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ELIZABETH A. NEVILLE,M[M[C Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Bill Duffy,Town Attorney Chief Flatley, Southold Town Police Department Robert Fisher, Fire Inspector Melissa Spiro, Land Preservation From: Elizabeth A. Neville Town Cle Dated: June 7, 2016 Re: Fireworks Application of Greenport Fire Department Phoenix Hook& Ladder Company Transmitted herewith are two(2) applications for Fireworks Permits for Greenport Fire Department Phoenix Hood & Ladder Company for July 2 &4, 2016. Please advise if you have any objections to a permit being issued. Thank you. * Applicant is in the process of obtaining the letter of approval from the Chief of the Greenport Fire Department. ELIZABETH A. NEVILLE,MMC pyo �y Town Hall,53095 Main Road TOWN CLERK - P.O. Box 1179 c/s Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 1-2 . Fax(631)765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER �� �, Telephone(631)7 www.southoldtownny.gov nny.go0 gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT For PUBLIC DISPLAY OF FIREWORKS I,ELIZABETH A.NEVILLE,Town Clerk of the Town of Southold, Suffolk County,New York,being an officer duly designated by the Town Board of the Town of Southold for this purpose,do hereby GRANT TO: GREENPORT FIRE DEPARTMENT PHOENIX HOOK&LADDER CO.#1 and RELIEF HOSE CO.#2 3RD STREET,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 10:00 PM on Saturday,July 2,2016 (Rain Date: 10:00PM,Sunday,July 3,2016))on the property of GREENPORT HIGH SCHOOL Athletic Field, north side Front Streel 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. -- -- -- — ` --- ------ Elizabe .Neville,Southold Town Clerk Su o1k County,hTew York (Town Seal) Date: June 17,2016 THIS PERMIT IS NOT TRANSFERABLE I * * * RECEIPT * * * Date: 06/06/16 Receipt#: 206651 Quantity Transactions Reference Subtotal 2 Fireworks 7/2&7/4/16 $200.00 Total Paid: $200.00 Notes: Payment Type Amount Paid By CK#2102 $200.00 Phenix, Hook & Ladder Co Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Phenix, Hook & Ladder Co Po Box 58 Third Street Greenport, N Y 11944 Clerk ID: BONNIED Internal ID:7/2&7/4/16 SOW ELIZABETH A.NEVILLE,MMC Torn flail,53095 Main Road TOWN CLERK co P.O.Box 1179 to 2e Southold,N'e%v York 11971 REGNSTRAR OF),WAL STATISTICS %X-- Fax(631)705-614RECEIVED MARRIAGE OFFICER Telephone(631)765-1800 southoldtownmortbfi I FREEDOM OF INFORAIATION OFFICER 6 2! RFCOIZDS OF IMANIAGEME NT OFFICER tg OFFICE OF THE TOWN CLERK TOWN OF SOUTI-IOLD Southold To Clerk APPLICATION PERMH'TO DISPLAY F114E W01,ZKS APPLICATION IS HEREBY MADE, pursuant to the provisibns of Section 405.00 of the Penal Law of the State 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' 7/2/2016 @=PM____jD DQ EXACT LOCATION OF DISPLAVGreenport High School Athletic Field. SUFFOLK COUNTY TAX MAP NUIVIBE�TO�SITE IZAIN DATE&TIME The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Joseph Caipatizano 47 10+Years Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Approximately(43 4) 3 5"Aerial Shells&(890)Cakes. ................. 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. 1 . nizati p)�'4 e-16 a of Orga i FEE; $100 =- , io See policy for additional information Ry Signature ure of Ap ant —Aiat( ---Application— ® CERTIFICATE OF LIABILITY INSURANCE DATE011'6 DD/YYYY) ACOR,U 4/4/2016 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). PRODUCER CONTACT NAME: Britton Gallagher a/ON a Ext:21 - -710 (FAA/X,No): 1 -6 -71 1 One Cleveland Center, Floor 30 E-MAIL 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A-.Axis SurplusIns Company INSURED INSURER B:Everest National In ran e Company 10120 Legion Fireworks Co., Inc. INSURER C: 10 Legion Lane INSURER D: Wappingers Falls NY 12590 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1362048383 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR D POLICY NUMBER MM/DD/YYW MM/DD/YYYY B GENERAL LIABILITY S18ML00116-161 3/15/2016 3/15/2017 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 _ CLAIMS-MADE a OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- LOC $JECT B AUTOMOBILE LIABILITYIMIT S18CA00058-161 3/15/2016 3/15/2017 Ea accident L $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ A UMBRELLA LIAB X OCCUR EAU731294 3/15/2016 3/15/2017 EACH OCCURRENCE $4,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N T RY LIMIT ER 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 below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Date of Display: 7/2/2016. 