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HomeMy WebLinkAbout2017 Neville, Elizabeth From: Neville, Elizabeth Sent: Wed esday, May 17, 2017 10:35 A,$ M / To: Fl y, Martin; Fisher RobeZpir elissa; DuV, Bill; Hagan, Damon;Silleck, Mary Subject: Emailing: Fireworks Applic Matt Li_20170517090844 Attachments: Fireworks Applic Matt Li_20170517090844.pdf Importance: High Attached, please find a Fireworks Application of Mattituck Lions for your review and comments/recommendations. 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: Fireworks Applic Matt Li_20170517090844 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. a 1 Neville, Elizabeth From: Duff*/, Bill Sent: Wednesday, May 17, 2017 11:21 AM To: Neville, Elizabeth Subject: RE: Emailing: Fireworks Applic Matt Li_20170517090844 I have no objection to the permit being issued 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.duffy@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:Wednesday, May 17, 2017 10:35 AM To: Flatley, Martin; Fisher, Robert; Spiro, Melissa; Duffy, Bill; Hagan, Damon;Silleck, Mary Subject: Emailing: Fireworks Applic Matt Li_20170517090844 Importance: High Attached, please find a Fireworks Application of Mattituck Lions for your review and comments/recommendations. 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: 1 Neville, Elizabeth From: Spiro, elissa Sent: Thursday, May 18, 2017 8:57 AM To: Neville, Elizabeth Subject: RE: Emailing: Fireworks Applic Matt Li_20170517090844 This property is not preserved. melissa -----Original Message----- From: Neville, Elizabeth Sent:Wednesday, May 17,2017 10:35 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>; Duffy, Bill <billd@southoldtownny.gov>; Hagan, Damon <damonh@southoldtownny.gov>;Silleck, Mary<marys@southoldtownny.gov> Subject: Emailing: Fireworks Applic Matt Li_20170517090844 Importance: High Attached, please find a Fireworks Application of Mattituck Lions for your review and comments/recommendations. 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: Fireworks Applic Matt Li_20170517090844 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 V Neville, Elizabeth From: FlatleVartin Sent: Wednesday, May 17, 2017 12:03 PM To: Neville, Elizabeth; Fisher, Robert; Spiro, Melissa; Duffy, Bill; Hagan, Damon; Silleck, Mary Subject: RE: Emailing: Fireworks Applic Matt Li_20170517090844 I have no objections to this permit being issued. 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:Wednesday, May 17, 2017 10:35 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>; Duffy, Bill<billd@southoldtownny.gov>; Hagan, Damon <damonh@southoldtownny.gov>;Silleck, Mary<marys@southoldtownny.gov> Subject: Emailing: Fireworks Applic Matt Li_20170517090844 Importance: High Attached, please find a Fireworks Application of Mattituck Lions for your review and comments/recommendations. 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: Fireworks Applic Matt Li_20170517090844 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 i I RESOLUTION (ID # 13155)! REVIEWED DOC ID: 13155 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. (ID# 13155) WAS REVIEWED AT THE SPECIAL MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 12,2017: i RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a Fireworks Permit by the Town Clerk to the Mattituck Lions Club,for fireworks displays on Thursday June 15, 2017 at 9:15 PM; Friday June 16, 2017 at 10:00PM and Saturday June 17, 2017 at 10:15 PM on property located at 9095 Sound Avenue Mattituck(Strawberry Fields) upon the payment of a single fee of$100.00, and subject to the applicant's compliance with the requirements of the Town's policy regarding the issuance of fireworks permits. a i Elizabeth