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HomeMy WebLinkAbout2017 ,%%aFFIX 4A- ® ELIZABETH A. NEVILLE,MMC may® G� 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 TOWI R"WJTHOLD 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 ORIENT HARBOR JULY 4TH FESTIVITIES_,INC. 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, ON Sunday, July 2, 2017 at 9:15 PM (Rain Date: Monday, July 3, 2017 at 9:15 PM on barge off Orient Yacht Club.the time and place set forth in the application therefor. 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 feet from the nearest above ground telephone or telegraph line,trees or other overhead obstruction; that the audience at such a 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 into 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 a manner that the falling residue from the deflagration will fall into such lake, or body of water; that any fireworks that remain unfired after the display is concluded shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task, that there shall be at least two such operators constantly on duty during the discharge and that at least two soda-acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. ` Elizabeth A.Neville, Town Clerk Town of Southold Dated: May 30, 2017 Suffolk County,New York (TOWN SEAL) THIS PERMIT IS NOT TRANSFERABLE o, rx ,rt ORIENT FIRE DEPARTMENT, INC. 23300 Main Road • Orient NY 11957 (631) 323-2445 • Fax 323-9706 OLUNTE'�Q' D Chief William Wysocki RECEIVE® 1st Asst. Chief Michael Prindle 2nd Asst. Chief Richard Gillooly MAY 10 26171 May 15, 2017 Southold Town Clerk Elizabeth A. Neville, MMC Southold Town Clerk PO Box 1179 Southold, NY 11971 Dear Ms. Neville: The Orient Fire Department is aware of the Orient Yacht Club fireworks application for July 2, 2017 and we currently have no objections of them having this event. Please contact me if you need any additional information or if you have any questions. Sincerely, Bill Wysocki Chief Cell #: 631-603-5731 Email: bi1199x@hotmail.com Neville, Elizabeth From: Neville, Elizabeth Sent: Friday,April 07, 2017 12:00 PM Cc: Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland,William; Russell, Scott Subject: Emailing:-Eirewworks Apl Orient Har_20170407104437 ,Firewo Attachments: rks Api rient kar 0407104437`pdf- Attached, please find a request for a Fireworks Permit submitted by the Orient Harbor Festivities for July 2,2017 (Rain Date July 3, 2017),fo4 a reviewrand recommen` : Elizabeth A. Neville, MMC Southold Town Clerk& FOIL Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: Fireworks Apl Orient Har_20170407104437 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: Eisber,_Robert... Sent: -hurscI6,,'April`20, 2017 10:11 AM To: Neville, Elizabeth Subject: RE: Emailing: Fir works Apl Orient'Har_20t70407104437 Categories: Red Category Betty have no objections to this event.being held,as>in theepas Bob Robert Fisher Fire Marshall,Town of Southold robert.fisher@town.southold.nv.us (W) 631-765-1802-(C) 631-786-9180 PRIVILEGED AND CONFIDENTIAL COMMUNICATION CONFIDENTIALITY NOTICE:This electronic mail transmission is intended only for the use of the individual or entity to which it is addressed and may contain confidential information belonging to the sender which is protected by privilege. If you are not the intended recipient,you are hereby notified that any disclosure,copying, distribution,or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this transmission in error, please notify the sender immediately by e-mail and delete the original message. -----Original Message----- From: Neville, Elizabeth Sent: Friday,April 07, 2017 12:00 PM To: Flatley, Martin<mflatlev@town.southold.nv.us>; Fisher, Robert<Robert.Fisher@town.southo Id.ny.us>;Spiro, Melissa<Melissa.Spiro@town.southold.ny.us> Cc: Dinizio,James<iames.dinizio@town.southold.nv.us>; Doherty,Jill <iill.doherty@town.southold.nv.us>; Evans, Louisa <louisae@southoldtownny.gov>; Ghosio, Bob<bob.ghosio@town.southold.ny.us>; Ruland,William <williamr@southoldtownny.gov>; Russell,Scott<scottr(o)south oIdtown ny.gov> Subject: Emailing: Fireworks Apl Orient Har_20170407104437 Attached, please find a request for a Fireworks Permit submitted by the Orient Harbor Festivities for July 2, 2017 (Rain Date July 3, 2017)for your review and recommendation. Elizabeth A. Neville, MMC Southold Town Clerk& FOIL Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 i Neville, Elizabeth From: Spiro, Melissa Sent: Monday,April 10, 2017 8:44 AM