Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
2018
Southold Town Board - Letter Board Meeting of May 22, 2018 f$ �oserrote�°y4 RESOLUTION 2018-471 Item# 5.8 ADOPTED DOC ID: 14132 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2018-471 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MAY'22, 2018: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a fireworks permit by the Town Clerk to Star Hose Company of the Greenport Fire - Department for a fireworks display at 10:00 PM on Saturday May 26, 2018 (Rain Date of: Sunday May 27, 2018) at Greenport High School's Athletic Field located on the north side of Front Street and the east side of Moores Lane, 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: William P. Ruland, Councilman SECONDER:Robert Ghosio, Councilman AYES: Dinizio Jr,Ruland, Doherty, Ghosio, Russell ABSENT: Louisa P. Evans Generated May 24, 2018 Page 22 gUFFO(,F ®� RESOLUTION (ID # 14132) REVIEWED DOC ID: 14132 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. (ID # 14132) WAS REVIEWED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MAY 22, 2018: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a fireworks permit by the Town Clerk to Star Hose Company of the Greenport Fire Department for a fireworks display at 10:00 PM on Saturday May 26,2018 (Rain Date of: Sunday May 27,2018) at Greenport High School's Athletic Field located on the north side of Front Street and the east side of Moores Lane, 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 1 ELIZABETH A.NEVILLE,MMC O` FFOL Town Hall,53095 Main Road TOWN CLERK y� P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS coo Fax(631)765-6145 MARRIAGE OFFICER ,f. ®�. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �Ol �°Z► 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,GREENPORT 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 26,2018: Raindate:Sunday, May 27,2018 on the property of GREENPORT PUBLIC SCHOOL Athletic Field, located on the north side Front Street and east side Moores Lane GreenportNew 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. ---- -fir.-- - - ------- Efizabem A. Neville,Southold Town Clerk Suffolk County, New York (Town Seal) Date: May 22, 2018 THIS PERMIT IS NOT TRANSFERABLE Town of Southold Police Department Special Event Cost Analysis Event: Greenport Fire Dept Fireworks Display Date(s): May 26, 2018 Location: lGreenport High School Grounds Patr@-Allocatior_i for went. LRegHours OT Hrs Hrly Wage Total Comments PAl1COffIG�CS r P.O. Witzke -- 1.5 $97.17 S.P.O Robbins 1.5 $32.47 _ Reg Hours OT Hrs Hrly Wage Total Comments Bcyblq Patrol, Highway,Patrol_ Marine Units:- ^- Reg Hours OT Hrs Hrly Wage Total Comments TC TC TC TC TC Equipment Costs ._. , . ... ..._.. . . _. .- - -. .__-�_---�----'----- _. #&vehicles cost/hr hours._._ Total Police Vehicles 2 $10/hr 3 $30.00 Marine $15/hr $0.00 Command Van 0 $15/hr 0 $0.00 Prepared by Capt.M. Flatley 5/7/2018 Page 1 Town of Southold Police Department Special Event Cost Analysis A-Vs 0 $5/hr 0 $0.00 Flares/Cones $20.00 Total Department Cost for Event = $ $179.64 Prepared by Capt.M. Flatley 5/7/2018 Page 2 Neville, Elizabeth From: FlatlPy, Martin Sent: Saturday,April 21, 2018 12:59 PM To: Neville, Elizabeth; Fisher, Robert; Spiro, Melissa; Doherty,Jill; Doroski, Bonnie; Duffy, Bill; Ghosio, Bob; Hagan, Damon;Jim Dinizio; Standish, Lauren; Louisa Evans; Noncarrow, Denis; Rudder, Lynda; Russell, Scott;Silleck, Mary;Tomaszewski, Michelle;William Ruland; Duffy, Bill; Hagan, Damon; Silleck, Mary Subject: RE: Emailing: GFD Appication Fireworks_20180419113807 Attachments: CA for GFD Memorial Day Fireworks.xls o_. I have no WgeLtions to this event being held as in the pa--;t. My�oct analy�����atta�harl 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 20,201810:17 AM To: Flatley, Martin<mflatley@town.southoId.ny.us>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>;Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Doherty,Jill <jill.doherty@town.southold.ny.us>; Doroski, Bonnie <Bonnie.Doroski@town.southoId.ny.us>; Duffy, Bill<billd@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.ny.us>; Hagan, Damon<damonh@southoldtownny.gov>;Jim Dinizio <jim@jamesdinizio.com>;Standish, Lauren<Lauren.Standish@town.southold.ny.us>; Louisa Evans <Ipevans06390@gmail.com>; Neville, Elizabeth<E.Neville@town.southold.ny.us>; Noncarrow, Denis <denisn@southoldtownny.gov>; Rudder, Lynda <lynda.rudder@town.southold.ny.us>; Russell,Scott <scottr@southoldtownny.gov>;Silleck, Mary<marys@southoldtownny.gov>;Tomaszewski, Michelle <michellet@town.southold.ny.us>;William Ruland <rulandfarm@yahoo.com>; Duffy, Bill <billd@southoldtownny.gov>; Hagan, Damon<damonh@southoldtownny.gov>;Silleck, Mary<marys@southoldtownny.gov> Subject: Emailing:GFD Appication Fireworks_20180419113807 Transmitted herewith is the application of the Greenport Fire Department for their May 26th, 2018(Rain Date May 27th) Fireworks Event. Please review and advise of any concerns questions and/or objections that you may have to the granting of this Fireworks Permit. Thank you. 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 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: GFD Appication Fireworks_20180419113807 1 l Neville, Elizabeth From: Fisher Role Sent: Tuesday, May 08, 2018 10:02 AM To: Neville, Elizabeth Subject: RE: Emailing: GFD Appication Fireworks_20180419113807 Betty Sorry about the delay. I have no objections to this aPrmit as this vocation b -c be nAisBf fox manyya.r..s.. • Bob Robert Fisher Fire Marshal,Town of Southold robert.fisher@town.southold.ny.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 20, 201810:17 AM To: Flatley, Martin<mflatley@town.southold.ny.us>; Fisher, Robert<Robert.Fisher@town.southoId.ny.us>;Spiro, Melissa<Melissa.Spiro@town.southoId.ny.us>; Doherty,Jill <jill.doherty@town.southold.ny.us>; Doroski, Bonnie <Bonnie.Doroski@town.southoId.ny.us>; Duffy, Bill<billd@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.ny.us>; Hagan, Damon<damonh@southoldtownny.gov>;Jim Dinizio <jim@jamesdinizio.com>;Standish, Lauren<Lauren.Standish@town.southold.ny.us>; Louisa Evans <Ipevans06390@gmail.com>; Neville, Elizabeth<E.Neville@town.southold.ny.us>; Noncarrow, Denis <denisn@southoldtownny.gov>; Rudder, Lynda <lynda.rudder@town.southold.ny.us>; Russell,Scott <scottr@southoldtownny.gov>; Silleck, Mary<marys@southoldtownny.gov>;Tomaszewski, Michelle <michellet@town.southold.ny.us>;William Ruland <rulandfarm@yahoo.com>; Duffy, Bill <billd@southoldtownny.gov>; Hagan, Damon<damonh@southoldtownny.gov>; Silleck, Mary<marys@southoldtownny.gov> Subject: Emailing: GFD Appication Fireworks_20180419113807 Transmitted herewith is the application of the Greenport Fire Department for their May 26th, 2018 (Rain Date May 27th) Fireworks Event. Please review and advise of any concerns questions and/or objections that you may have to the granting of this Fireworks Permit. Thank you. 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 631765-6145 Cell 631466-6064 1 Neville, Elizabeth From: �. Bi. ll Sent: Friday,April 20, 2018 4:06 PM To: Neville, Elizabeth Subject: RE: Emailing: GFD Appication Fireworks_20180419113807 -lo biection i William M. Duffy, Esq. Town Attorney Town of Southold Southold Town Annex 54375 Route 25 (Main Road) P.O. Box 1179 Southold, Nww York 11971-0959 Office: 631.765-1939 Fax: 631.765.6639 Email: bill.duffv@town.southold.nv.us town.southold.ny.us ATTORNEY-CLIENT COMMUNICATION;ATTORNEY WORK PRODUCT; INTER/INTRA AGENCY COMMUNICATION; NOT SUBJECT TO FREEDOM OF INFORMATION LAW DISCLOSURE; DO NOT FORWARD WITHOUT PERMISSION Note: Service of legal documents is not permitted via electronic mail or fax. The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain information that is privileged,confidential and exempt from disclosure under applicable law. Unintended transmission shall not constitute a waiver of the attorney/client privilege or any other privilege. If the reader of this message is not the intended recipient,you are hereby notified that any review, retransmission, conversion to hard copy,copying, reproduction,circulation, publication, dissemination or other use of,or taking of any action, or omission to take action, in reliance upon this communication by persons or entities other than the intended recipient is strictly prohibited. If you have received this communication in error, please (i) notify us immediately by telephone at 631.765.1939, (ii) return the original message and all copies to us at the address above via the U.S. Postal Service, and (iii) delete the message and any material attached thereto from any computer, disk drive, diskette, or other storage device or media. -----Original Message----- From: Neville, Elizabeth Sent: Friday,April 20, 201810:17 AM To: Flatley, Martin; Fisher, Robert;Spiro, Melissa; Doherty,Jill; Doroski, Bonnie; Duffy, Bill; Ghosio, Bob; Hagan, Damon; Jim Dinizio;Standish, Lauren; Louisa Evans; Neville, Elizabeth; Noncarrow, Denis; Rudder, Lynda; Russell,Scott;Silleck, Mary;Tomaszewski, Michelle;William Ruland; Duffy, Bill; Hagan, Damon;Silleck, Mary Subject: Emailing:GFD Appication Fireworks_20180419113807 Transmitted herewith is the application of the Greenport Fire Department for their May 26th, 2018 (Rain Date May 27th) Fireworks Event. Please review and advise of any concerns questions and/or objections that you may have to the granting of this Fireworks Permit. Thank you. Elizabeth A. Neville, MMC 1 Neville, Elizabeth From: :�oiro Melissa Sent: Friday,April 20, 2018 3:58 PM To: Neville, Elizabeth; Flatley, Martin; Fisher, Robert; Doherty,Jill; Doroski, Bonnie; Duffy, Bill; Ghosio, Bob; Hagan, Damon;Jim Dinizio; Standish, Lauren; Louisa Evans; Noncarrow, Denis; Rudder, Lynda; Russell, Scott; Silleck, Mary;Tomaszewski, Michelle;William Ruland; Duffy, Bill; Hagan, Damon; Silleck, Mary Subject: RE: mailing: GFD Appication Fireworks 20180419113807 This is not preserved land. Melissa Spiro -----Original Message----- From: Neville, Elizabeth Sent: Friday,April 20, 201810:17 AM To: Flatley, Martin<mflatley@town.southold.ny.us>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>;Spiro, Melissa<Melissa.Spiro@town.southold.ny.us>; Doherty,Jill<jill.doherty@town.southold.ny.us>; Doroski, Bonnie <Bonnie.Doroski@town.southold.ny.us>; Duffy, Bill<billd@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.ny.us>; Hagan, Damon<damonh@southoldtownny.gov>;Jim Dinizio <jim@jamesdinizio.com>;Standish, Lauren<Lauren.Standish@town.southold.ny.us>; Louisa Evans <Ipevans06390@gmail.com>; Neville, Elizabeth <E.Neville@town.southold.ny.us>; Noncarrow, Denis <denisn@southoldtownny.gov>; Rudder, Lynda <lynda.rudder@town.southold.ny.us>; Russell,Scott <scottr@southoldtownny.gov>; Silleck, Mary<marys@southoldtownny.gov>;Tomaszewski, Michelle <michellet@town.southold.ny.us>;William Ruland <rulandfarm@yahoo.com>; Duffy, Bill<billd@southoldtownny.gov>; Hagan, Damon<damonh@southoldtownny.gov>;Silleck, Mary<marys@southoldtownny.gov> Subject: Emailing: GFD Appication Fireworks_20180419113807 Transmitted herewith is the application of the Greenport Fire Department for their May 26th, 2018 (Rain Date May 27th) Fireworks Event. Please review and advise of any concerns questions and/or objections that you may have to the granting of this Fireworks Permit. Thank you. 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 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: GFD Appication Fireworks 20180419113807 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. CHIEF WAYNE MILLER (631)477-9801 -STATION 1 'I'ASST.CHIEF JEFFREY WEINGART (631)477-8261 -STATION 2 2ND ASST.CHIEF SUSANO JIMENEZ (631)477-1943-CHIEFS OFFICE CHAPLAIN T.MURRAY s (631)477-4012-FAX ASST.CHAPLAIN C.KUMJIANTHIRD STREET•P.O.BOX 58 RECEIVEED GREENPORT,NY 11944 TREAS/SECRETARY J.KALIN I Email:gfdfire@optonline.net Organized 1845 APO 19 2018 www•greenportfd.org To Whom It May Concern, Southold Towr e r h Greenport Fire Dept. will be having a fireworks display on May 26th 2018 with a rain date of May 271h 2018. We will be standing by with at least 2 pumpers from Greenport and possibly a couple of additional apparatus from neighboring departments. If you have any questions please feel free to contact me at the number below. Firematically, Wayne D. Miller Chief Engineer 9 Neville, Elizabeth From: Neville, Elizabeth Sent: Friday,April 20, 2018 10:17 AM To: Flatley, Martin; Fisher, Robert; Spiro, Melissa; Doherty,Jill; Doroski, Bonnie; Duffy, Bill; Ghosio, Bob; Hagan, Damon;James Dinizio; Standish, Lauren; Louisa Evans; Neville, Elizabeth; Noncarrow, Denis; Rudder, Lynda; Russell, Scott; Silleck, Mary;Tomaszewski, Michelle;William Ruland; Duffy, Bill; Hagan, Damon; Silleck, Mary Subject: Emailing:GFD Appication Fireworks_20180419113807 Attachments: GFD Appication Fireworks_20180419113807.pdf Transmitted herewith-is the application of the Greenport Fire Department for their May 26th, 2018 (Rain Date May :27th) Fireworks Event. Please review and advise of any concerns questions and/or objections that you may have to the granting-of this Fireworks Permit. Thank you. 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 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: GFD Appication Fireworks_20180419113807 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 Ti j7.ARF.T1FtA.NEVIUM,MMC Zbwn Hall,53095-Main Road TOWN eimm o P.O.Box 1179 to ft Southold,Newlbrk 11971 REGISTRAR OF VITAL STATISTICS It& Pax(631)765-6145 GyaTelephone . 00 RECORDS OFF MANAGEMENT OFFCER southoldtownnorthforkne t FREEDOM OFINFORMANON'OFMCER O + +ICE OF THS TOWN CLERK TOWN OF SOUTHOLD APPLICATION PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law of the State of New York,for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY Star Hose Company-Greenport Fire Department PRINCIPAL OFFICE AT P.O. Box 345, Greenport; NY 11944 DATE&TIME O ,DISPLAY 5/26/18 @ 10:00 pm EXACT LOCATION-OF DISPLAY Greenport High School Athletic Field SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE&TIME 5/27/18 @ 10:00 pm The following persons are to be in charge of the actual shooting of the fireworks: Name. Age Experience Physical Condition William Lotterhos dob: 5/26/75 13 years experience Health: Excellent r, (Additional names and'information may be submitted on an attached sheet Number and type of fireworks is as follows: 1.3G.Fireworks: . 2-3 inch=422. Cakes--5. Manner and place of storage of fireworks prior to display: Delivery day of display from our Westhampton Facility. 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. r Y FEE: .$100 Name-of Organization See policy bg addition I information ' jwAe_� T/ q� By Printe0 Name of ApplicantSignatwre_ofA Ii t e-mail address: ��S 1$ perk Luh u0f Telephone Number 631- YT?-3_-0q7 Date of Application Town of Southold P.O Box 1179 Southold, NY 11971 RECEIPT * * * Date: 04/19/18 Receipt#: 237938 Quantity Transactions Reference Subtotal Fireworks 626.18 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#1480 $100.00 Greenport, Fire Departrnetn Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Y. 7 Name: Greenport, Fire Departrnetn Po Box 58 Greenport, NY 11944 Clerk ID: BONNIED Internal ID:5.26-18 A Rfl® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DOATM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 5/2018 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 pol(cy(les)must have ADDITIONAL INSURED provisions or 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 WNIACT NAME: Joseph Cherepowich Mcmann Price Agency Inc PHONE (531)477-1680 828 Front Street arc No Elk a Nei: (631)477-8930 P.O.Box 2065 ADDRESS: donna@mcmannpdce.Com Greenport INSURER(S)AFFORDING COVERAGE NAIC S INSURED NY 11944-0876 INSURER A: Arch Insurance Company Village of Greenport Fire Department INSURER B; PO Box 58 INSURER C: INSURER 0: GreenportINSURER E: NY 11944-0058 INSURER F: COVERAGES CERTIFICATE NUMBER: CL183502021 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MOLIC MM0]D OMITS x COMMERCIAL GENERAL UA131UTY EACH OCCURRENCE g 1,000,000 CLAIMS-MADE .J OCCUR PREMISES Ea occurrence S 100,000 MED EXP An one rson g 5,000 A MEPK06726912 06/01/2017 06/01/20181,000,000 PERSONAL a ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 10,000,000 POLICY E]JEP:T E]LOC PRODUCTS-COMP/OPAGG g 10,000,000 OTHER- Liquor Liab.Cov.Part s 3,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea a.d OWWNEDNED SCHEDULED ent ABODILY INJURY(Per person) g AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED AUTOSNON-OWNEDPROPERTY AUTOS ONLY AUTOS ONLY LY DAMAGEPeracadent) g a x UMBRELLA LMB x OCCUR 5,000,000 EACH OCCURRENCE S A EXCESS LIA9 ICLAIMS-MADE MEUM06473412 06/01/2017 06/01/2018 AGGREGATE $ 5,000,000 DED RETENTIONS WORKERS COMPENSATIONS PER DTI+ AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLu0ED7 ❑ N/A I E.L.EACH ACCIDENT g (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If fnam apace Is required) With respect to Cam)val from 5/24/2018 to 5/28/2018 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 AUTHORIZED REP ON Southold NY 11971 ACo CERTIFICATE OF LIABILITY INSURANCE DATE' ,D°", ' 04/09/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CER71FICATE 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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 endomement(s). PRODUCER NAMECONCT Shauna Marquis Clark Insurance PHONE(Ew 860)430-3700 A X�: (860)4-1M-3730 180 Glastonliury Boulevard AODREss, smarquts@mayboneeclark.Com Suite 401 INSURERS AFFORDINGCOVERAGE NAICA Glastonbury CT 06033 INSURERA: Lexington insurance Company 19437 INSURED INSURERS: Liberty Mutual Insurance Company 23043 Pyro Engineenng Inc.,DBA:Bay Fireworks INSURER C'. Chesapeake Employers'Insurance Company 11039 999 S.Oyster Bay Rd. DISURER D; Suite 111 INSURGRE Bethpage NY 11714 IHSURERF: COVERAGES CERTIFICATE NUMBER: 18-19 Master REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPEOFINSURANCE Sp PDLICYNUMBER UCYEFF CIFY Lam COMMERCMLOEHMALUA131UTY EACH OCCURRENCE $ 1,000.000 CLAIMSDE � 4M OCCUR PREMISESEa:."u nw $ 100.000 NED ExP one versos S A 023627358 02/151 M8 02/15/2019 PERSONAL&ADVINJURY ; 1.000,000 GEMLAGGREGATELIMITAPP{LIEESSPHt GENERAL AGGREGATE ; 2,000,000 POLICY !ERCT F-1 Loc PRODUCTS-COMP/OPAGG S 2.000.000 OTHER: $ AUiOMOBILELIABILRYO�eEDSINGLELIMIT S ANYAUTO flODILYIWURY(perparsort) S OWNFA LY SCHEDULED AUTOS ONAUTOS SODILY1N,rURY(fecddyy) S HIRED ND"WNED PROPERTY GE $ AUTOS ONLY AUTOS ONLY Per a S UMBRELLALL46 OCCUR EACHOCCURRENCE ; 9.000.000 A EXC95SLIAB Ed CLAIMS-MADE 023627359 07!1512018 0211511019 AGGREGATE ; 9.000,004 DED RETENTIONS ; WORIO:RS COMPENSATION PER AND EMPLOYERS'LIABILITY STATUTE -ER YIN S ANY PROPRIETORIPARTNERO(ECUfIVE D NJA WC5.39S-387471-018 02H612018 02/1512M9 E•L•EACHACCIOENT ; 1,000,000 OFFICERIMEMBER EXCLUDED? (MandawlITHR) F-LDISEASE-EA EMPLOYEE: ; 1,000;000 If describe under 1,000,000DES DESCRIPTION E.L.DISEASE-POLICYLPNR S E.LAc EaCIrcldent 1.000.000 C Workers'Compensation 5451949 03/0612018 03/06/2019 E.L Disease-EAE to I LLI I I Maryland P Yee 1,000,000 E.L Disease-Policy LImII 1.00 .000 DESCRIPTION OF OPERATiONSI LOCAMONSI VEMCLES(ACORD 101,AddlUwW Remulre Schedub,may ba anadwd U mom spay is required) Liberty Mutual Workers'Compensation States:CT,GA.NC,NV,SC,VA Date of Display:May 26,2D18 LOCATION OF DISPLAY:Greenport High School Athletic Field.Greenport NY Star Hose Company;Greenport Fire Department:Village of Greenport:Town of Southold;Suffolk County;Greenport UFSD are Included as additional Insured as respects to the General Liability policy per w itten agreemeWcontract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE OELIYERED IN Greenport Fife Department ACCORDANCE WITH THE POLICY PROVIStONS. PO Box 345 AUTHORRED REPRESENTATIVE Greenport NY 11944 ®1988 2015 ACORD CORPORATION. AN rights. ived. ACORD 25(2016103) TheACORD'name and logo are registered marks of ACORD ACCO CERTIFICATE OF LIABILITY INSURANCE 04/16/2018 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATLVELYAMEND,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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the poilry,certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NCAONTACT DeckerAgency The DeckerAgency Inc PHONE , (716)8831455 (716)8&3-6210 AIC No 3715IOnYoodAYenue A-FRAIL : DISURER(S AFFORDING COVERAGE MAIC N Buffalo NY 142012018 1flSURERA-. National Continental Ins Co 10243 INSURED INSURER B: Pyro Engineering Ine.DBA Bay Rreworks INSURER C: 999 S Oyster Rd Suite 111 INSURER D: INSURER E: Bethpage NY 11714 INSURERf; COVERAGES CERTIFICATE NUMBER: 18.19 Master5 mliNon 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 ANYREGUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN 1S SUBJECTTOAU-THETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_UMTfS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ LTR TYPE OF INSURANCE POLICYNUMBER POLING POLING EXP LIMITS COAUAFRC14LGENERAL LIABILITY EACHOCCURRENCE S •M CLAIMSADE OCCUR KENIbu PREMISES Me ocwrtenos S MEDEXPIAreonewmMI S PERSONALaADVIKIURY S GENLAGGREGMEUWrAPPUESPER: GENERALAGGREGATE S POLICY Ej PRO. F-I LOC PRODUCTS S OTHER S AUTOMOBILE LIABILITYC SINGLE LWIT S 5.000.000 cid ANY AUTO BODILY I NIURY(Perperson) S AAUTOS OVMEDY AUTSCHEDULED CNY0004909233-8 02115/2018 02115!2019 awILy WURY(Peracddem) S HIRED NON-OWNED PROPERTYDA E S AUTOSONLY AUMONLY acaft Additional Personal Injury E 100,00D UMBRELLAL" OCCUR EAWOCCURRENCE S EXCESS UAH HCLAMS-MADE AGGREGATE i OED I I RETENTION S S WORKERS COMPENSATION! PER EOR "AND EMPLOYERS'UMILI" Y/N STATRITE ER AOFFiCNYPROPRf3UIEMEMBTDER f7K:WPARTNERIEiUDED9XECUTWE ❑ NIA EL.EACHACCIDENT S (riandatmIn" I-L 0IS4EASE-EA EMPLOYEE S ON HYes.descrOF OF OPERATiOt�tatoar E.I..DISEASE.POLICY UWr S DESCRIPTION DESCRPTION OF OPERATIONS!LDCAVM I VEMCLES(ACORD 1191,AddMlanat Pernarks Schedule,maybe anadiod Umcm spats Is required) Operations of the named-Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Greenport fire Department ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 345 AUTHORIZEDREPRESENTATIVE Greenport NY 11944 ®1988,2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) TheACORO name and logo are registered marlrs ofACORD T� GREENP09T FIRE,DEPA RTMEx1i, . E j GREE.;T- ' '� 1TE J�' YORK � �1 300 f# wadi ms J inch ini max �r M dlson vc T s rrl r kyr*y� r �1 l�r jr y✓ 1, .. n z 't`''"€�' w b.4 ..e a. ,...G r�;' - �",: •.., k f fig ��. IL#' A 'Yr • - '� r ^r = t-. :� s, - rt _ "�' �''x., `�' - - �-�' r k ria... •-rte• '*- r ir FIX ,�1�'m•. wt IV x ' i� tom" ^`r ' �~. +r r_r , .. t • wa: S. h T r Mks (G 2013Go�og1,0 �5. 4a' FVlfl . ��/ 'y. ,a l,t...t fi , ,1, r,W) .r, r f .' Yz•: r ti �' �1� '''s w: 4/11/2018 servlet.FileDownload(2448X3264) ,e„`(" ;�,.. ,-;*. - -"',}'.. +i"y'� - .¢:�r <�L'"3;i'w�r?�;�m.4'°t'"-'.=.�: }:e`4_t�;-'k• - r: ' u., '^x.r"'Y -^'t n -z'' - - i {r .,N� ,.''�, x%''�""�j!!"M��1'Lt♦ i'4r ,1'.:.i� :1�a40',y Y•"�t`�:e 5. tili' S`l'..I. Je�i�hvi�t,` ?`"„x'���.x- i. ¢. �i.��R,'iR'r t'��Ny�^�� �� .;xiS, zxkn°';'`t`rw„ +F'�+;'-F�,r1•`S;:''` ,' pti s,�`•� `£J J:it� .V``-`;r^' -'5'°""'"'L'y'',$''..'".e1; `ix7�,s``"';a't2, a. �''l•,3k_-{.r�{��.�, .�.,�3i7wa, 'zwL.� _ .;,�� j7 r�+ `"�; `q�":'" •�r' L,n ,n• ° ,yid ,p. ' 'r.,;",4_"'=�� �'';,�• �y _, `'n„<'!Lr✓'.t4"r� ,xp l�ke d �c V �" k'e.`^'}= .5 d�' Y��sgs��. OP -E NPTM n,„• " .".¢ �' j'••,g'r't"Cig�'�=%'f ; -"'. uk' � .'� �'r�,;''4i-d'$�F,h t�,i't`-1,�,.�A+''F'"k k•�'�S.•�" -° , ' ' ��, <Yr h- - - __ _ �*- •- ••`, t, -.- - _"r - = - .::.ti�sv`Sp�-ar�r" Y'�`='t^•-�%J'}:,'e,'-r"{tr��`'^ ,iwl'L„M1'G' �� ' "'c'-'� '�''- ;���- - r- •�-",_e�hf.�ez:«`r„�,�.rti�.w`t-_..,� -��yM1 "=�,� ',-,",a�"+,�7:*�r�aS'x; Ww X' '", t 1 ts J _ ... - "1- � �SS'�-•_ e,-4^ --' '� ff rf Y�Ac�'y:. ', F�'" ,�'"•`x�P�h,'•R� " _ •re4$5s '¢- - r- - - 'i;' 'TROR��! TT-����''.°°rr. AUDII((]((.'''''�� E� �F, i'4` i,i� V 11i4YL`4.-"�iy ���.` 'i y•w • - - - U'e-y 111 - .�;� Sou' - ,- t;.,s:;i-- ,. __ .:r��.5a•:,`�. z� •� k �" ,�-^ t �,• --'!�".f NYS %t ' , a #, ,a rr httpsJ/c.na57.content.force.com/servIeUserviet.Fi[eDownload?file=00P330000od0b7v 1 J7 �doARMS 4M aOSI+todsjo lmd w4 uo AsId atpja Suglpatpseutbat a Jo aasNodsIO)4q P axaw w PazuaWe aosNodSm WO&APO--V Qq aOPwOSS ams •PaKgW aQ Heys saup to pae suaganb pe ulOLVA q W850 SAMNods so poputisopagIMS ' I& afWHdIlW UG"SFm9P31141 IWVV&WSNCdS t '13d JO Io*m ettlPt�4S�osm Jo Jelq " Pu!Aq P =idsMw>��$�03 uo qo au SW4 PW 13d imp Pmft Puz PKISAm q u -an, (31S)et►oyd�cclJo waam**mwllltecjodtatl w pqmlp a4 41wts ! JGj 11OSNOcIS t PGn1� UV sasuSft3 JoPU'&n d PSE MV ars uo amv SWO.L Swonni!d ABS eDUO sasu �olwan d axe AW' Sb51 >9ilemo uD w iW? Jet{e PaWks}1 sash JOPUBA AWqd PSE MN i 9 sLISt'!90 uo iw tvn pa"oull slsaQ�4lpPV 3 �!