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 C.— @ 1988-201 _©1988-2010 ACORD CORPORATION. All rights reserved. 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Chapter 40) a€e nar�auirsmtalrmtrt In accordance with the provisions of Title XI,Organized Crime Control Act of 1970,and the regulations issued thereunder(27 CFR Part 555),you may engage in the activity specified in this license or permit within the limitations of Chapter 40,Title 18,United States Code and the regulations issued thereunder,until the expiration date shown. THIS LICENSE IS NOT TRANSFERABLE UNDER 27 CFR 555.53. See"WARNINGS"and"NOTICES"on reverse. Direct ATF ATF-Chief,FELC Lieensespermit p Correspondence To 244 Needy Road Number • 0 Martinsburg,WV 25405-9431 Chief,Federal �Explosivesie�Licen/sing,Center(F EL Expiration�s�'C �• ��� Date 2 MOO I 41)o Name LEGION FIREWORKS CO INC Premises Address(Changes?Notify the FELL at least 10 days before the moue.) 10 LEGION LANE WAPPINGERS FALLS,NY 12590- Type of License or Permit 20-MANUFACTURER OF EXPLOSIVES Purchasing Certification Statement Mailing Address(Changes? Notify the FELL of any changes.) Ilse licensee or permittee named above shall use a copy of this license or permit to assist a transferor of explosives to verify the identity and the licensed status ofthe licensee or permittee as provided by 27 CFR Pati 555. The sigu attire on each cony must be an original LEGION FIREWORKS CO INC signature.atur_e. A faxed,scanned or e-mailed copy ofthe license or permit with a signature untended to be an original signature is acceptable. The signature must he that ofthe Federal 10 LEGION LANE Explosives Licensee(FEL)or a responsible person ofthe FEL. I certify that this is atrue WAPPINGERS FALLS, NY 12590- copy of a license or pennit issued to the licensee or permittee named above to engage in the business or operations specified above under"Type of License or Permit." �.� 5< � s President Licensee'Permittee Responsible Person Signature Positiotu'Title Frank M. Coluccio — Printed Name Date ;a'1z'r-orn,540,0.14;_4.1,,15 rat 1 Previous Edition is Obsolete LmtoN nREPoORXSCOWCtOLM04 IAR'E115MY-07-20�9tb359]:Mxieht,Z0192GIddNUFnCTURER OF EXPLOSIVES Revised October 2011 Federal Explosives License(FEL)Customer Set-vice Information Federal Explosives Licensing Center(FELC) Toll-free Telephone Number: (877)283-3352 ATF Homepage:www.atf.gov 244 Needy Road Fax Number: (304)616-4401 Martinsburg,WV 25405-9431 E-mail: FELC(datf.gov Change of Address (27CFR 555.54(a)(1)). Licensees or permittees may during the terns of their current license or permit remove their business or operations to a new location at which they intend regularly to carry on such business or operations. The licensee or permittee is required to give notification ofthe new location ofthe business or operations not less than 10 days prior to such removal with the Chief;Federal Explosives Licensing Center. The license or permit will be valid for the remainder ofthe tern ofthe original license or permit. (The Chief,FELC,shall,if the licensee or permittee is not qualified,refer die request for amended license 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 can,,on the same explosive materials business or operations at the same address shown on,and for the remainder ofthe term of,a current license or permit. Such persons are: (I)The surviving spouse or child,or executor,administrator,or other legal representative of a deceased licensee or permittee;and(2)A receiver or trustee in bankruptcy,or an assignee for benefit of creditors. (b)In order to secure the right provided by this section,the person or persons continuing the business or operations shall furnish the license or permit for for that business or operations for endorsement of such succession to the Chief,FELC,within 30 days from the date on which the successor begins to cam]on the business or operations. (Continued on reverse side) Cut Here' Federal Explosives LieenselPetmit(FEL)Information Card I License/Permit Name:LEGION FIREWORKS CO INC 1 1 I I 1 Business Name: I 1 I Lieense?Permit:Number:6-NY-,027-20-9C-00077 1 I Lieense,Permit Type:20-MANUFACTURER"OF EXPLOSIVES I 1 Expiration: March 1,2019 I I I Please Note: Not Valid for the Sale or