To: Neville, Elizabeth Subject: RE: Emailing: Fireworks Api Orient Har_20170407104437 This is not preserved land;therefore I have no comment. Melissa -----Original Message----- From: Neville, Elizabeth Sent: Friday,April 07, 201712:00 PM To: Flatley, Martin<mflatley@town.southold.ny.us>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>;Spiro, Melissa<Melissa.Spiro@town.southo Id.ny.us> Cc: Dinizio,James<fames.dinizio@town.southold.nv.us>; Doherty,Jill<jilt.doherty@town.southold.ny.us>; Evans, Louisa <louisae@southoldtownny.gov>; Ghosio, Bob<bob.ghosio@town.southold.nv.us>; Ruland,William <williamr@southoldtownny.gov>; Russell,Scott<scottr@southoldtownny.gov> Subject: Emailing: Fireworks Apl Orient Har_20170407104437 Attached, please find a request for a Fireworks Permit submitted by the Orient Harbor Festivities for July 2, 2017 (Rain Date July 3, 2017)for your review and recommendation. Elizabeth A. Neville, MMC Southold Town Clerk& FOIL Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: Fireworks Apl Orient Har_20170407104437 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 Neville, Elizabeth From: Flatley, Martin Sent: Friday, May 05, 2017 12:45 PM To: Neville, Elizabeth Cc: Rudder, Lynda Subject: RE: Special Events Attachments: Orient Fireworks.xls I have no objections with the fireworks applications being approved, my cost analysis is attached. Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic,New York 11958 631-765-3115 From: Neville, Elizabeth Sent: Friday, May 05, 201712:41 PM To: Flatley, Martin<mflatlev@town.southold.nv.us> Cc: Rudder, Lynda <Ivnda.rudder@town.southold.nv.us> Subject: RE:Special Events No, I have is. Betty From: Flatley, Martin Sent: Friday, May 05, 2017 12:40 PM To: Neville, Elizabeth Cc: Rudder, Lynda Subject: RE: Special Events I believe I did because I have a cost analysis for it, but I can send it again if you would like? Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 i; 1 Neville, Elizabeth From: Flatley, Martin Sent: Wednesday,April 12,2017 3:38 PM To: Neville, Elizabeth; Fisher, Robert;Spiro, Melissa Cc: Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland,William; Russell, Scott; Epple,Andy Subject: RE: Emailing: Fireworks Apl Orient Har_20170407104437 Attachments: Orient Fireworks.xls I have no objection to this event being held, my cost analysis is attached.With regards to their Department of Homeland Security Application for Marine Event, it should be noted that we will provide our PD Marine Units for the security for the fireworks display and we will work with the US Coast Guard and Orient FD to coordinate, if they should be able to attend. I'm not sure who they were referring to in section 8 as a "fiberglass Security Vessel".The remainder of the costs is for traffic control on the East Marion/Orient Causeway. Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Neville, Elizabeth Sent: Friday,April 07,201712:00 PM To: Flatley, Martin<mflatley@town.southold.ny.us>; Fisher, Robert<Robert.Fisher@town.southold.nv.us>;Spiro, Melissa<Melissa.Spiro@town.southold.nv.us> Cc: Dinizio,James<fames.dinizio@town.southold.ny.us>; Doherty,Jill<fill.doherty@town.southold.nv.us>; Evans, Louisa <louisae@southoldtownny.gov>; Ghosio, Bob<bob.ghosio@town.southold.nv.us>; Ruland,William <williamr@southoldtownny.gov>; Russell,Scott<scottr@southoldtownny.gov> Subject: Emailing: Fireworks Apl Orient Har_20170407104437 Attached, please find a request for a Fireworks Permit submitted by the Orient Harbor Festivities for July 2, 2017 (Rain Date July 3,2017)for your review and recommendation. Elizabeth A. Neville, MMC Southold Town Clerk& FOIL Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: Fireworks Apl Orient Har_20170407104437 1 Town of Southold Police Department Special Event Cost Analysis Event: Orient Yacht Club Fireworks Display Date(s): July 2, 2017 F-- Location: Orient Harbor Patrol Allka-tid0brEven't, Reg Hours OT Hrs Hrly Wage Total Comments ?o 1. , ", Ice P.O. Williams 2 $24.86 $49.72 ,p, Reg Hours OT Hrs Hrly Wage Total comments Bic 0 jj PO Ounfrak 2 $65.18 $130.36 SBC Epple 2 $39.90 $159.60 BC O'Leary 2 $28.68 $114.72 ra. 1 - 9n F9 *g Hours OT Hrs Hrly Wage Total Comments TC Officer TC Officer TC TC TC Marine Fuel $50.00 ,Total Department Cost for Event = $ $504.40 1 1 Prepared by Capt.M. Flatley 5/5/2017 Page 1 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. a ` `l 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 ELIZABETH A.NEVILLE,MMC �� q, Town Hall,53095 Main Road TOWN CLERK p P.O.Box 1179 y 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p Fax(631)765-6145 MARRIAGE OFFICER �ifj Q� Telephone(631)765-1800 RECORDS OF MANAGEMENT OFFICERof `�►a southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER RECEIVED OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD MAR 3 1 2017 APPLICATION PERMIT TO DISPLAY FIREWORKS Southold Town Clerk 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 Orient Harbor July 4th Festivities, Inc. PRINCIPAL OFFICE AT PO Box 653, Orient, NY 11957 DATE& TIME OF DISPLAY Ay 017 @ approx. 