►d .D wN�w�W 90 � !J�aQ GP q algal S*ao pawl eq Fm--q fu p*gosaylu9mwdlsod 8 tad Ja PIP=0%Auul9q tloseaJ Jatgo true Jo)Jo'WR PSW-&gne4 4=p a Mlaa mmO an Aq w*equualep dq Jo JagteaH►)tleulalou!M anP AeSMSU s2&MnP8qmQwuausucdFDd s Trane a*ul •anoq¢y�2as wPt! �M atA a4 Pe1uP�ps act iteys awes'tad)a laam Balt puoliaq uoseau taylo Jiue Joh 'uo.pWqpr4&L4wqftcWw IMMUM46 eta A1 Usv! s p Aq IDJ84W"I iaUMP18P umsm fq Pwnpsgww mwdPod s!WjoMM ap jo 1SStft9elpa 'oW "uoRgRn 9M os P 0MmA4Pm pasoduy saSnyouw Ja saxes'se4AgW jo 'Ne Im (oil suson spa om, 'sales'01 M.IM tau PA'&WPu!ISM PUB sea)(wuaamt MQIB 'Wjq:auo sm 91tltwed'e►su2o�'as�xa astl " lie to luaw�iad atI}Jo)ai9!suadsav sl?IOSPt4dS :eloltil aseald 8 tox'sz��so w�N uo�1q�ane alta ao aao's�:�o e�alu•a Xm sv wqcftd PLwenP aq Rwp 00` WV S p tuns(WOmp algegdde JaMo#e So DOM/ields.V qj)isMat!t t4tD' S S -a*igd A1f1dSW S�aOIIA�J4d1d SwiN31Y/AV4f QNVJSW Z '(A*hMP majoA9 voWgMmfNUVaq sM~o leMwwwu 8 atp A9 PeWwjWP aq gp A1dM Maio eu4t dma pttw~PuPwe111 MON} -gm%IJ%P Mm wgm*l="W Poe sa!O*w%Vous Ojos etp aq fls+#S 13d�P s;ql"uearutpai Pwee1#13d g#o���JaPun eq tlu�delds!p atLL'uo!lpot�lds!p s�laa"d atA 7e�tdslp ayl Jo)ivatudlmia Pug WOM"MP OwDid IIWS i3d4LWQ fMdwa QWaq) SM'9z AW 'u0 A UM MMM2alW I OP o7aw4 sap,ed a48'lWo3;n Ja4leuia oq Weue=pus su WKW'MUAO QtRJ0 UQ4WaPlsuoo W'3a MEHt'MCN W Smauoa PULP mum atp uo hidsip mp maJg a uugpsd Pus aonpeud'uo.mp of ed aBeBus w M Jateu�1 aosNodssvma"m Pus%Romp mpwa*Sw4uaa pua'sWnpwd'sal WP 13d'Mt13kM 'i.Z103NOdse Jelletr!atati} Mi.& 1W VMhowO '8nt/ 09 M 'AuedusoO seop xqq Pus ,Li3 a xWu!woq) Mt& AN `a a8 '11L IMlaS'PWH X43 J Q WWS 666 q SMPPe O04nt"-Xq'6ll! UJMA3*Md uammaq 10 Aq gHm'9 1p*GPM 1N311I133wy JMPW ,9VAV7dSla SWOMMilmf 81.09`99 Agn=optl Asids!Q JSPV*7 SWQMWt-4 SOVIO PROM A.OVIMWV L'd d!ro.90'8L 9L Jdy Apr 1618,05:45p p.4 s. i~7L iSMON PLANI4 OR CHECKLiST. It is astlerstood and agreed by the parties hereto that the Frewaft Display shalt be contingent upon the attid compliance,by SPONSOR ihrith all Rem specified on the Exhibition Planner Checklist(E-PC')which is annexed hereto and made a part hereof. Failure on the part of SPONSORto comply uMh ail requirements set forth in the EPC to tie satisfaction of PM wvigtin the tims limits the set forth shag be deemed to be an event of default of SPON SMS abiigations hereunder. $.WC PJTt+/SAFETY• SPONSOR shag provide and maintain sufident Security betore3,duff and after the Fkawaft Display until the pyre teduriaan in charge declares the am dear Seccuiiy shag be deemed to kidaft,but not Ilm tied to. be aN security firms,police protection,snow fencing.rape lines.barricades or any othm item deemed necesisarlr by the tent government or by PEI.StPONSM shall also pm*k and main n an area clear of any buildings cars and spectators vu M a snkiimum radius as specified by cum=#edition of NFPA Code 3123, as a l=ire SafetyZvne(FSS during the eriti3+e pehiod commencing from the timethe fireworks are delivered to the site unUl to ares is dede ed dear by Qts pymbl dWelan. itis understood acrd agreed that PE will cease all frcevvarlts discharge due to any security breach of the FSZ. Pd shall W be responsible for personal film,:veilide or property damage creating within the FSZ as a rejult of the SPONSOR'a fallume to maintain ft FSZ in accordance with:the standards of current edition of NEPA 1123 which, incalw t ly,are only rrrkdmwn starmands of distances,. SPONSOR acknowledges and agrees thatMs responsibilities are liin fled to the Fireworics Display and tM PB Is relying on SPONiSaRto main the aforemeiftned FSZ and to oomPlywith a8 Feder 1.State. municipal and local laws,orders,regulations and ordinances pertaining to the implementation of any and all security measures at the site of the Firevveartcs Display►.Any site vbft made during the&splay setup by or on behalf of SPONSOR shall be in arxordartce with the current adition of NFPA 1123-and under the direct supervision of the PE teciini lam In ego".Airy such Wpedtioh thbil not:many way interfere with the safety,setup or-schedule of the preparation for and disassembly afterthe nrewaft Display.The PEI technician in charge may.at his dbsemetian cancel any inspection that In his safe opinion may compromise the safety of time setup or the F'uevi oft Display or the setup sdhadute_The PEI technician may at oW tine temporeft discontinue the dischaW of fusewmits for any reason. 7.CRED03:As a material inducement to PES agreeing to enter into iris Agresrnent.SPONSM shall give PUJ program credit as sole tireworfcs supplier and pry in ail press releases,advertisirg,and any carer program arnouncemenL%printer or otherwise. JMAWLRY es DELJt1ER or CONDUCT FJREIV ORKS DISPL WORCE MAJE1RE. PEI shail not incur any tiabTdyl fior any loss or for arty feh'tm to perform any abloation hereunder due to causes beyond its reasonable control including without limitallan legal or regulatory mtricdons. tabor disputes of whatever mature, panzer loss,talecommufications lure.acts of God,or any other cause bwyand its ale cantrasl. in the event 'PEI is unable to delivm the Fir�evtorlce Display an the Delivery Date this contract will maab► In full fame and effect and ft Fir ewarks Display vA he perlbrmled on the Allemate Date or N no Allemale Dath is stated then on mob other date as may beagreed upon by the parties. &GommaCT stmuECY Td GsOtIE?HmaffRLcmATJQN: This Agreement and PEVs obligations;hereunder are subject to all applicable Federal,State,libhnicipal and local bavvs,rulm ordinances.regulations and cedes,now or hereinafter in etlact and to the conditions and l'rnitatioms contained in the permits required to be opined by SPONSOR pilar to the Firewrarlcs Display. In tyre event arty Federal.Slate,municipal"local law,rule,regulailon or ordinance shall be enacted which in slays way prohibit fimifs or restricts the sale.performance or operon of the exhibition of the Fkevaorha Display or in time event SPONSOR'S pem*in any wall firalts or restrictsthe sate,peribunance or operation of said exhibition,PSS shag limit or restrict its performance or the Fheworlm Display so as to complyvulth such lm nine,regulation orordinaenee or i'mtQatlan or lWdcdom of SPONSOR'S permit.SPONSOR adahaiMedges that any such limit or restriction pied on the pnedbanarm or operation of the Frawaft Display sly in no way rem in or entitle SPONSOR to a reduction or abatement in the fug corif alt price. 10. GENERAL.PROtf1SlONS: a) This agreerrmA conaftiles the entire agreement behveen the parties relating to the su*d matter hereof.and may not be changed,rnodked.renewed or extended excW by a written agreement,soled by both parlieases. SPONSOR acknowledges and agree=s that PEI has not made any representations or warranties except those specilicalty set forth In this contract. Should any ctairse.seclian,or part of this agreement be held or declared to be void or ftal for any reason,all cher dam,seckms, or parts of this agreementwhich can be affected rted wittrad such Illegal cause.section.or part shaft nevertheless eon in ue in full ft"s and effect. b) !SPONSOR Is responsible forr ramoval of paper debris associated with the Fireworks Display. c) PEI is not rasponsbla for pr=dag any marine services associated vuith the production of SPONSOR'S event: Should SPONSOR require these services,PEI troy,upon vdllene request.assist SPONSOR In the kwallm and contradhV of:such services. All additional leafs and fees a nodeted fruit►uterine 3enfims are the respor&Willy of the SPONSOR it is specifically understood and agreed that PEI shag not be responsible in any way Eany third party service With vthich SPONSOR has contracted for service fails to pedwm and to display canned proceed as planned. d) SPONSOR is responsible for any additional marine c ft and fees.d y pemfflMscort fees,County JSt9teJM FDJFM fees, local town permit fees.etc. e) In the event SPONSOR cancels the Frceworirs Display the full c onbW price as set forth herein shall become imrrhedsabely due and payable. SPONSOR will have up to 30 days from the date of cancellation to requed PE to reschedule rte Fireworlm Display, Fireworks Display shall take place no later than rix ranahs tiara originally schededed Freworks Display 1) PEI agrees to proixhre Why Insurance on behalf of SPONSOR,and to kxler niify SPONSOR,to the extent theneol,far all claim arising out of Ms negligence. Any additional brsurance that is required that incurs a cost,wgi be the SPONSOWS respor ilby. Fletase ireiibl eadpage. 110111M MOWS TP W. 1 �BJfTO!(�.101Jd tt[tA w P8PMWOjaq!! t!li"plLam.A at f3up000e'deldelp Jnodp dap VO V/j AjWH '(tiesssmi P'APowe letgo jo tegsretu a%em da pamdds)sale kidslp w m emssom sn mum alit way sua�n4sul eutar ayt ja ddoa a sn xad -ails dt4dslp ata oz uefd alrao�a!elnate ue dues true tt�cµalrnSsu suatelrlSai 1�aP� '� �Ie{dsgs®tp ►1P P1sQ arolaq lata¢ `le!►u!e uodn tMt sspMGM 10 dtunoasM gUemm*w vwmw&J j S suu0}po xe�'paxnbar es a de /4tatFawwi MRS* w3tU®1!,("2m Pulff Iem"I 'z sal Poe$EqW2P t+Me=ld��ltld E :uo uortetuqur umtgo AAA ' es pl sae agaunile3 WV—P a C4jo s tzp J t mo og aoBto soar a �o Ji$494&VONOdS uo uo_gwMdde i eta!a;Nmmjaded eta aredwd gm and �ttuad ds�s u +f� �1euW twg!cy a�of atePdoldde tettlo f � a�.da6e�t3o'y6r 'utxol`dtunofl`�'aletrjttod lfea AIdN�s�Osuosi5 s!if =r1J.1'I181SIdOdS3N 5.�iaSljQdS •(AgCfBfp 444Jaao uogalPstltt(f3tINN tast;jt04PU IgwewvOA08 WS tq ip o"oq am detdsp ap So dow Pus Vap its sqL =old '11MMd JLV M-S fl SAt{QRI HLj 'e =�.ZSI�t:73H�?l3NNt/Td NOI.LIr91HX3 9i t�1t P ;ueurlledttfl►op -1tPJD tdMm M sl Bd Pus 0d pue WS"OdS dq PWMw IMM tad uo&V qq est lou imp M4=-IJ. 13%ta v tet, 'tilaA Mall!o 8IM Maio$+last mitt"ra eW3a m*tgldde At FGAPM eq IIe4$Pue'tOA mN of ssaulsnq jo oqpesg4 s tuosj wasps aMl of PaEMP Qq 11945 p84uoo solo stmt!aqt po flue tsttls6e m ueaMq'dq pasuawaraa poamtn;uatupuqm Aug p���s�#a sit�et 6utte{�� uo�u�w!0 3o ana`spun fkaspe s6u�a2oold m'uo►tae 3o sasn>?aa'sutlep'sine 'semmwqm'sat !P 9H pue dtty "fie u!ftmAawjw 2D twag due jo ua9 p ta#Btnpttad'ulna;da!!o tt Aw4wt}e `uGazm(tn'at pstlmou vm'Burpnpu!'u eio pie ul dpawar IeLus.md due ugrpMnf wuatsdwoo jo tum m#W04 Kari ieut deed spPou:io uopttqe epos due she surtat str dq t aro plates due equm o)<!ou'xueat6V satj jo vasuwad ssardxa Aue dhow m of ltsnod ou anal l 1 dsranoAtoo 4 ul lo�wP. ay l -uop:upslmf ttratadusta s ttrwa dos ut uoa�atp parapra a9 deco tuau�fismi pus Btopusq P�it�g�!lfe4s togat�.te�3o P at4.t.�3 shatuotis Plt�e dsut��tlq�� Poe'pawtt6a�eq i��oit3lt!9w(l.)aua dW0'uapBl��+tMb treolrettty arg;a f3tgrnelt� $slot tapnaunuao�aF tutartslnd WOA"N ' fl nt>SseN u!uo4wpW dq pallom al 1pW'IDalau ualslnold 4ue pe uo.wmxtmul to DL4usew all;of m Std_pnlaul `tuaussWEV app m U002iw ut Jo jo w suture dmrta4m}o ad4lat4o due to'saouarajpp'salmisep its pop MV ,NOLLb't►d1 V," 'eoPd PwPm PIMP tuMaDPW!o UO.WnM s at UOSHods eon jo ul tm fees ou ul pt s swWgjsgns duy •soweu Pt�9 Poe saddl•sagttPxtb'so�s� 'ot .! utq xAl l'ttre�atd atll�dtlt�10 solea► g eta U104pW lou scop awes paWpsd dressagau 5ua3ap a s4mmy due of lam.t sa 4e'p 6P mR RmP Ind �SI1fQUli US13 U -OW d9 Perms w6mimp o4jo epwpo eMmmm pin pqpmq AprQ=s)q*wVqApwd ' sIOUs!BdOMP=M"41'•ta5 a#Agpmft Wqm#'qtl'uolsowdls*PmL Ku4PM UOPU.uUWPP$14 Inq" nsgnseq p.m mneMqoosuodq;ormwssv taa AW pammmsaftump wu s dsq anp wilmoppaWmamiI e. Ed P4 gaw4 mpod atllLVWAks4&4xmpqw Le undn pal Pwq!ibLpmppuwaq pts e4wal wom wpefue aq Imp©a�a saos s ►8ew lna is U P��tgp sla MMWaalLVQM - •paute UM toalaq suogAold pus suuat 9%jo duap 4tq9p SVOSNodS3o jnser B se ssowap m AWAkIM sop soros due had of?jQgjMS pdwoo of =4 m(Bup oemd mW Rus jo twpegxM Owpae M ,Iva asuawu OO ntP Isd use a4t ul stsaxtJKP pue saej AOWO a elgeuasear Md fed PP P M mft 3.1684 SaM HOMOds atop onp ORD914E WO44unaum pledun atµuo tnuam!ed 405'E 3o aim eqt m tsarega•tunaure tis otrtpjPpe fu'asgd pays ?IOSNOdS'towWo SJ4!}sa stumt atlliapun anp uager►u des fed 1.q pays aoSNQdg tuana"ul u7ttwea swswdS u g d d9ti:90'8L 9L AV Apr 1618,05:45p p.3 b.COAST GUARD PERMITS(where reauired): 9. If the fireworks are to be displayed on or nearthe water,the following maybe required: (Requests for permits roust be filed at least 60 days prior to the Display Date(135 days prior for4th of July events). 2. Coast Guard Application and Permit to Handle Hazardous Materials. 3. Coast Guard Marine Event Permit c.SPONSOR RESPONSIBILITIES AND EXPENSES(The fnllowina services need to be provided and Paid for by the SPONSOR in addition to the Fireworks Display Price. SECURITY: MUST BE PROVIDED FOR FIREWORKS TRUCK(S) AND TO MAINTAIN THE FIRE SAFETY ZONE AT STAGING AREA FROM FIREWORKS TRUCK(S)ARRIVAL,UNTIL TRUCK DEPARTURE WHICH MAY BE FOLLOWING THE REQUIRED FIRST LIGHT DUD SEARCH ON THE MORNING AFTER THE DISPLAY. 2) 3) Sand; Please provide 0 yards of sand. 4) Laborer(s): 0 laborers to arrive at fireworks site on (They will not handle fireworks). ry Hotel Room(s):—PL_hotel rooms.(within 10 miles of shoot site) 6) Vehicte(s): Four-wheel drive vehicle for movement on sand:Yes No XX 'n If you have ordered a set p(ece(s),you are responsible for erecting the scaffolding and it must be ready when the crewarrives d RADIO SIMULCAST EXPENSES(if applicable): 1) Setup and staff a fireworks simulcast command centeron site by 1:00 PM on the display date. 2) Provide broadcast relay to PEI Firing Center. Call our office for details. 3) Speaker system for VIP viewing stands. e:INSURANCE: Please list below the additional insured,as they should appear on the insurance certificate: 1. S')r q i K 14--fX 0 (U3 L—W b= 3. fA 6 2. (l,LZpsd p G 4. Spy T v' .a-1k Name of Sponsor 5fn N sr VvwDate! Of 'Pyro En fneerin r lure Date By: - Signed on behalf ofSponsor(Signature) Print Name e Tate of authorized re resentative of Sponsor Tide ■■srrerrrrrrarrarrrrrrrrrsrrrr,■�rrrrrrrrrsrrrrrrrrr■zrrararrrrarrrr�r■ ■rrrar®Mr�srrr�Mrrr 400"OF cbc�L- State of County of On the_day of .in the year before me,the undersigned,a Notary Public in and for said State,personally appeared personally known tome or proved to me on the basis of satisfactory evidence to be the individuals)whose narne(s) is(are)subscribed to the within instrument and acknowledged to me that helshefthey executed the same in his►her/their capacity(ies),and that by hirdher/their si8nature(s)on the instrument,the individual(sl or the person upon behalf of which the individual(s)acted,executed the instrumenL Signature and Office of individual taking acknowledgment [seal] Pieasemaleachpaga. Initial hole: Sponsor PEI Apr 1618.05:45p p.2 PYRO ENGINEERING, INC. DISPLAY SITE PLAN QUESTIONNAIRE M ferns IBM below are a*ad to a6 9 MIS Federal,St te.Mwg4al and locst taws,tabs,ordinances,ngulat um amd codes,now or hers;mftr in OWL to the candiffM and fintil tw oentained b tt*Mmb required or ID be obtained by Spmrm SPONSOR: Star One Company Display Date S �� / gain Date: ILIAF 8 Sud9 : #pas, O-D DEsplay Locate:_ T� Lar r� l i--L egg&pb R p fee.(fit, T ittts of Dispyay: I 0 �1 "r (Nole: The actual start and stop tient:of tha display YM be determined by the governmental authorities hwAnggta%dtwe over ft tttsplay� 1MPtaRTANT PLEASE PROWDElA S1TEPLAN FOR YOUR EVENT LOCATION,INDICATING WITHANX THE EX4CTSFOTWHERE RREWORKS ARE TO BE SET-UP. Local Fire Mataltah. Telephone no: Cell Phone No: Crew Caniect Person: Telephone NO: Cell Phone No: The Following infonrratlon is necessary In order for as to provide yourcommurmy or organ&abon with a+dlspDay OW cswfarms with Nmw*r)ts safetir reflUbd0fiS and for the bwance of Lgurirtsuranc+e cerUffeaft DISTANCES,IN FEET,FROM-THE FIRING AREA TO THE FOLLOWING: FEET SPECTATORS,AUDIENCE OR PARKED CARS.........�.as.�..... OCCUPIED BUILOINGS(HOMES,APARTMEMS,ETC.).. PUBLIC BWLDINGS(SCHOOLS,HOSPITALS,CHURCHES,ETC)....4�6�."'...f...... TBIIPORARY EVENT SET-LIPS(CONCESSIONS,TEINT%ETC.)......L c c..f'....M. MAIN PARKING AREAS......3'-' R............... .......... ...,.....,............... ............ . 09 HIGHWAYSOR ROADS......�........................................................................ OVERHEAD OBJECTS JPOWER LINES,LIGHT POLES,TREES,ETC.. FUELSTORAGE...... ' ............................................................................. PLEASE PROVIDE DIRECTIONS FROM NEAREST INTERSTATE TO DISPLAY SITE. A MAP WOULD ALSO BE HELPFUL. Lacaf Afoft1sMbfdw Telephone Arora Date © � S rNr: Ho rd Co Pieria bs�al suit pagQ� I�1 h� New York State Insurance Fund Workers'compemation A DisablUly Benefits Specialists Since 1914 8 CORPORATE CENTER DR,2ND FLR,MELVILLE,NEW YORK 11747-3166 CERTIFICATE OF WORKERS'COMPENSATION INSURANCE � O A A A A A A 753044987 BOSTON INSURANCE BROKERAGE 24 FEDERAL ST FL 4 � } BOSTON MA 02110 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE.HOLDER GREEHPORT HIGH SCHOO PYRO ENGINEERING INC GREENPORT FIRE DEPARTMENT DBA BAY FIREWORKS PO BOX 345 999 S.OYSTER BAY RD, STE 111 GREENPORT NY 11944 BETHPAGE NY 11714 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2437 559-4 578815 02/27/2018 TO 02/1512019 4/9/2018 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2437 559-4, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS, COMPENSATION UNDER THE NEW YORK WORKERS` COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDERS REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPSJNVW WA"W.COWCERTICERTVAL.ASP.THE NEW YORK STA'T'E INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS, THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND10R MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOWER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE 'UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:1008241145 U-26.3 r� Y RECEIVED MAR 0 6 2018 �r VILLAGE OF G CLERK'S DE ARTMENNRT eh 631-477-0248 Fax: 631-477-1877 PUBLIC ASSEMBLY PERMIT APPLICATION ;+ 7;� application applies to any form of public assembly or entertainment expected to attract or involve twenty- five(25)or more persons. A cover letter is required,describing in detail the proposed event. $50.00 non-refundable permit fee must be submitted with the complete application. SECTION 1: , i 'Name of Applicant/Organization: J)-AP, 14D5r 3gh Address of Applicant/Organization: Gj p ffk coe.r ig ligo E-mail Address: f! X 11; nh P_ c>6,D4 Ll we , Ivy( Phone No.: 63I- Location of Event: t ��av ��' +Ic b rvl� Loy Type of Event, Date of Event: s )R0 Hours of Event: J 7; l j Description of Event: C APKp i V�, 1'V lJ� �ip1S�� 4Ir"g rwl>(,k,- s"r$/2��s tiC6,1, ¢l,r Estimated Number of people in attendance: Fees to be charged: Pyy, �I 1 hereby declare that 1 will comply with the Village of Greenport Code and all conditions of this permit. 4naiture of Applicant Date Please Circle Appropriate Answer Road(s)to be closed? Yes No Tent or Structure to be erected? Yes No Sidewalk(s)blocked? Yes No Food to be served? Yes No - Have you previously obtained a permit for this event? es No If yes,When? P0Q s (ta Clean up-wians: L b -Q 41�C,rs A/ L9 S 7A- jfy� :public Assembly Permit Application'(approved 5-23-2011) r Approval by the Board.of Trustees is required,and this permit must be submitted no later than 60 days-prior to the event. �EcnoN 2- A deposit check in the amount of five hundred dollars($500.00)must be submitted with this application,whici, may be refunded after event conclusion if the property is returned to its original state and there are no cosiS incurred by the Village. Insurance required: Applicant will provide proof of liability insurance in the amount of one million-dollars ($1,000,000)per occurrence naming the Village of Greenport as additional insured for risks or as may otherwise be determined by the Board of Trustees. Alcoholic Beverages: No person shall consume any alcoholic beverage in any Village park,playground;beach, or other Village park property or facility,nor shall any person possess any alcoholic beverage with intent to consume or facilitate consumption'by others of same in any Village park,-playground,beach,or other park property. - Signed: Dated: LO Applicant must return completed application,cover Tetter and checks to the Village of Greenport,at 236 a Street,Greenport,NY 11944 SEMOM 3: FOR OFFICE.USE ONLY This ap icati n is here - Approved Denied Sylvi 'Pirillo,village Jerk 22 ,Q Dat' vi"Date of Board of Trustees Action:v l'd CC: Finance Department Police Department DPW I Utilities Fire Department Public Assembly Permit Application(approved 5-23-2011) • �� ®r ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMO]QIYYYII) 03/05/2018 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 pol)cy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject lathe 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 Joseph Cherepowich Mcmann Price Agency Inc. PnHieNr o E�: (631)477-1680 F AIC No (631)477-8930 828 Front StreetDA4VIAIL : donna@mcmannpdce.Com P.O.BOX 2065 INSURERS)AFFORDING COVERAGE NAIC A Greenport NY 11944-0876 INSURER A: Arch Insurance Company INSURED INSURER B Village of Greenport Fire Department INSURER C: PO BOX 58 INSURERD: INSURER E: Greenport NY 11944-0058 INSURER F: COVERAGES CERTIFICATE NUMBER: CLIS3502021 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 LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY POLICY P LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence) S 100,000 MED EXP(Any oneperson) S 5,000 A MEPK06726912 06/01/2017 06/01/2018 PERSONAL BADVINJURY S 1.000,000 i GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 10,000,000 POLICY❑JECT F LOC PRODUCTS-COMP/OP AGG S 10,000,000 OTHER: Liquor Liab.Cov.Part s 3,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea soddent ANY AUTO BODILY INJURY(Perperson) S OWNED SCHEDULED BODILY INJURY(Per S AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per acdden! S X UMBRELLA LIARX OCCUR EACH OCCURRENCE S 5,000,000 A EXCESS LIAB CLAIMS-MADE MEUM06473412 06/01/2017 06/01/2018 AGGREGATE S 5,000,000 DED I I RETENTIONS I I 1 S WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY YIN STAME ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA EL EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.LDISEASE-EAEMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS]LOCATIONS)VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If mora space Is required) With respect to Carnival from 5/24/2018 to 5/28/2018 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Greenport ACCORDANCE WITH THE POLICY PROVISIONS. 236 Third Street AUTHORIZED REPRESE Greenport NY 11944 01988 2015 ACORD CORPORATION, All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD GREENPORT UFSD D MAR 6 2018 720 Front Street iso S Greenport, NY 11944 APPLICATION FOR USE OF SCHOOL FACILITIES 1 The Administration is responsible for the use of all school facilities in order that they may consider your request for such use, kindly complete the following: 1. Facilities Use Request: (Organization), !; r 90 CAJfyQ®a�" requests the use of M>P-1-4 4d OF rlV eat Greenport Public Schools for the purpose of: F)(Zg'W vt*'j h )5 n1 A on(date), S Ar - M A 2�, yc> 1 at(time) ,4 l 1, DIa` 'A1y a Will activity be open to the public? (Circle one)<�pNo Is this a For Profit Organization?(Circle one) Yes Admission of }�,+o r4+'4-,I( will be charged; proceeds will be used for Does applicant agree to submit financial records for examination upon requests? Does applicant agree to conform to the regulations of the Board of Education and all laws regulating to the use of school property including Section 414 printed on the reverse side of this application? I!1 Name: �(A,$)An-� / l��u Address: ��� �'l� C4P Q L�ulf;�2t� t� �Lr X� 19 7 3� . �-rte r Telephone# �� of the person responsible on this occasion. II. Insurance Information A certificate of insurance of at least$1,000,000 public•liability per occurrence and$2,000,000 aggregate liability insurance and$50,000 property damage shall be submitted at least three days in advance of the event and must designate both the using organization and the Greenport Union Free School District with ISO endorsement CG2026.The absence of such a certificate will preclude use of the facility. The policy must contain a 30-day guarantee notice of cancellation.The user agrees to indemnify the district for any applicable deductibles. III. Rules Governing Use of Facilities A. No smoking is allowed in the building or on the grounds.The organization using the facility is responsible for enforcement. 