A. Neville , Southold Town Clerk i 1 i i $u© RESOLUTION (ID # 13155) DRAFT DOC ID: 13155 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. (ID# 13155) WAS DRAFT AT THE SPECIAL MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 12,2017: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a Fireworks Permit by the Town Clerk to the Mattituck Lions Club, for fireworks displays on Thursday June 15, 2017 at 9:15 PM; Friday June 16, 2017 at 10:00PM and Saturday June 17, 2017 at 10:15 PM on property located at 9095 Sound Avenue Mattituck(Strawberry Fields) upon the payment of a single fee of$100.00, and subject to the applicant's compliance with the requirements of the Town's policy regarding the issuance of fireworks permits. Elizabeth A. Neville Southold Town Clerk ELIZABETH A. NEVILLE,MMC ��® G� Town Hall,53095 Main Road TOWN CLERK PO. Box 1179 � ze Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER '�� ®�' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ®� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD PERMIT for PUBLIC DISPLAY OF FIREWORKS I, ELIZABETH A. NEVHLLE, 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: MATTITUCK LIONS CLUB-STRAWBERRY FESTIVAL PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York on Thursday , June 15, 2017 at 9:15PM; Friday, June 16,2017at 10:00PM ; Saturday,June 17, 2017 at 10:15 P.M., on the property known as `STRAWBERRY FIELDS",located at 9095 Sound Avenue,Mattituck,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 feet 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 into 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 last two soda acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. --- - -------------- (Town Seal) i beth A.Neville, Southold Town Clerk Town of Southold,New York Dated: June 13, 2017 THIS PERMIT IS NOT TRANSFERABLE RESOLUTION 2017-537 offer ADOPTED DOC ID: 13155 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2017-537 WAS ADOPTED AT THE SPECIAL MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 12,2017: RESOLVED that the Town Board of the Town of Southold hereby approves the issuance of a Fireworks Permit by the Town Clerk to the Mattituck Lions Club, for fireworks displays on Thursday June 15, 2017 at 9:15 PM; Friday June 16, 2017 at 10:00PM and Saturday June 17, 2017 at 10:15 PM on property located at 9095 Sound Avenue Mattituck(Strawberry Fields) upon the payment of a single fee of$100.00, and subject to the applicant's compliance with the requirements of the Town's policy regarding the issuance of fireworks permits. 0k&q(4?,2�0� Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: James Dinizio Jr, Councilman SECONDER:William P. Ruland, Councilman AYES: James Dinizio Jr, William P. Ruland, Robert Ghosio, Scott A. Russell ABSENT: Jill Doherty, Louisa P. Evans 45 �'z� so ELIZABETH A.NEVILLE,RINK,CMC Town Hall,53095 Main Road TOWN CLEF �� P.O.Box 2179 r< r r;: :,; Southold,New York 11971 REGISTRAR.OF VITAL STATISTICS MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER lfj', V� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER a � ' ��, southoldtown.northfork.net RECEIVE® OFFICE OF THE TOWN (CLERK TOWN OF SOUTHOLD MAY 1 7 2017 APPLICATION PERMIT TO DISPLAY FIREWORKS Southold Town Clerk APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law of the State of New York, for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY A1-411-40,k C 9'�-1 G l✓� PRINCIPAL OFFICE AT z., )0o DATE & TIME OF DISPLAY1 EXACT LOCATION OF DISPLAY Ct O5.