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HomeMy WebLinkAbout2018 WH ELIZABETH A.NEVILLE,MMC Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ® www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD 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: MATTITUCK ENVIRONMENTAL,LLC A PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York, on Wednesday, July 4, 2018 at 9:30 P.M. (Rain Date: Saturday, July 7, 2018 at 9.30 P.M.) on private beach located at 9205 Skunk Lane, Cutchogue,New York,the time and place set forth in the application therefore, ON CONDITION THAT the bond (indemnity insurance) required shall continue in full force and effect in favor of the Town-of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be-at least two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feet from the nearest above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such a display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines; that all fireworks that fire a projectile shall be so set up that the projectile will go into the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore or a lake or other large body of water, then they may be directed in such a manner that the falling residue from the deflagration will fall,into such lake, or body of water; that any fireworks that remain unfired after the display is concluded shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during,any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task, that there shall be at least two such operators constantly on duty during the discharge and that at least two soda-acid or other approved type fire extinguishers of at least two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. , El' beth A. Neville, Town Clerk Town of Southold Suffolk County,New York, (TOWN SEAL) Date: June 28,2018 THIS PERMIT IS NOT TRANSFERABLE o��g11EFOL��O . ELIZABETH A.NLTEUR,MMC Town Hall,53095 Main Road 2 P.O.Box 1179 TOWN CLERK. o - vr = Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p Fax(681)765-6145 MARRIAGE OFFICER 'f' aft' Telephone(681)765-1800 RECORDS OF MANAGEMENT OFFICER �� '�► southoldtown.northfork.net FREEDOM OT INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Law of the State of New Yoik,for a permit to display fireworks as hereinafter specified: DISPLAY IS TO BE SPONSORED BY Mattituck Environmental PRINCIPAL OFFICE AT 800 Wickham Avenue, Mattituck, NY 11952 DATE&TIME OF;DISPLAY 7/4118 @ 9:30 pm EXACT LOCATIOMOF DISPLAY Private Beach-9205 Skunk Lane,Cutchogue,NY SUFFOLK COUNTY TAX MAP MMI3ER FOR SITE RAIN DATE&TIME 7/7/18 @ 9:30 pm The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition Robert Ceely dob: 4/15/86 13 years Health Excellent (Additional names and information may be submitted on an attached sheet Number and type of fireworks is as follows: 1.3G Fireworks: 2-2.5"=1,024. Cakes=27. Manner and place of storage of fireworks prior to display: Delivery day of display. 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. -Ac�' �(U- ``— Av"--04"'l FEE: $100 Name of anization See policy for additional information By ignature of Applicant D too Application Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/01/18 Receipt#: 241447 Quantity Transactions Reference Subtotal 1 Fireworks 7.418 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#57190 $100.00 Mattituck, Environmental Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Mattituck, Environmental 800 Wickham Ave Po Box 1402 Mattituck, NY 11952 Clerk ID: BONNIED Internal ID,7418 6^ S_ _ f ,�y r.i".rl�. �_�.��r T f 1�'�i.��^ +.� ry,r►.• y � �, 1 -3 t� 4��c. LOMANGINO PARTY < ; 9205,SKUNK LANE CU7"GH000E N - . Y �• +f�r� iI •'t � �'t 41:-01-04 N 072-2&56 W v,�,-�R.�'t�fY't'+i•, i�� th �4 `tY�' °r �s, a��=,kr ��Yr' ,� J �rr� �t +Mf a� + �� 3 ` lire ~* ► �` x =`` � � r 05 SkunE L11 ter,, YY i l r 4*70 ly.-t4�[ l y � � t.: ' I ,y � T ..�� 7`r� �i �k�l+t,t C�. r f F.T Y �i'�" * •F a �( ; .jMl C...t + y,.� s x.,1x ;S C s y � .j,•,,N•„'.'Yi + i \ ,_ lj•�/ `it / �'..'j!� y Y TIN �R �!.• ♦• t r _ •tr����Gw `i F 7 7 /I7 Inti ai 4 �•; Go e-ear{hy .fit � "�••�' ��,,,�* r�. +x � }2 f •; DMV# 793092361 17 FOUND, RETURN TO; �$ EYES CERN NYSDOL - LCC UNIT Ima HAIR PRO ROOM 161 HUILDING 12 $ HGR 60 STATB OFBICS CAMPUS .o �• ALBANY NY 12240 w0 j TSTA :o NEW.YO :` ,.7 J P_YRQTEC�iN R "D�FgRFMEIU•, � r`=1'r'r;r;;� ( x�CfAN CERTIEIC'A'f`OF RO` Rr J CEELY,: -CARD U. USING pyftOT•CF�Rr+a RO j �t tj ;'Exp?R E-0 1 ; :NYC"8c'NYS:CRTffil a " ; "tN Nk- .ry.�e Y J,1_ y'�Yr.• 2rV_..'_ . _`,_,'�-. ... �'"-sC ^'�.'