Other Disposition of Explosives. I ------------------------------------ STATE OF NEW YORK � N , � DIVISION OF DEPARTMENT OF LABOR �, �S. � SAFETY AND HEALTH LICENSE TO DEAL IN OR MANUFACTURE EXPLOSIVES Expires: 4/30/2017 Legion Fireworks Co., Inc. 1'0 Legion Lane THIS LICENSE MIDST BE Wappingers Falls, NY 12590 POSTED IN YOUR PLACE OF BUSINESS Frank Coluccio License No -231 is hereby licensed to deal in or manufacture explosives in compliance with the requirements of the Labor Law and 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 COMMISSIONER 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) ELIZABETH A.NEVILLE,MMC -Town Ball,i3<3095 Main Road TOWN CLERK P.O.Box 1179 2e Southold,Nev.,York 11.a7l REGISTRAR OF',WAL STATISTICS Fax(631)765-61AECEIVED NLAIMIAGE OFFICER Telephone(631)765-1800q RECORDS OF N11ANAGEMENTIT OFFICER southoldtown.nortl net FREED02M OF INFORMATION OFFICER ft 6 OFFICE OF THE TOWN CLERK Southold Town TOWN OF SOUTHOLD APPLICATION PE'RMITTO 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: Relief Ho se DISPLAY IS TO BE SPONSORED BY Phenix Hook & Ladder Co. #1 & Co. #2. PRINCIPAL OFFICE AT 3rd Street Greenport, NY 11944 DA:rE&TIME OF*DISPLAY' 7/4/2016 (i�Elpm 10 . 00 ?- EXACT LOCATION OF DISPLAVGreenport High School Athletic Field. SUFFOLK COUNTY TAX MAP NUMBER FOR ITE RAIN DATE&TIN, JE TBD @ 0 PM The following persons are to be in charge of the actual shooting of the fireivorks: Name Age Experience Physical Condition Joseph Caipanzano 47 10-4-Years Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Approximately(374)3"-5"Aerial Shells&(780)Cakes. 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 besubmitted with the Application, -'e, 6� V- 1-11 A ce X FEE, $100 lV fo �o, rganiza ion See policy for additional information — -, . --on L By , I -- ---�Ln-' Signature t, Si nature o App Date of Application AcoEro® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/4/2016 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). PRODUCER CONTACT NAME: Britton GallagherPHONE FAX One Cleveland Center, Floor 30 a AIL E>d:216- 8-71 ac No:2 - -7 1 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A Axis SurplusIns Company 26620 INSURED INSURER B:EV r t National Insurance Company 0120 Legion Fireworks Co., Inc. INSURER C: 10 Legion Lane Wappingers Falls NY 12590 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:694477824 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 ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS B GENERAL LIABILITY S18ML00116-161 3/15/2016 3/15/2017 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO REN ED PREMISES Ea occurrence) $500,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X 1jECT F-]PRO- LOC $ B AUTOMOBILE LIABILITY S18CA00058-161 3/15/2016 3/15/2017 COMBINED SINGLE= 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 HIRED AUTOS X AUTOS Per accident A UMBRELLA UAB X OCCUR EAU731294 3/15/2016 3/15/2017 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY - -R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Date of Display: 7/4/2016. 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 25(2010/05) The ACORD name and logo are registered marks of ACORD U.S.Department of Justice Federal Explosives License/Permit Bureau of Alcohol,Tobacco,Firearms and Explosives (I8 U.S.C. Chapter 40) ctietr®rnitar�in�aataini�rua®in In accordance with the provisions of Title XI,Organized Crime Control Act of 1970,and the regulations issued thereunder(27 CFR Part 555),you may engage in the activity specified in this license or permit within tate limitations of Chapter 40,Title 18,United States Code and the regulations issued thereunder,until the expiration date shown. THIS LICENSE IS NOT TRANSFERABLE TINDER 27 CFR 555.53. See"WARNINGS"and'NOTICES"on reverse. Direct ATF AIT-Chief,FELC LicensePermit III11 Correspondence To 244 Needy Road Number • V , 0 I 1 , O • Martinsburg,WV 25405-9431 Chief,Federal Explosives Licensing Center(FELC Expiration Date 'Aarch , • Name LEGION FIREWORKS GO INC Premises Address(Changes?Notify the FELC at least 10 days before the move.) 10 LEGION LANE WAPPINGERS FALLS,NY 12590- Type of License or Pen-nit 51-IMPORTER OF EXPLOSIVES Purchasing CertificationStatement Mailing Address(Changes? Notify the FELC of any changes.) The licensee or permittee named above shall use a copy of this license or;permit to assist a