'y Jul B. No drinking of alcoholic beverages is permitted. C. Activity shall be restricted to that area for which permission is granted. D. Activity shall not extend beyond hours approved by district. E. Programs shall not interfere will regular school schedule. F. Organization shall be responsible for moving its equipment into and out of the building. G. The supervisor of the activity shall be present before it is due to start and remain with the group until all have left. H. In the absence of administrative personnel,the custodian is charged with the responsibility of the building. I• School authorities must have free access to all rooms at all times J. A careful examination will be made after use of the area by the applicant who will promptly make good on any loss or damage,which might-have occurred. K. No school property or equipment is to be altered or removed from the premises. L. Tliis license is revocable at any time by school authorities. M. No reservation will be made until this application is returned and approved by the districts Chief School Administrator. Not for Profit®reanization IV. Rental Fees Other Fees or Conditions: Auditorium for performance $100 -Auditorium for practice $50 - Gymnasium for performance $100 Gymnasium for practice $50 When-an approved activity takes place outside the normal hours of school operation,the organization will be charged$40.00 per hour for personnel services for a minimum of 4 hours.This all must be paid seven days in advance and is not refundable unless the district receives notification of cancellation at least 48 hours in advance. f �J' a For Profit Oreanization Auditorium $350 per hour= hour{s)X rate= Custodial $40 per hour Monday—Friday=hour(s)X rate= Custodial $60 per hour Saturday&Sunday=hour{s)X rate= Technical(sound&lights)$60 per hour=hour(s)X rate This ail must be paid seven days in advance and is not refundable unless the district receives-notification of cancellation at least 48 hours in advance. ' V. I agree on behalf of theabove-mentioned org�nizatlon that all members and guests will observe the regulations and that we,individually,and as an organization,will assume all financial responsibility for any and all damages done to the Greenport School property during the above- indicated period of use.We also agree that our organization will at all times hereafter indemnify the above-named school against any loss,damage or expense of any kind,which said school may sustain or incur because of the use of the above-mentioned building by our organization,and we further will hold said school harmless for loss of any Vnd in connection herewith. Applicant Signed: Date: D P P I Superintendent: Granted,` Denie Date: " ' Specific Details of Use: EXCERPTS FROM SECTION 414 OF THE EDUCATION LAW "...The Board of Education of each district may...permit the use of the school house and rooms therein, and the grounds and other property of the district,when not in use for school purposes,for any of the following purposes: 1. For the purpose of instruction in any branch of education,learning or the arts. 2 for holding social,civic and recreational meetings and entertainments,and other issues pertaining to the welfare of the community;but such meetings,entertainment and uses shall be non- exclusive and shall be open to the general public. 3 For meetings,entertainments and occasions where admission fees are charged,when the proceeds thereof are to be expended for an educational or charitable purpose;but such use shall not be permitted if such meetings,entertainments and occasions are under the exclusive control,and the said proceeds are to be applied for the benefit of society,association or organizations of veterans of the military,naval and marine service of the United States and organizations of volunteer firemen." `J WC DATE(MMIDD/YYYY) ACCOCERTIFICATE OF LIABILITY INSUR l�� 03/05/2018 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 have ADDITIONAL INSURED provisions or 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 Joseph Cherepovnch NAME: Mcmann Price Agency Inc. IPA (631)477-1680 F IX (631)477-8930 AIC No Ext• A1C No 628 Front Street AIL ADDRESS: donna@mcmannprice com P.O.BOX 2065 INSURER(S)AFFORDING COVERAGE NAIC A 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: CL183502021 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 CONTRACTOR 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 ILTPOLICY EFF POLICY EXP R TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence)DAMAGE 0 RENTED $ 100,000 MED EXP(Any one person) $ 5,000 A MEPK06726912 06/01/2017 06/01/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 10,000,000 POLICY JELOC PRODUCTS-COMP/OP AGG $ 10,000,000 OTHER Liquor Llab Cov Part $ 3,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Peracradent) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acddent X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE MEUM06473412 06/01/2017 06/01/2018 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) With respect to Carnival from 5/24/2018 to 5/28/2018 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Greenport Union Free School District ACCORDANCE WITH THE POLICY PROVISIONS. 720 Front Street AUTHORIZED RESEN 1 Greenport NY 11944 ©198 -2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD ELIZABETH A.NEVILLE,MMC ®� _ ®�� Town Hall,53095 Main Road TOWN CLERK 0.5 P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS L`r,'.:' Fax(631)765-6145 MARRIAGE OFFICER ®� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ®� rte, ��® www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER fir' 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,GREENPORT 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 26, 2018: Raindate:Sunday_May 27 2018 on the property of GREENPORT PUBLIC SCHOOL Athletic Field,located on the north side Front Street and east side Moores Lane GreenportNew 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. Efizabem A. Neville,Southold Town Clerk Suffolk County, New York (Town Seal) Date: May 22, 2018 THIS PERMIT IS NOT TRANSFERABLE RESOLUTION (ID # 14132) REVIEWED DOC ID: 14132 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. (ID # 14132) WAS REVIEWED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON MAY 22, 2018: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a fireworks permit by the Town Clerk to Star Hose Company of the Greenport Fire Department for a fireworks display at 10:00 PM on Saturday May 26,2018 (Rain Date of: Sunday May 27,2018) at Greenport High School's Athletic Field located on the north side of Front Street and the east side of Moores Lane, 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. a Elizabeth A. Neville Southold Town Clerk Town of Southold Police Department Special Event Cost Analysis Event: Greenport Fire Dept Fireworks Display Date(s): May 26, 2018 Location: IGreenport High School Grounds Patral.All®cation for.EVe91 Reg Hours OT Hrs_ _Hrly__. Wage__ Total Comments Police�Off'icers P.O. Witzke 1 5 $97.17 S.P.O Robbins 1.5 $32.47 Special Patrol- _ Reg Hours OT Hrs Hrly Wage Total Comments Bicycle_Patrsal _. Hghway�Patro( __ " Wiarine Units .. �'raffic Control. _ _ Reg Hours OT Hrs Hrly Wage Total Comments TC TC TC TC TC Equipmenfi Costs #of vehicles :::6 / r hours Total Police Vehicles 2 $10/hr 3 $30.00 Marine $15/hr $0.00 Command Van 0 $15/hr 0 $0.00 Prepared by Capt.M. Flatley 5/7/2018 Page 1 Town of Southold Police Department Special Event Cost Analysis ATVs 0 $5/hr 0 $0.00 Flares/Cones $20.00 Total Department Cost for Event= $ 11 $179.64 Prepared by Capt.M. Flatley 5/7/2018 Page 2 Neville, Elizabeth From: atlev. M� actin Sent: Saturday,April 21, 2018 12:59 PM To: Neville, Elizabeth; Fisher, Robert; Spiro, Melissa; Doherty,Jill; Doroski, Bonnie; Duffy, Bill; Ghosio, Bob; Hagan, Damon;Jim Dinizio; Standish, Lauren; Louisa Evans; Noncarrow, Denis; Rudder, Lynda; Russell, Scott; Silleck, Mary;Tomaszewski, Michelle;William Ruland; Duffy, Bill; Hagan, Damon; Silleck, Mary Subject: RE: Emailing: GFD Appication Fireworks_20180419113807 Attachments: CA for GFD Memorial Day Fireworks.xls I hcost analysis is attached 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 20, 201810:17 AM To: Flatley, Martin<mflatley@town.southold.ny.us>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>;Spiro, Melissa<Melissa.Spiro@town.southold.ny.us>; Doherty,Jill <jill.doherty@town.southold.ny.us>; Doroski, Bonnie <Bonnie.Doroski @town.southold.ny.us>; Duffy, Bill<billd@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.ny.us>; Hagan, Damon<damonh@southoldtownny.gov>;Jim Dinizio <jim@jamesdinizio.com>;Standish, Lauren<Lauren.Standish@town.southold.ny.us>; Louisa Evans <Ipevans06390@gmail.com>; Neville, Elizabeth <E.Neville@town.southold.ny.us>; Noncarrow, Denis <denisn@southoldtownny.gov>; Rudder, Lynda<lynda.rudder@town.southold.ny.us>; Russell,Scott <scottr@southoldtownny.gov>; Silleck, Mary<marys@southoldtownny.gov>;Tomaszewski, Michelle <michellet@town.southold.ny.us>;William Ruland <rulandfarm@yahoo.com>; Duffy, Bill<billd@southoldtownny.gov>; Hagan, Damon<damonh@southoldtownny.gov>; Silleck, Mary<marys@southoldtownny.gov> Subject: Emailing:GFD Appication Fireworks_20180419113807 Transmitted herewith is the application of the Greenport Fire Department for their May 26th, 2018 (Rain Date May 27th) Fireworks Event. Please review and advise of any concerns questions and/or objections that you may have to the granting of this Fireworks Permit. Thank you. 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 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: GFD Appication Fireworks_20180419113807 Neville, Elizabeth From: Fisher Ro prt Sent: Tuesday, May 08, 2018 10:02 AM To: Neville, Elizabeth Subject: RE: Emailing: GFD Appication Fireworks_20180419113807 Betty Sorry about the delay. I have'no objections to this permit ac thislocation b hPPn i,rprl fnr Many years Bob Robert Fisher Fire Marshal,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 20, 201810:17 AM To: Flatley, Martin<mflatley@town.southold.ny.us>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>;Spiro, Melissa<Melissa.Spiro@town.southold.ny.us>; Doherty,Jill<jill.doherty@town.southold.ny.us>; Doroski, Bonnie <Bonnie.Doroski@town.southoId.ny.us>; Duffy, Bill<billd@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.ny.us>; Hagan, Damon<damonh@southoldtownny.gov>;Jim Dinizio <jim@jamesdinizio.com>;Standish, Lauren<Lauren.Standish@town.southold.ny.us>; Louisa Evans <Ipevans06390@gmail.com>; Neville, Elizabeth<E.Neville@town.southold.ny.us>; Noncarrow, Denis <denisn@southoldtownny.gov>; Rudder, Lynda <lynda.rudder@town.southold.ny.us>; Russell, Scott <scottr@southoldtownny.gov>;Silleck, Mary<marys@southoldtownny.gov>;Tomaszewski, Michelle <michellet@town.southold.ny.us>;William Ruland <rulandfarm@yahoo.com>; Duffy, Bill<billd@southoldtownny.gov>; Hagan, Damon<damonh@southoldtownny.gov>;Silleck, Mary<marys@southoldtownny.gov> Subject: Emailing: GFD Appication Fireworks_20180419113807 Transmitted herewith is the application of the Greenport Fire Department for their May 26th, 2018 (Rain Date May 27th) Fireworks Event. Please review and advise of any concerns questions and/or objections that you may have to the granting of this Fireworks Permit. Thank you. 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 631765-6145 Cell 631466-6064 1 Neville, Elizabeth From: huffy. Biles Sent: Friday,April 20, 2018 4:06 PM To: Neville, Elizabeth Subject: RE: Emailing: GFD Appication Fireworks_20180419113807 .blo obiection William M. Duffy, Esq. Town Attorney Town of Southold Southold Town Annex 54375 Route 25 (Main Road) P.O. Box 1179 Southold, Nww York 11971-0959 Office: 631.765-1939 Fax: 631.765.6639 ' Email: bill.duffv@town.southold.nv.us ATTORNEY-CLIENT COMMUNICATION; ATTORNEY WORK PRODUCT; INTER/INTRA AGENCY COMMUNICATION; NOT SUBJECT TO FREEDOM OF INFORMATION LAW DISCLOSURE; DO NOT FORWARD WITHOUT PERMISSION Note: Service of legal documents is not permitted via electronic mail or fax. The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain information that is privileged, confidential and exempt from disclosure under applicable law. Unintended transmission shall not constitute a waiver of the attorney/client privilege or any other privilege. If the reader of this message is not the intended recipient,you are hereby notified that any review, retransmission,conversion to hard copy, copying, reproduction,circulation, publication, dissemination or other use of,or taking of any action, or omission to take action, in reliance upon this communication by persons or entities other than the intended recipient is strictly prohibited. If you have received this communication in error, please (i) notify us immediately by telephone at 631.765.1939, (ii) return the original message and all copies to us at the address above via the U.S. Postal Service, and (iii) delete the message and any material attached thereto from any computer, disk drive, diskette, or other storage device or media. -----Original Message----- From: Neville, Elizabeth Sent: Friday,April 20, 201810:17 AM To: Flatley, Martin; Fisher, Robert;Spiro, Melissa; Doherty,Jill; Doroski, Bonnie; Duffy, Bill; Ghosio, Bob; Hagan, Damon; Jim Dinizio;Standish, Lauren; Louisa Evans; Neville, Elizabeth; Noncarrow, Denis; Rudder, Lynda; Russell,Scott;Silleck, Mary;Tomaszewski, Michelle;William Ruland; Duffy, Bill; Hagan, Damon;Silleck, Mary Subject: Emailing:GFD Appication Fireworks_20180419113807 Transmitted herewith is the application of the Greenport Fire Department for their May 26th, 2018(Rain Date May 27th) Fireworks Event. Please review and advise of any concerns questions and/or objections that you may have to the granting of this Fireworks Permit. Thank you. Elizabeth A. Neville, MMC 1 Neville, Elizabeth From: Snir elissa Sent: Friday,April 20, 2018 3:58 PM To: Neville, Elizabeth; Flatley, Martin; Fisher, Robert; Doherty,Jill; Doroski, Bonnie; Duffy, Bill; Ghosio, Bob; Hagan, Damon;Jim Dinizio;Standish, Lauren; Louisa Evans; Noncarrow, Denis; Rudder, Lynda; Russell, Scott; Silleck, Mary;Tomaszewski, Michelle;William Ruland; Duffy, Bill; Hagan, Damon;Silleck, Mary Subject: BE: Emailing: GFD Appication Fireworks 20180419113807 This is not preserved land. Melissa Spiro -----Original Message----- From: Neville, Elizabeth Sent: Friday,April 20, 201810:17 AM To: Flatley, Martin<mflatley@town.southold.ny.us>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>;Spiro, Melissa<Melissa.Spiro@town.southold.ny.us>; Doherty,Jill<jill.doherty@town.southold.ny.us>; Doroski, Bonnie <Bonnie.Doroski @town.southold.ny.us>; Duffy, Bill<billd@southoldtownny.gov>; Ghosio, Bob <bob.ghosio@town.southold.ny.us>; Hagan, Damon<damonh@southoldtownny.gov>;Jim Dinizio <jim@jamesdinizio.com>;Standish, Lauren<Lauren.Standish@town.southold.ny.us>; Louisa Evans <Ipevans06390@gmail.com>; Neville, Elizabeth <E.Neville@town.southold.ny.us>; Noncarrow, Denis <denisn@southoldtownny.gov>; Rudder, Lynda <lynda.rudder@town.southold.ny.us>; Russell,Scott <scottr@southoldtownny.gov>; Silleck, Mary<marys@southoldtownny.gov>;Tomaszewski, Michelle <michellet@town.southold.ny.us>;William Ruland<rulandfarm@yahoo.com>; Duffy, Bill<billd@southoldtownny.gov>; Hagan, Damon<damonh@southoldtownny.gov>; Silleck, Mary<marys@southoldtownny.gov> Subject: Emailing: GFD Appication Fireworks 20180419113807 Transmitted herewith is the application of the Greenport Fire Department for their May 26th, 2018 (Rain Date May 27th) Fireworks Event. Please review and advise of any concerns questions and/or objections that you may have to the granting of this Fireworks Permit. Thank you. 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 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: GFD Appication Fireworks 20180419113807 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 t Neville, Elizabeth From: Neville, Elizabeth Sent: Friday,April 20, 2018 10:17 AM To: Flatley, Martin; Fisher, Robert; Spiro, Melissa; Doherty,Jill; Doroski, Bonnie; Duffy, Bill; Ghosio, Bob; Hagan, Damon;James Dinizio; Standish, Lauren; Louisa Evans; Neville, Elizabeth; Noncarrow, Denis; Rudder, Lynda; Russell, Scott; Silleck, Mary,Tomaszewski, Michelle;William Ruland; Duffy, Bill; Hagan, Damon; Silleck, Mary Subject: Emailing: GFD Appication Fireworks-20180419113807 Attachments: GFD Appication Fireworks_20180419113807.pdf Transmitted-herewith is the application of the Greenport Fire Department for their May 26th, 2018 (Rain Date May 27th) Fireworks Event. Please review and advise of any concerns questions and/or objections that you may have to the granting of this Fireworks Permit. Thank you. 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 631765-6145 Cell 631466-6064 Your message is ready to be sent with the following file or link attachments: GFD Appication Fireworks_20180419113807 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 ��g�FFOL�►�,O - EL_ARF.T1Ft A.NEVU LE,MMC Zbwn Hall,53095 Main Road TOWN CBM o P.O.Baas 1179 1 Southold,NewYork 11971 REGISTRAR OF VITAL STATISTICS p • Fax(631)765-6115 MARRIAGE telephone(681) RECORDS OFF MANAAGRAONT OFFICER ��Oj ,1� •*`�O� hfork net FREEDOM OF INFORMATION OFFICER T eontholdtown.narthforkn OFFICE OF THE TOWN CUSS 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 19 TO BE SPONSORED BY Star Hose Company-Greenport Fire Department PRINCIPAL OFFICE AT P.O. Box 345, Greenport; NY 11944 DATE&TIlVlE OF DISPLAY 5/26/18 @ 10:00 pm EXACT LOCATION-OF DISPLAX Greenport High School Athletic Field SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE&TIME 5/27/18 @ 10:00 pm The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition William Lotterhos dob: 5/26/75 13 years experience Health: Excellent (Additional names and information may be submitted on an attached.sheet Number and type of fireworks is as follows: 1.3G Fireworks: 2-3 inch=422. cakes--5. Manner and place of storage of fireworks prior to display: Delivery day of display from our Westhampton Facility. 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 Properly Owner,must be submitted with the Application � - S 7-A-e, b !�� ��d'�t'�C tea t.,r Y FEE,; - $100 Name of-Organization. See policy4of additional l ej_wr, � / ekA4 By. ,Printed Name o_ Applicant./ _Signature_of Ap lic t- e-mai! address: (2pPruLuh u�l �` /9 11(9- Telephone Number I. Y -?-2-0L(7 Date of Application Town of Southold P.O Box 1179 Southold, NY 11971 RECEIPT Date: 04/19/18 Receipt#: 237938 Quantity Transactions Reference Subtotal, Firewrks 0 5.26.18, $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#1480 $100.00 Greenport, Fire Departmetn Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Groenport, Fire Deplartmetn Pd'Box 58 Greenport, NY 11944 Clerk ID: BONNIED Internal ID:5.26.18 A00RO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYYI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 2018 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 have ADDITIONAL INSURED provisions or 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 CONrAc' NAME: Joseph Cherepowich Memann Price Agency Ina ZADDRESS: 828 Front Street st: (631)477-1680 Ne; (631)477 8930 P.0 Box 2065 donna@mcmannprice.comGreenport INSURERS)AFFORDING COVERAGE NAIC S NY 11944-087 : Arch Insurance Company INSURED : Village of Greenport Fire Department PO Box 58 INSURER C: INSURER D: Greenport INSURER E: NY 11944-0058 INSURER F COVERAGES CERTIFICATE NUMBER: CL183502021 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THETOWHICH TERMSTHIS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I R LTR TYPE OF INSURANCE INSD WVO POLICY NUMBER R4MIDD MM100 X COMMERCIAL GENERAL LIABILITY LIMITS tFXP RRENCE $ 1,000,000 CLAIMS-MADE OCCUR 100,000 a oeeurrenee S one arson) $ 5,000 AMEPK06726912 06/01/2017 06/01/2018 ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY❑PRC LOC GENERAL AGGREGATE S 10,000,000 PRODUCTS-COMP/OP AGG g 10,000,000 OTHER. Liquor Liab.Cov.Part $ 3,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO Eeaaident S OWNED BODILY INJURY(Per person) S SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED AUTOSNON-OWNEDONLY PROPERTY OHMAGE AUTOS ONLY AUTOS ONLY Per aaatent $ X UMBRELLA LtAB X OCCUR a5,000,000 A EXCESS LIAR RAGGREGATE OCCURRENCE E CLAIMS-MADE EACH 06/01/2017 06/01/2018 g 5,000,000 DED RETENTION E WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY ER OTH- Y/N TATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA CH ACCIDENT g (Mandatory In NH) If Dyes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.LDISEASE-POLICYLIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached If more space Is required) With respect to Carnival from 5/24/2018 to 5/28/2018 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 AUTHORIZED REP NTA Southold NY 11971 AC�� CERTIFICATE OF LIABILITY INSURANCE DAM(IMIDDITYM 04/09/2018 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 have ADDITIONAL INSURED provisions or 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 endomement(s). PRODUCER NAME Shaunne Marquis Clark insurance PHONE (860)430-3700 Arc.No: (880)4303730 ISO Glastonbury BOule+rard smrquis@mayboneeclark.com ADI>REss: rq s@nraYboneeGarlc.cam , Suite 401 tNSURERIS)AFFORDING COVERAGE MAIC O Glastonbury CT W033 INSURER A: LexingtoninSINSI eCompany 19437 INSURED IrdSURBt a• Liberty Mutual Insurance Company 23043 Pyro Engineering Inc_,DBA:Bay Fireworks INSURER C: Chesapeake Employers'Insurance Company 11039 999 S.Oyster Bay Rd. INSURER D. Suite 111 INSURERE: Bethpage NY 11714 irSURk1RF COVERAGES CERTIFICATE NUMBER: 18-19 Master REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR rdrEOFamuRANCEPDIJCYNUIdBER LMYEFF PQUCYEXP LDlyE7S ICOMMFRCIALGENERALLIABILRY EACH OCCURRENCE § 1,000.000 CLAIMS4NADE F9 OCCUR PREMISES a"Eu nco o § 100,000 MFA ExP one oerssn § A 023627358 02/15/2018 02/1512019 PERSONAL&AOV INJURY § 1.000.000 GENLACGREGATEUMITAPPLIESPER: GENERALAGGREGATE a 2.00O-000 POLICY 1:1 SENT- LOC PRODUCTS-COMPIOPAGG S 2,000.000 OTHER: § AUTOMOBILELIAGU Y COMaWEDSINGLEfJMFT $ IV AWAUTO BODILY]SUURY(P8r_r+erae) S OWNED SCHEDULED AUTOSONLY AUTOS BODILY INJURY O'er scdded) S HIRED NOr1AWNE0 AUTOS ONLY AUTOS ONLY pFPERTYl) $ S UMBRELLAIJA9 OCCUR EACHOCCURRENce s 9.000,000 A EXCESS LIM CLAIMS-MADE 023627359 02/15/2018 02/15/2019 216GREGAT6 $ 9.000,000 DED I I RETENTION s $ WORKERS COMPENSATION ppR AND EMPLOYER9'LtAMLRY YIN STATUTE -1 ER B ANY PROPRIETORMARTNEWEXECUME D NIA WC5.39S-38T47i-018 02H5P1018 02/1512019 CL.EACHACODENT § 1.000.000 OFFICERtMEMaER EXCLUDED? 1,000.000 IMandatorY In Nnr) El-DISEASE-EA EMPLOYEE S H yes,describe ceder DESCRIPTION OFOPERATNONSbebw E.LDISEASE-POLICY LWAT S 1.000,000 Workers'Compensation E.L EachAcddent 1,000.000 C Maryland 5451949 0310=018 030=19 E.L Disease-EA EAIDYee 1.000.000 _ EJ_Disease-Policy Limit 1,000.000 DESCRIPTION OF OPERATIONSI LOCATIONSI VE ICLES_(ACORD 101,Additlmd Remarks Schedt0%may bo a1ffidred N mora spm Is requked) Liberty Mutual Workers Compensation States:CT,GA.NC.NV,SC,VA Data of Display:May 26,2018 LOCATION OF DISPLAY:Greenport High School Athlete Field.Greenport NY Star Hose Company;Greenport Fire Department;Village of Greenport;Town of Southold;Suffolk County;Greenport UFSD are included as additional Insured as respects to the General Liability policy per written agreementicontraol. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN Greenport Rre Department ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 345 AUTHORIZED REPRESENTATIVE Greenport NY 11944 {� _ ®1988-2815 ACORD CORPORATION. All rights reserved. ACORD 25(2016fO3) The ACORD name and logo are registered marks of ACORD ACo CERTIFICATE OF LIABILITY INSURANCE DATE(1fNUDWYYYYt 04/1612018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,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 cerilficate holder is anADD1T ZONAL INSURED,the policypes)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER COMACT The DeckerAgency[noPHONE . (716)883-1455 (716)883-621D 18 883.621D AIC Na: 37 EhnwDodAyenue ADDRESS: INSURER! AFFORDING COVERAGE NAZCA Buftato NY 142012018 INGURERA: National Continental Ins Co 10243 INSURED INSURERB: Pyro Engineering Inc.DBA:Bay Fireworks INSURER C: 999 S Oyster Rd Suite 111 INsttREN D: INSURERE: tbpB91i NY 11714 INSURERf; COVERAGES CERTIFICATE NUMBER- 18.19Master5million 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.NOTWITHSTANDINGANY REGUIREMENT,TERM OR CONDITION OF ANYCONTRACT OR OTHER DOCUMENT W iTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERRN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER POU EXP LIMnS COMMERCIAL GENERAL LUOLnY EACHOCCURRENCE S CIAIMS4WIADE D OCCUR PREMISES[Ea oaunenca5 MW EXP ow 0w person) S PER50NAL&ADVIIWURY $ GENIAGGREGA7E UMrrAPPLES PER: GENERALAGGREGATE S RPOLICY El JEC�T F-1 LOC PRODUCTS-COMPIOPAGO S OTHER:- $ AUTOMODU LGMLITYOttN SIa LIMIT $ 5,000,000 ANYAUTO BODILY DUURY(Pervwum) S A00MED SCHEDULED CNY0004909233-8 02/15/2018 02!1512019 BODILYWJURY(Per=ddam> S HAS ONLY AUTOS AUTOS ONLY AUTOS ONLY A E $ Additional Personal Injury S 100,000 UMBAELLALIABOCCUR EACH OCCURRENCE S EXCESS L1AB HCLAtMs4=E AGGREGATE S DED I I RETENTIONS $ WORKERSCOMPENSATION PEROTH- AND EMPLOYERS'LIAMUrYYlN URSTATE ER ANYPROPRIETORIPARTNERIEXECUTNE ❑ NIA F-LEACHACCIDFNT $ OFFICERIMEMUEREXCLUDED? (MandetoryInNH) ELDISEASE-EAEMPLOYEE S DESCRIPTION OF er O F_L.DISEASE.POLICY LINUT S OESCRIPTRON OF OPERATIONS ladaw DESCRIPTION OF OPE RATIONSI LOCATIONS I VEHICLES(ACORD 101-Addldorud Remarks StBeddo,may be smadod U mors Spate N requbed) Operations of the named-Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN Greenport Fire Department ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 345 AUTHORIZED REPRESENIIATIVE Greenport NY 11944 f ^i� ®1988,2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) TheACORD name and logo are registered marks of ACORD ' CL GREEITPIT.'FZIiE DE ' R 'MENl ` a . r GREE�TF` RT, NEV YaRIi 300 #t kAd s c Ax. f S I 1 �j;. • t f t,�` at �`sbr: � S:, s^ � .�"v ��'ti','�` i� {y'�_'"�_ W�St$1,,,, �x.! �"- "�. it 5 ( ,.f� ��' C � � n .fi< y- t� ,ALL - n.3+�� �' -„� � s� _ -'.(� '-'•�' � �1 ,. f = r� 1 r �y y y�'� F A, ,. { t ', FT. 4 r p¢ °t• `+ o.0 t { 'T"o ... kV f t k. 5 t, r'3 :.so _ - �'� „ �vk ,G-, #•r ^r ,r,r' :9" 1F�f a IY T� yi M'ji7lt J I` `, + €14 s �,p _ .• _ � ,:� ^:.1;; ti {- ,r w .,5•a __ { }1Rih ;�' .errs^ 'U 1 _ w s) cC 2013Goople F. r t r' v �. 3'#."'Ef 4/11/2018 servlet.FileDownload(2448X3284) .l*%�'5,,.; `: -- ,�!-•j4'm ;l:-.�:�- - "�tisl!-,'Y`-; �+'4'+M=>i' at.,,�4y?��,�;� �!,•,i *ya"�,,.�;'i,n_��,���,.: ri J��- , ,n�u'di `,z:t, " 1 aa'e .> k 4 l�.r..� �3 S ;f ti t. 'r_ •'P;.W� •" p,•s.`,<y ti.c,'� 'v ",- 'i ""• !, - ,n;`, n.-..a ;ri f r _.,'r w;c v✓.^,t ,'ft'a."A: r.3 ,, ;rt+" L 1,�. mJ'�e?'.,:e ''�rp'�q. '.',c.•, rP.'zx y:L_� - ��� �'-<"^„_i"°'yy,R;.`^�'�,�..- •,7"+'�Y^: _ a`' �`• i ns„mac _� { r .. {Y:''° — r'1 �f•yg �3%'�` 'c b• q ,� s�$^� ,.��..a t=,^k.•k�i'. a:�.i"n�,y:J% 7^:;':t.., mea _}�., t �'`s �', ,�rt�#�`-'-;•R.'y`:'.A,i ,,�`;«f :w ,}.�r.'4X �0 4 'f}i1e%'a 4�.� - q �.F, P'1• 7 u i,�.t �i�����.5?�§. ,4'�. - �. '�k c� �%,�a ='” Sys �:a� _ ,nit• r+`ys'"y�`,,,y y5 2 �.4� y Z' y' +fir °Fµ��•.4 •N ' 111•• •t4 .,;pf aw-*���Ni �� I �rY� , ��v MAE �,(��i 'r '� _q�t PA Y1 R t' i T �L I '§l��_..�x•.�-xy�,�':� k;'-�t� a,�-tx,�.��,�. +� `, ' t"��, �"�'���;�(°-(fit„" -�. � -?,_. ILLIAM -0 NONMAT,E-AICD tE E�4NLY'-1 - THIS CAR6 MI IOE-CA WHEN !1_St'NG,'.PY_ ROIMPM e � _yypy��� }{N'y� 'Qj - ivy{y�'.- - N" WT NYS CE•RTI 'T ' 5.�YF' 4 •t+ Y Oyiq<. httpsJ/c.na57.content.force.com/servlet/servlet.FileD6wnload?file=00P3300000d0sTv 1/1 Apr 1618,05:44p p.1 r Amerfes's Wa4d Class Fireworks Leacher DisjWby Date:May 26,2048 FIREMRKS D1SPLAYAGREEMENT AGREEMENT made April 6,2018 by and between Pyro Engineering,Ina,whose address Is 999 South mar Say Road,Suite 111, 8eihpag% NY 41714 (hereinafter "PEr), and star Hose Company, 240 Vh Avg. Greenport NY 11944 (hereinafter"SPONSOR0. WHEREAS,PEI designs,produces,and conducts fireworks displays;and WHEREAS,SPONSOR wishes to engage PEI to design.produce and perfrxrn a fireworks dispiay on the terms and comMons twelaatter set forth; NOW.THEREFORE,in consideration of the ferns,conditions and aovemft hera'vhaiter set fordh,the parties hereto do mutuatlyagreeas1wit s: T.MR1=U8+OM DIM AY- On, Allay 26,2016 (hesekmfw'tita Display Dale j,PEI shall pratr&the*em t3 and equtpmerd for the display at the Fmwiorks t]isp w locadm The display will the under the supervision of PEI trained technician.It Is agreed prat PEI shell be the sole fwxorks supplier and prodtsaar forihe event=*ahfed for herain. (Nate: The actual start acrd stop time of the delay wfS ire determined by the governrnerriat Alludes having judediadon hsvert he ditsplayh. ALTERNATE VATS: May 2'►i,2018 2 COST AND PAYMENTS: FIREWORKS MSPILAY PRICE: �► 3 The total(Fuewaft Display minae Plus so other applicable )sura of$4„900 00' shall be due and payable as*&ram a.The sten of:S 6,000 00 Due and Pgabte;on N1*4 cf!Spay 26.2M8 tsleewe Note: SPONSOR is msponsible for the payrnent of an goverrnnental fees and testes,induding,but not limited to,sates, use,excise,license6 pennit,entertainment,or oMerfees,taxes or surcharges hnposed mghwwbe applied to this ehrhlbhllon. Also, please see Section 16(o belmv. 3. 9the may of the fhb is postponedImschedulad by reason ofahrlernent weatherar by determination by the governmental authority having jurkdclion,or fa any other reason beyond that omhV of PEI,same shall be re- scheduled tothe Memate Data setforfh above. in the event a postponementhesdheduRS Is necessary due to kelementvreatber or by detmminatfon by the govermental authority having jurisdiction,or for any other reason beyond the control of PEI a postpone menthscheduling lee will bre based on the table below. D)esorliron I %of Rreworks Pisft Price I Additional Costs If notified 12:01 AM an 05115115 5% ►Any F Vendor Experhses It notilled atter 12:01 AM an 05125116 9616 Any 310 Party Vendor rises Once Say Fireworks Techs Arrive an Site 1 2tt% ,"Eeqy Vendor rases Any request rrrads by SPONSOR for rescimiuIrWcanceling shaft be directed to help@bayfireworks.com or by phone(516)233- 4132 It is ted and agreed that PFJ sW have no obligation to resdm dole a display except as required by inclement weather or reasonsfieyendthe contra!of PM. 4.SPONSORS A Nr:lit,.E Ward sleben CELL PHONt:: 931 7`(S`- ����- shall be deserted as SPONSOR'S agent to whom all questions and inquiries shad be relayed. Sponsor's agentshaA be the only agent of SPONSOR aul hofted to rnake decisions on behaff of SPONSOR or to request rescheduling of the frevarlmdisplay on the pet of SPONSOR. PJeasB&dfatea:hp�l ln5albem t BMW Apr 1618,05:45p p.4 S. f7fHi13MON PLANNER CHECKLIST* ht is.wood and agreed by the p"es hereto that the Fireworks Display+shalt be contingent upon the strut compliance by SPONSOR with all items specified on the Exhibition Planner Chad"(EPC)which is annexed hereto and made a part horse Fahlurs an the part of SPONSORto comply with ail requirements set fW&in the EPC to the satisfaction of PEI within the time limits therein set forth shall be deemed to to an event of default of SPONSORS obligations hereunder. S.Sl»CURITYISAFPTY• SPONSOR shall provide and mWnlain suffctwd Sam*before,during and after the F'vre nit Display tmfl the pyrotadm'saan in charge declares the area dear. Security shall be deemed to lode but not limited ta, be allsecurity rims,police protection,snow[fencing.rope lines.barricades or any othm deem deerried necessary by the[awl government or by PEs.SPONSOR shall also provide and maintain an area clear of any buildings cats acrd spectators tutu a minimum rafts as specified by cummd edition of NFPA Code 1123. as a Fire Safety Zone(F50 during the entire period commencing from the timethe firewarks are delivered 10 the site until the area is dectaied dear by the pyrolmhnician_ itis understood and agreed thad PEI will cease all faewoft discharge due to any security breach of the FSZ PF]shall not be responsible for personal iryury,vehiole or property damage occurring within the FSZ as a redo of the SPONSOR'a failure to maintainthe FSZ in accordance with the standards of current edition of NFPA 1123 which, incWentaliy,are wdy minircu n standards of dst>3avm& SPONSOR aclawwfedges and agrees that Vi's responsibilities are hafted to tate Fireworks EMsplay and toad PEI is relying an SPONSM to maintain the afinementiuned FSZ and to amnply withal Fedora.State, municipal and local laws.orders,regulaticins and ordinances padakft to the implementation of airy and all security mires at the site of the Fireworks Oi WWi Any ske visits mace during the&&play setup by or on behalf of SPONSOR shalt he in acoordanae with the current erf llm of NEPA 1123-and under the direct supervision of the P9 techairxan In charge.Airy duct inspection abet stat:in any way Interfere with the safety,setup orschedde of the preparation for and disassembly after the Flrewoft Display.The PEI technician in charge may.at his discretion.cancel any Inspection n that In his sole opinion may compromise the safety of the setup or the Firewarics Display or the setup schedate_The PEI technician may st any time temporarily moue the fischillge of fireworks for any ren. T.CRMT5:As a material inducement to PE1 agreeing to enter into Htis Agroornent.SPONSOR shag give PFJ program credit as sole fireworks supplier and producer in alt press releases,advertising,and my atter program arimuncement%printed or otherwise. S.ANABILRY to!i nOt or CONDUCT FOWIMORKS DISPLAWORCE MAJEURE. PEI shall not incur any liability for any loss at for any failure to perform any abligaUan hereunder due to causes beyond its reasa wdit control including without limUlion Incl or regulatory restrictions. labor drspues of whatever nature. Rower loss,telecomm micalions feroure.acts of God,or airy other cause bepM fig ale control. in the event PEI is unable to deliver the Fireworks Misplay an the Ddnrery Date this contract will remain in full fay and effect and the Rreworits Display will he perbnrmed on the Alternate Date ar#no Atonale Daae Is stated then on such olfr date as may beaWwd upon by the pies. &CONTRACTSUSd6CTTdGOIiERhiMIfiNrnEwWi74N: ThisAgreementandIpEI'sd*jaaonshermxkrmesubjecttoaU applicable Federal,Slate.Minhicipai and local laws.rules,ordinances.regulations and codes,now or hereinafter in effeCt,and to the conditions and I'hmitations contained in the permits required to be mined by SPONSOR prior to the Firevmrtcs Display. In the event airy Federal,State,murddpal or local low,rule,regulatk n or ardu nee shalt be enacted which in any wary protatiiis;limits or restricts the sale.performance or operation of ibe exhibition of the Fireworks ENsplay or in the event SPONSOR'S p=ermit in anyway limits or r estricisthe sale,performance or operation of said exhibillorr.P13 shall fr,Nt or reddd Is performance or the Fireworks Display so as to comply with such law,nde,region orordinanee or t'unilatlon or restriction of SPONSOR'S permit.SPONSOR admMe ges that any such Itnlit or restrldon placed our the pedwnence or operatics of the Frawadw Display shall in no way result in or entitle SPONSOR to a reduction or Wn temad in the full eonkact price. 1(. GENERAL PRObtISIQNS, a) This agreement constitutes the etift agreement between the parties relating to the subject natter hereof.and may not be changed,modfied,renamed or extended c by a written agreement,sated by bolls parties. SPONSOR saknowledges and agrees that PW has not made any representations or wanwities except[base specifically set fortb In this contrail. Should any dame,setdtn,or part of this agreement be held or declared to be void or legal far ashy reason,all other daces,sections, or parts of this,agreementwhich can be effected without such illegal ceruse.section.or part shall nevertheless continue in full farce and effect. b) SPONSOR is responsiblafar removel of paper defer associated with the Fireworks Display. iiiI is not responsbta for procuring any marine services associated with the produdlon of SPONSOR'S event. 6lwWd SPONSOR require these services,PEI may,upon written request;assist SPONSOR En the kaffm and contracting of such services. AN additional costs and fees wo)dated with marine services aro the responsibiilly of the SPONSOR It is speeficaliy understood and agreed that PEI shall not be eesponsible in any way if any third party service with whish SPONSOR has canbacled forservice falls to perform and the display cannot proceed as planned. cl) SPONSOR is responsible for any additlaod murine arra and fees,wily pernMescoht fess.County IStateWDlFWM few, total town permit fees.etc. e) in the event SPONSOR cancels the Frrawnrks Display the full owrr>rw price as set fdnlh herein shall become tmmedid*due and payable. SPONSOR will have up to 30 days from the date of cancellation to request PEI to reschedule the Faeworks Display. Firevrorks Display shall take place no Wer than six miont hs from originally scheduled Fireworks Display 1) PEI agrees to pr ommes iiabibly insurance on behalf of SPONSOR.and to Indemnify SPONSOR,to ire extent thereat.for an claims arising out of PQ's negggence. Any addlk"insurance that is required dW uncus a cost will be the SPONSMS responsibility►• hoose esapap. Umbers: � 3ba a t Apr 1618.05:45p p.5 11.SPONSOR'S OF.FAUL.T. In the event SPONSOR shall fail to pay any shah when due under the terms of dus contract.SPONSOR shall pay.in addi3'nn to such amount,interest at the gate of 1.5%per month on the unpaid anhount frons the original due We. SPONSOR does further agree drat it shaft pay PFJ reasonable afthmey fees and ogrereosts in the event PEI shall commence any proceeding(Aftn3ft of any OHM proceeding)ar Inver fees to compel SPONSOR to pay any suns due hereunder or otherudse as a resultof SPONSORS default of any of the tettns and provisions hereat contained. 12 UQllfflATWDAif SES,. lt is agreed by mrd n the parties hereto that in Ow evente 8Pt7lilS ITS dot hrueundw PEI shat be ended to resolve the errlire eor*Wptoe and sameshall be considered'liqu*Iated dernage;i"based the parties hereb that Ile WO haus suffered damages dire bSporaoft d obulL Tire damages sutfeied by PEI as a result of Slowm's dlebult vA be subsbalial,btd k=pable of delenia181lon wilts murentadcat precifw-Nis,fhersibm,agreed bythe pedes ilial the amount due PEI is not a per,bid ram a nttrtrrrdy bww lcis!and ressor We eeftele of the =AWW by PES. 13 S JBSTiTUTiOIVS_ PEI shah have the diltd,at ds discretion,to substlthde any fimw tcs it deems necessary prnvbed same does not detract from the sesdWft value or quality ofthe program,This incudes,but is not Cunfted to.shell sizos,quwass.types and brand names. Any substilift"shall in no way result in or endite SPONSOR to a reduction or abalement of tine full contract price. %ARB1MT10N. Any and all computes.diftrences.or any othertype of conbvversy arising out of or in relation to ttds Agreement, indicating as to the meaning or interpretation of any provision hereof,shall be resolved by artti mftn in Nassau New pursuant to ft comnercia!tyles then obtaining of the American Arbihation Associadmr.Only one(1)hh Wralor s required,and the arbitrator mhay award at#omeys fees.The sward of the arbitrator shalt be final and bending and3 judgment may be entered thereon in any court of competentAnisdiutiion.'Etre arbltratorsift9 in such controversy sham have no power to a#eror modify any express provision of this Agre ffm%nor to make any sward which by Is terms eifeds arry such aiferation or modification. Elhex padyr may seek from the court of competentAdscmcilon any provisional remedy in aid of ati oration.incluft,but not fimited to,injunction, atiachnm t or replevin.pending the determinsfion of any claim or controversy In arbilration_ Any and all disputes.conlrovendes, actiom claims.causes of at im or proceedings arising under,out of or in connection wide or t+atating to the leans of this contact and any anyerutment thereof,commenced bY.behmn or against any of the parties of ibis contract shaft be deemed to have arisen frmn a transaotton of business In NOW York.and shall be resolved by application of the substenttve tarsus of fire State of New Yank. 1S.SOMG 18RFECT ?'itis eonbad shag not be binding on PEI tai execuled by SPONSOR and PEI and Pia is In receipt of tie downpaymtretit*Wtiereunder. IS. EJCNI,SfFION PLANNER CNECKUST(EPQ. a. F1REVV0RKS ()!§PLAT PERMIT: (Note. The ad:ftral start and stop time of tine display will be+dekmffdm d by Ow govemmerdal aatthorlties having)urtsdiciton overthe display). SPONSOR'S RESPONSIBILITY, it Is Sponsors responsibUy to call your State,City,County,Toam.Borough,or liget=ee Marshal m ether mate authority to Re for and obtain the Fireworks Display perrnlL PEI vA prepare ftne paperwork for the p and appticaton en SPONOR'S behalf. mon MgMof lour oennit M rnMsend the nermll to mu office for ow fecarcts r than 30da s or to mate. Failure:fn so C td ge . You must obtain infarmabon on: 1. Filing appikabon deadline and fees. L Local and state reVilrements for fireworks Chcense for transportation arWordisptay. If a license is required,fax allforms immediately to us. 3, Fire tNarshed'sregner�ernerits torserxnrity r>t firequohks truck upon arrinral.and the secwity of tine foe zone before and dung the dsplay. 4. Federal regulations require that we carry an accurate route plan to the display site_ Fax us a copy of the route instnwftns frarn fire nearest US tntersWe to the COSplay area(approved by the fee marshal or ollw aLdhority,i+f necmaty). 5. Nioffy FAA an day of your display,acoon tag to the instructions in the FAA Leiter of Appmval,wtnfchh will be forwarded to you pnorio YoardisplaY. t P1e�e wild each page �6a1lhere „� B Apr'1618,05:45p p,3 b.COAST GUARD PERMITS(where required): I. If the fireworks are to be displayed on or nearthe water,the following maybe required: (Requests for permits must-be filed at teas160 days priorto the Display Date(135 days pdorfor4th of July events). 2. Coast Guard Application and Permit to Handle Hazardous Materials. 3. Coast Guard Marine Event Permit: c:SPONSOR RESPONSIBILITIES AND EXPENSES(The following services need to be provided and gaid for by the SPONSOR in adclMon to the-Fireworks[Tistilay Price. SECURITY: MUST BE PROVIDED FOR FIREWORKS TRUCK(S) AND TO MAINTAIN THE FIRE SAFETY ZONE AT STAGING AREA FROM FIREWORKS TRUCK(S)ARRIVAL,UNTIL TRUCK DEPARTURE WHICH MAY BE FOLLOWING THE REQUIRED PIRST LIGHT DUD SEARCH ON THE MORNING AFTER THE DISPLAY. 2) 3) Sand: Please provide 0 yards of sand. 4) Laborer(s): 0 laborers to arrive at fireworks site on (They will not handle fireworks). 5) Hotel Room(s): 0 hotel rooms.(within 10 mites of shoot site) 6) Vehicle(s): Four-wheel drive vehicle for movement on sand:Yes No XX n If you have ordered a set pfece(s),you are responsible for erecting the scaffolding and it must be ready when the crevsranrives d RADIO SIMULCAST EXPENSES(if appficable1: 1) Setup and staff a fireworks simulcast command centeren site by 1:00 PM an the display date. 2) Provide broadcast relay to PEI Firing Center. Call our office for details. 3) Speaker'system for VIP vievAng stands. e-INSURANCE: Please list below the additional insured,as they should appear on the insurance certificate: 1. STA14 0-fY tt d+i da a. 3. Z 7".fk eb 14 F 99 2. G Wf,. 4. Sn,,T ti :o xx Uzu-mit1 � n .� Name of sponsor SI-AN sr P,V'>I I Date !(j 7 Pyro En ineerin n tore' Date B - Si By: by on behalf of Sponsor(Signature) Print Name c. Title of authorized representative of Sponsor Title Z R- - ■■a��e����Mtar•�w�a�s����nsr•���������■��■�...ara.....z..e...........a.■ a...�..rras...rr... Slate of County of On the_day of ,in the year_before me,the undersigned,a]Votary Public in and for said Stale,personally appeared Personally(mown to me or proved to me on the basis of satisfactory evidence to be the individual(s)whose name(s) is(are)subscribed to the wWm instrument and acknowledged to me that helsbe they executed the same in his►her/their capacity(ics),and that by hislher/their signatures)on the instrument,the individual(s),or the person upon behalf of which the individual(s)act4 executed the instrument. Signature and Office of individual taking admowledgment [seal] Please tibial each pagp- Initial bete: Sponsor 1"Pe Apt 161$M:45p p.2 PYRO ENGINEERING, INC. -01SPI.AY SITE PLAN QUESTIO11NAIRE Ail fems listed bebw ane**J"to a6 gamft Federal,State.mwfwVw wW 1=1 lam eulm ordinanem regi and cos.Www or hownefbar in eflbtt.and to the cwditw and tiv abw cm Wrad to#*pemfs regoimd ario be obt&ad by Sponsor. SPONSOR: Star How Company Display Date S I Rain Date: 5 2-1 ! budget: $ ", tx osplsy Locatlon: effIAOb e PD>LT Tww of Dwplay: (Note: The actual start and slap tirrm of the lisp ►wilt be determined by the governmental aul1writles having jtadsdhbn over the disptay} MIPOATAMT: PLEASE PROWDEA WE PLAN FOR YOUR EVENT LOCATION,INDICATING JWTHANX THE EXACT SFOT INHERE FIREWORKS ARE TO BESET-GAP. Local Fire A6atshal- Telephone No: CeA Phone No: crew contact Person: Telephons No., Cell Phone No: The iwowing intomadw Is nerceasary in order for as to pnavlde your community or argankadon with's dllSplay dW ccnfarms t+1►ft'It Nmbw)tsSOfW- re-qu tim6 and forthe ftuanc&o1&urlograncc cw0bate, DISTANWS,IN FEET,FROM THE FIRING AREA TO THE FOLLOWING: FEET SPECTATORS,AUDIENce OR PARKED CARS......1..1.ab�111- .. OCCUPIED BUILMOS(HO1l M APARTMENTS.ETc.)....�r:.��...�.....»............. PUBLIC BUILDINGS(SCHOOLS,HOSPITALS,CHURCHES,ETC.)�../SA f...._ TEMPORARY EVENT SET-UPS(CONCESSIONS,TENM ETC.)...... - NIAIN PARKF S AREAS......3 L D.............. .......... ...... .... _............... ............. HIGHWAYSOR ROADS.„... ..........«....................._...................................... ONERFIEAD OBJECTS{POWER LINES,LIGHT POLES,7REES,ETC.-o FUELSTORAGE......b° ............................................................................. PLEASE PROVIDE DIRECTIONS FROM NEAREST INTERSTATE TO DISPLAY SITE. A MAP WOULD ALSO BE HELPFUL. Local MatelsNaidls: Telephone Nos. v. tro Signature l A a 1^l rd' .o ' Data__.. � �' ��� S AA Pisa idffaleadi paga� h�tlal Jtet+c New York State Insurance Fund Workers'Conipensalion A Disabilfty Benefits Specialists Since 1914 8 CORPORATE CENTER DR,2ND FLR,MELVILLE,NEW YORK 11747-3166 CERTIFICATE OF WORKERS'COMPENSATION INSURANCE e A A A n w 753044987 BOSTON INSURANCE BROKERAGE 24 FEDERAL ST FL 4 Qui BOSTON MA 02110 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GREENPORT HIGH SCHOO PYRO ENGINEERING INC GREENPORT FIRE DEPARTMENT DBA BAY FIREWORKS PO BOX 345 999 S.OYSTER BAY RD, STE 111 GREENPORT NY 11944 BETHPAGE NY 11714 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2437 559-4 578815 02/27/2018 TO 0211512019 419/2018 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH TME NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2437 559-4, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK. TO THE POLICYHOLDERS REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:IMWW.NYSIF.COWCERTICERTVALASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF-FAILURE TO GIVE SUCH NOTIFICATIONS. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS COMPENSATION ANDIOR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE-WAIVED. THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. i NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:10=41i45 U-26.3 f` RECEIVED fi ofix MAR 0 6 2018 VILLAGE OF GREENPORT 'ei: 631-477-0248 CLERK'S DEPARTMENT Fax: 631-477-1877 1 PUBLIC ASSEMBLY PERMIT APPLICATION :+ '74*s application appries to any form of public assembly or entertainment expected to attract or involve twenty- five(25)or more persons. A cover letter is required,describing in detail the proposed event. 