9:15pm EXACT LOCATION•OF DISPLAY Barge off Orient Yacht Club SUFFOLK COUNTY TAX MAP NUMBER FOR SITE 1000-24-2-28.1 RAIN DATE & TIME July 3, 2017 @ approx. 9:15pm The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Anthony Magno, Sr. 62 39 years Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Grucci Grand Illuminations-4500 2%2-3"- 1020 4"-325 5"-300 6"-275 8"-32 Total: Not to exceed 1952 Firework Shells and 4500 Illuminations Manner and place of storage of fireworks prior to display: In UN approved boxes in company vehicle. 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. Orient Harbor July 4th Festivities, Inc. FEE: $100Name ganization See policy-foe additional information By Sig a ure of scant �d Dae of Application ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/9/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Britton Gallagher PHONE FAX C o E t• - 58- 1 (AIC' AIC No: - - One Cleveland Center, Floor 30 E-MAIL 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC# INSURER A:EVereSt National InsuranceCompany INSURED -INSURER B.Continen al Indemnity Company Fireworks By Grucci Inc and/or Pyrotechnique INSURERC.AXIS SU IUS Ins Company 66 0 By Gruccl, Inc. and/or Phllny Effects, Inc INSURER D: 20 Pinehurst Drive Bellport NY 11713 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:897704960 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 ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICYNUMBER MM/DD MMIDD A GENERAL LIABILITY S18ML00093-171 2/17/2017 2/17/2018 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE 15F]OCCUR MED EXP(Any one person) $ PERSONAL BADV INJURY $1,000,000 Liability GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ A AUTOMOBILE LIABILITY SIBCA00044-171 2/17/2017 2/17/2018 Ea accident $1000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS IX NON-OWNED PROPERTY DAMAGE $ AUTOS Per.cadent C UMBRELLA LIAB X OCCUR EAU620937 2/17/2017 2/17/2018 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ B WORKERS COMPENSATION 73-474435-01-01 5/27/2016 5/27/2017 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N LI ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E L DISEASE-EA EMPLOYEE $1,000,000 If yes,descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT 1$1,000,000 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.July 2,2017; Rain Date:'July 3,2017, Location.Orient Yacht Club, Orient, NY, Additional Insured(s):Orient Harbor July 4th Festivities, Inc;Theodore A. Strauel, Orient Yacht Club; Greenport Shipyard, Orient Fire Department;Town of Southold; State of New York; Crowley Marine, Costello Marine; CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orient Harbor July 4th Festivities, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P O. Box 653 ACCORDANCE WITH THE POLICY PROVISIONS. Orient NY 11957 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD rico CERTIFICATE OF LIABILITY INSURANCEF3/9/2017 DATE(MM/DD/YYYY) 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 PHONE FAX One Cleveland Center, Floor 30 rc o :t:21 -658-71 AIC,No:21 - - 1 01 E-MAIL 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC# INSURER A: V r nce Company 10120 INSURED INSURER B: n inental Indemnity Company Fireworks By Grucci Inc and/or Pyrotechnique INSURERC-Axis Surplus Ins Company 620 By Gruccl, Inc and/or Phllny Effects, Inc INSURER D: 20 Pinehurst Drive Bellport NY 11713 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:2133311743 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 IEXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDY EFF MM/DDY/YYYY LIMITS A GENERAL LIABILITY S18ML00093-171 2/17/2017 2/17/2018 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ PERSONAL BADV INJURY $1,000,000 Llablllty GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 -]71JECT POLICY X PRO- LOC $ A AUTOMOBILE LIABILITY S18CA00044-171 2/17/2017 2/17/2018 Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED, SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS Ix NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident C UMBRELLA LIAR X OCCUR EAU620937 2/17/2017 2/17/2018 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION 73-474435-01-01 5/27/2016 5/27/2017 X WCLATT- OTH- AND EMPLOYERS'LIABILITY Y r N ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N r A (Mandatory in NH) EL DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 1$1,000,000 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:July 2,2017, Rain Date July 3,2017; Location. Orient Yacht Club, Orient, NY, Additional Insured Orient Harbor July 4th Festivities, Inc,Theodore A Strauel, Orient Yacht Club, Greenport Shipyard, Orient Fire Department;Town of Southold; State of New York, Crowley Marine, Costello Marine, 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 Town Hall 53095 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. South Hold NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Neville, Elizabeth From: Neville, Elizabeth Sent: Friday,April 07, 2017 12:04 PM To: 'loper98@optonline.net' Subject: FW: Emailing: Fireworks Apl Orient Har_20170407104437 Attachments: Fireworks Apl Orient Har_20170407104437.pdf Dear Chief Loper, Once again,this fireworks application requires you to submit a written letter of approval similar to the one you submitted for last year's event. Thank you for your cooperation. Elizabeth A. Neville, MMC Southold Town Clerk& FOIL Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 -----Original Message----- From: Neville, Elizabeth Sent: Friday,April 07,201712:00 PM To: Flatley, Martin; Fisher, Robert; Spiro, Melissa Cc: Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland, William; Russell, Scott Subject: Emailing: Fireworks Apl Orient Har_20170407104437 Attached, please find a request for a Fireworks Permit submitted by the Orient Harbor Festivities for July 2, 2017 (Rain Date July 3, 2017)for your review and recommendation. Elizabeth A. Neville, MMC Southold Town Clerk& FOIL Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to'be sent with the following file or link attachments: Fireworks Apl Orient Har 20170407104437 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: Friday,April 07, 2017 12:00 PM To: Flatley, Martin; Fisher, Robert; Spirelissa Cc: Dinizio,James; Doherty,Jill; Evans, Louisa; Ghosio, Bob; Ruland,William; Russell, Scott Subject: Emailing: Fireworks Apl Orient Mar 20170407104437 Attachments: Fireworks Apl Orient Har_20170407104437.pdf Attached, please find a request for a Fireworks Permit submitted by the Orient Harbor Festivities for July 2, 2017 (Rain Date July 3, 2017)for your review and recommendation. Elizabeth A. Neville, MMC Southold Town Clerk& FOIL Officer PO Box 1179 Southold, NY 11971 Tel. 631765-1800, Ext. 228 Fax 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: Fireworks Apl Orient Har 20170407104437 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 * * * RECEIPT * * * Date: 04/07/17 Receipt#: 217785 Quantity Transactions Reference Subtotal 1 Fireworks 7/2/17 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#1004 $100.00 Orient Harbor, July 4th Festivities Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Orient Harbor, July 4th Festivities Po Box 653 Orient, NY 11957 Clerk ID: BONNIED Internal ID•7/2/17 Neville, Elizabeth From: Neville, Elizabeth Sent: Friday,April 07, 2017 3:31 PM To: Ed; Neville, Elizabeth Subject: RE: Emailing: Fireworks Apl Orient Har_20170407104437 Thank you very much! Sent from my Verizon Wireless 4G LTE smartphone -------- Original message -------- From: Ed<loper98noptonline.net> Date: 04/07/2017 3:05 PM (GMT-05:00) To: "Neville, Elizabeth" <E.Neville@town.southold.ny.us> Subject: Re: Emailing: Fireworks _ 04437 Ms.Neville, I have forwarded this to the urrent Orient Fire Department Chief William Wysocki as my term ended on Jan 1st. His email is bi1199x@hotmail.co Please let me know if I can be of any other help. Sent from my iPhone >On Apr 7,2017,at 12:04 PM,Neville,Elizabeth<E.Neville@-town.southold.ny.us>wrote: >Dear Chief Loper, >Once again,this fireworks application requires you to submit a written letter of approval similar to the one you submitted for last year's event. >Thank you for your cooperation. >Elizabeth A.Neville,MMC >Southold Town Clerk&FOIL Officer >PO Box 1179 >Southold,NY 11971 ->Tel.631765-1800,Ext.228 >Fax 631765-6145 >Cell 631466-6064 >-----Original Message----- •From:Neville,Elizabeth >Sent:Friday,April 07,2017 