transferor of explosives to verify the identity acrd the licensed status oftbe licensee or permittee as provided by 27 CFR Part 555. The simiature on each eopv must be aiiorigutal LEGION FIREWORKS CO INC sigpature. A faxed,scannedor e-mailed copy ofthe license ocpennit with a signattire intended to be an original signature is acceptable. The signature must be that of the Federal 10 LEGION LANE Explosives Licensee(FEL)or a responsible person of the FEL. I certify that this is a true WAPPINGERS FALLS, NY 12590- copy of a license or pernh issued to the licensee or pennittee named above to engage in the business or operations specked above under"Type of License or Permit:" 2 �� President LieenseelPermittee Responsible Person Signature Position;Title Frank M. Coluccio — Printed Name Date ATF For,s 40.14 5400.15 Part I Previous Edition is Obsolete LEGION EIOEWONRSCO INC 10 LEGION LANE 125508-NYN2731-9C4a1C91:Mx h1,261931-IMMRTER Of EXRO51VES Revised(ktober?till Federal Explosives License(FEL)Customer Service Information Federal F,xplosives Licensing Center(FELC) Toll-free Telephone Number: (877)283-3352 ATF Homepage:wvw.at£gov 244 Needy Road Fax Number. (304)616.4401 Martinsburg,WV 25405-9431 E-mail: FELCIdat£gov Change of Address (27 CFR 555.54(E?)(1)). Licensees or permittees may during the terns of their current license or permit remove their business or operations to 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 new location of the business or operations not less than 10 days prior to such removal with the Chiu Federal Explosives Licensing Center. The license or permit will be valid for the remainder of the tent of the original license or permit, (The Chief,FELC,shall,if the licensee or permittee is not qualified,refer the request for amended license or permit to the Director of Industry Operations for denial iii 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 explosive materials business or operations at the same address shown on,and for the remainder of the teen of a current license or permit. Such persons are: (1)The surviving spouse or child,or executor,administrator,or other legal representative of a deceased licensee or permittee;and(2)A receiver or trustee in bankruptcy,or an assignee for benefit of creditors. (b)In order to secure the right provided by this section,the person or persons continuing the business or operations shall furnish the license or permit for for that business or operations for endorsement of such succession to the Chief,FELC,within 30 days from the date on which the successor begins to carry on the business or operations_ (('ontinued on reverse side) Cut Here`;; Federal Explosives License/Permit(FEL)Information Card I Lieense,'PermitName:LEGION FIREWORKS CO INC I 1 I 1 I I Business Name: I I 1 Lieense,'PermitNumber 6-NY-027-51-9C-00091 i LicenseTermit Type:51-IMPORTER OF EXPLOSIVES � I I Expiration: March 1,2019 i I 1 Please Note: Not Valid for the Sale or Other Disposition of Explosives. I 1 ��gUFFO(,�c ° RESOLUTION 2010-474 ADOPTED 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) a copy of a valid certificate of competency as a pyrotechnician for the individual supervising the firing of the display; (b) 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; (c) 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. Elizabeth A.Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Albert Krupski Jr., Councilman SECONDER:Vincent Orlando, Councilman AYES: Ruland, Orlando, Talbot, Krupski Jr., Russell ABSENT: Louisa P. Evans Updated: 6/30/2010 10:43 AM by Lynda Rudder Page 2 IFFo44® ELIZABETH A.NEVILLE,1V MC ® r-e Town Hall,53095 Main Road TOWN CLERK '-� P.O. Box 1179 C= s 'r Southold,New York 11971 REGISTRAR OF VITAL STATISTICSio Fax(631)765-6145 MARRIAGE OFFICER A. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT For PUBLIC DISPLAY OF FIREWORKS I,ELIZABETH A.NEVILLE,Town Clerk of the Town of Southold,Suffolk County,New York,being an officer duly designated by the Town Board of the Town of Southold for this purpose,do hereby GRANT TO: GREENPORT FIRE DEPARTMENT 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 28,2016(rain/date Sunday May 291h)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. Piizabe A.Neville,Southold Town Clerk Suffolk County,New.'York (Town Seal) Date: May 18,2016 THIS PERMIT IS NOT TRANSFERABLE RESOLUTION 2016-483 ADOPTED DOC ID: 11910 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2016-483 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MAY 17,2016: 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 28, 2016 (r/d 5/29/16), 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: Jill Doherty, Councilwoman SECONDER:William P. Ruland, Councilman AYES: Dinizio Jr,Ruland,Doherty, Ghosio, Evans,Russell CHIEF WAYNE MILLER 1 �. � (631)477-9801 -STATION 1 1sTASST.CHIEF JEFFREY WEINGART �; (631)477-8261 STATION 2 2ND ASST.CHIEF SUSANO JIMENEZ i (631)477-1943-CHIEFS OFFICE (631)477-4012-FAX CHAPLAIN T.MURRAY THIRD STREET•P.O.BOX 58 ASST.CHAPLAIN C.KUMJIAN GREENPORT,NY 11944 TREAS/SECRETARY J.KALIN , Email:gfdfire@optonline.net www.greenportfd.org Organized 1845 RECEIVED MAY 17 2016 5/16/16 To Whom It May Concern, ���k Southold Town Flo The Star Hose carnival has been approved by the Chiefs and Board of Fire Wardens for the weekend of May 26th to May 30th with a Fireworks display on the night of May 28th at Greenport High School. The rain date will be May 29th . If you have any further questions please feel free to contact me at 831-5645. Firematically, Nay, Wayne Miller Chief Engineer RESOLUTION 2010-474 ADOPTED 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) a copy of a valid certificate of competency as a pyrotechnician for the individual supervising the firing of the display; — (b) 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; _ (c) Detailed diagram showing location of fireworks discharge and minimum separation distances in accordance with the applicable requirements of Penal Law Section 405(2); , la com an • 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 c e lk3td �_ approval by the Town Board. **c Chief Fire., Chief Wayne Miller is aware of this application by Star Fire Company for a Fireworks Permit for May 29, 2016 and approves of it. He will bring a le ter of,.,aproval into the Town Clerk's Office on Tuesday 5/17/16• ry 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. 4 Elizabeth A.Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Albert Krupski Jr., Councilman SECONDER:Vincent Orlando, Councilman AYES: Ruland, Orlando, Talbot, Krupski Jr.,Russell ABSENT: Louisa P. Evans Updated: 6/30/2010 10:43 AM by Lynda Rudder Page 2 o�*pF SO�ryol ELIZABETH A.NEVnJ E h Q ToWm.Hall,53095 Main Road TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS - G Q' Southold,New York 11971 MARRIAGE OFFICER • �O Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ��� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER' CQ� ,� A&holdtown.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 Rim:h 0--a d3 PRINCIPAL OFFICE AT sed 5r- rb N pr' DATE&TIME OF DISPLAY 11 Al I;_? P '2-,D d 4, /D ,�i/� $ w OL EXACT LOCATION OF DISPLAY e,-g-r",Q fcr,-r- arcA Iv 7ALtrj;,- SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE&TIlVIE j"1 A :'- ?—aid /D P�j The following persons are to be in charge of the actual shooting of the fireworks: Name Age, Experience Physical Condition (FA(r�, 45 4 X IC;A/ (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: 414 7—.TA L C Af..f� Manner and place -'of storage of fireworks prior to display: �,�► �S� �� ��Co�� C Fier, du�-7 dvcI �ex� d o A rj/SFA 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. Name of Organization By &J- J"'-1-- 61 e- Signature of Applicant Date of Application '' ^" 'o STATE OF NEW YORK - DEPARTMENT OF LABOR CHFTRACIOPPO .11 -r7ei� 2- L S' N s CARRIED TECHNICS ECA OTECHNICS N EEXPIRES 07/16 NYC & NYS CERTIFICATIONS REQUIRED IN NYC i t 300 ft radius + rich , la. sty � -��'fid'. � 1 Y �� '`��`� , � 'lr. _ � ... � �+ F•v ww IAG YZ YAre • r Ne- f fig;, i ,.�-.� „.. ,�.+� a< v v tt .a:.+�!^'.h H .. •^+ s ` " " _ •x W'.3'�f. ��, (�, sr �'�+ � *K"' x "�, + "''�`y° - � y €`:. •`+ :.►•ems,+►' ..�„.- _ �M�+�I�p� '4'�a :(j „ F PYRO ENGINEERING, INC. DISPLAY SITE PLAN QUESTIONNAIRE All Item rested below are subject to an governing Federal.State.Municipal and focal laws,rules,ordinances.regulations and codes,now or hereinafter In efied,and to the conditions and 6rreitatkns contained to the Permits required or to be obtained by Sponsor. SPONSOR: Star Hose Company Display Date � Rain Dater 2•f� 07r � t. 01(P BudgeQ Display Location: _ ttite G (`r � (3reQ-VV l oaf UF57) r"eiytoo Time of Display: E -M g PT (Note; The actual start and stop time of the display will be determined by the governmental authorities having jurisdictlon over the dESplay). IMPORTANT. PLEASE PROVIDE A SITE PLAN FOR YOUR EMTLOCATION,INDICATING WITH ANX THE EXACT SPOT WHERE FIREWORKS ARE TO BE SET-UP. Local lima Marshal: Telephone No.