1. '$S0.00 non-refundable permit fee must be submitted with the complete application. SECTION 1- I t 'Name of Applicant/Organiiation: Jr t FA K D 5 H 3 Address of Applicant/Organization: d9 O u7 L,--� 'sq Gj Kmq Saar jv 9 E-mail Address: fr-l- �A,,� 0 CA_ou L1 N , �11�j' Phone No.: (,3l" location of Event: t-o Lo Gf-DAJj no,-,46 L}Qhly Type of Event: Nou-11 Vs Date of Event: /� T i> s Hours of Event: J 7 1 l Description of Event: C 10,CLN i V?3 f U 144 Estimated Number of people in attendance: d 6� Fees to be charged: _I"1_-s_ Z66- 1 hereby declare that I will comply with the Village of Greenport Code and all conditions of this permit. - -lu� � 3 O-�' ;gnature of Applicant Date Please Circle Aonroariate Answer Road(s)to be closed? Yes No Tent or Structure to be erected? Yes He Sidewalk(s)blocked? Yes No Food to be served? ` yes Na - Have you previously obtained a permit for this event? es No If yes,When? P0@ s ( ' /3 Clean tip Pians: 7'6 !7 R�/�C,rS A/ E3 ,5 7 P, Y6 SsF (f�I Public Assembly Permit Application•(approved 5-23-2011) Approval by the Board of Trustees is required,and this permit must be submitted no later than 60 days-prior to the even SEMON 2• A deposit check in the amount offive hundred dollars($500.00)must be submitted with this applicatiork,whick may be refunded after event conclusion if the property is returned to its original state-and there are no costs incurred by the Village. Insurance required: Applicant will provide proof of liability insurance in the amount of one million-dollars ($1,000,000)per occurrence naming the Village of Greenport as additional insured for risks or as may otherwise be determined by the Board of Trustees. Alcoholic Beverages: No person,shall consume any alcoholic beverage in any Village park,playground;beach, or other Village park property or facility,nor shall any person possess any alcoholic beverage with intent to consume or facilitate consumption by others of same in any Village park,_playground,beach,or other park property. Signed: Dated: o�� Applicant must return completed application,cover Tetter and cbecks to the Village of Greenport,at 236 e Street,Greenport,NY 11944 SEMON 3: FOR OFFICE USE OWN" This ap icati n is here Approved Denied Sylvi "Piri110,Village lerk 22 �J Oat' ' Date of Board of Trustees Action:V �'0 CC: Finance Department Police Department DPW!Utilities Fire Department Public Assembly Permit Application(approved 5.232011) ACRO DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03105/2016 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(los)must have ADDITIONAL INSURED provisions or 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. as NN Fse: (631)477-1680 FAX C No: (631)477-8930 828 Front Street ADDRESS, donna@mcmannpdce.CDm P.O.BOX 2065 INSURER(S)AFFORDING COVERAGE MAIC 0 Greenport NY 11944-0876 INSURERA.. Arch Insurance Company INSURED - INSURER B Village of Greenport Fire Department INSURER C: PO BOX 58 INSURER 0: INSURER E: Greenport NY 119440058 INSURER F: COVERAGES CERTIFICATE NUMBER: CL183502021 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 CONTRACTOR 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMroo MMMD P LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE 7 OCCUR PREMISES Eaaaurtenca S 1001000 MED EXP Any one arson) S 5,000 A MEPK06726912 06101/2017 06/01/2018 PERSONAL 8 ADV INJURY S 1.000,000 GENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 10,000,D00 POLICY❑JECTPRO- D LOC PRODUCTS-COMP/OPAGG S 10,000,000 OTHER: Liquor Liab.Cov.Part S 3,000,0DO AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANYAUTO BODILY INJURY(Perperson) S OWNED SCHEDULED BODILY (Per S AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Peracddent S X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 5,000,000 A EXCESS UAB CLAIMS-MADE MEUM06473412 06/01/2017 06/01/2018 AGGREGATE S 5,000,000 DED I I RETENTION S S WORKERS COMPENSATION PER OTH. AND EMPLOYERS'LIABILITY Y/N- STATUTEER ANY PROPRIETORIPARTNEWEXECUTIVE ❑ N/A E.L EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT Is DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is mqulmd) With respect to Carnival from 5/24/2018 to 5/28/2018 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Greenport ACCORDANCE WITH THE POLICY PROVISIONS. 236 Third Street AUTHORIZED REPRES Greenport NY 11944 O 988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACOAD t �0 1 T � GREENPORT UFSD 720 Front Street MAR 2010 isa Greenport, NY 11944 TV APPLICATION FOR USE OF SCHOOL FACILITIES The Administration is responsible for the use of all school facilities in order that they may consider your request for such use, kindly complete the following: / 1. Facilities Use Request: (Organization), S� r 90 ro A1fy741'1'r requests the use of A>P-1-4 44d OF I5711rL dat Greenport Public Schools for the purpose of: F)kir W a tj�'j S 04A on(date), S A f M y 2 , �� I k at(time) 14 t /Q jZ�I,a A 1' Su>� " Ai J'1 Y��-7)yDlP Will activity be open to the public? (Circle one)(�5?No Is this a For Profit Organization?(Circle one) Yes i� Admission of W A 1 u-d will be charged; proceeds will be used for Does applicant agree to submit financial records for examination upon requests? Does applicant agree to conform to the regulations of the Board of Education and all laws regulating to the use of school property including Section 414 printed on the reverse side of this application? /fes Name : �vsbon� � 5J*� Au Address: 9aS' �2< CAk/ J Lia L�Xh � � 7 r Telephone# 6 � �� of the person responsible on this occasion. II. Insurance Information A certificate of insurance of at least$1,000,000 public•liability per occurrence and$2,000,000 aggregate liability insurance and$50,000 property damage shall be submitted at least three days in advance of the event and must designate both the using organization and the Greenport Union Free School District with ISO endorsement CG2026.The absence of such a certificate will'preclude use of the facility. The policy must contain a 30-day guarantee notice of cancellation.The user agrees to indemnify the district for any applicable deductibles. III. Rules Governing Use of Facilities A. No smoking is allowed in the building or on the grounds.The organization using the facility is responsible for enforcement. B. No drinking of alcoholic beverages is permitted. C. Activity shall be restricted to that area for which permission is granted. D. Activity shall not extend beyond hours approved by district. E. Programs shall not interfere will regular school schedule. F. Organization shall be responsible for moving its equipment into and out of the building. G. The supervisor of the activity shall be present before it is due to start and remain with the group until all have left_ H. In the absence of administrative personnel,the custodian is charged with the responsibility the building. ty of I School authorities must have free access to all rooms at all times J. A careful examination will be made after use of the area by the applicant who will prompt) - make good on any loss or damage,which might have occurred. y K. No school property or equipment is to be altered or removed from the premises. L. This license is revocable at any time by school authorities. M. No reservation will be made until this application is returned and approved by the-dist j School Administrator. of Not for Profit Organization IV. Rental Fees Other Fees or Conditions: Auditorium for performance $100 Auditorium for practice $50 Gymnasium for performance $100 Gymnasium for practice $50 When an approved activity takes place outside the normal hours of school operation,the organization will be charged$40.00 per hour for personnel services for a minimum of 4 hours.This all must be paid seven days in advance and is not refundable unless the district receives notification of cancellation at least 48 hours in advance_ ' o For Profit Oreanization Auditorium $150 per hour= hour{s)X rate= Custodial $40 per hour Monday—Friday=hour(s)X rate= Custodial $60 per hour Saturday&Sunday=hour{s)X rate= Technical(sound&lights)$60 per hour=hour(s)X rate This all must be paid seven days in advance and is not refundable unless the district receives notification of cancellation at least 48 hours in advance. V. 1 agree on behalf of the above-mentioned organization that all members and guests will observe the regulations and that we,individually,and as an organization,will assume all financial responsibility for any and all damages done to the Greenport School property during the above- indicated period of use.We also agree that our organization will at all times hereafter indemnify the above-named school against any loss,damage or expense of any kind,which said school may sustain or incur because of the use of the above-mentioned building by our organization,and we further will hold said school harmless for loss of any 'nd in connection herewith. Applicant Signed: Date: d P t"Denie Superintendent: Granted Date:"I 11A Specific Details of Use: EXCERPTS FROM SECTION 414 OF THE EDUCATION LAW "...The Board of Education of each district may...permit the use of the school house and rooms therein, and the grounds and other property of the district,when not in use for school purposes,for any of the following purposes: 1. For the purpose of instruction in any branch of education,learning or the arts. 2 for holding social,civic and recreational meetings and entertainments,and other issues pertaining to the welfare of the community;but such meetings,entertainment and uses shall be non- exclusive and shall be open to the general public. 3 For meetings,entertainments and occasions where admission fees are charged,when the proceeds thereof are to be expended for an educational or charitable purpose;but such use shall not be permitted if such meetings,entertainments and occasions are under the exclusive control,and the said proceeds are to be applied for the benefit of society,association or organizations of veterans of the military,naval and marine service of the United States and organizations of volunteer firemen." CERTIFICATE OF LIABILITY INSURWCE�V DATE(MM/DDIYYYY) 03/05/2018 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 have ADDITIONAL INSURED provisions or 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 Joseph Cherepowlch NAME: Mcmann Price Agency Inc PHONE (631)477-1680 FAX (631)477-8930 A1C No Ext: AIC,No): 828 Front Street ADDRESS: donna@mcmannpnce com P.O.BOX 2065 INSURER(S)AFFORDING COVERAGE NAIC# Greenport NY 11944-0876 INSURER A: 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: CL183502021 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 CONTRACTOR 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 NSR AUUL15ULSK POLICY EFF POLICY EXP INSD WVD POLICYNUMBER MM/DD MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 7 OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A MEPK06726912 06/01/2017 06/01/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 10,000,000 P ❑PRI r7JECT LOC PRODUCTS-COMP/OPAGG $ 10,000,000 OTHER Liquor Llab.Cov.Part $ 3,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acadent ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per acadenl) $ HIRED NON-OWNED PROPERTY acDAMAGE $ AUTOS ONLY AUTOS ONLY Per ddent X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE MEUM06473412 06/01/2017 06/01/2018 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E L DISEASE-FA EMPLOYEE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) With respect to Carnival from 5/24/2018 to 5/28/2018 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Greenport Union Free School District ACCORDANCE WITH THE POLICY PROVISIONS. 720 Front Street AUTHORIZED R RESEN I Greenport NY 11944 @ 198 -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD FROM LEGION FIREWORKS Co Inc PHONE NO. : Jun. 04 2018 09:35AM P1 F.1_i7.ARh'TH A.NEVII1.E,MMC �`�:` Town Ilgill,5309.5 Main lfaad TO"CLEPM P.D.Box 1179 ate° Southold.New York 11971. REGISTRAR 0)?VITAL STATIS'TICR Fnx(C331)76.5-6145 RECEIVED MARRXAGE OFFICER y"` Telep}tone(hal)765.1800 R»C HDS OF MANAGEME34T OFFICER " r'otathnldtown.northtork.ract. FREEDOwl OF INFORMATION OFFICER JUN 6 2018 O CE OF TM TOWN CLERK Southold Town Clerk TOWN OF SO=OLD APPLICATION PERMff TO]DISIPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law of the Statc of New York,for a permit to display fireworks as hereinafter specified: Relief Hose DjSpLAY IS TO BE SPONSORED BY Phenix Hook & Ladder Co. #1 & Co'.: #2. PRINCIPAL OFFICE ATI' t, WY 11944 3rd Street Green Greenport, DATE 8t TIME OF.DISPLAY P - ,0 l '� Pei 7 / 5 / 2018 Start Time��- E CTL CATIO -OF DISpI.AyGreenPort Hir h SCh0Q1. Athletic Flela SUFFOLK COUNTY TAX MAP NUMBER FOR SITE �� w / �'/ �I S Start Time: ` f RUN DATE&TYNE, _____,;,�,._�.._ ..r_,p. ne following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Joseph Carpanzano 49 10+Years Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Approximately (1,184 Shots) 1-5" --S" 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 polio of insurance coverage. NOTICE: Written permission,with signature of the Property q ermast be submitted with the Application. " EEE: $100 e of Olrganii,mtio See policy:for additional information I Signatum of Applicant µms. Date of A pplicatiorl FROM : LEGION FIREWORKS Co Inc PHONE NO. : Jun. 04 2018 09:36AM P3 Legion Fireworks Co., Inc. �.., 10 Lesion ixnc Wappingers falls,NY 12590 ('845)831-8328 THIS CONTRACT AND AGREEMENT for the sale of fireworks made and concluded 6/4/2018 by and between Legion Fireworks Co., Inc. (*Legion") and Phenix Hoak& Ladder Company#1 and also Relief!lose Company#2(*Sponsor*). W11NESSI:TI-1:for and in consideration of the sura of One Dollar,each to the other in hand rcccipu.of which is hereby aeknow lodged,and of the terms and conditions hereinafter mentioned,Legion and the Sponsor do actually and severally agree to perform their several covenants and to guarantee terms,conditions and pa.ytnents of this contract. Legion agrees to sell and.furnish unto the Sponsor,a Fireworks Display in accordance with a program proposed and agreed upon at the time of the signing of this agreement,said.Fireworks to be furnished l" r display on the following dates: 7/5/2018 Raitl.l ate: Legion agrees to furnish unto the Sponsor at least two experienced professional display operators to present the said display,said display operators to he agents ofLegion and to act under instructions and directions of the Sponsor, Uegion shall also prnvide display liability in the amount of$5 Million dollars coverage('combined single limit)for protection against claims of bodily injury or property damage arising solely out of the operators of Legion. The Sponsor agrees to procure and furnish,in accordance with Local or State 'Law,a suitable place to display the said fireworks.Thu Sponsor also agrees to secure all police,Fire,Loua.l and State permits,and to arrange for any security bonds if required by Law in their community.In the interest of safety and to prevent:damage to fireworks,claims of alleged negligence,or injury to it's reputation;Legion reserves the right to determine inclement weather conditions which will prevent the giving of said display. The sponsor shtrll always have the right to postpone to a rain date ONLY ON condition of inclement wcathcr. In the event a rain date is declined by the sponsor at the time ol'the signing of this agreement,the sponsor agrees to pay Lcgion a cancellation fee amounting to fifteen(15%)percent of the display price stated below. Said fee shall be for reimbursement to Legion for cxpcnscs itucurrud with display preparation, equipment rentals and display operator labor.The:Sponsor agrees to furnish necessary Police and Hire protection,including crowd control rind auto parking. It is further agreed the Sponsor will provide a continuous barricade,rope line or snow fence to establish an ash fallout zone between spcLtators,parked automobiles or dwellings;and the place of discharge of fireworks.The only authorized persons in the fallout toric during the display shall be the professional display operators furnished by Legion. The Sponsor agrees to kucp the 1.411out zone free ol'all persons during and immediately after the display to facilitate inspection for any dud fireworks by the display operators. Until the display site has been thoroughly inspected and cleaned,the Sponsor agrees to take all necessary precautions to guard and prevent persons from entering the display site area. The Sponsor hereby agrees to indemnify and hold harmless Legion from any personal injuries or property damage which result from the Sponsors Iailure to perform the obligations set forth in this paragraph. The Sponsor agrees to pay Legion or it's duly authorized agent for collection,the sum of$7,500.00 dollars said fireworks display.Payments to be made as follows: %15 Deposit of$1,125.00 due at signing of the contract. $6,375.00 Due imtmediately following the display. In the event of late payment,the Sponsor agrees to pay Legion a finance charge of Two(2%)percent per month on the unpaid balance. All payments shall be made by draft or certified chcuk payable to the order of Legion fireworks Co.,Inc,unless otherwise specified and authorized in writing. Should Sponsor fait to pay to Legion the agreed upon contract price tis specified above,as and for Legion's services,the Sponsor hereby agrees to pay any and all reasonable attorney's fees incurred as a result of collecting any and all sums due and owing pursuant to this agreement and.further agrees to pay all disbursements, including but not limited to filing fees,process serving fees, investigative fees,and any other reasonably incurred disbursements and/or expense made in connection with the collection,of monies due and owing Legion pursuant to this agreement. ''it is further agrucd by the Sponsor that in the event of a lawsuit initiated for the purpose of collecting the agreed upon contract price as set forth in this agreement,the sponsor hereby waives any and all counter-claims and/or defenses thcrcto.Tbis contract shrill not be construed to create a partnership between the parties or persons mentioned herein, In the event of tire,accident,strike,delay,flood,act of God or government or other causes heyond the control of Legion which prevent the delivery of said materials,the parties hcrc-to release each other from any and all performances of the convenants herein contained and from damages resulting from breach thereof. IN WITNESS WHEREOT',WE SET OUR HANDS AND S1 Ai,S TO TI IiS AGREEMENT IN DUPLICATE TI IF.DAY AND YEAR FIRST ABOVE WRITTEN, AI-MST: LEGION FIREWORKS(().,'INC:. SPONSOR---- Si rratu 4 Frank A Coluccio,President t Print Mame/Title FROM : LEGION FIREWORKS Co Inc PHONE NO. : Jun. 04 2018 09:36RM P2 4G' L6101'12 TE IMMIOD/YPYY) CERTIFICATE OF LIABILITY INSURANCE 018 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 con8ltlons of the pollcy,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 CONTA CT Britton Gallagher PHDt� I (AveF „Hal7101 ,(AI ,,tit?»/rxrl, 1$._a 0..-. 6 8 One Cleveland Center, Floor 30 I�.MAIL m 1375 East 9th Street Cleveland OH 44114 „INSURERI S AFFOROINO COVEPAOe NAIL u INSUREAd A.Aylaw. l fplu r.lrls Company,.. . tNSUR D INSURER a°Ev r Not' .Mot drN 4xh Le ton Fireworks Co.,ine. INsUR a c 10 Legion Lane INWRCR0 Wappingers Falls ICY 12:590 INsuRER s INSUrR F', COVERAGES CERTIFICATE NUMBER:1728635391 REVISION NUMBER' THIS IS TO CERTIFY THAT THE.POLICIES OF IIS 'RANGE LISTED BELOW HAVE.BF-EN ISSUED TO THE INSURERNAMED ABOVE FOR THE POLICY PI RIOD 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 AFFORDE=D 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. I ,. �, -. _.�.. POLICY IFP I POLICY E'XP LTR TYPE OF MSURANCE POLICY NUMSER MMIODdYYYY M YV UMI'C S GENERAL LIABILITY SIOMLOO116-181 3175/1018 3/15/2078 COMMERCIAL GENERAL LIA91L11Y EACH OCCURRENCE S5000 0; CLAIMS-MADE n OCCUR MED EXP Arty one PenSn) .,. .. .,,.. 1 PERSONAL L'ADV INJURY ,. rODD 0..R�p 9 1414 RAL AGGREGATE $2,000,000 GENE,AGGREGATE LIMIT APPLIES PER; PRODUCTS-comPIOP ACaG 1$2 OK000 s POLICY X, PCO- Lac B AUTOMOBILE LIABILITY S18CA00058-1 al 3115/2018 3/15/2019 Ma ao4den1 .,11 000 000 ANY AUTO BODILY INJURY(Per person) $ AALL UTOS NED SCHEOu,FO BODILY INJURY(Per accident) $ NON-OWNED 0466i66ANIACEE $ X HIRED AUTOS X AUTOS (Por A UMBRELLA uAR X OCCUR EAU731294 3115/2018 3/15/2019 _EACH OCCURRENCE $4,000,000 X EXCESS UAB CLAIMS-MAD£ AGGREGATIL 54,000,000 -� .._ r DED RETENTION$........ $ WORKERS COMPENSATION AYKr' OTHr AND EMPLOYERS'LIABILITY Y PROPRIETORIPARTNER/EXECUI1VE YwJr AN ❑ NIA E.L EACHACCIDEN1 $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E l OIFASP EA t4tPl.0Y S I'M r e.deacribe under E L DIS!ASE-POLICY LIMIT S DSCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATION5I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,R more apace Is requlrod) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Date of Display.715120'181 Locatiolrt 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 Phenix Hook&Ladder Co.#1 & Relief Hose Co.#2 THE EXPIRATION DATE THEREOF, NOTECE WILL BE DELIVERED IN PO Box 58 ACCORDANCE WITH THE POLICY PROVISION$. 3rd Street Greenport NY 11944 AUTHORIZED REPRESENTAtIVE / ..../ ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD FROM LEGION FIREWORKS Co Inc PHONE NO. : Jun. 04 2018 09:38AM P5 ELIZA)<3IjTH A, NEVILLE,KNC � -Town Ball.Br'lgo-ad-adTOWN C1.k.RH P.O.,Box on ]]799 Sc>ulht,ld,New York 11971 RE 01ST1tAR OF VITCAI.STAT151'ICS � Ft x(6$1)7654i 145 IAlM1A EOF'FICER ��� ' w� 1'elephono(s:i]);6�..,saRECEIVFD U10'ORDS C'A'FAG INT OFFICER Foi.ithraldtown.aorthfork.zte:t F I0 OrINX'4A ION OFFICER 0MCE OF T1W,TOWN CLERK TOWN OF SOUTHOLD of Clerk ,APPLICATION PLrRMT'i'Iro DISPLA V FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the pmvisions of Section 405.00 of the Pei lief th the state of New York,for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED DY Fh"en x 11Oo1 Ladder Co 7 Co'. . PWNCIPAL OFFICE AT 3rd ;Street C eenporL, NY 11944 T)AT19&"ME OF.DISP Y 7 / 7 / 2018 Start, School,..Athletic —�_ VUCT LOCATION-OF DISPLAY Greenport i . SUFFOLK COONTY TAX MAP NUMBER FOR SITE RAID DATE&T E1 i The following persons are to be in charge 4 � e of the actual shooting of the flreworks_ dame Age Experience Physical Condition Joseph Carpatt no 49 10 Years Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows' Approximately (1,820 Shots) 1.5" - 5" 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 head. Also attached is a,certificate or policy of insaraoce coverage. NOTICE: Written permission,with signature of the Property Owners tloust be submitted with the Application. 4f" FEE• s1 o0 Ily � e of Organimtjon See policy-for additional information Signature of Applimt Date v A ppli ltior FROM LEGION FIREWORKS Co Inc PHONE NO. Jun. 04 2018 09:39AM P7 Legion Fireworks Co., Inc. 0 IU Lcgion Lane Wappin�en I Fills,NY 12 590 + +� ($45)831-8318 TUI IS CONTRACT AN1) AGRH:E,ME'N'1'`'l�for the sale of firework, made and co eluded 6/4/2018 by and between Legion Fireworks Co.,Inc. ("Legion*) and Phenix Hook& 'ILadder Company##1 and also Relief Hose Company#2(*Sponsor*). WiTNi?SSETFI:for and in consideration of the sun:of One Dollar,each itr the other in hand receipt of which is hereby acknowledged,and of the terms and conditions hereinafter mentioned.Legion and the Sponsor do actually •and,everaliy agree 14)perform their several covenants and to guarantee terms,conditions and payments of this contract. Legion agrees to sell and furnish unto the Sponsor,a Fireworks Display in accordance with a Prol,►ram proposed and agreed upon at the time of the signing of this agreement, ,said Fireworks to be furnished for display on the following dates: 7/7/2018 Rain Date: Legion agrees to furnish unto the Sponsor a1L least two experioncod prufessional display operators to present the said display,said display operators to he agents of Lcgion and to act under instructions and directions of the Sponsor. Legion shall also provide display liability in the amount of$5 Million dollars coverage(combined single limit)for protection against,claims of bodily injury or property damage arising solely out ot'the operators of Lcgion. The Sponsor agrees to procure and furnish,in accordance with Local or State i.aw,a suitable place to display the said fireworks.Tho Sponsor also agrccs to secure all police,Fire,Loath and State permit,~,and to arrange lir tiny scc:urity bonds if required by i..aw in their community. In the interest of safety and to prevent:damage to fireworks,claims of alleged negligence,or injury to it's reputation;Legion reserves the right to determine inc:leracnt wcuther conditions which will prevent the giving of said display, the sponsor shall always have the right to postpone to a rain date.ONLY ON condition of inclement weather. in the event a miA date is declined by the sponsor al,this time of the signing of'this agrcumunt,the sponsor agrees to pay Legion a cancellation fee amounting to fifteen(1501a)percent of the display price stated below, Said fee shall.be fo.r reimbursement to Legion for expenses incurred with display prcpa ration, equipment rentals and display operator labor.The Sponsor agrees to furnish necessary Police and fire protection,including crowd control and auto parking, it is further agreed the Sponsor will provide a continuous barricade,rope line or snow fence to establish an ash fallout zone between spectators,parked automobiles or dwellings;and the place of dischaarge of fireworks-The only authors rccf persons in the 1':Fllout/,one during they dkpluy ,hall he the prcafessional display operators furnished by Legion '1 he Sponsor wises to keep the.fallout zone frac of all persons during and ittarrtcdiately ullur the dispfay to fau,:rlitaa1 inspection for any dud fireworks by the display operators. until the display site has bcon thoroughly inspcatcd and cleaned,the Slaun%vT t gTccs tar take°ull necessary precautions to,guard and prevent persons from entering the display site arca. The Sponsor hereby aagrccs to tr durnnify and hold hurr Ics' Idugiurr from any personal injuria tit property damage which result from the Sponsors failure to perform the obligations set forth to this paragraph. The Sponsor agrees to pay Legion or it's duly authorized agent for collection,the sum of$5,000.00 dollars said fireworks display.Payments to be made as follows: %15 Deposit of$750.00 dine at signing of the contract. $4,250.00 Due immediately following the display. lnthc event of late payment,the Sponsor atttrees to pay Legion a finance charge of'l\vo(2%)percent per month on the unpaid balalnee:. All payments..