12:00 PM >To:Flatley,Martin;Fisher,Robert; Spiro,Melissa >Cc:Dinizio,James;Doherty,Jill;Evans,Louisa;Ghosio,Bob;Ruland,William;Russell, Scott >Subject:Emailing: Fireworks Apl Orient Har_20170407104437 >Attached,please find a request for a Fireworks Permit submitted by the Orient Harbor Festivities for July 2,2017(Rain Date July 3, 2017)for your review and recommendation. >Elizabeth A.Neville,MMC >Southold Town Clerk&FOIL Officer >PO Box 1179 1 r >Southold,NY 11971 >Tel.631765-1800,Ext.228 >Fax 631765-6145 >Cell 631466-6064 >Your message is ready to be sent with the following file or link attachments: >Fireworks Apl Orient Har_20170407104437 >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. ><Fireworks Apl Orient Har 20170407104437.pdfl 2 Neville, Elizabeth From: Neville, Elizabeth Sent: Friday, May 05, 2017 1:07 PM To: 'bill99x@hotmail.com' Subject: Orient HarborAol Fireworks Permit Importance: High L_J Fireworks Apl Orient Har 2017... Dear Chief Wysocki, I need a letter from you as the Chief of the Orient Fire Department stating that you are aware of their application and approve of the fireworks display being held within your district. Please place it on the letterhead of the Orient Fire Department with your signature and deliver it tome at your earliest convenience. Please call me at 631765-1800, if you have any questions. Thank you. Elizabeth A.Neville, MMC Southold Town Clerk&FOIL Officer PO Box 1179 Southold,NY 11971 Tel. 631765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 1 'HELP MAKE IT A TRADITIONI., F�-u � �.:. o DONATE lei OWI., ORIENTHHAR OR INDEPENDENCE DAY ���� �--� -' •� �Iy F I R E W O R K S 011, �,y X - - - SPECTACULAR X, JULY 2 ' o #L . -X 15 IT. 20, 4L: PHOTO BY JOSHUA NIEFSKY HELP OUR COMMUNITIES ESTABLISH THIS PROUD NEW TRADITION. FUNDED ENTIRELY BY FRIENDS AND NEIGHBORS. P TIORAY, . LEASERO YOUR PART BY SENDING UN YOUR RONATFlION, [3 VISIT WWW.GOFUNDNE.COM ./ORIENTHARBOR2017 OR SEND YOUR CHECK. PAYABLE TO ORIENT HARBOR JULY 4TH FESTIVFfIES, TO PO BOX 6 53. ORIENT. MY, 1 19 5 7� LAST YEAR'S DISPLAY WAS AMAZING! WE NEED EVERYONE TO PITCH IN TO ENSURE ANOTHER UNFORGETTABLE 4TH! ORIENT HARBOR JULY 4TH FESTIVITIES IS A 50 1(C)3 NON-PROFIT ORGANIZATION. YOUR DONATION IS TAX DEDUCTIBLE. THIS INDEPENDENCE DAY FIREWORKS CELEBRATION IS ORGANIZED BY ORIENT HARBOR JULY 44TH FESTIVITIES, INC, A NON-PROFIT 5 11 (C)(3) ORGANIZATION, WHOSE MISSION IS TO HONOR THE NATION'S HISTORY AND ITS MILITARY SERVICE MEMBERS WITH AN ANNUAL DISPLAY FOR THE BENEFIT OF THE COMMUNITIES SURROUNDING ORIENT HARBOR. RECEIVE® a � March 24,2017 MAR 3 1 2017 Elizabeth Neville,Town Clerk Town of Southold Southold Town Clerk / 53095 Route 25 Southold,NY 11971 Phone: 631-765-1800 Fax: 631-765-6145 Email: e.neville@town.southold.ny.us CC:lynda.rudder@town.southold.ny.us Dear Ms. Neville: Please find attached hereto for the Orient Harbor July 4`h Festivities,Inc. fireworks display scheduled for July 2,2017 with a Rain Date of July 3,2017 at 9:15 PM the following: 1) Town of Southold Permit to Display Fireworks Application 2) Check for$100.00 for Permit Fee 3) Insurance Certificate 4) Site Plan 5) Chief Pyrotechnician's Data Form 6) Chief Pyrotechnician's NYS Certificate of Fitness 7) Pyrotechnic Product Count 8) FAA Notification Letter 9) U.S. Fish&Wildlife Notification 10) DEC Notification 11) US Coast Guard Marine Event Application 12) Letter to Sponsor Thank you for your help in this matter and if you should have any questions please call. Sincerely, in eveE,�c X1 Edward Rubio Logistics Manager Fireworks by Grucci,Inc. Cell: 516-658-4486 Fireworks by Grucci,Inc. Office#: (631) 286-0088 20 Pinehurst Drive Fax#: (631) 286-9036 Bellport,NY 11713 E-mail: erubio@grucci.com THE FIRST FAMILY OF FIREWORKS Orient Yacht Club - Orient,. Nle July 2, 2017 - Firemorks by Gruccl FIREWORKS BY �\ x.45 Barge Display Site Max Shell Size 8" 1,000' Fallout Area * Exceeds Coast Guard Required 100'/1" ** Exceeds NFPA 1123 Recommended 70'/ 1" Latitude: 41° 08' 02.71" N 0' 250' 500' 750' 1000' Longitude: 720 18' 34.28"W All Information contained on this document is copyright material and the intellectual property of Fireworks by Grucci Inc.Reproduction and/or circulation without approval of Fireworks by Grucci is prohibited Rev 1 4/6/16 March 24,2017 As per the document N.F.P.A. 1123-2000 Code for Fireworks Display and the Town of Southold regulations, the following information is provided. Sponsor/Client Name: Orient Harbor July a Festivities, Inc. Location and