.. '1y,'Y_v.,r I -}i•-i..i _. �Yom""'�.p 3. Environmental Services RECEIVED MAY 3 1 2018 May 29, 2018 Southold Town Clerk To Whom It May Concern; I,Stanley Lomangino,the property owner of 9205 Skunk Lane, Cutchogue, NY 11935 authorize Mattituck Environmental Services, LLC.to conduct the fireworks display on my property on July 4, 2018. Sincerely, i Stanley Lomangino Managing Member Mattituck Environmental Services, LLC. 560 Commerce Road,Cutchogue,New York 11935 Office:631-298-8888 Fax:631-298-2023 CUTCHOGUE C UTC H O G U E FIRE DISTRICT E g T e 260 New Suffolk Road, Cutchogue, NY 11935 F.D. Telephone (631) 734-6907 - Fax (631) 734-7079 Over 88 E-mail: cutfd@optonline.net Years of www.cutchoguefiredept.org Service June 15, 2018 Ms. Bonnie Doroski Deputy Town Clerk Southold Town Clerk's Office 53095 Main Road Southold, NY 11971 Ref: Fireworks Permit,July 4th, 2018 Private Beach,9205 Skunk Lane, Cutchogue, NY 11935 Dear Ms. Doroski, Per your request, I Larry Behr, Chief of the Cutchogue Fire Department have reviewed the application for Fire Works permit on the above date and location and see no reason not to authorize the application and hereby approve the application. Thank you for the opportunity to review the application, I remain, Very truly yours, job /" 041L Larry Behr, Chief of Cutchogue Fire Department INSTRUCTIONS FOR DISPLAY OF FIREWORKS 1. Name of body sponsoring fireworks display. 4, 2. The date and time of day at which the fireworks display is to be held. 3. The exact location planned for the fireworks display,including TAX MAP NUMBER. 4. The age,experience and physical characteristics of the persons who are to do the actual discharging of the fireworks. 5. The number and kind of fireworks to be discharged. 6. The manner and place of storage of such fireworks prior to the display. 7. A diagram of the grounds on which the display is to be held,showing the point at which the fireworks are to be discharged, the location of all buildings, highways and other lines of communication, the lines behind which the audience will be restrained and location of all nearby trees,telegraph or telephone lines or other overhead obstructions. 8. Such other information as the Southold Town Clerk may deem necessary to protect persons and property. Written permission of the property owner is required. 9. An indemnity insurance policy with liability coverage and indemnity protection of$1,000,000.00 per person for bodily injury;$1,000,000.00 per accident;$1,000,000.00 property damage. 10. The Town Clerk of the Town of Southold must have the insurance policy in her possession before the fireworks permit is issued. The named insured must read.T7i�rin OF SOUTHOLD. 11. Application for a fireworks permit must be made at least advance of the date of the fireworks dis la . (The above instructions are in accordance with the Penal Law, Article 405 - Licensing and other provisions relating to fireworks.) U.S.Department of Commander 120 Woodward Avenue Korneland$eCurity United Slates Coast Guard New Haven,CT 06512 Sector Long Island Sound Phone:(203)468-4665 United States Fax:(203)468-4423 Coast Guard 166001P036-18 Lomangino Fireworks Display Pyro Engineering Inc.db Bay Fireworks Attn:Ms.Jo-Anne Triolo 999 S.Oyster Bay Rd.Suite l I I Bethpage,NY 11714 Ms.Triolo: Thank you for submitting your Marine Event Application for the Lomangino Fireworks Display,to be held on July 04,2018 in Cutchogue,NY. After reviewing your application,we have determined that your event does not introduce extra or unusual hazards that would jeopardize the safety of human life on die navigable waters of the United States,and therefore will not require any additional regulatory action. It rs your responsibility to contact this office tfthere are any changes to cite event,including the number of parricipantv and/or erpected spectators,location,or any other significant change that otay necessitate reconsideration as to whether u permit is required As the event sponsor,you are reminded that safety is paramount,you are responsible fur flee overall safety of the event,including monitoring and appropriately responding to changing weather conditions as well as cancellation of the event should conditions warrant. You are also responsible fur participant accountability and appropriate event communication to participants far updates,safety,and cancellations. Nothing in this determination is intended to restrict lite Coast Guard's ability to take action authorized under the Pons and Waterways Safety Act,the Magnuson Act,or other authorities to ensure the safety of vessels and waterfront facilities,and the protection of the navigable waters and the resources therein.Such actions could include promulgation of Regulated Navigation Areas or Limited Access Areas,broadcasting safety notices or other actions taken under die authorities granted to the United States Coast Guard. Coast Guard review and recognition of this event in no way implies that the event is without risk or deemed completely safe,nor does it imply that the Coast Guard has"approved"the event.As the event sponsor,you are reminded that you are responsible for the overall safety of the event and must comply with all existing Federal, State,and local laws that may require additional pennits.You should take appropriate action to ensure compliance with all such requirements prior to holding your event. It is recommended that sponsors of fireworks events that will be launched within?'of a mile of beaches and any