- Coll o.Call Phone No: Crew Contact'Perso n: Telephone No: td ( u Cell Phone IVo: 3 J—7417— Z(3D t 4-iNN The Following irrfxw890n is necessary In orderforus to provide yourcommunity or organization with a display thatconforms with flreworkssafetyMAg of ons-and&r the issuance ofyourinsurance coWficate. ...,_.�..�..,_, DISTANCES,IN FEET,FROM THE FIRING AREA TO THE FOLLOWING: FEET SPECTATORS,AUDIENCE OR PARKED CARS.................��..��:'........................ OCCUPIED BUILDINGS(HOMES,APARTMENTS,ETC.).....a'.f�.. .:t:��................. PUBLIC BUILDINGS(SCHOOLS,HOSPITALS,CHURCHES,ETC.)7.tP. U.......... TEMPORARY EVENT SET-UPS'(CONCESSIONS,TENTS,ETC, ...7...��'.. ........ MAINPAR19NG AREAS..... .. ................................................................ HIGHWAYS OR ROADS.......:....0.Q .....................................................g........... OVERHEAD OBJECTS(POWER LINES,LIGHT POLES,TREES,Ei'C...��.'..t�.D..p.... FUELSTORAGE... . !CQ ............................................................................ PLEASE PROVIDE DIRECTIONS FROWNEAREST INTERSTATE TO DISPLAY SITE. A MAP WOULD ALSO BE HELPFUL. Local Nvtals/Kat+alS: Telephone Nos. signature &I--' j aate� / :z Wove a 3 �I Please friZat eaM page, ,j tnitni here: �"'►'`� SPWW Pial America's World Class Fireworks Leader Display Dafe;May 28, 2016 FIREWORKS DISPLAY AGREEMENT AGREEMENT made January 11, 2016 try and between Pym Engineering, Inc.,whose address is 999 South Oyster Bay Road, Suite Ill, Bethpage, NY 11714 (hereinafter *PM, and Star Rase Company, 240 Br" Ave., Greenport, NY 11944 (hereutaffer'SPONSOR`). WHEREAS,PEI designs,produces,and conduits fireworks displays;and WHEREAS,SPONSOR wishes to engage PEI to design,produce and perform a firewoft 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, May 28,2016 (hereinafter'the Display Date'),PEI shall provide the fireworks and equipment for the display at the Fireworks Display locaUork The display will be under the supervision of a PEI tralr a technician_It is agreed that PEI shall be the sole fireworks supplier and producer for the event contracted for herein. (Notre: The actual start and strop time of the display will be determined by the govemmental aufhoritles having Jurisdiction overthe display), ALTERNATE DATE. May 29,2016 2. COST AND PAYMENTS: 1rIREWORKSUSPLAY PRiCE: 1 $ 4,500.00 The total(Firewo(ks Display Price plus all other applicable charges)sum of$4,540.00 shall be due and payable as foitoww. a.The sum of:$4,500.00 Due and Payabte,on Nlghtt cf May 28,2016 Please Note: SPONSOR Is responsible for the payment-of all governmental fees-and tares, including, but not limited to,sales, use,'exase,Icense,permit,entertainment,or oftener fees,taxes or surcharges imposed or otherwise applied to this exhibition. Also, please see Section 16(c)below. 3. POSTPOMEMENTIRESCHEDUI,ING:if the display of the fmrewo*s Is postponed/rescheduled by mason of Inclement weather or by determipation by time governmental authority having Jurisdiction.or for arty other reason beyond the control of PEI,some shall be re- scheduled to the Alternate Date set forth above. In the event a postponementlreschedulirtg is'necessary 6e,to inclement weather or by determination by the governmental authority havinghuisdic Ilon,or for any other reason beyond the control of PEI a postponement1tesc heduling fee will tie based on the table glow. Description 9t,of Fireworks Dis Price AddtOona[Costs if notified by IZ.01 AM on 05127116 51V0 Any- Pa Vendor ses n If notified after 12:01 AM on 115/27116 159'4 An V Party Vendor Expenses Once M'Fireworks Techs Arrive on Site VIVO --, - . —..VendorExpenses Any request made by SPONSOR for resched0rigkanceC mg shall be directed to helg@bayfireworks.com or by phone(516)233- 4132, It is understood and agreed that PEi shall have t10'0'09646111 16 resoliedirle a display except as required by inclement weather or reasons beyond the control of PEi. 4.SPQNSORS AGENT:lfr.Dill ftgardus, CELLPHONE: 6 3t—V I'V V?Q shalt be designated as SPONSOR'S agent to whom all questlons and inquiries shall be relayed. Sponsor's agent shall be tate only agont of SPONSOR authorized