*,,-hall be made by draft or certified chock payable to the order of Legion Fireworks Co.,Inc.unless otherwise specified and autbori!cd in writing. Should Sponsor fail to pay to legion the agreed upon contract price as spcuifiud al+ove,as and for l.eginn"s services,trite Sponsor hereby agrccs to pray any and all remsonable attorney's fees inc'urrcd its to rea'tylt Of'collebling any and all suras due and owing pursuant to this agreement and further agrees in pay ail disbursements. including but nor limited to filing fees,process serving fees, 'investigative fees,and any other reasonably incurred disbursemeMs audioe expense made in connection witlx the,collec:lion of monies due and owing Legion pursuant to this agtecrnenl, It i;ti furtber agreed by the'ponsor that in tite event ofe lawsuit initiated for the purpose of collecting the agreed upon contract price as set forth in this tagrecmcnt,the sponsor l'rers,hy waives any and all counter-claims and/or defenses thcrcto.This contract,hall not be corlstrued to create a partnership between the parties or penins mentioned herein. in the event of fire:,accident.strikes,delay,Blood,acct of(.od or government or other causes beyond the control of Legion which prevent the delivery ofsa id materials,the parties hereto release carob other from any and ail performances of the convcnant,herein contained and from damages resulting from,breach thereof. 1N WITNESS WHEREOF,W.E Sr-,7'0(1R I(ANDS ANIS SEALS TO THIS AGRrf:MI:NT T'N DkIPLIC:A'T'E THE DAY AND YEAR FIRST ABOVIs ATTEST: LFGiON i IRPWOR.KS CO.,INC. SPONSOR: .. d Sgature Frank M.Coluccto,Presidcat - Print.Name/Title FROM : LEGION FIREWORKS Co Inc PHONE NO. Jun. 04 2018 09:38AM P6 C J0 CERTIFICATE OF LIABILITY INSURANCE DATE(IAMIDD/YYYY) /1101 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 CONT ACT l ritton Gallagher NAMM .._ One Cleveland Center, Floor 30 EMAIL 1375 East 9th Street Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIL INSURIxrLA-W'Surplus..=_CD:Dsp INSURED KtUACR M:EVgrv§LNAlariAlns rr artce.. onV Legion Fireworks Co.,,Inc, INSURER C:s 101.egion Lame INSURER D. Wappingers Falls NY 12590 INSURER r COVERAGES CERTIFICATE NUMBER:1947222271 REVISION NUMBER: THIS IS TO CEIRTIFY'THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN 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. ILTSRR IR.. _.. . .-..__ 'Y EI(IT.. POLICY EFF PDLIC . — TYPE OF INSURANCE amo,WvVPOLJCY NUMBER MMIOD vvanww"YY LIMITS B GENEW.LIABILITY SI8ML00116-181 3/15/2018 3/1512019 EACH OCCURRENCE $1,000 DOD X ET6REWMD''' COMMERCIAL GENERAL LIABILITY P10FA IFa mrnimarra $500,000 Ct.AIMS4IIADE1�1 OCCUR HIED E7 P(Any OIpO Peraot+3 ., g._..... PFRSONAL&AOV INJURY 51,000.000 GENERAL AGGREGATE_ S2 000,000 GEN^LAGGREGATE LIMIT APPLIES PER — PRODUCTS COI+%,NOPAGG $2,000 000---- , ._. 1 17 POLICYO LOC $ AUTOMOBILE LIA9IIJTY g18CADD058-161 3!15/2018 3/15!2019 -COMBINED SINGLE UMIT (,Ee,ast� $1,000,00D ANY AUTO BODILY INJURY(Per par-son) E ALL OWNED SCHEDULED _ j AUTOS AUTOS BODILY INJURY(Por aceidont) S 'xr NON OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS -(r'-EL °- " UMBRELLA LIAR X OCCUR EAU731294 3115/2018 3/1512019 EACH OCCURRENCE 84,000,000 A,, EXCESS UAB _ CLAIMS-MADE ACCAECATf. DEO I RETENTION$ WORKERS COMPENSATIONWC STATU- OTH-'. AND EMPLOYERS LIABILITY Q NIA T ANY PROPRIETOR/PARTNERICXECUTIVE E.L.EACH ACCIDENT E OFMCER/MEMBER EXCLUDED? (M andatory In NH) E.L.DISEASE-EA EMPLOYEE $ _ under DESCRIPTG�ON OF OPERATIONS Celaw E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Apoltlonat Ramarles Schedule,N more space is required) Additional Insured extension of Coverage is pTOVlded by above reforenwd General Liability policy where required by written agreement, Date of Display:71712015, Location of Display,Greenport High School 7201 Front Street Greenport,NY 11944. -Additionally Insured Certificate Holder,"Tom 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 Phenix Hook& Ladder Co.#1 &Relief Hose Co.#2 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 58 ACCORDANCE WITH THE POLICY PROVISIONS, 30 Street Greenport NY 11944 AUTHORIZED REPRESENTATIVE - 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CHIEF JEFFREY WEINGART III (631)477-9801 STATION 1 1STASST CHIEF SUSANO JIMENEZ (631)477-8261 STATION 2 (631)477-1943-CHIEFS OFFICE 2"°ASST.CHIEF JAMES KALINi (631)477-4012-FAX CHAPLAIN CLAUDE KUMJIAN 311 THIRD STREET•P.O.BOX 58 GREENPORT,NY ASST.CHAPLAIN THOMAS MURRAY III Email:gfdfire@opton 11944 ireQoline.net SECRETARY/TREASURER JAMES KALIN www.greenportfd.org Organized 1845 RECEIVED jLN 6 20181 June 04, 2018 Southold Town Clerk Town Clerk Elizabeth Neville Southold Town Hall 53095 Main Road Southold, NY 11971 Re: July 2018 Carnival Fireworks Dear Ms. Neville: The Board of Wardens of the Greenport Fire Department at a regular meeting in December 2017 approved the Phenix Hook& Ladder Co.#1 and Relief Hose Co.#2 request to hold a Carnival at the Polo Grounds on Moores Lane from July 03 through July 07, 2018 with Fireworks to be held on Thursday,July 05 and Saturday,July 07, 2018 at 10:00 pm (rain date of Friday,July 06, 2018 same time). If you wish to discuss this event with me or have any questions, please do not hesitate to contact me. I can be reached at 631.466.5294. esectful,ly,4, . kle, . James H. Kelm Assistant Chief Greenport Fire Department ^, � - � ���' � � a ��"� {rr'r :d�' ..,g'�Y44����'"`�A"'" �1N.a• y Y� � � �'j � 4✓ / � '�W"" M k m °��4 4+�.'�'p.� ✓ � �q P b^Y tl p?µ;���w' � � ��tlV q.r S��y �"�, 1 �m�� y'�°�� �^'I,���rY k L TO x W Flo � �" �;" ,`�p � „�� iy�, �yMnld�� ">�'r �m r �Y t���n✓�s~� i s �� � �`r'"��.T�� "'m �+ "mix n P a tiq' r Oar r Po ,4 , a a �'r yk� pr y b ark� d a1 x i ey d � �' M�"» ✓ erve�l�r r '� ,� a Sp a "rN �✓sd s r r. � 1N I a .b i r w r �" 9✓tisµNi�° Y ������ tµ N"" & Y*�'.�V3, r'� '�`� � ,� rP. ' ,� r •� a s a rC ) r"r i p es '� � 7r e�+t�s��g w fir` � � ; ��,✓ � �� J4 � ,fxr ,� r l r� �� y"hJ 1 ✓ a � a n,r'a"i+' b + .� ��,. P r` 9 o 9"'a'b< ..,�E ,n. ':,' � � ���� " :.4 .�"� ✓ +L^5'�my wL '� �u'r� .a N wr +............... FROM : LEGION FIREWORKS Co Inc PHONE NO.. Jun. 05 2018 02:45PM P1 w d Shooter,: Joe Carpanzano Cell p1jone #: (914) 260-7693 4 r y a � ary Y�a�"�;a+z��f �a w �m ti✓M G„�sw z,�a i C r': ' �I� ;I F'II �* ` � } v�M�� ry ,�1�5.gM➢�WI�M.w)�$�I �� � H « �°u✓, w w�s y M ^Y y Name J-X °4. ri 7 Date A Address A�m_011 el —City C-4 rxfr.,4__ST.__�V Y' Telephone Number(s): Home: M� Work: Cell: E-mail � ��'...� — ^", Date of Birth 3 Social Security IL Traditional and Contemporary Pyrotechnics for Exhibition at Fairs • Concerts •Events U.S.Department of Justice Federal Explosives License/Permit Bureau of Alcohol,Tobacco,Firearms and Explosives (I8 U.S.C Chapter 40) EM umw•a n>r�nrarur•rrrn®ut•ia 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 THISw LICENSE NSE IS NOT TRANSFERABLE UNDER 27 C1711'555.53. See"WARNINGS"and NOTICES"on reverse. Correspondence )w'lartalnslatyRoaV25405-9431 lenttwtl Direct ATF ATT-Chief,FELC .Lic clise' po _44 Needy Road i 1v111rnhca • �r • 1 � ' • Martinsburg, Chief,Federal 43:.Itlta lvei Licensing Cenlc*r C,,TJ 1 Expiration R• Date �I�� • I�i� VIII ViI� �� i Name LEGION FIREWORKS CO INC Premises Address _ •ess(Changes? Notify the FELC at least 10 days before time move.) 10 LEGION LANE WAPPINGERS FALLS,NY 12590- Type of License or Permit 51-IMPORTER OF EXPLOSIVES Purchasing Certification Statement Mailing Address(Changes:Notify the FELC of any changes) The Licensee or permittee named above shall use a copy ofthis license or pconkit to assist a transferor of explosives to verify the identity and the licensed sial us Of the licensee or permittee as pfxcd�dscannedorby 27 e-medR Pan 6opoftltehceriseor5. nNe penriitwitltrErtbt ntasrC LEGION FIREWORKS CO INC t a signature intended to be an original signature is acceptable. The signature must he that of the Federal 10 LEGION LANE Explosives Uccnsce(FEL)or a responsible person of the FEL Icertify that this isatrue WAPPINGERS,FALLS, NY 12590- copy of a license or permit issued to the licensee or pemtittee named above to engage in the r business 6 operations speed above under"Type of License or Permit" `" - t Preside Licensee'Permittee Responsible Person Signature Position'Title Frank M. Coluccio Printed Name Date ATF Form.54M 14!x100.15 Part I PreviaasEdition isMsolete uLmNnlwanstoIK11acmLmj8 t HI'V741 vc4mlM...N1.MulTIRaEutuMs Revised October 2011 Federal Explosives license(FEL)Customer Senice Information Federal Explosives Licensing Center(FELC) Toll-free Telephone Number: (877)283-3352 ATF Homepage:%v%vw.atf gov 244 Needy Road Fax Number: (304)616-4401 Martinsburg,WV 25-405-9431 E-mail: FELC(itlatfgov Change of Address (27 C F7R 555.54(x)(1)). Licensees or permittees may during the term 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 ncty location of t)te business or operations not less than 10 days prior to such removal with the Chief Federal Explosives Licensing Center. The license or pcmut will be valid for the remainder of the term of the original license or permit. e 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 in accordance eitlt§555.54.) Right of Succession (27 CTR 555.59). (a)Certain persons other than the licensee or permittee may secure the right to canyon the same explosive materials business or operations at the same address shown on,and for the remainder of the tern 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 fumish 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. (Continued on reverse side) Cut Here X Federal Explosives License/Permit(FEL)Information Card p q Licensc:Pennit Name:LEGION FIREWORKS CO INC N t t 1 N 1 Business Name: N 1 tl E License'PemtitNumber 6- Y-027-51-9C-00091 1 N LicenscPetmit Type:51-IMPORTER OF EXPLOSIVES t I Expiration: March 1,2019 N 1 Please Note: Not Valid for the Sale or Other Disposition of Ewplosives, tl I � M FROM LEGION FIREWORKS Co Inc PHONE NO. : Jun. 05 2018 10:33AM P1 Rio STATE OF NEW YORK DIVISION OF DEPARTMENT OF LABOR SAFETY AND HEALTH LICENSE TO DEAL IN OR MANUFACTURE EXPLOSIVES Expires: 4/30/2019 Legion Fireworks Co., Inc. 10 Legion Lane THIS LICENSE MUST BE Wappingers Falls, NY 12590 POSTED IN YOUR PLACE OF BUSINESS Frank Coluccio License No D-2310 is hereby,licensed to deal In or manufacture explosives in compliance with the requirements of the Labor Law and Industrial Code mules, 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) n p C� MM9TM JUN GREENPORT UFSD �E -4 2018 720 Front Street By, Greenport, NY 11944 APPLICATION FOR USE OF SCHOOL FACILITIES The Administration is responsible for the use of all school facilities in order that they may consider your request for such use, kindly complete the following: 1 1. Facilities Use Request: (Organization), 4 V requests the use of at Greenport Public Schools for the purpose of: on(date)4 LA vryjAjV at(time)__l P. y r _ 1" , 30 Y Will activity en be open tot p the public? (Circle one) Ye No Is this a For Profit Organization? (Circle one) Yes Admission ofwill be charged; p ��; r Js- _ proceeds will be used for Does applicant agree to submit financial records for examination upon requests? C Does applicant agree to conform to the regulations of the Board of Education and all laws regulatin to the use of school property including Section 414 printed on the reverse side of this application?7e.S Name : • L�'S Address: Telephone# — - .....of the person responsible on this occasion. II. Insurance Information A certificate of insurance of at least$1,000,000 public liability per occurrence and$2,000,000 aggregate liability insurance and $50,000 property damage shall be submitted at least three days in advance of the event and must designate both the using organization and the Greenport Union Free School District with ISO endorsement CG2026.The absence of such a certificate will preclude use of the facility. The policy must contain a 30-day guarantee notice of cancellation.The user agrees to indemnify the district for any applicable deductibles. III. Rules Governing Use of Facilities A. No smoking is allowed in the building or on the grounds.The organization using the facility is responsible for enforcement. For JProfiLQ0fgan4gjqn Auditorium $150 per hour= hour(s)X rate= Custodial $40 per hour Monday—Friday=hour(s)X rate= Custodial $60 per hour Saturday&Sunday= hour(s) X rate= Technical (sound & lights) $60 per hour= hour(s) X rate= This all must be paid seven days in advance and is not refundable unless the district receives notification of cancellation at least 48 hours in advance. V. I agree on behalf of the above-mentioned organization that all members and guests will observe the regulations and that we, individually, and as an organization, will assume all financial responsibility for any and all damages done to the Greenport School property during the above- indicated period of use. We also agree that our organization will at all times hereafter indemnify the above-named school against any loss, damage or expense of any kind, which said school may sustain or incur because of the use of the above-mentioned building by our organization, and we further will hold said school harmles for to s of any ki46onnecOoin herewith. Applicant Signed: Date: - Superintendent: Granted ed Date: Specific Details of Use: EXCERPTS FROM SECTION 414 OF THE EDUCATION LAW "...The Board of Education of each district may... permit the use of the school house and rooms therein, and the grounds and other property of the district, when not in use for school purposes,for any of the following purposes: 1. For the purpose of instruction in any branch of education, learning or the arts. 2 For holding social, civic and recreational meetings and entertainments, and other issues pertaining to the welfare of the community; but such meetings, entertainment and uses shall be non- exclusive and shall be open to the general public. 3 For meetings, entertainments and occasions where admission fees are charged, when the proceeds thereof are to be expended for an educational or charitable purpose; but such use shall not be permitted if such meetings, entertainments and occasions are under the exclusive control,and the said proceeds are to be applied for the benefit of society, association or organizations of veterans of the military, naval and marine service of the United States and organizations of volunteer firemen." FROM : LEGION FIREWORKS Co Inc PHONE NO. Jun. 05 2018 10:34AM P2 DATE IMwnomvY) A CERTIFICATE OF LIABILITY INSURANCE 6/S/201s 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. It 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 endorsements CONTACI PRODUCER #Amg Britton Gallagher ( CxNe Eu0,2 PNiDNE 1fi-6`�-71Q0 �fiAX ,Ne);21 One Cleveland Center, Floor 30 WAAIL "` 1375 East 9th Street Al Cleveland OH 44114 tNIIOa(s)arwneplNc cran, r.... .... _...raaaC Legion Fireworks Co., Inc. INSURER s. 10 Legion Lane Wappingers Falls NY 12590 NS'I/RER E 1N5uR'A'l F COVERAGES CERTIFICATE NUMBER:20884044Zg REVISION NUMBER_ Tfll$IS TO CERTIFY THAT THE POLICIES OF INSURANCELISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AWE FOR HE 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, POLICY EFF POuCv EiP, t?XCLUSION3�D��DIRTAIO�OF SUCH POLICIES-OMITS SHOWN LICVMAY HAVE BEEN REDUCED BY PAID CO�m ,- n L ER INSR. R,�,.,� B .GENERAL LIABILriY SISMLD0116-181 3115/2018 3/1=01g EACH OC Ui^99NCV $1 000 cm )t &1IYkfETOREN'rOW7�.. C�OMME'RCIALGENE 4LIw�(UTY CLAIM S-MAOC OCCUR �nE��#�" PERSONAL&ADV GENERAL AGGREGATE GE 'L AGGREGATE LIMIT APFUeILS PI:R.' .._ PRODUCTS-CC'IMPIOO Aeq 3; 000000 Pouc'Y LOC PRO" B A'UTOIWCr LELIADIUTT S18CAOOD55-181 3/15/2018 3/15/2019 E cace1 a1a000000 X ANY AUTOBODILY INJURY(Per Person) ALLOWNED SC► OULED PROP �NJURV( t) 3 AUTOS U _. . xv A HIREDAUT0C3 X AVTOS FC P ,... . tl A UMBREUA LIAB X OCCUR EAU731294 3/15/2018 3/1512019 EACH OCCURRENCE $4.000,000 X EXCESS LIAB E AJMS^MADE AGGREGATE $4.0N.001 OEO RETENr10N8 _ WORKERS COMPENSATION TATO* OrIM E OR1PA63 n-T " Y/N .,.._ -„®A ANY PMPMIEfaIj EARTWEfW FGLr`IWI N f A t L EACH ACCIDENT �S AN OMPE "a Ira NH} El.DISEASE-EA EMPLOYE I M yea desedbe vnd El DISEASE-POLICY LIMB 1 oe,S60710N OF OPERATION'S bellow OESCRIPTION OF OPERATIONS I LOCATIONS I VOMCLES(ARach ACORO 701,Addhlonal Remarks Schedule,if more apace ib ropuintd) Additional insured eXtonSjon of Cover gs is provided by above referenced General Liability policy vlrhers required by written agreement. Etats of Display: 7fi5/"201 S. Location of Display*Greenport High School 720 Front Street Greenport,NY'11944. Additionally Insured-Certificate Holder,Town of SouttloK Vftge of Greanport,Greanport Public Schools,and Greenport Fire Department. CERTIFt!C TE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE GrB llport High School THEEXPIRATION DATE THEREOF. NOTICE WILL BE DELNERED IN 720 Front Street ACCORDANCE WITH THE POLICY PROVISIONS. Greenport NY 11944 AUTHORIZED REPRESENTArT�IV�. 191xa 2010 ACCIRD CORPORATION. All rights reserved. AGORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ELIZABETH A.NEVILLE,MMC Town Hall,53095 Main Road �� s� P.O.Box 1179 TOWN CLERK Southold,New York 11971 REGISTRAR OF VITAL STATISTICS g Fax(631)765-6145 MARRIAGE OFFICER ,!. ®�. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �0,( �,�► 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 PHOENIX HOOK&LADDER,THIRD STREET,GREENPORT TA 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 7,2018; ( No Raindate)on the property of GREENPORT PUBLIC SCHOOL Athletic Field,located on the 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. - ---- ----- ----�,------------ --- Eliza- A. Neville,Southold Town Clerk Suffolk County, New York (Town Seal) Dated:July 3, 2018 THIS PERMIT IS NOT TRANSFERABLE ELIZABETH A.NEVILLE,MMC ®�'; 11IFF®LOCO Town Hall,53095 Main Road TOWN CLERK a� � P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 0 ® Fax(631)765-6145 MARRIAGE OFFICER ,f. ®t• Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER 0�+ �`� 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 PHOENIX HOOK&LADDER,THIRD STREET,GREENPORT 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 Thursday,July 5,2018; (Raindate:10:0013M, Friday,July 6,2018)on the property of GREENPORT PUBLIC SCHOOL Athletic Field, located on the 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. --- ------ ------ ---------- Elizabe A. Neville,Southold Town Clerk Suffolk County, New York (Town Seal) Dated:July 3, 2018 THIS PERMIT IS NOT TRANSFERABLE FROM LEGION FIREWORKS Co Inc PHONE NO. Jun. 04 2018 09:35AM P1 a F.I_IZABE 11 A.NEVILLE,XMC ��® Town Ilnll,:r.3095 FVlatn hood Tovi'N GLtI RR - P0,Sox 1179 Soulhvld,New`fork 11971 U fiEGI.STRAR 01:VATAl.STAMMC:R O Fax(G31)76S-i145 RECEIVED 3LARRYAGE OFFICER '�'�j„ �Q� Telephone(Cal)763-t800 ?MvMRDS OF MANAGEMENT NT OFFICER :ottthnldtown.northlork tict FREEDOM. OF RNFORMATION OFFICER J U N 6 2018 OMCE OF TM TOWN CLEF Southold Town Clerk TOWN OF SO=OLD ,,APPLICATION PERMff 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 perudt to display fireworks as hereinafter specified_ Relief Hose DjSPLAY IS TO BE SpONSOREII BY Phenix Hook & Ladder Co. #1 & Co 2. PRINCIPAL OFFICE AT 3rd Street Greenport, NY 11944 DA'1'F:&TIME OF.DISPI AY 7 � S / 2018 Start Time-� T I0l c°J EXACT LOCATION-OF l)I,SPLAYGreenport High School Athletic Fi.ela. SUFFOLIC COUNTY TAX MAP NUMBER FOR SITE RAIN DATE&TIME /�c� Start Time. Jft (,0`cj3'Q The following persons are to be in charge of the actual shooting of the fireworks_ Name Age Experience Physical Condition Joseph Carpamano •r_- --- 49�- 10+Years �.. Fxeellent --- (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: Approximately (1,184 Shots) 1.5" -�5" J -,T 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. MF 6d _ 4 FEE: $100 eofOrganintio See policy,for additional information; BY Signature of Applicant em u► z-. 4- Date otApplication FROM : LEGION FIREWORKS Co Inc PHONE NO. : Jun. 04 2018 09:36AM P3 � Legion Fireworks Co., Inc. �!` 10 ixgion Lune Wappingers Falls,NY 12590 1 (845)831-8328 THIS CONTRACT AND AGREEMENT for the sale of fireworks made:and concluded 6/4/2018 by and between Legion Fireworks Co.,Inc. (*Legions) and Phenix Hook& Ladder Company#1 and also Relief Hose Company#2 (*Sponsor*). wl1'NF,sst-, la:for kind in consideration of the,um of One Dollar,each to the other in hand receipt of which is hereby aeknowledged,and of the terms and conditions hereinafter mentioned,Legion and the Sponsor do actually and severally agree to perform their several covenants and to guarantee terms,conditions and payments of this contract. Legion agrees to sell and furnish unto the;Sponsor,a Fireworks Display in accordance with a program proposed and agreed upon at the time of the signing of this agreement,said Fireworks to be famished f r display on the following dates: 7/5/2018 Rain Date: Legion agrees to furnish unto the Sponsor at Icaat two experienced professional display operators to present the said display,said display operators to he agents ofLegion and to act under instructions and directions of the Sponsor. Legion shall also provide display liability in the amount of$5 Million dollars coverage('combined single limit)for protection against claims of bodily injury or property damage arising solely out of the operators of legion. The Sponsor agree to procure and furnish,in accordance with Local or State Law,a suitable place to display the said fireworks.The Sponsor also gees to secure all police.Fire,i,ocal and State permit-,,and to arrange for any security bonds if required by Law in their community.In the interest of sHfcly and to prevent:damage to fireworks,claims of alleged negligence,or injury to it's reputation;Lcgion reserves the right to determine inclement weather conditions which will prevent the giving of said display. The sponsor shall always have the right to postpone to a rain date ONLY ON condition of incicmcnt weather. In the event a rain date is declined by the sponsor at the lime of the signing of this agreement,the sponsor agrees to pay Legion a cancellation fcn amounting to ftftccn(15%)percent of the display price stated below. Said fee shall be for reimbursement to Legion for expenses incurred with display preparation, equipment rentals and display operator labor.The:Sponsor agrees to furnish necessary Police and Hire protection,including crowd control and auto parking. it is further agreed the Sponsor will provide a continuous barricade,rope line or snow fence to establish an ash fallout zone between spectators,parked automobiles or dwellings;and the place of discharge of fireworks.The only authorized persons in the fallout zone during the display shalt be the professional display operators furnished by Legion. The Sponsor agrees to kccp tho hillout•none free ol'ail persons during,and immediately after the display to facilitate inspection for any dud fireworks by the display operators. Until the display site has been thoroughly inspected and cleaned,the Sponsor agrees to take all necessary precautions to guard and prevent persons from entering the display site area. The Sponsor hereby agrees to indemnify and hold harmless Legion from any personal injuries or property datnago which result from the Sponsor,failure to perform the obligations set forth in this paragraph. The Sponsor agrees to pay Legion or it's duly authorized agent for collection,the sum of$7,500.00 dollars said fireworks display.Payments to be made as follows: %15 Deposit of$1,125.00 due at signing of the contract.