< S �,cl Au,-, /t1 4A, 4 SUFFOLK COUNTY TAX MAP NUMBER FOR SITE RAIN DATE & TIME /f'/'Puit The following persons are to be in charge of the actual shooting of the fireworks: Blame Age Experience Physical Condition rll-�CC'ti —r (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: 3 e(f Manner and place of storage of fireworks prior to display: r5uV'a l' -Ir 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. GCS Name of Organization By Signature of Applicant * * * RECEIPT * * * Date: 05/17/17 Receipt#: 219767 Quantity Transactions Reference Subtotal 1 Fireworks Strawberry $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#0983 $100.00 Suglia, Benjamin W Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Suglia, Benjamin W Po Box 890 Mattituck, NY 11952 Clerk ID: SABRINA Internal ID:strawberry x a c �'yFn 4 �"" ri,ie}. 'a ,�,�' 'sR .� + `f Y � �,'►. <���1y^ M*A•��S"k a`��+�'¢�.K aq 64 3Y k w 1 t 4 -,n`��'5�,dY M"' 3�•I�N�� YOP r t. ' ar r IN , � �,, .�,,•� A� - �," � >`� .�'` ` � �ir�1 F}r�e�w,orks Launch Site : ��; �fi �, �� w, ;Y �" h�•�i,�'�+Aa�.�.-�y�",aly^i r- _ a1,� �.;tis�'9. . i,�h]4�'"fi�,„'tcr�i r €' -i .gy��.4r� .:w• :. • s t 4a." 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THIS LICENSE'IS NOT TRANSFERA P1LE`t}NDER' 3 ��ft'c��S3 - See"WAlUi NGS"and"NOTICES"on reverse. Direct A•FF ATF-Chief.FELC Licens�Alcrmit , Correspondence To 241 Needy RoadNiimbcr_ ' m • 87-51-7G-00,982 Martinsburg.WV 25405-9.131• _ Ghiet:Federal Ti losiVtsLicensineCenler(Fi 1.C� Gxpiitioit_' ' L�t�t/d/fst iDate Nance -- , AMERICAN FIREWORKS DISPLAY LLC Premises Address(Change�t7\OtifynljFEiU:n'leasll0dnsbel'orethem+icz.) 2 =._ 105-COUNTY ROUTE 7 MCDONOUGH, NY 13801- Typo of License or Permit 51-IMPORTER OF EXPLOSIVES« Purchasing Cerlilicatio6 Statement- Mailing -LC s(changes?N'aiify the hZT.0 of an} changes.) T1rc lit eiitiee or p�rnrit(ee named above shall use a coli},isftliit_licens�or, er'rriit to'as%m a- `, , transf{rar of��Itisiv to ien£y the idrntity and ilie licensed siptus ot'tht lictitiisae tit a" ^ I permittee as provided by 27 CFIt Pan 555. The si�taiiire°rni'erre'h wpv must lid M)irrieinal AMER ICAN'FIRE_ WORKS DISPLAY LLC Miniature, A i'ax�d sainted w c tnmlcd tom}c>►'thc 1i3z'6%iennrt tt lilt a sii�iu£urc = intcitdedtobeanoriginal 5i tamreisa4aptahlz. 7ltasietatii��,ryny4ticduitoftheFedcral POBOX980,,,'-'," " yF 1S:,pios'nec LicemsK(FEL,)or a respunsible perst�tt of itis FT'ti r7 c�Rti1'}•;ilial iltiy is a true OXFO "•RD;."`AIY` `1,3830- COP) of a license or permit issued to the lietuw,car pemaittet tt:tat�l,*dVc to,eng te4 in the.;-�,:-,.'•. - businu s or operations specit ted above under"TFpe or Liceue or Peritiit'. Licensee Permittee Responsible Peron Signature Position,T=itic� Primed Name Date ' • <1'i'F Ftm:t;qix}I4'�tt01 S Fart t ftoei�usEdit:nnis(ksofeie amtwt4wvuns6iPuricnmcoua nauccc,smsnmra>Laes.rac:z�s:srzrtnci[�turts R�+is�TCt.�des�ttli Federal Exploshes License(FEL)CustomerSeraicc information Federal Exploshes Hcensing Center(FELC I Toll-t}et TelephoneNumber. (877)283-3352 ATF LIomepage:wvywatf.gov 244 Need} Road Fax Numlier, (304)616-4401 Martinshure,WV25405-x131 E-mail: F ELCdatfizov Orange of,lddresst (27 CI7l 555.5d(r)(1)). Licensees or permittees;way during the win of iheir current license or permit remote their business or opeinItions to a nciv location at vehich they intend regularly to_caM-on such business or operatinns_ 'File licensee or permittee is required to give notification of the nc%N location orthe business or operations not less than 10 days prior to such removal ttiith the Chic[Federal Explocites Licensing Center. The license or permit will be valid for the remainder of the term of the of iginal license or permit. Mie,CUef,FELL,shall',if the Licensee or perriiittee is not qualified,refer die request for amended license or perntit to the Director of Industry Operations for denial in accordance with§555,54J -Right of Succession (27 CFI 