must contain a 30-day guarantee notice of cancellation.The user agrees to indemnify the
district for any applicable deductibles.
III. Rules Governing Use of Facilities
A. No smoking is allowed in the building or on the grounds.The organization using the facility is
responsible for enforcement.
For Profit Organization
Auditorium $150 per hour= hour(s)X rate=
Custodial $40 per hour Monday—Friday=hour(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 cancellation at 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 any kind in connection herewith.
Applicant Signed: Date:.
Superintende t: Grante De,.ied Date:
Specific 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 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."