to make decisions ort behalf of SPONSOR or to request rescheduling of the fmreivarks disp*on the part of SPONSOR. Ream In'u each page. INN herrn 65 Spomr PEI * * * RECEIPT * * * Date: 04/29/16 Receipt#: 203798 Quantity Transactions Reference Subtotal 1 Event Fee 5.28.16 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#1409 $10000 Greenport, Fire Departmetn Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Greenport, Fire Departmetn Po Box 58 Greenport, NY 11944 Clerk ID: BONNIED Internal ID 5.28 16 Doroski, Bonnie From: Flatley, Martin Sent: Mon ay, ay 02, 2016 8:03 AM To: Doroski, Bonnie; Kruszeski, Frank; piro, Melissa; uffy, Bill Kiely, Stephen, Fisher, Robert Cc: Doroski, Melanie; Silleck, Mary; Blas o, Regina Subject: RE: Emailing: gpt fd fireworks_20160429143936 I have no objections to this fireworks display being approved as in the past. Martin Flatley, Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Doroski, Bonnie Sent: Friday, April 29, 2016 3:42 PM To: Flatley, Martin <mflatlev@town.southold.ny.us>; Kruszeski, Frank<fkruszeski@town.southold.nv.us>; Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Duffy, Bill <billd@southoldtownny.gov>; Kiely, Stephen <stephen.kiely@town.southold.nv.us>; Fisher, Robert<Robert.Fisher@town.southold.ny.us> Cc: Doroski, Melanie <Melanie.Doroski @town.southold.ny.us>; Silleck, Mary<marys@southoldtownny.gov>; Blasko, Regina <rblasko@town.southold.nv.us> Subject: Emailing: gpt fd fireworks_20160429143936 Please review the attached application for fireworks display and let me know if you approve or have any comments regarding it. Thanks, Bonnie Your message is ready to be sent with the following file or link attachments: gpt fd fireworks_20160429143936 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. 1 Doroski, Bonnie From: Spiro, Melissa Sent: Monday, May 02, 2016 8:27 AM To: Doroski, Bonnie Subject: RE: Emailing: gpt fd fireworks_20160429143936 This is not preserved land. thanks -----Original Message----- From: Doroski, Bonnie Sent: Friday, April 29, 2016 3:42 PM To: Flatley, Martin <mflatley@town.southold.ny.us>; Kruszeski, Frank<fkruszeski@town.southold.ny.us>; Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Duffy, Bill <billd@southoldtownny.gov>; Kiely, Stephen <stephen.kiely@town.southold.ny.us>; Fisher, Robert<Robert.Fisher@town.southold.ny.us> Cc: Doroski, Melanie <Melanie.Doroski@town.southold.ny.us>; Silleck, Mary<marys@southoldtownny.gov>; Blasko, Regina <rblasko@town.southold.ny.us> Subject: Emailing: gpt fd fireworks_20160429143936 Please review the attached application for fireworks display and let me know if you approve or have any comments regarding it. Thanks, Bonnie Your message is ready to be sent with the following file or link attachments: gpt fd fireworks_20160429143936 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. 1 Doroski, Bonnie From: Fisher, Robert Sent: Thursday, May 05, 2016 9:35 AM To: Doroski, Bonnie Subject: RE: Emailing: gpt fd fireworks_20160429143936 Bonnie I have no objections to this fireworks display being approved as in the past. Bob Fisher From: Doroski, Bonnie Sent: Friday, April 29, 2016 3:41 PM To: Flatley, Martin; Kruszeski, Frank; Spiro, Melissa; Duffy, Bill; Kiely, Stephen; Fisher, Robert Cc: Doroski, Melanie; Silleck, Mary; Blasko, Regina Subject: Emailing: gpt fd fireworks_20160429143936 Please review the attached application for fireworks display and let me know if you approve or have any comments regarding it. Thanks, Bonnie Your message is ready to be sent with the following file or link attachments: gpt fd fireworks_20160429143936 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. 7429/2016 (MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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). PRODUCER CONTACT p NAME: Joseph Chere OW1Ch McMann Price Agency Inc. PHCNNo Ext (631)477-1680 FAC No: (631)477-8930 828 Front Street E-MAIL donna@mcmannprice.com ADDRESS: P.O. BOX 2065 INSURERS AFFORDING COVERAGE NAIC# Greenport NY 11944-0876 INSURERA•Arch Insurance Company INSURED INSURER B Village of Greenport Fire Department INSURER C: PO BOX 58 INSURER D: INSURER E Greenport NY 11944-0058 INSURER F. COVERAGES CERTIFICATE NUMBER:CL1642901230 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A All A CLAIMS-MADE F OCCUR PREM SES Ea occur ence $ 100,000 MEPK06726910 6/1/2015 