555.59). (a)Certain persons other than the licensee or-penuitlue ma}secure the right to carry on the same explosive materials business or operations at the same address shown on.,nnd,for the remainder of the terns of,a eurrent license or permit. Such persons are: (1)The surviving spouse or child,or executor,administrator.or other lek aal,representative ora deceased licensee or permittee:and(2)A receiver or trustee its bankruptcy,or an amignec for bene$t of creditors (1))In order to secure the richt provided bvthis section.time person or persons continuing the business or operations shall furnish the license or permit for for that business or operations for endorsement of such succession to the Chief FELC,mithin 30 days from the date on which the successor begins to carry on[lie business or olxarations Cut Nrre. 7G (Connnrted on reverse side) t Federal Explosives License/Permit(FEL)InrormatiCard t I on t i License.Pertit Name:AMERICAN FIREWORKS DISPLAY LLC t t I I Business Name: I License'Pennit Number.64Y-017-51-7G-00982 i LicensePermit Type.51-IMP.0RTER'6F EXPCOSIVES t - t Expiration: duly 1,2017 t I I - t 1 ]'lease Note: Not Valid for time Sale or Other Disposition of Explosives, I ----------------------------------I pF N�lv " STATE OF NEWYYORK „ rf DIVISION OF 'DEPARTMENT OF LABOR” , a , - SAFETY AND HEALTH -' LICENSE TO DEAL IN'OR MANUFACTURE EXPLOSIVES Expires: 4/30/2018 American-Fireworks Display PO Box 980 THIS 'LICENSE MUST BE -Oxford, NY 1383Q ,' "POSTE6IN YOUR PLACE ".OF BUSINESS, Kevin-Jon Fritschler License No D_5171 is hereby licensed to deal in or manufacture explosives in compliance with the,requirements of the Labor Law and Industrial Code Rules. Any change in the conditions under which this license is granted may,cause it to be , revoked. ' Elleen.M,.Fran ko,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' - {7) the NAME or TYPE;and QUANTITY of explosives,SOLD,DELIVERED&GIVEN:'NdW No iicen'se is- needed to purchase smokeless-powder,-oY black powder,in quantities-not exceeding'fve,pounds for.use in firing antique firearms or artifacts or replica§thereof- However,dealers MUST post all such transactions on the"Dealer-Manufacturer Report o(Explosives Transactions'. 2) -the DATE OF EACK SALE,DELIVERY or GIFT. 3) the'NAME,LICENSE NUMBER,a'nd,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., µ SH-862(5-98) A4CGk®® CERTIFICATE OF LIABILITY INSURANCE DAii(MWDD""") 05/10!2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS.UPON THE'CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR-ALTER THE COVERAGE AFFORDED BY THE POLICIES .BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(les)must 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 ,Allied,Speciaity Insurance,Inc. CONTACTMichelle Kugler_ 10451 Gulf Blvd PHONE 727_547-3070 Treasure Island,FL-3370.6-4814 E-MAILe AIC No).- 727-367-5695 ADDRESS rnkugler@alliedspecialty.com INSURERS AFFORDING COVERAGE NAIC# INSURERA: T.H.E.Insurance Company 12.866 INSURED AMERICAN FIREWORKS DISPLAYS,LLC INSURER B: P.0.BOX 980 INSURER C: OXFORD,NY_13830 INSURER V: INSURER E': INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN,ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY'PERIOD INDICATED._NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUBR 'POLICY EFF POLICY EXP iLTR TYPE OF INSURANCE INSDPOUCY NUMBER- MM/DD MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY X CPP0105319-01 03/17/2017 03/17/2018 �CHOCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR /� PREMISES Ea occurrence $ 100,000 MED EXP Any orieperson) s N/A PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s, 10,000,000 POLICY❑PRO= ElJECT LOC PRODUCTS-COMP/OPAGG s 2,000,000 OTHER: Protection&Indemnity -$' 1,000,000 A