Date of Fireworks Display: Barge off Orient Yacht Club 2110 Village Lane, Orient,NY 11957 July 2,2017—Rain Date July 3,2017 @ Approximately 9:15 PM Chief Pyrotechnician: Health: Age: Years Experience: Anthony Magno Excellent 62 39 Product: Not to Exceed 1952 Firework Shells and 4500 Illuminations 1.3G& 1.4G explosives, UN0335,Maximum Aerial Shell Diameter= 8 inches. Storage will be at secured safety zone in D.O.T. approved fiberboard containers #UN-4G, and stored in company vehicle approved for this purpose. Fireworks by Grucci complies with all requirements of the NFPA 1123 and The Town of Southold. The above information is submitted and verified by: �("/ , Edward Rubio Logistics Manager (631) 286-0088—Phone (631) 286-9036—Fax (516) 658-4486 - Cell Fireworks by Grucci,Inc. Office#: (631) 286-0088 20 Pinehurst Drive Fax#: (631) 286-9036 Bellport,NY 11713 E-mail:erubio Qgrucd.com THE FIRST FAMILY OF FIREWORKS i �,II�I�I��1���1��11�861�80� • sF�f 559ormaG Zip FSS,• '"um To. ©. B� .L7z'-.�u BkoZV�S'31�E+ - L&G' ViSE`� °o BRg R09w 3.62 BEITLB.iriiG 22 00 !G 5' G " STATL OFFICE CMWUS °a N O __ ,, .] •.tib:;M•:✓r i`ri5t" •��i=r,^' ;[' V %�• , 1 'ki!;•.,: • r{1[7 ;f:�i�oj _lye' �• ' March 24,2017 I1 DISPLAY: Orient Harbor July 4h Festivities,Inc. FROM: Edward Rubio Re: July 2,2017 Fireworks Displays / Rain Date:July 3,2017 SHELL SIZE NOT TO EXCEED 8" SHELL SIZE: QUANTITY IN PCS. Grucci Grand Illuminations - 4500 2'/2 -3" - 1020 4" - 325 5" - 300 6" - 275 8" - 32 10" - N/A 12" - N/A 24" - N/A Grucci Grand Illuminations = Gerbs,Mines,SPX, Comets,Roman Candles _ Water Falls,Strobe Pots Storage will be at secured safety zone in D.O.T. approved fiberboard containers # UN-4G, and stored in company vehicle approved for this purpose. Total:Not to exceed 1952 Firework Shells and 4500 Illuminations Type: Fireworks LN0335 (Display Fireworks) (Explosive 1.3G) Fireworks UN0336 (Special Effects) (Explosive 1.4G) Thank You, Edward Rubio Logistics Manager Fireworks by Grucci,Inc. Cell: 516-658-4486 Fireworks by Grucci,Inc. Office#: (631) 286-0088 20 Pinehurst Drive Fax#: (631) 286-9036 Bellport NY 11713 E-mail:erubioQgrucci.com THE FIRST FAMILY OF FIREWORKS Attachment 1 faftow Eastern Service Center 1701 Columbia Ave. U.S.Department Operations Support Group College Park,GA 30337 of Transportation AJV-E2 -mrNEST ROW FMEW®RKS DISPLAY Company Name: Fireworks by Grucci Email Address of Person Submitting Request: vvaz@grucci.com Event Name:Orient Harbor July 4th Festivities. Inc. Display Date: July 2, 2017 Rain Date: July 3, 2017 Display Start Time: 9:15 PM Duration of Fireworks Display: 16 - 17 minutes Max Height of Fireworks 8" max with height of 800' Barge off Orient Yacht Club City or Town and State(Physical Address): 2110 Village Lane, Orient, NY 11957 Latitude: 410 08' 02.71" (North) Longitude: 72018' 34.28" (West) List the Closest Public Use Airport Within 25 Nautical Miles of the Display if the Fireworks Will Reach or Exceed 500 Ft.- _I$p Special Notes: l ,SUsL.a,eulll hUllll Lc51.tU}J lilliludl i 11cr,Oflti I iuLca411VS JUt UOkj 1lIZJ II.t10 �i/✓rlil 12/6/2013 March 24,2017 TO: Mr. Steve Papa COMPANY: U.S. Fish&Wildlife Service ' E-MAIL: steve papakfws.gov PHONE: 631-776-1404 x 201 / FAX: 631-776-1405 FROM: Edward Rubio TOTAL PAGES: 3 Dear Mr. Papa: Attached please find site map and the plover protection plan for the fireworks display noted below: i EVENT: Orient Harbor July 4ffi Festivities,Inc. LOCATION: Barge off Orient Yacht Club 2110 Village Lane,Orient,NY LATITUDE: 41°08'02.71"N LONGITUDE:72° 18'34.28"W DATE: July 2,2017 RAIN DATE: July 3,2017 TIME: Approx. 9:15 PM DURATION: 16 - 17 Minutes We would appreciate your assistance in getting a notice out to the Coast Guard with copy to us of your agency having no objections to this site being used. Thank you for your help and cooperation in this matter. Sincerely, �Cw-ar Edward Rubio Logistics Manager Fireworks by Grucci,Inc. Cell: 516-658-4486 Fireworks by Grucci,Inc. Office#: (631) 286-0088 20 Pinehurst Drive Fax#: (631) 286-9036 Bellport,NY 11713 E-mail:info@grucci.com THE FIRST FAMILY OF FIREWORKS I. � March 24,2017 1� TO: Kevin Jennings COMPANY: Bird Conservation Biologist NYS DEC Region 1 50 Circle Road SUNY Stony Brook Stony Brook,NY 11790 PHONE: 631-444-0308 FAX: 631-444-0272 EMAIL: Kevin. ennings(adec.n� og_v FROM: Edward Rubio TOTAL PAGES: 2 Dear Mr.Jennings: Below please find display information for a coming contracted fireworks display with our site plan for this event attached. EVENT: Orient Harbor July 4`''Festivities,Inc. LOCATION: Barge off Orient Yacht Club 2110 Village Lane, Orient,NY LATITUDE: 41'08'02.71"N LONGITUDE:72' 18'34.28"W DATE: July 2,2017 RAIN DATE: July 3,2017 TIME: Approx. 