6/1/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 10,000,000 XPOLICY JECT LOC PRODUCTS $PRO 10,000,000 OTHER Liquor Liab Cov Part $ 3,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY Oa RTY DAMAGE $ HIRED AUTOS AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ MEUM06473410 6/1/2015 6/1/2016 $ WORKERS COMPENSATION PER H- OT EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Ya N/A E L EACH ACCIDENT $ D OFFICER/MEMBER EXCLUDE (Mandatory in NH) E L DISEASE-EA EMPLOYEE[$ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) With respect to Carnival from 5/26/16 to 5/30/16 CERTIFICATE HOLDER CANCELLATION (631) 765-6145 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1179 ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPR E TATIV ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) AC�® DATE(MMIDDIYYYY) `� CERTIFICATE OF LIABILITY INSURANCE 5/10/2016 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 NAME: Joseph Cherepowich McMann Price Agency Inc. PHONE (631)477-1680 AX o•(631)477-8930 828 Front Street aooRless:doana@mcmannyrice.com P.O. BOX 2065 __ INSURERS AFFORDING COVERAGE NAIC A -Greenport _ _,NY 11944-0876 INSURERA Arch Insurance CoMRany INSURED INSURER B: Village of Greenport Fire Department INSURER C: PO BOX 56 INSURER D: INSURER E: Greenport NY 11944-0058 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CLi651001252 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 ILTR TYPE OF INSURANCE ADDL R ----- POLICY EFF POLICY EXP POLICY NUMBER MMIDD ANDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A _ ��CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 -PREMISES fEa occurrence) $ X MEPK06726910 6/1/2015 6/1/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT PLAPPLIES PER GENERAL AGGREGATE $ 101000,000 POLICY C j JECT �LOC PRODUCTS-COMP/OP AGG $ 10,000,000 OTHER LlquorLlab Cov Part $ 3,000,000 AUTOMOBILE LIABILITY Ea accident)SINGLE $ ANY AUTO + BODILY INJURY(Per person) $_ f ALL OWNED ( SCHEDULED JI BODILY INJURY Per accident $ AUTOS ItAUTOS ( ) HIRED AUTOS I NON-OWNED PROPERTY DAMAGE $ ( l FFF AUTOS Per accident $ JCq UMBRELLA LIAS X OCCUR EACH OCCURRENCE $ 5,000,000 A IM EXCESSLIAB r CLAS-MADE AGGREGATE $ 5,000,000 R DED 1 1 RETENTION M3=06473410 6/1/2016 6/1/2017 $ WORKERS COMPENSATIONPER OTH. AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E L DISEASE-EA EMPLOYE $ It yea,descnbe under E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Town of Southold is added as an additional insured with respect to Carnival from 5/26/16 to 5/30/16 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 Route 25 ACCORDANCE WITH THE PO PROVISIONS. Southold, NY 11971 ZUTHOENTA V . - ©19 8- 014 AC CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and o are registered marks of ACOR INSTRUCTIONS FOR DISPLAY OF FIREWORKS 1. Name of body sponsoring fireworks display. 2. The date and time of day at which the fireworks display is to be held. 3. The exact location planned for the fireworks display, including TAX MAP NUMBER. 4. The age, experience and physical characteristics of the persons who are to do the actual discharging of the fireworks. 5. The number and kind of fireworks to be discharged. 6. The manner and place of storage of such fireworks prior to the display. 7. A diagram of the grounds on which the display is to be held, showing the point at which the fireworks are to be discharged, the location of all buildings, highways and other lines of communication, the lines behind which the audience will be restrained and location of all nearby trees, telegraph or telephone lines or other overhead obstructions. 8. Such other information as the Southold Town Clerk may deem necessary to protect persons and property. Written permission of the property owner is required. 9. An indemnity insurance policy with liability coverage and indemnity protection of $1,000,000.00 per person for bodily injury, $1,000,000.00 per accident; $1,000,000.00 property damage. 10. The Town Clerk of the Town of Southold must have the insurance policy in her possession before the fireworks permit is issued. The named insured must read: TOWN OF SOUTHOLD. 11. Application for a fireworks permit must be made at least five days in advance of the date of the fireworks display. (The above instructions are in accordance with the Penal Law, Article 405 - Licensing and other provisions relating to fireworks.) b