AUroMOAUEuneILITY CPP0105319-01 03/17/2017 03/17/201B EOMB de�tsINGLELIMIT $ 1,000,000 OWNED ANY AUTO BODILYINJURY(Perperson) AUTOS ONLY X 'AUTOSBODILYBODILY INJURY(per accident) $ X HIRED v NON-OWNED PROPERTY DAMAGE S AUTOS ONLY /� AUTOS ONLY Per accident A UMBRELLA LIAB X OCCUR ELP0012117-01(GL) 03/17/2017 03/17/2018 EA014OCCURRENCE $ 4,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 4,000,000 DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY OTH- YIN WCP0005259 002 03/17/2017 03/17/2018 X STATUTE ER ANYPROPRIEOR/PARTNERIEXECtrfIVE E.L.EACH ACCIDENT $ 100,OD0 OFFICERIMEMBEREXCLUDED7 ❑ N/A Coverage is afforded in the State( of:NY '(Mandatory In beun E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT It 500,000, A Excess VL ELP0012118-01(VL) 03/17/2017 03/17/2016 Each Occurrence Limit $4,000,000 Aggregate Limit $4,000,000 DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is requlretl) Display Date:6115117,6116117,6/17117 Rain Date: Location:Sound Ave.,Mattituck,NY RE:General Liability,the following are named as additional insured in respects to the negligence of the named insured• Reithoffer Shows,Inc.;Mattituck Lioris Club;Town of Southold,NY;County of Suffolk,NY;JIMD Corp.(property owner) CERTIFICATE HOLDER CANCELLATION Town of Southold 53095 Route-25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO'Box 1179 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold,NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,'Q ©_1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03)' The ACORD name and logo are registered marks of ACORD bsuglia@mattlaundry.com From: Jason Wahl <jwahl@nsainsure.com> Sent: Tuesday, May 16, 2017 2.46 PM To: bsuglia@mattlaundry.com Subject: Certs for Town &County Attachments: MLC-2017 Festival Certs -Town and County.pdf Ben, Attached are certificates of liability insurance for the Town and the County. This is for the first 1 M/2M we are provided through Lions International. I will forward an updated cert for the Town once we have the excess 1M liability policy bound. - I sent Jon Shearin the certs from the fireworks guys and from us for the first 1 M/2M—I will forward Jon the excess as well once it's available. Thank you, Jason Wahl Sales Executive NSA .Insurance & Financial Services Street. 54985 Main Road, Southold, NY 11971 Mailing:PO Box 2340, Aquebogue, NY 11931 Phone: (631)722-3500 Ext 301 Fax: (631)722-3591 iwahl(a)-nsainsure.com # i The Neefus Stype Agency Inc- Visit our website at www.nsainsure.comi FIhd us q4 F'a�Ce4g,ok f ria Choice, One of the greatest compliments that clients and associates can give to me is a referral of friends, loved ones and co- workers. Thank you for your trust. Please note that email will not be effective to bind or amend coverage or report a claim until such time as you receive confirmation that your request has been processed. Any statements concerning accounting or legal matters are based solely on our experience as insurance agents and brokers and are not to be relied upon as accounting or legal advice for which you should consult your own professional advisors This facsimile or email is intended only for the use of the addressee named herein and may contain LEGALLY PRIVILEGED AND CONFIDENTIAL INFORMATION from THE NEEFUS-STYPE AGENCY,INC. If you are not the intended recipient of this facsimile/email,you are hereby notified that any dissemination,distribution or copying of this facsimile is stnctly prohibited If you have received this facsimile/email in error,please immediately notify us by telephone and return the original facsimile/email to us at the above via the appropriate postal service. We will reimburse any costs you incur in notifying us and returning this facsimile/email to us 1