9:15 PM DURATION: 16 - 17 Minutes We would appreciate your assistance in getting a notice out to the Coast Guard ASAP with copy to us of your agency having no objections to this site being used. Thank you for your help and cooperation in this matter. Sincerely, Edward Rubio Logistics Manager Fireworks by Grucci,Inc. CELL: 516-658-4486 Fireworks by Grucci,Inc. Office#: (631) 286-0088 20 Pinehurst Drive Fax#: (631) 286-9036 Bellport,NY 11713 E-mail:erubio, gruc��i.com THE FIRST FAMILY OF FIREWORKS DEPARTMENT OF HOMELAND SECURITY APPLICATION FOR MARINE EVENT OMB Number: 1625-0008 Expires: 9/30/2017 Date Submitted: 03/22/2017 Tracking No:169230 FORM INSTRUCTIONS 1. Please complete either this online form or a paper CG-4423. 2. This application must reach the appropriate Captain of the Port(selected via dropdown box) at least 135 days prior to the event. 3. Attach a section of a chart or scale drawing showing boundaries and/or courses and markers contemplated. 4. Submit a copy of your entry requirements, and any special rules pertaining to equipment, rigs or procedures. 1. Name of Event Orient Independence Day Celebration 2. Date of Event 07/02/2017- 07/03/2017 3. Location of Event Barge off Orient Yacht Club-Orient, NY 4. Time From: 9.15 PM To: 9.15 PM Latitude:41?08?02.71?N Longitude: 72? 18?34.28?W 5. Name and Address of Sponsoring Organization (Include Zip Code) 6. No. of Participants 7. Sizes of Boats Orient Harbor July 4th Festivities, Inc. 3 90x30 PO Box 563 Orient, NY 11957 8. Types of Boats 9. No. of Spectator Craft Steel Barge, Steel Tug, Fiberglass Security Vessel 20 10. Description of Events A fireworks display that will be approximately 16-17 minutes in duration with a max aerial shell size of 8". 11. Will This Event Interfere or Impede the Natural Flow of Traffic? YES 11a. If YES briefly explain: Traffic will cease within the 1 000'safety perimeter during the display. CG-4423 (3/2011) 12.What Extra or Unusual Hazard (to participants or non-participants)Will Be Introduced Into the Regatta Area? A fireworks display-a no wake zone will be put in place surrounding the barge. 13. Have any Objections Been Received from Other Interested Parties? NO 13a. If YES briefly explain: 14 Vessels Provided by Sponsoring Organization for Safety Purposes(number, description and length) Number Description Length 15. Does the Sponsoring Organization Deem their Patrol Adequate for Safety Purposes? YES 15a. If NO briefly explain- Yes, we still request the Coast Guard's presence for this event. 16. Is a Coast Guard or Coast Guard Auxiliary Patrol Requested for Control of Spectator and/or Commercial Traffic? YES 16a. If YES how many vessels do you recommend and why?- Yes, one vessel because we would like to add additional safety although our security vessel is adequate. 17. Person In Charge Edward Rubio 18. Where Will'Person In Charge' be During Event? Command Center 19. How Can 'Person In Charge'be Contacted During the Event? 516-658-4486 20. Person to be Contacted for Further Details (Name, Address, Zip Code) 20a.Area Code and Phone No.: 631-286-0088 Edward Rubio 20 Pinehurst Drive 20b. Email Address- vvaz@grucci.com Bellport, NY 11713 The undersigned has full authority to represent the sponsoring organization. CG-4423 (3/2011) 21. Name: Edward Rubio 22. Title: Logistics Manager 23.Address(Include Zip Code) 23a.Area Code and Phone No.: 631-286-0088 20 Pinehurst Drive Bellport, NY 11713 23b Email Address. vvaz@grucci.com 24. The person submitting the form certified that they have full authority to represent the sponsoring organization. 25. COTP Zone Submitted: LONG ISLAND SOUND PRIVACY ACT STATEMENT Privacy Act Notice Authority: 33 U.S.0 § 1233 authorizes the collection of this information. Purpose. The Coast Guard will use this information to determine whether an event poses an extra or unusual hazard to the safety of life and whether or not, and under which conditions, to permit the event on the navigable waters of the United States. Routine Uses: The information will be used by and disclosed to Coast Guard personnel to evaluate the request.Additionally, the Coast Guard may share the information with facility operators, law enforcement or other government agencies as necessary to promote public safety during the requested marine event Disclosure: Furnishing this information is voluntary; however, failure to furnish the requested information may delay or prevent the approval of the requested marine event. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The Coast Guard estimates that the average burden for this collection of information is 60 minutes. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commandant(CG-5521), U.S. Coast Guard, 2100 2ND St., SW, Washington D.C. 20593-7683 or Office of Management and Budget, Paperwork Reduction Project(1625-0008), Washington, DC 20593. CG-4423 (3/2011) March 24,2017 Theodore Strauel Orient Harbor July 4"'Festivities,Inc. 680 Croton Lake Road Bedford Corners,NY 10549 Cell: 914-523-9289 Email: tstrauel&mail.com Dear Mr. Strauel: Please-find attached hereto for the Orient Harbor July 4h Festivities,Inc. fireworks display scheduled for July 2,2017 with a Rain Date of July 3,2017 at 9:15 PM the following: 1) Letter to Town of Southold Clerk's Office 2) Town of Southold Permit to Display Fireworks Application 3) Insurance Certificate 4) Site Plan 5) Chief Pyrotechnician's Data Form 6) Chief Pyrotechnician's NYS Certificate of Fitness 7) Pyrotechnic Product Count 8) FAA Notification Letter 9) U.S. Fish&Wildlife Notification 10) DEC Notification 11) US Coast Guard Marine Event Application Please sign the enclosed application and forward to the Town of Southold along check for $100 made out to the Town of Southold with written permission from the Orient Yacht Club's property owner to: Elizabeth Neville,Town Clerk Town of Southold 53095 Route 25 Southold,NY 11971 Thank you for your help in this matter and if you should have any questions please call. Sincerely, 1 Edward Rubio Logistics Manager Fireworks by Grucci,Inc. Cell: 516-658-4486 Fireworks by Grucci,Inc. Office#: (631) 286-0088 20 Pinehurst Drive Fax#: (631) 286-9036 Bellport,NY 11713 E-mail: erubio@grucci.com THE FIRST FAMILY OF FIREWORKS Neville, Elizabeth From: Vanessa Vaz <vvaz@grucci.com> Sent: Friday, March 24, 2017 3:29 PM To: Neville, Elizabeth Cc: Rudder, Lynda; Edward Rubio; Corey Grucci Subject: Town of Southold - Fireworks by Grucci - Orient Independence Day Celebration - 7/2/17 Attachments: Packet to Clerk's Office.pdf *** HARD COPY WITH CHECK FOR PERMIT FEE TO FOLLOW FROM SPONSOR *** Dear Ms. Neville: Please find attached hereto for the Orient Harbor July 4th Festivities, Inc. fireworks display scheduled for July 2, 2017 with a Rain Date of July 3, 2017 at 9:15 PM the following: 1. Town of Southold Permit to Display Fireworks Application 2. Check for $100.00 for Permit Fee 3) Insurance Certificate 4. Site Plan 5: Chief Pyrotechnician's Data Form 6. Chief Pyrotechnician's NYS Certificate of Fitness 7) Pyrotechnic Product Count 8) FAA Notification Letter 9) U.S. Fish & Wildlife Notification 10) DEC Notification 11)US Coast Guard Marine Event Application 12) Letter to Sponsor Thank you for your help in this matter and if you should have any questions please call. Respectfully, Vanessa Vaz Logistics Assistant Fireworks by Grucci, Inc. 20 Pinehurst Drive Bellport, New York 11713 p: 631-286-0088 ext. 114 f: 631-286-9036 vvaz@grucci.com www.grucci.com 0 __--_ 2 DUBUB AI,UAE UAE 7.0CATE GTV Kt S,FFF t `""-' Proud to have been part of the celebration of 1 i V r i I Q iiiALVIL) (718)786-0643 SHIP DATE:30MAR17 L ACTWGT:1.00 LB CAD:1093279541INET3850 Y 11101 BILL SENDER ED To ELI VILLE, TOWN CLERK TOWN OF SOUTHOLD 53095 ROUTE 25 � o � ( SOUTHOLD NY 11971 1631)765-1800 REF 3 PO DEPT a IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Express I I FRI -31 MAR 12:OOP FTRK"02017787 84191234 PRIORITY OVERNIGHT 11971 E4 WSHA iiY-us JFK r l � i I i I s J Norklun, Stacey From: Neville, Elizabeth Sent: Wednesday, June 28, 2017 9:04 AM To: Norklun, Stacey Subject: FW: Fireworks Permit -Orient Harbor Festivities, Inc. Attachments: Laserfiche Documents.zip Importance: High Stacey, Please also add this e-mail to the file. From: Neville, Elizabeth Sent: Wednesday, June 28, 2017 8:46 AM To: 'Vanessa Vaz' Cc: Rudder, Lynda Subject: Fireworks Permit -Orient Harbor Festivities, Inc. Importance: High Vanessa, This permit was issued on May 30, 2017 and picked up at the Town Clerk's Office by the applicant/chairman of the event,Theodore Strauel. Attached, please find a copy of the permit. Please let me know if you need anything further.' Elizabeth A. Neville, MMC Southold Town Clerk,Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel. 631765-1800,Ext.228 Fax 631 765-6145 Cell 631466-6064 1