$6,375.00 Doe immediately following the display. 1n the event of late payment,the Sponsor agrees to pay Legion a finance charge of Two(2%)percont per raonth on the unpaid balance. All payments shall be made by draft or certified check payable to the order of Legion Fireworks Co..Inc.unless otherwise specified and authorized in writing. Should Sponsor fail to pay to Legion the agreed upon contract price kib specified above,as and for Legion's services,the Sponsor hereby agrees to pay any and all reasonable attomey's fees incurred as a result of collecting any and all sum-,due and owing pursuant to this agreement and further agrees to pity all disbursements, including but not limited to filing fees,process serving fees,investigative fees,and any other reasonably incurred disbursements and/or expense made in connection with the collection of monies due and owing Legion pursuant to tbis agreement. It is further agrccd by the Sponsor that in the event of a lawsuit initiated for the purpose of collecting the agreed upon contract price as set forth in this agreement,the sponsor hereby waives any and all counter-claims and/or defenses thcrcto.This contract shall not be constnied to create a partnership between the parties or persons mentioned herein, In the event of fire,accident,strikes,delay,flood,act of God or government or other causes beyond the control of Legion which prevent the delivery of said materials,the parties hcr,,to rcicka.+e each other from any and all performances of the convenants herein contained and from damages rcsulting from breach thereof. 1N WITNESS WHEREOF,WE SH7 OUR BANDS AND S13AI,S TO TI IIS AGREEMENT IN DUPLICATE TI lE DAY AND YEAR FIRST ABOVE WRITTEN. AI-MST: LEGION FIREWORKS CO.,INC:. SPON -- J - Si nature Frank M.Coluccie,President ��S l✓/Z�e� Print blame/Title FROM : LEGION FIREWORKS Co Inc PHONE NO. Jun. 04 2018 09:36AM P2 AC oR E0 CERTIFICATE OF LIABILITY INSURANCE D:018I°DIYYYY, 6/1/2018 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 condiflons of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certeficate holder in lieu of such endorsements. PRO°UCER TA NAME: , . .,..-•--------- - Britton Gallagher x�c o. u►216- _ Ac N,- One Cleveland Center, Floor 30 E•MAIL 1375 East 9th Street ADDRESS __,•„„ __.._. .....___ —_ Cleveland OH 44114 _ INSURERS AFFORDING COVERAGE NAIL s INSURER A;�(l:i_ .rplus I,ns Company ..__..._..�._.__ Z6620-- INSURED ir4suRER a Ever Evergst Natignpi InsNr?in.qe_Company, _ Legion Fireworks Co.,Inc. INSURER C: _,___•_—__ 10 Legion Lane INSURERD: Wappingers Falls NY 12590 INSURER 6: INSURER F: COVERAGES CERTIFICATE NUMBER:1728635391 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 POLICY NUMBER MMIDD/YYCY FF PMLICY EXI U1Ir1S B GENERAL LIABILJry S18ML00116-181 3115/2018 W1512019 EACH OCCURRENCE 61,000,000 DAMAGVTORL X COMMERCIAL GENERAL LIAUILIIN D�_y $600,000 CLAIMS4 4ADE K-l OCCUR MED EXP Any one person) S _ _ — PERSONAL&ACV INJURY $1,000,001) GENERALAGGREGATF S2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMPIOP AGG $2,000,000-_ POLICY X PRO-JFCT El LOC NED-b-[NGLtE LIMIT B AUTOMOBILE LIABILITY B18CA00058-181 3115/2018 3115/2019 Ea awdentZ_._. , , -._•�$1 000 000 X ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED SCHEOULFO BODILY INJURY(Per=Went) $ AUTOX N R DSAUTOS P AUTOS�ED (Pe AUTOS owl AGE $ UMBRELLA IJAII X OCCUR EAU731294 3/16/2018 3/15/2019 EACH OCCURRENCE $4,000.000 2DED, XCESSLIAB CLAIMS-MADE AGGREGATE r4,000,000 RETENTION$ 5 WORLGI COMPENSATION ATORYLIM1YU- OTH• AND EMPLOYERS'LIABILITY YIN ANY PROPRI6TORlPARTNERIEXECUTNE❑ N/A E L EACH ACCIDENT $ OFFICERIMCMBER EXCLUDED? (Mandatory in NH) E.4_DISEASE-EA EMPLOYE S ";as describe under DESCRIPTION OF OPERATIONS below E L,DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more apace Is required) Additional insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Date of Display:715=18. 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 BOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Phenix Hook&Ladder Co.#1 &Relief Hose Co,#2 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 58 ACCORDANCE WITH THE POLICY PROVISIONS. 3rd Street Greenport NY 11944 AUTHORIZED REPRBSENTAnVE ®1933.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD FROM LEGION FIREWORKS Co Inc PHONE NO. Jun. 04 2018 09:38AM P5 ELIZMETH A.NEVU LE,WlTd(: Q Town t{P.( .Bj)x 179 Road p,0,tio3:1275 TOWN CLVAIH v ` yJ � South4Ad,New"!'oYk 11971 Im Fax(45,31)7fi5-6145 RE011WRAROFVITAT,sTAi't5y'res iv Aw RECEIVED 11AIU1 AGE OFFICER �� QQ� lblcphono(8:;1)765 18(K IL1S(:O1ms OF MANA0FMEiVT OFFICER. 0� � Fo»thnidtowri.northfork.zit!t FREED01%OF INF'OILMATIO�OFFICER J U N 6 2018 O CE OF THE TOWN CLERK TOWN OF SOLMOLD Southold Town Clerk ,A,PPLICATIOPT PERMrf TO DISPLAY FIREWORKS APPLICATAON IS HEREBY MADE, pu y=l to the provisions of Section 405.00 of the Pcn�?w ef Hose pM State of New York,for a init to display fireworks as hereinafter specified: DISPLAY IS TO B4E SPO'VSQRTsIi BY P-h Nook & Ladder Co. #1 & Co', #2. pRINCIPAL OFFICE AT 3rd Street Greenport, NY 11944 AAT)N;&"ME OF.DISPLAY 2 / 7 / 2018,�T Start Time: �m 10`co EXAL'TLOCATION-OFDISPLAY'Oreenport High School Athletic Fie Id. - SUFFOL K COUNTY TAX MAP MWBER FOR SITE The following persons are to be in charge of the actual shooblag of the fo-eworks: Name Age Experience Physical Condition arP 49 10+Years Exccllcnt Joseph C atiiz�lo --•--.._._....,. •--� —...,.�..r.,. --- - •----....-- . �.__ (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows_ Approximately (1,820 Shots) 1.5" - 5 Manner and place of storage of fireworks prior tv display: In a SYS 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 field Also attached is a certificate or policy of insurance coverage. NOTICE: Written permission,with signature of the Property Owner,tnu,5t be submitted with the Application. ` _ � &!_J FEE: $100 a o1'(?roani7.ation See policy-for additional information a� - Signature of Applicant _ twe Q sr ._. Date o Application FROM LEGION FIREWORKS Co Inc PHONE NO. Jun. 04 2018 09:39AM P7 Legion Fireworks Co., Inc. 10 Legion Laate Wappingem t naffs,NY 12590 (845)831.8328 THIS CONTRACT AND A( RRE?MENT for the sale of fireworks made and concluded 6/4/2018 by and between Legion Fireworks Co.,Inc. (*Legion*) and Phenix Hook& Ladder Company##1 and also Relief Hose Company#2(*Sponsor*). WiTNESS1 Ti4,for and in consideration of the sum of One Dollar,each to the other in hand receipt of which is hereby acknowledged,and of the terms and conditions bercina)icr mentioned.Legion and the Sponsor do actually -and severally agree tp perform their several covenants and to guarantee terms,conditions and payments of this contract. Legion agrees to sell and furnish unto the Sponsor,a Fireworks Display in accordance with a progi-arn proposed and agreed upon at the time of the signing of this agreement,said Fireworks to be furnished for display on the following dates: 7/7/2018 Rain Date:A6,0:& Legion agrees to furnish unto the Sponsor at least two experienced professional display operators to present the said display,said display operators to be agents of Lcgion and to act under instructions and directions of the Sponsor. Legion shall also provide display liability in the amount of$5 MilIion dollars coverage(combined single limit)for protection against claims of bodily injury or properly damage arising solely out of the openttors of Legion, The Sponsor agrees to procure and Banish,in accordance with i.ocal or State I.aw,a suitahic place to display the said fireworks.The Sponsor also agrees to secure all police,Fire,Local and State permits,and to arrange for any security bonds if required by i.aw in their community.In the interest of safety and to prevent:damage to fireworks,claims of alleged negligence,or injury to it's reputation;Legion reserves the right to determine inclement weather conditions which will prevent the giving of said display. 17hc sponsor shall always have the right to postpone to a rain date ONLY ON condition of inclement weather. In the event a rain date is declined by the sponsor at the time of the signing of this agrccment,the Yponsor agrees to pay Legion a cancellation fee amounting to fifteen(1501a)percent of the display price stated below. Said fee shall,be for rcimbursement to Legion for expenses incurred with display prcparatiov, equipment rentals and display operator labor.The Sponsor agrees to furnish necessary Police and Fire protection,including crowd control and auto parking. It is further agreed the Sponsor will provide a continuous barricade,rope line or snow fence to establish an ash fallout zone between spectators,parked automobiles or dwellings:and the place of discharge of fircworkY.Tho only authorized persons in the fallout/one during the display shall he the professional display operators furnished by Lcgion. The Sponsor agrees to keep the fallout zone free of all,pctsons during and immediately after the display to facilitate inspection for any dud fireworks by the display operators. Until the display site has been thoroughly inspected and cleaned,the Sponsor agreeb to take all necessary precautions to guard and prevent persons from entering the display site area. The Sponsor hereby agrees to indemnify and hold harmless i,.e,gion from any personal injurie&or property damage which result from the Sponsors failure to perform the obligations set forth in this paragraph. The Sponsor agrees to pay Legion or it's duly authorized agent for collection,the sum of$5,000.00 dollars said fireworks display.Payments to be made as follows: %15 Deposit of$750.00 due at signing of the contract.$4,250.00 Due immediately following the display. In the event of late payment,the Sponsor agrees to pay Legion a finance charge of Two(2%)percent per month on the unpaid balance_ All payments shall be made by draft or ccrtiftcd chuck payable to the order of Legion Fireworks Co..Inc.unless otherwise specified and authorized in writing. Sbould Sponm)r fail to pay to Legion the agreed upon contract price as spcei f od above,ac and for Legion's services,the Sponsor hereby agrees to pay any and till m amnablc attorney's fees incurred as a resti)t of collecting,any and all sums due and owing pursuant to this agreement and further agrees to pay all disbursements, including but not limited to filing fees,process serving faces,investigative fees,and any other reasonably incurred disbursements and/or expenee made in cwnncction with the collection of monies due and owing Legion pursuant to this agtecment. it it,further agreed by the Sponsor that in the event of a lawsuit initiated for the purpose of collecting the agreed upon contract price as sct forth in this agreement,the vponsor hereby waive,any and all counter-claims and/or defenses thcrcto.This contract shall not be Construed to create a partnership between the parties or parrots mentioned herein. In rite event of fire.accident.strikes,delay,flood,act of(mod or government or other causes beyond the control of Legion which prevent the delivery of said materials,the parties hereto release each other front any and all performances of the convcnants herein contained and from damages resulting from breach thereof. 1N WITNESS WHEREOF,WF,SET O(1R I IANDS AND SEALS TO THIS AGREEM1,3NT iN Di)PLIC:ArE THE DAY AND YEAR FIRST ABOVE W I2i I'PEN. ATTEST: LEGION PIRFWORKS CO..INC. SPONSOR: --� S" Frank X Coluccio,President :��5 214 Print NAtnc/'1':t1c FROM : LEGION FIREWORKS Co Inc PHONE NO. Jun. 04 2018 09:38AM P6 l� ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYn ACORO 6/1/2016 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 endorsements. CONTACT PRODUCER NAME: _ Britton Gallagher _ PHONE Em21 71� a,No1:915 -7101 One Cleveland Center, Floor 30 E-MAIL R� 1375 East gth Street ADDRESS: Cleveland OH 44114 INSURERS AFFORDING COVERAGE` _ NAIL St INSURERA- is.S.Urplus.(Us_CoMpM 6§20.-_..._... INSURED INSURER B y r N i nal lnsyrance-Comp10120 Legion Fireworks Co.,Inc. INSURER 0, _____ _,_•�_. 10 Legion Lane INSURER D: _- Wappingers Falls NY 12590 INSURER E•_ INSURER F: COVERAGES CERTIFICATE NUMBER:1947222271 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. 1�TR TYPE OF INSURANCE POLICY NUMBER POLICY Evv POLICY Dom Y LIMITS B GENERAL LIABILITY SIBMLO0116-181 3/1512018 3/15/2019 EACH OCCURRENCE 81,000,00D COMMERCIAL GENERAL LIABILITY PREMISES DES 6'RE nra $500.000 _ CLAIMS-WDE F-1 OCCUR MED EXP(Any one PERSONAL B ADV INJURY 31.000.000 „ GENERAL_AGGREGATE_« $2 000.000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMHOP AGG 52,000.000•__,r POLICY X PRO-17 LOC S B AUTOMOBILE LIABILITY $18CADOD58-181 3115/20% 3/15MO19 0 y 1 000 000 ANY AUTO BODILY INJURY(Per pet-.on) E AAUTIDS ILL OWNED ACREDUI,ED BODILY INJURY(Par accident)J$ NON-0VUNED PROPERTY DAMAGE S X HIRED AUTOS X AUTOS -IP�Lecs�- S A UMBRELLA LIAR X OCCUR EAU731294 3/16/2018 3/15/2019 EACH OCCURRENCE $4,000,000 X EKCESS UAS CLAIMS-MADE ACGRECATE _-- 34.000,000 OED RETENTION S 3 WORKERS COMPENSATION WE 3TATU- OTH- AND EMPLOYERS LIABILITY ANY PROPRIETORIPARTNCR/E(ECUTNE a N/A E.L.EACH ACCIDENT E _ OFncER/MEMBER EMLUDEO? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S _ If yes.desaibe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,A001nonal Remarks Schedule,If mom space is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Date of Display:71712018. Location of-Display:Greenport High School 720 Front Street Greenport,NY 11944. -Additionally Insured:Certificate HDlder,Town of Southold,Village of Greenport,Greenport Public Schools,and Greenport Fire Depaitrilent_ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Phenix Hook&Ladder Co.#1 &Relief Hose Co.#2 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 58 ACCORDANCE WITH THE POLICY PROVISIONS. 3rd Street Greenport NY 11944 AwHORREOREPRESENTATiTlve 0 1988 2010 ACORD CORPORATION_ All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD 1• §:r, rk•:;r",ur.:•-ave,•..:,:,e: " 'r-'4: -� .'t,,,; ,Ily,- - ..•. v. ! 4 tq}'W�.•�-,ter[,+•,r�',,T�?,}�'sA; 'r' ';••-; ft;' •y s �,., ��. ;. ,tdt� 1,{; � �.� �y � `5,•)}ii'Si"`�„=,`/3d tv.,,n,r �yy:,.`. "' J •'�''. Y e#. L r e '{'�,., Itis�( r'Y�`��.i• r-•fir .19�h;r•a'l. x •; �It �} e.r `,�y�'°' a s„ i. �"'�',.,,.,,�� v.,<r ,„ 'Y t,y to-• j,^; [5sb, _ .�'s •� `�r+'.r� r�. V .� `L[ _ _ ^ „ir,.?^:fi�Vu��,r��.'.v Z �'1' f• a��:, ���„«r ,,2 L ��' '4,y. � CG� �, ✓� �a.G3��L;�`.�«,,��¢'��,'T � A� 1p�`�E;dk��t ':'.'"i +� ry.W'-, '• 7 ` f ,f r.e�'�I s r'9�i r' fe `:7•s�•�'�it L :cL�Sr rr'a. " `31 ':'EhA Y '1,�¢` r` [ y ;f� r'�' Ai, I [ A.�• { � �` •�,� •p� ` Wd,1rP+•`ru"µ�.��P,R > s � a�f�5"' `,, !�S•r�^ J ^"�P�`�^r`°may'=r-''^'"�d. 9,��+,1.(^,• ��lU A."" �,+�..,p,:s; "•";5�y: !Y�t � � ,1 "• 4 _n,'' ; c�.i.F`:v,U•y�1 �i "( _ ,�'•(,n r'' '�v"V 'ti,$•, F`-7' `';trrr�� i7•" {; ';";�` •,. F§.lkrt,,�,�.• tii:l,:, a 3; �v ta'��,,..,{ao�• rr'fi 7 +j�7) �.�" ��'n r. .;A rI 4 p.."�t �"�`•'{'';.}•`�:..r� {•. �aS3: !• ,t 4.._�• ,f,•r, ; r R,v,,:+r,,,. ,•,;r _, ";,, •7 0�; �t,HL°:4rr r,.F Y.WSi.xJk- Lp .'i:' °siL' .{'7j: .rs,•,�J 2,1. ;'r.-.�! 'e'v ":-., .v.� .ir, .3' n,[u••ry, °' j2� ' % % -y ' ' ' �".� ''"(f•i!• 'i'dni��In:�r. ��1�•+srr .x•ay�.. .k,i �;" ._�;v. `r;r.i°:1?,z' p �.t• `14•�• i+�'',,}}77'��.�. k�' ,'`i�`;•_ "v^, d 1 v t? r �.'. •`!r �i'Y'F�r, T �?'-7 1F,, {' 4'iF'"Jhr, e r .C,tla.• Y. ^r r%•.,V-+' ,f{y.} R^ XG ' 'r .' 'i7LieV ,} ':% i3 IA'fM1`s• k,'r>{,�rk'sE' ,�? ,x•` i -2., t'•�axr'•;1,,W•7 •¢ Y' VY •t> C"' a )" yr ' tt:, ry a' i3,.�,{<l, t.zn'ltii. +liTk A .1 '';t5„•''�'L !'>'. r'-trJ>i li, S,fiZ 1( '�N�l�Th'�f n i�d'W` qq fit•{r,•<i, ')j� ��• r J Ar�Jn`N+ 4 11 'F :a a yl!r s•�. '•` 1 �. +9t1•c 1�f 1 r =h / 4`u ��: A`:+{1',(�y'�"i,. +F+,k� .,stih�.•,yy'„'�•", 1 •. 77. ,'b'°,v.�. �i � t </mil s�,�,,•5 �?;�, $°' x '} 'h: ;Y"it.;�u' _i.. ?r..{YLp"�i r`at iri+°:�j.:P•,sfe ,nW,' #.yam ?s+•'y:� F•r 'x1e,,. t,w k '+{�#'al�c�'ity, �1+ •isv:ks��`iry�� ,� rY.tk,'%.I':',! :•t s:,.fr�y���r`�^{��,.;c` -4 y.: F. •''S"%g� >LJ<s?. n' ',. 1,4,'; HIM- !Cl t �•,y M1to'''r' '1'b, y ,�, .� '(!).S„�5r'e- ,• •'��•�-""'kr t '.�y `F�$liY.l_5"X'MT, -� .�K:i,.. [i �X,! ,[ �F.,"��•5�ty,�+_I� � �' i'c s, Y ,J' ��t _ 1.. F'�'j,j, u't Y[•n''(.f'.l y�',ty'JJ,.Y,• f-SSi..','K;s ,'�'••'�N •./J�l ATr1♦i.,,,i•` '/ - 1 +lY _' M�;:f�}.f.''•` J 1 Y��.f�F%!' Lf�^"'1 �f�)fJ"••^• (,n i.+r• J 1'S,b,>< 's >>a I.ti- 4 ::•+ �. �ff. �.. > •rjyi 9%. -'�xr`• y`-:, •Ic,'�i<s''..4ic'�`iyP'';7•,qr•c:,-.',-=�.• rrg}��T�4�' .� �'"�t!'�✓ p�E,}'•• i,;.S,'�(r: 'iny :j� r 3� FfZ c,y1i ''' �•. .�w'?1.,:}.r ,'e:�'.S3?,cti'mr%'.,w•«-:3:%''" fri`Z.,� :94;.F�f�4 '�;♦ ,' :pt F ��M, x •, ,y+:{�'k .T /r4' f' Y' 3�'i'� a a. rr,rl,-,.'t, n: !.. + h�yt • _ ";. ay� ;'s" ;,�:. {a -(� , A •tf+".? f' I' `�' r�` k' :'+.�•,w,},�,[ n1� '�N'' „y =�A•" `��'ry, '' ��++ •,. ,C SI ,b,t. tjt:,?11 �5�. ''!`' r _ I•tall i, , tU .„ C! W �E5 't `` 4 ,i iil:r,. i,tf.+l .r:y 9..5`•' �2•r�;n•' .3 ;i•,� 'r� r 14, «�,/ ,��; ,� qt 1,"•,#.'a�� �,•' v` 2�'t .sre ar a'�.�•, '�:•^,'J•�,•. pry ,,'J, `f.'• +( 1.£J��•ao f ,' 3 � r `�.''�! �tt��, f'/-s,< i�,,�d', r � i "{r.1.r?k, s...• 4rf+ y'r, ,�y 4 d �� ,'`t ,r.s ¢c�';��f!'�'''-�,E;'+y.•.:%��;'.��;���;"•! 2, '� ;:y';y,'tid •.G:..(1q,�.,,,,k w,r'314.,ru5`T^•' r ,d,'r�3�'y`�•',`•�,''t' %i �fY?,'S�}+i�i�.. , / "y ,ye r '�',t l ,j� ;3%7='� �.,t:+ ��;}: {'„i, '`'�,`ti�r tt�iti+a,t1''13«�Ya.y`;•;''y. '.,?n'^.`v,,n >" a ,( •,�l � .1'' t� '�6' �S lye;-Yi+-�' 'rf'^'�.rt�,,e•'.7: �•rin k+ Sti•1 si°"" 6'/. [;,s}, ,'. ,,:°, ,��,, ♦ ,'( ,'1 .s Y'. 1 %�. e ,x r. 0. ii '' ',Y, �;%,h� ,.'[. �"t,e•a fi* .T ^t•',�l,, �'�:�{7,sn:5r, •.�' try s( F�-' � ! •f j. r' `_L��'��'ti;.�. :r' ;}d �`'." �±r,' �.f`.• ,rt°..-. ,[i;. - Y Ff ;� J}4' { `� v* n , �' „� �` :n:�• ' •)�� _ .,,, � va.^fu .s.w..,:.,rN •-;,r•a•rcj,_"v':'';'.'I•:� s;;_;.+y'.•r„„[• z a[�'�``ilt`�,1 ',;, J;. 4', ,��r � b � , .}�,�` (,a«+yi;..=•�1fx(i ,� .r+r a r/ �> 2' )s'ss+' �',:; 'f kY. °3 -,_ � 1 �`� 1.•trl�,,, �) Y"f�.'yt �' � `��rr� •r7 :n�," th t' �{ n`�. r1,"','"�^"t+ 1. a'; rrCC�,r{ ;� (��,.f!`�p/•r P4* ''4t y :`'t'" :rry+♦tr'ia'` or }�F ''• '{>IS�. i d .a' !. j +�.S�A.•.���CN+";a�:••�'�t_:;''��`!��„*pli`+.r �E�v.'; ��f��F/;�,#' �'�t „� r. �,• is '� � t r , t�r' .f'.., +'`M1 .`�•��4-;�`:^:ISY ':Ct'•'~>'•4;�•C�. ;.[9•,c�-" �'r'"jam'•_.�x;M1fi.:''?'�'c�.�;sr t:t.�':4,3.4 :t. 1, .�F.�,�, ^Y r .."`�' "'y}+,�`,,'��•yS'�e{j+ ,4 aFj;+ •, t',.`.,v�;� Ys r�,' �yy,yy�!f'[r6•�.,'.V'%x�,�r• . �r�.,t,..., �, �. , rr''�[ �• 'r �•a '' �^r{�Sx "F{" +l'/cj'�Y;•f t ,z(3;+.�fi y,• 4��""`2-'.�,. °.i{''R��.f•4'.�„`r>='N�;,4aa::ba"r��,''" ��C .ri�., ,s er A,�• , � �. F',+717 ;� •,!Y}s L'rl'•,4r:?'iT'' - F"t"i ��>E.f •,,.�h^:a',;y;5,p,.',7.•41; f '4P �� �Y}�+/�. y>: ., ,jr'r r�3•ES""'>;,A�;fc, ^, �n Y1 Sf( t`.,. '>D.V 1 .,;i: i JF"`4 y V S`,'17 ,c`:�<F.s.:;;;h' ,1 r a, 1\ • 4?' "t,: ,y, •'.,iir'+ ,tr�l{ srf 'i �Frf•'t`.:r,+,,• .`t ,s r,`1 `, U '{+a+ 'f fw d �, l„• :'3. +� 3`�?''�..'y:.; '✓r:',�r' f7�i +;. 1.Sr' 'fl,•. n• It% ° P f •�• 1� .t. k Jai, . 'F�' s`•'``i"•,`:',rN4yrtiS:.�;fit".'•t'"sy,.;�y- ?:y J'n ` ,� 'r .+�'�y�,,ren� L " ty ' `"n• t.k� a ' ' �'!fiS f '( ;.,� ;�[y.."•4k'd'4'.v.,- � ';' al �..,, �• 1.'.,r'�.:.. �{ ' ;fit :d,�,;.` =i• }. ,r•#:F�.yY.;A '.%.• •;h -'E._rs.. - �?,j�lj_( ,o-{+s «L S<`Nf ..,Kr � e�,` t .r w.`;.t •f.njyf ., ^ ��'� ,PY 4 . •.t•.Mi>1 N ,•R+4 f !,, s• f 4','• M [ ,.' M• ;T. S "4,v.,f o'Y:S:T• Y ,•4;r< c �',Gy.y/ <,f: t 'y' i "S .a Y✓u'Y;' S.ri,a-'. '"r;•g. ~J`V;, c ,2; '�.-;,,f:`:t'`I SV, ' �• '€,, ,'n y' =b• j'�,� , .. :��Ai� ' „ � _ krieo '; '.,;a >r,;,/-; f• _ td 5:._?�'� t _ "•.`�,eka� 7C " fu`t .1;,2 c[ ,,4• N c°Y N''f f"-- ti,: •`-- r GL'�')--" '�� , A •', �,P j, fir. w t'n1;:•f';" t R:'i5r, y.;! iFY�'.•.--1XI-.:�zL f[ b ?•* ;'[! "f•, ly�i.,• / *)•V - 1'r � iti,{. � ,'• �vs, ` u,��r '.� lTt;""1•'9., c" r..,." •,.,.�•t:'%e' � `�•�'' f��` �' _t,.• •r 23, „ '�" srrl" `m,;ji+„" {•1 It .�:w"'a'%c�t.•l?;.' i .'"'`�" i`i=',:i`.,., V t�,r,'}�•,�', � ' .t •P v" `1t"y'r 'r• y^'S ,rfL;S`tlfc �5: 'v f, e'up•s;'•n4y S Lf l- f�c< .1�- iik J'�;i•4�, � i �r,W�'r ..� 7 `�. � � ( � h142Y•: *.' ` S rM�,T� r,,«>r (tjr ..rr ". !. jyr�:,`-;.•. s�:� J.,aw•a t,..r•T,1[r. H",�^{y .'✓ t( `i. _ �,• ...'1'.n'i.ry kY: �,�' -( _,•� cn•"is t .e«u}d'm`i. �:.j„r, n•'i'i�,'+En"�t�i}YK} f�4T'A3m�{'....r+t" ? C�.��f" {.�,,,T1 3" f -.i+,�-, .,JY .X t1 f Yw:ww- ..,w••.r kC��"'V;yf•'n��l'P�,:''Y.•`al.;•v`f'" �rx"' rlfilYx „J•k' ,,.s...t�n+'-• •.••+`�i' jc" 1,{{I y�ij� tas Y.�•','•�r� ECffd9i'+`g'fk.I,,'�a;.^� [ E5� in qTi l �• i�.x' ', :°• �f rf ",�t."fyr ,_ +•i:7i•'r f t.a.%7YEt,['C+3,-�t+i+'§'^�9GSa•�• ?N'�i •*�'�. •'•`�.+ y ,yl •"i,• ,dP �f ( to >9 �yt ,�y{7, Y S 4,{'. ?':', j� �5 ���f•. �.:'�J '-, :'. ..�..t:u �.'7F°''i7y rr fY.�i•�4.,a � t 2t,. :: " a• fy[rY•N q sL;"'f' :'.'.+.i' �.z.,t� �rt,� 'fa'•+��. % µ s ;+"'7'`r , �` ) .y,Y. •..i`,.' 4�• `�'rt: y�, Y ' - .'-.�, , rY�J ily j2.' r �.3.`','1 � �. �r 9, a �A t; y'r` ° .,.� !�r .P � t n� .. ,., ..>�f�•S)i'�FYP'•4�'4,�� ��•: �. ,�;P`r�}Y t .Tr[t 'R' i / t t , pt tsy''y. y,,,T.Cvt"s!r'n0. "c:% of •J. ~��`, �r'.,t.,, .,.el`.`,aYB rt � U( ,t.�r�....,''"tv3;i3.f�r�'�-/����f��•Lyi i;�•.• `�-c �' ,. J�. FROM LEGION FIREWORKS Co Inc PHONE NO. Jun. 05 201B 02:45PM P1 .. w Time .ifS�"ia°; eli';f• �1�11L'. :Sp,Ci• �' ° _I•:{t°: !. '-' :pit.. ., i t, 5 .. _ 1.1, r r � - Shoofen Joe Carpanzano Cell Plzone ##: (914) 260-7698 w 1 4!h.••�i 'fh- . - �j�,;�,�.p�yfNZ'p i�;`�,wn;1�i;T`'��C. •.��:".:icy .•,r'• . �, r r,�pr�. •.0 •t'" '.C;`iLh" �, ,,-.•t ry- a?�''Y" .,'f i ' it�r � 5 t �•° A -A!'yf�){,�1-•' �)�i,gs v.`• 'r�'`� .. 1?r T:�,nY! °•�^4�?'a{�'! S"r' '.�.rr.'. , �>'"�'r 4 St J�itW:�`1}'1 • .� ar ,��'�,x� .._ .'•�-v•��r�e,-'•`�°:r}a�;i Ybb yv':r I•�°;`•7',i IIt I I`I S I I. •4 y - •y t rt)-' xey,;�I,•,1� +,.,�tit ..F f e au S T,Awia��. Name �1�e�� �s v� Datea I Address City L4q rC,�r?-P 1,4 ST. A� Y Zip / �- Telephone Number(s): Home: Work: Cell: E-mail c2 7/ 6V 4v e—,. ,,7 Date of Birth 3 3 19 C0�` Social Security# Traditional and Contemporary Pyrotechnics for Exhibition at Fairs•Concerts • Events U.S.Department of Justice Federal Explosives License/Permit Bureau of Alcohol,Tobacco,Firearms and Explosives (18 U.S.C. Chapter 40) nUnanunMaunuat®mUma12111 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 4Q,,TitleJ8 United States Code and the regulations issued thereunder,until the expiration date shown. THIS LICENSE IS NOT TRANSFERABLE_)'NDER 27,6 S 5:53._See"WARNINGS"and"NOTICES"on reverse. Direct ATF ATF-Chief,FELC - r' - Correspondence To 244 Needy Road . :rz ° ` '` _ Ntiinber`* z • f • • Martinsburg,WV25405-9431 `. °�s° __ '_ z Chief,Federal F-p � losives Licensing Center(FELC � ,��- I , - 0 �•;R,; -.� ��- Expuation��,C Date • NameLEGION FIREWORKS CO INCH_ Premises Address(Chan "'r s?Notill the'AI(CJai l(as 0 da}rs before the moV'._ 10 LEGION LANE $ `'w`� WAPPINGERS FALLS,NY.1259d:r,'� } eofLicenseorPermit ', '`=' "T �,_„ T v> P^ m "';`` �p _�.t o x `h t} c.: =�?= .=3 i.-''� 51-IMPORTER OF EXPLOSIVES., �s arm.. ` �,.} _ M — r -if"a, sma rt-+ Purchasing Certification'Statentent - j, MailingAdd ess,(Cltan^es?,Notify the FELC of any changes.) The licensee or permittee named above shall use a coptiyofUtu Itcense or-permitto ist a: .; , rf#. -pJ ,i. =r�I i ; transferor of eTlosives to verify the identity and the tensed status oftlie licensee oar `'. ,, Fr't- )'.if i J`t °., � permittee as prodded by 27 CFR Part 555. Ilia si�tatur�on eadi coov mti'st be,an,onwtal�� f -- - siQrtatwz Afased,scannedore-mailed copy oftlte`lieenseI'ocipennitwithasignature`� 010N FIR" CO INC Y+,)Y intended to bean original signature is acceptable. The signatu A'rnust'bethat ofihe Federal y, 10 LEG IQN;:t NE;:` C .., - ,,.:.".r;- :*.;:'•fir.':'s Explosives Licensee(FEL)or a responsible person ofihakEl. I'cettify.8ist this istrue a .......... :. WAPPI.IVCERS+iFALL'S, NY 12590- copy of a license or permit issued to the licensee or petmitteenau(ea�bot'` e to:,,cigagr�:m the v 4'° i. . business o�operations speed above under"Type of Liccaso or P .yam Pre -ter. .� ". ,v'Y f - L= --� 'sident � �.tri„ Licensee/Permittee Responsible Person Signature Position/Title 'i Frank M. Coluccio - PrintedName Date- _ _ _ ATF Fran.54091413W.15 Part i Previoas Edition is Obsolete Lrcmaaatwoactcousc1aucrovunE��narrmrsrset s�a�,�},t�nymMratafQarosn.s Re+7sed October 2011 Federal Explosives License(FEL)Customer Service Information Federal Explosives Licensing Center(FELL) Toll-free Telephone Number_ (877)283-3352 ATF Homepage:www.atfgov 244 Needy Road Fax Number. (304)616.4401 Martinsburg,WV 25405-9431 E-mail: FELCoa atf gov Change of Address (27 CFR 555.54(a)(1)). Licensees or permittees may during the term 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 Chiet Federal Explosives Licensing Center. The license or permit will be valid for the remainder of the term 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 in accordance with§555.54.) Right of Succession (27 CFR 555.59). (a)Certain persons other than the Iicensee or permittee may secure the right to catty on the same explosive materials business or operations at the same address shown on,and for the remainder of the term of,a current license or permit. Such persons are: (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 ereditors. (b)In order to secure the right provided by this section,the person or persons continuing the business or operations shall famish the license or permit for for that business or operations for endorsement of such succession to the Chielz FELL,within 30 days from the date on which the successor begins to carry on the business or operations. (Conamred on reverse side) Cut He1-e X Federal Explosives License/Permit(FEL)Information Card I License/Permit Name-LEGION FIREWORKS CO INC I Business Name: ;gf '' V%- ..�':di oc+ I LicenserPem it Number.6=NY'027-51-SC-00091 I License/Permit Type.51-IMPORTER`OF-EXPLOSIVES I I Expiration: March 1,2019 I I I Please Note: Not Valid for the Sale or Other Disposition of R%plosives. I I I FROM LEGION FIREWORKS Co Inc PHONE NO. Jun. 05 2018 10:33AM P1 N STATE OF NEW YORK DIVISION OF DEPARTMENT OF LABOR SAFETY AND HEALTH LICENSE TO DEAL IN OR MANUFACTURE EXPLOSIVES Expires: 4/30/2019 Legion Fireworks Co., Inc. 10 Legion Lane THIS LICENSE MUST BE Wappingers Falls, NY 12590 POSTED IN YOUR PLACE OF BUSINESS Frank Coluccio License No D-2310 is hereby ricensed 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: !) 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. 31 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) e JUN '4 2018 GREENPORT UFSD 720 Front Street By o� Greenport, NY 11944 APPLICATION FOR USE OF SCHOOL FACILITIES The Administration is responsible for the use of all school facilities in order that they may consider your request for such use, kindly complete the following: _ 1. Facilities Use Request: (Organization) ( �' �'f�l Cr 6 , f/ e requests the use of 'c at Greenport Public Schools for the purpose of: on(date), at(time) IPyvj , k\:,30 if!M RWK s�ay� Will activity be open to the public? (Circle one) Ye No Is this a For Profit Organization?(Circle one) Yes®o Admission of ' Fi(,P�.e. will be charged; proceeds will be used for ke-eA o-(:- � en-�E lii aF 6 Does applicant agree to submit financial records for examination upon requests? Does applicant agree to conform to the regulations of the Board of Education and all laws regulatrin to the use of school property including Section 414 printed on the reverse side of this application? 7'eS Name : ��OCW- 'S Address:c=W14R CIC� rf /19f�f� Telephone# 6_4y f 0 of the person responsible on this occasion. II. Insurance Information A certificate of insurance of at least$1,000,000 public liability per occurrence and$2,000,000 aggregate liability insurance and $50,000 property damage shall be submitted at least three days in advance of the event and must designate both the using organization and the Greenport Union Free School District with ISO endorsement CG2026.The absence of such a certificate will preclude use of the facility. The policy must contain a 30-day guarantee notice of cancellation.The user agrees to indemnify the district for any applicable deductibles. III. Rules Governing Use of Facilities A. No smoking is allowed in the building or on the grounds.The organization using the facility is responsible for enforcement. For Profit Organization Auditorium $150 per hour= hour(s)X rate= Custodial $40 per hour Monday—Friday=hour(s)X rate= Custodial $60 per hour Saturday&Sunday=hour(s)X rate= Technical (sound &lights)$60 per hour=hour(s)X rate= This all must be paid seven days in advance and is not refundable unless the district receives notification of cancellation at least 48 hours in advance. V. I agree on behalf of the above-mentioned organization that all members and guests will observe the regulations and that we, individually, and as an organization,will assume all financial responsibility for any and all damages done to the Greenport School property during the above- indicated period of use.We also agree that our organization will at all times hereafter indemnify the above-named school against any loss,damage or expense of any kind,which said school may sustain or incur because of the use of the above-mentioned building by our organization, and we further will hold said school harmles for to s of any kind i connection herewith. �y Applicant Signed: Date: 1,8 Superintendent: Granted ied Date: h Specific Details of Use: EXCERPTS FROM SECTION 414 OF THE EDUCATION LAW "...The Board of Education of each district may... permif the use of the school house and rooms therein, and the grounds and other property of the district,when not in use for school purposes,for any of the following purposes: 1. For the purpose of instruction in any branch of education, learning or the arts. 2 For holding social, civic and recreational meetings and entertainments, and other issues pertaining to the welfare of the community; but such meetings, entertainment and uses shall be non- exclusive and shall be open to the general public. 3 For meetings, entertainments and occasions where admission fees are charged,when the proceeds thereof are to be expended for an educational or charitable purpose; but such use shall not be permitted if such meetings, entertainments and occasions are under the exclusive control,and the said proceeds are to be applied for the benefit of society, association or organizations of veterans of the military, naval and marine service of the United States and organizations of volunteer firemen." FROM, : LEGION FIREWORKS Co Inc PHONE NO. Jun. 05 2018 10:34AM P2 Alt ,tic Rd 6/ /2 CERTIFICATE OF LIABILITY INSURANCE 5/21 018 Dnff"I`' 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 andorsament s- PRODUCER CONTACT MAW: Britton Gallagher PHONE One Cleveland Center,Floor 30 E.MAVL rim: =6z5B-7100 _�_•_.,I�A.c,Nor216-S ZtQ 1375 East 9th Street ADDREss_�_-- . . .. _ ......_ _ _ _.... ._ Cleveland OH44114 iN9uRatlslaFFoa�NGcoveRAGE _._PAIc# ie►suRERA AXis SUrnfus -26620 ins Gomnanv,-•.• _ INSURED INSURERB st)yadonat insurance CofWM_—_— 012.0_.„_ . Legion Fireworks Co_,Inc_ INS(IRER c: 10 Legion Lane Wappingers Falls NY 12590 "�S° D�--- INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER:2058404479 REVISION NUMBER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T14E 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. IR _ TWE OF INSURANCE ( POLICY NUMBER PMIDCrYY F DIY MM/D YY LT -� LIMP B GENERAL VABILrrY SIOML00116.181 31152018 31"I 2019 EACH OCCUAR9NCE _ 51,000,0110 "AMAX COMMERCIAL GENERAL LIASILRY 0 1 ES9RiE9*15 orcunenco) E5001000 +_ CLAIMS-MADE li-I OCCUR MLUEXP ono n S — _ PERSONAL$ADVD1dU_R_Y__ _57,000,000-- GENERAL AGGREGATE - S2�000,000 GEW'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S2 000 000 x POLICY JECT PRO. LOC S AVrOMOSILFLULGIL111r S18CAODDSB-181 3/152018 3/1W019 �..�emf a1000—000 a ._. X ANYAUTO BODILY INJURY(Per person) S ALLOWNED SCHEDULED _ AUTOS AUTOS (1OOILVINJURY(Per aorident) S X HIRED AUTOS X NON-OWNf50 PROPERTY niiMAGE a, AUTOS _.— E AuM11t:fLLn LIAR Rx OCCUR EAU7312B4 3/152018 V1512019 EACH OCCURRENCE $4,000,000 X EXCESS UAt3 CLAIMS MADE AGGREGATE E4,000,000 __~ OED I I RETENTION S S WORKERS COMPENSATION WC STATU• I OTH. AND EMPLOYERS'LIABILO'r Y/N 03141MUS, „ ANY PROPRIETORIPARTnIER1EXEGUTIVt E.L_EACHACCIDENT S OFFICEPJMEMW-R EXC95FD7 R 1 A (Mandatory in NN) El.DISEASE-EA EMPLOYEE S IlyOa desalbeunder OFRIPTION OF OPERATIONS below El DISEASE-POLICY LIMP S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101.AddMonal Remarks Scteeaule,if more apace ib n,quired) Additional Insured extension of Coverage is provided by above referenced General Liability policy where required by written agreement Date of Display:7/512018. 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 Green rt High School SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO 9 THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 720 Front Street ACCORDANCE WITH THE POLICY PROVISIONS. Greenport NY 11944 AUTHORIZED REPRESENTATNF ®1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ' r FROM LEGION FIREWORKS Co Inc PHONE NO. Jun. 04 2018 09:38AM P6 ACC® CERTIFICATE OF LIABILITY INSURA C DATE(UMMDNYYY) N 6/1/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER_ 7HIS 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 endorseme s. PRODUCER NTACT NAME': Britton Gallagher WENo. 1 71 a Na ^� One Cleveland Center, Floor 30 E-MAIL ��� " �- 1375 East gth Street ADDRESS- Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIL$ __ __ _ INLURER A AXi.5,SUrpIUS.nS C9mY 6§2Q_.,.•. INSURED — INsuRER B V r N i1LaI InsurancQ__C_0 Ip Legion Fireworks Co.,Inc. INSURER C 10Legion Lane INSURERO. --- - �` Wappingers Falls NY 12590 -- - ---- INSURER E INSURER F t ------- COVERAGES CERTIFICATE NUMBER:1947222271 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REOUIREMENT. 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 - POLICY EFF POLICY E](P -- '�— LTR TYPE OF INSURANCE POLICY NUMBER I D1YYYV1 UNITS B GENERAL UABILITY SI8ML0011G_181 3/15/2018 3/15/2019 EACH OCCURRENCE $1.000 OOD flCGE70REN11`0 .".- COMMERCIAL GENERAL LIABILITY P A i n o $500,000 CLAIMS-MADE I1 OCCUR MED EXP(Any one peTot•), 1 PERSONAL A AO_V INJURY_ 51,000,000 _ GENERAL_AGGREGATE_^ $2 000,000 GEN'L AGGREGATE LIMI TAPPLIE8 PER. PRODUCTS-COMP/OP AGG 52,000.000 POLICY EJ PRO= LOC L "— B AUTOMOBILE UABIUTY SI8CAOODSB-181 3/15/2018 3115RO19 @ 1 000 000 ANY AUYO BODILY INJURY(Per po-son) 8 ALL OWNED SC14EDULED BODILY INJURY(Par accttlmpt) $ — AUTOS AUTOS PROPERTY X HIRED AUTOS X _(PROE!ME isl_ = Yw a UMBRELLA LIAS X I OCCUR EAU731294 3/19/2018 3/1512010 EACH OCCURRENCE S6,000,000 EXCESS LIAO F CLAIM$-MADE ACC RECATE $4.000.000 OED RETENTION$ - .,$ ----- INDRKERS COMPENSATION WC STATU OTH- AND EMPLOYERS LIABILITY Y/NO;ZY ANY PROPRIETORIPARTNERIEXECUTNE E L.EACH ACCIDENT E orncat/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L DISEASE-EA EMPLOYE S U yes.drathe Under —. _....... _. ._.____ DESCRIPTION OF OPERATIONS DeioW E.L.DISEASE-POLICY LIMIT $ 6ESCR115TION OF OPERATIONS!LOCATIONS I VEmICLES(AIIBeh ACORD 101,AOdltlonat Remarks SchedLde,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:7/712018. 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 Phenix Hook&Ladder Co.#1 &Relief Hose Co.#2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 58 ACCORDANCE WITH THE POLICY PROVISIONS. 3rd Street Greenport NY 11944 AUTHORIZED REPRESENTATIVE 0 1988-2010 ACORD CORPORATION. All rights reserved. ACOR13 26(2010105) The ACORD name and logo are registered marks of ACORD FROM : LEGION, FIREWORKS Co Inc PHONE NO. Jun. 04 2018 09:36AM P2 d c�� CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYY17 6/1/2018 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 to rms and condltlons 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 so. PRODUCER CONTA CT NAME: Britton Gallagher PHONE �.216----- --_�_ Past One Cleveland Center,Floor 3058-7 E•MAIL 1375 East 9th Street ADDRESS: -, , „--__,___� Cleveland OH 44114 -.........INSURER(S)AFFORDING COVERAGE Ntucs 620 INSURERAAv�SItplus IJ(s Company..-....__.._.._.._. INSURED iNsuRGRO:Everest National In iran5e Cqw ny, ---.. . 120 Legion Fireworks Co.,Inc. INSURE I C: 10 Legion Halle INSURER D: Wappingers Falls NY 12690 INSURER 6: - —" ---` INSURER F: COVERAGES CERTIFICATE NUMBER:1728635391 RBVISION 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 REOUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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. MS " AODL — POLICY EFF POLICY TYPE OF INSURANCE fNSR POLICY NUMBER IMM/0 M 0 09NERAs.uASllm SISML00116-181 31151201B W1512019 EACH OCCURRENCEDAMAGE __ 51,000,000 X COMMERCIAL GENERAL LIABILITY 5500,000 CLAIMS-MADE X OCCUR MEDEXP(AnyoneoMon) PERSONALaADVINJURY— t1000000 - GENERAL AGGREGATE $2.000,000 GENL AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG 32,000,000 POLICY X PRo- LoC S B AUTOMOBILE I#ABILITY SIBCA00058-181 3/16/2018 3115/2019 Es eoadenl 000 000 L..__......_ _ X, ANY AUTO BODU.YINJURY(Per person) S ALL GOWNED SCTOSUIED BODILY INJURY(Per S AUTOS NON-OWNED PRO+�tRTY DAMAGE S HIRED AUTOS x AUTOS O',ertL UMBRELLA LIAR X OCCUR EAU731294 31151:2018 3/15/2019 EACH OCCURRENCE S4,00,000 XqEXCESS LIAB CLAIMS-MADE AGGREGATE S4,000,000 10 RETENTIONS WORKt2RSCOMPENSAYION ATU OTH• AND EMPLOYERS,LIABILITY IN ANY PROPRIETORIPARTNERIEXECUTIVE Y NIA E.L.EACH ACCIDENT 3 OFRCERIMEMBER EXCLUDED? (MandatcrylnNlq EL.DISWE-EA EMPLOYEE S "'ye8 desalt under 0 SCRIPTIONOFOPERATIONSbelow E.LOISEASE-POItCYLIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addilronal Remarks Schedule,it more apace Is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Date of Display:71=018. Location of.Display:Greenport High School 720.Front Street Greenport,NY 11W. Additionally Insured:Cert+ficate Holder,Town of Southold,Village of Greenport,Greenport Public Schools,and Greenport Fire Department. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE Phenix Hook&Ladder Co.91 &Relief Hose Co.#2 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 58 ACCORDANCE WrrH THE POLICY PROVISIONS. 3rd Street Greenport NY 119" AUTHORIZED REPRESENTAMUE 01998.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD FROM LEGION FIREWORKS Co Inc PHONE NO. Jun. 04 2018 09:40RM P8 Legion Fireworks Co.,Inc. Displa,Pyratcalmita 6iaaC 17:0 Invoice: 6/4/2018 Seller: Legion Fireworks Co., Inc. 10 Legion Lane Wappingers Falls, NY 12590 (845) 831—8328 Customer: Phenix Hook&Ladder Company#1 Relief Hose Company#2 Fireworks Display:-7/�/�k� . _ J130 Display Total $5,000.00 Display Deposit $750.00 Total Balance Due $5,000.00 FROM LEGION FIREWORKS Co Inc PHONE NO. Jun. 04 2018 09:37RM P4 Y UTjon Fireworks Co.,Inc. DispleY pyrotechZiaR amce 1910 invoice:6/4/2018 i Seller: Legion Fireworks Co_, Inc. 10 Legion Lane Wappingers Falls, NY 12590 (845)831.—8328 Customer: Phenix Hook&Ladder Company#1 Relief Hose Company#2 Date:Rain I I Display Total $7,500.00 Display Deposit $1,125.00 Total Balance Due $7,500.00 I I I �I r . y B. No drinking of alcoholic beverages is permitted. C. Activity shall be restricted to that area for which permission is granted. D. Activity shall not extend beyond hours approved by district. E. Programs shall not interfere"will regular school schedule. F. Organization shall be responsible for moving its equipment into and out of the building. G. The supervisor of the activity shall be present before it is due to start and remain with the group until all have left. H. In the absence of administrative personnel,the custodian is charged with the responsibility of the building. I. School authorities must have free access to all rooms at all times J. A careful examination will be made after use of the area by the applicant who will promptly make good on any loss or damage,which might have occurred. K. No school property or equipment is to be altered or removed from the premises. L. This license is revocable at any time by school authorities. M. No reservation will be made until this application is returned and approved by the district's Chief School Administrator. Not for Profit Organization IV. Rental Fees Other Fees or Conditions: Auditorium for performance $100 Auditorium for practice $50 Gymnasium for performance $100 Gymnasium for practice $50 When an approved activity takes place outside the normal hours of school operation,the organization will be charged$40.00 per hour for personnel services for a minimum of 4 hours.This all must be paid seven days in advance and is not refundable unless the district receives notification of cancellation at least 48 hours in advance. I 64. / ' 1 �. .............................. s1....................r t,> 5 yr+� J y `yba ,%��A r�? S�ZtiNsM1 r7tywir .J�1 I tp r r n nr d t ) ♦ ' 1,7cs�+,. ! t.. >�;➢ t�f 4 I�+ I a t � M , M i �1 �r�I ! a6 ?w`�� � 1�ttJtl�f��a M1 �y F � M1�1'>y�' E r�`,l`,�f�,r�t4�r s �r roS ✓�., �� � a• 3„ ��q2 2 ���Sr gal�iq}t�:'{�S i� t .Z`u ✓ �Y ��nryY ids yy�,t(.�,��,l�(M`��� Ci��31��°'�rI`'s 4��(�+-Y k'�i��J e✓✓rt�iir�ti�rry r�Gfi(, �rdr RS��Y+�d�A'� '. • Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/06/18 Receipt#: 241797 Quantity Transactions Reference Subtotal 1 Event Fee 7.7.18 $100.00 1 Fireworks 7.5.18 $100.00 Total Paid: $200.00 Notes: Payment Type Amount Paid By CK#1364 $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, NY 11944 Clerk ID: BONNIED Internal ID:7.5.18 CHIEF JEFFREY WEINGART , (631)477-9801 -STATION 1 1sTASST.CHIEF SUSANO JIMENEZ f (631)477-8261 -STATION 2 2ND ASST.CHIEF JAMES KALIN � (631)477-1943-CHIEFS OFFICE (631)477-4012-FAX CHAPLAIN CLAUDE KUMJIAN 311 THIRD STREET•P.O.BOX 58 ASST.CHAPLAIN THOMAS MURRAY GREENPORT,NY 11944 Email:gfdfire@optonline.net SECRETARY[TREASURERJAMES KALIN www.greenportfd.org Organized 1845 RECEIVED JUN 6 2018 June 04, 2018 Southold Town Clerk Town Clerk Elizabeth Neville Southold Town Hall 53095 Main Road Southold, NY 11971 Re: July 2018 Carnival Fireworks Dear Ms. Neville: The Board of Wardens of the Greenport Fire Department at a regular meeting in December 2017 approved the Phenix Hook& Ladder Co.#1 and Relief Hose Co.#2 request to.hold a Carnival at the Polo Grounds on Moores Lane from July 03 through July 07, 2018 with Fireworks to be held on Thursday,July 05 and Saturday,July 07, 2018 at 10:00 pm (rain date of Friday,July 06,2018 same time). If you wish to discuss this event with me or have any questions, please'do not hesitate to contact me. I can be reached at 631.466.5294. espectfully, James H. Kalin Assistant Chief Greenport Fire Department Doroski, Bonnie From: Flatley, Martin Sent: Thursday,June 07, 2018 11:41 AM To: Doroski, Bonnie Subject: RE: Emailing: gfd-fireworks_20180607094924 I have no objections to this event taking place 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:Thursday,June 07, 2018 9:55 AM To:Sepenoski,John <iohnsep@town.southold.nv.us>; Blasko, Regina <rblasko@town.southold.nv.us>; Doroski, Melanie <Melanie.Doroski@town.southold.nv.us>; Duffy, Bill<billd@southoldtownny.gov_>; Fisher, Robert <Robert.Fisher@town.southold.nv.us>; Flatley, Martin<mflatlev@town.southold.nv.us>; Hagan, Damon <damonh@southoldtownnv.gov>; Kruszeski, Frank<fkruszeski@town.southold.nv.us>; Norklun, Stacey <Stacey.Norklun@town.southold.nv.us>;Silleck, Mary<marvs@southoldtownnv.gov>;Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Dinizio,James<Iames.dinizio@town.southold.nv.us>; Doherty,Jill <fill.doherty@town.southold.nv.us>; Ghosio, Bob<bob.ghosio@town.southold.nv.us>; Louisa Evans <Ipevans06390@gmail.com>; Russell, Scott<scottr@southoldtownny.gov>;Standish, Lauren <Lauren.Standish@town.southold.nv.us>;Tomaszewski, Michelle<michellet@town.southold.ny.us>;William Ruland <rulandfarm@vahoo.com> Subject: Emailing:gfd-fireworks_20180607094924 Please find attached the application received from the Greenport Fire Department for their fireworks display July 5 and July 7. If there are any comments/concerns, please notify this office. Thank you. Your message is ready to be sent with the following file or link attachments: gfd-fireworks_20180607094924 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: Duffy, Bill Sent: Friday, June 15, 2018 2:01 PM To: Doroski, Bonnie Subject: RE: Emailing: gfd-firework$_20180607094924 No objection William M. Duffy, Esq. Town Attorney Town of Southold Southold Town Annex 54375 Route 25 (Main Road) P.O. Box 1179 Southold, Nww York 11971-0959 Office: 631.765-1939 Fax: 631.765.6639 Email: bill.duffv@town.southold.nv.us ATTORNEY-CLIENT COMMUNICATION; ATTORNEY WORK PRODUCT; INTER/INTRA AGENCY COMMUNICATION; NOT SUBJECT TO FREEDOM OF INFORMATION LAW DISCLOSURE; DO NOT FORWARD WITHOUT PERMISSION Note: Service of legal documents is not permitted via electronic mail or fax. The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain information that is privileged, confidential and exempt from disclosure under applicable law. Unintended transmission shall not constitute a waiver of the attorney/client privilege or any other privilege. If the reader of this message is not the intended recipient,you are hereby notified that any review, retransmission, conversion to hard copy, copying, reproduction, circulation, publication, dissemination or other use of, or taking of any action, or omission to take action, in reliance upon this communication by persons or entities other than the intended recipient is strictly prohibited. If you have received this communication in error, please (i) notify us immediately by telephone at 631.765.1939, (ii) return the original message and all copies to us at the address above via the U.S. Postal Service, and (iii) delete the message and any material attached thereto from any computer, disk drive, diskette, or other storage device or media. -----Original Message----- From: Doroski, Bonnie Sent:Thursday,June 07, 2018 9:55 AM To: Sepenoski,John; Blasko, Regina; Doroski, Melanie; Duffy, Bill; Fisher, Robert; Flatley, Martin; Hagan, Damon; Kruszeski, Frank; Norklun,Stacey; Silleck, Mary; Spiro, Melissa; Dinizio,James; Doherty,Jill; Ghosio, Bob; Louisa Evans; Russell, Scott; Standish, Lauren;Tomaszewski, Michelle;William Ruland Subject: Emailing: gfd-fireworks_20180607094924 Please find attached the application received from the Greenport Fire Department for their fireworks display July 5 and July 7. If there are any comments/concerns, please notify this office. Thank you. Your message is ready to be sent with the following file or link attachments: gfd-fireworks_20180607094924 i Doroski, Bonnie From: Spiro, Melissa Sent: Thursday,June 07, 2018,10:00 AM To: Doroski, Bonnie; Sepenoski, John; Blasko, Regina; Doroski, Melanie; Duffy, Bill; Fisher, Robert; Flatley, Martin; Hagan, Damon; Kruszeski, Frank, Norklun, Stacey; Silleck, Mary; Dinizio,James; Doherty,Jill; Ghosio, Bob; Louisa Evans; Russell, Scott; Standish, Lauren; Tomaszewski, Michelle;William Ruland Subject: RE: Emailing: gfd-fireworks_20180607094924 This is not preserved land. Melissa Spiro -----Original Message----- From: Doroski, Bonnie Sent: Thursday,June 07, 2018 9:55 AM To: Sepenoski,John <iohnsep@town.southold.nv.us>; Blasko, Regina <rblasko@town.southold.ny.us>; Doroski, Melanie <Melanie.Doroski town.southold.nv.us>; Duffy, Bill <billd@southoldtownnv.gov>; Fisher, Robert <Robert.Fisher town.southold.nv.us>; Flatley, Martin <mflatlev@town.southold.nv.us>; Hagan, Damon <damonh@southoldtownnv.gov>.; Kruszeski, Frank<fkruszeski@town.southold.ny.us>; Norklun, Stacey <Stacey.Norklun town.southold.nv:us>;Silleck, Mary<marvs@southo.ldtownnv.gov>; Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Dinizio,James<lames.dinizio@town.southold.nv.us>; Doherty,Jill <iill.doherty@town.southold.nv.us>; Ghosio, Bob <bob.ghosio@town.southold.nv.us>; Louisa Evans <Ipevans06390@gmail.com>; Russell,Scott<scottr@southoldtownnv.gov>; Standish, Lauren <Lauren.Standish@town.southold.nv.us>;Tomaszewski, Michelle<michellet@town.southold.nv.us>; William Ruland <rulandfarm@vahoo.com> Subject: Emailing:gfd-fireworks_20180607094924 Please find attached the application received from the Greenport Fire Department for their fireworks display July 5 and July 7. If there are any comments/concerns, please notify this office. Thank you. Your message is ready to be sent with the following file or link attachments: gfd-fi rewo rks_20180607094924 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