event that will attract shore side spectators where Piping Plover shore birds may nest.Consult with the local U.S.Fish and Wildlife Service Field Office(Shirley,NY - 631-286-0485)regarding compliance with Section 9 of the Endangered Species Act and the New York State Department of Environmental Conservation Office(Mr.Kevin Jennings,831-444-0308)regarding equivalent State environmental laws. I sincerely appreciate your proactive effort in bringing this event to our attention.Because of the dynamic nature of the waterway,boating,and maritime activities,the Coast Guard carefully considers the totality of the risks associated with each event on a case-by-casc basis when determining whether a permit is needed.Please contact MSTC Katherine Linnick at(203)468-4565 if you have any questions or if the event is cancelled for any reason Sincerely, r t ndrew Lieutenant Junior Grade,U.S.Coast Guard Chief,Waterways Management Division Copy: CG Station Montauk NY DEC U.S.Fish and Wildlife Services(Long Island) O FAAIAir Traffic Organization 1701 Columbia Avenue Eastern Service Center College Park,GA 30337 ; U.S,Deportment of Transportation Federal Aviation Administration Dear Fireworks Proponent: FAA-Lomangino 2018 Thank you for informing us of your proposed fireworks display. Although there are currently no federal regulations specific to frreNvorks displays,the Federal Aviation Administration(FAA)has been tasked with regulating the safe and efficient use of the navigable airspace(49 U.S.C.§40103). In recognition of this role in promoting aviation safety,many jurisdictions require notice to the FAA as a condition of'approval of a fireworks permit. We acknowledge your notification and have no objection to the fireworks display provided it is conducted in a manner that does not create a hazard to other persons,or their property. To enhance the safety of your event,we recommend the following actions: + Fireworks staff should remain vigilant to ensure that no aircraft are in the area prior to beginning the fireworks display. + If your event is within 5 miles of a public use airport,or if the display will exceed 500 feet Above Ground Level (AGL),contact Leidos Flight Service at 1-877-4-US-NTMS (1-577-487-6867)at least 24 hours(but not more than 72 hours) in advance to request a Notice to Airman(NOTAM).You will need to provide the following information: o Name and address of the person filing the NOTAM o Date,time(s),and event location(City, State,and location in reference to the airport) Q Maximum altitude of the display This letter should not be construed as superseding or invalidating any existing rules or regulations promulgated by any other federal,state,county,or municipal government which may be required for this display. If you have any questions regarding this information,please contact our office at(404)305- 5570 or 9-ATO-ESA-OSG-Fireyvorks,cr faa.Eov. Sincerely, ft--- Ryan W.Almasy Manager,Operations Support Group Eastern Service Center, Air Traffic Organization DA0028ACOi CERTIFICATE OF LIABILITY INSURANCE 3/81011 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 NAME: Shauna Marquis Clark Insurance H No Ext: (860)430.3700 Arc No): (860)430-3730 IAI180 Glastonbury Boulevard ADDREss: smarquis@mayboneedark.com Suite 401 INSURERIS)AFFORDING COVERAGE NAIC ik Glastonbury CT 06033 INSURER A; Lexington Insurance Company 19437 INSURED INSURERB: Liberty Mutual Insurance Company 23043 Pyro Engineering Inc.,DSA:Bay Fireworks INSURER C: 999 S.Oyster Bay Rd. INSURER D: Suite 111 INSURER E: Bethpage NY 11714 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 Master REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 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. IPOLI Y F POLICY EXPLIMBS LTR TYPEOFINSURANCE INSD YYVD POUCYNUMBER MMIOD MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE N OCCUR FUIPREMISES Ea occurrence) $ 100'000 MED EXP(Any one person) S A 023627358 02115/2018 02/1512019 PERSONAL 8 ADV INJURY $ 1.000,000 GEN'LAGGREGATEUMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY ERT 1:1 LOC PRODUCTS-COMP/OPAGG $ 2.000,000 $ OTHER. AUTOMOBILE LIABILITY EaaccidenntSFNGLELtMIT $ ANYAUTO BODILY INJURY(Per person) $ �_ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY (Para x3dZ S X UMBRELLA UAB OCCUR EACH OCCURRENCE $ 9.000,000 A EXCESS UAB HCLAIMS44ADF 023627359 02/15/2018 02/15/2019 AGGREGATE $ 9.000,000 DED RETENTION$ $ WORKERS COMPENSATION X STTATUTE ERH- ANDEMPLOYERS'UABILIY YIN 1,000,000 B ANY PROPRIETORIPARTNER/EXECUTNE INIA 27-16628-18053404422 02/15/2018 02/15/2019 E.L EACH ACCIDENT S OFFICERIMEMSER EXCLUDED? 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ if yes.describe under E.L.DISEASE•POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below Workers'Compensation States: CT,GA,NC,NV,SC.VA DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) Date of Display:July 4,2018 LOCATION OF DISPLAY:9205 Skunk Lane,Cutchogue NY RAIN DATE:July 7,2018 Town of Southold;Anthony Lomangino(property owner);The Love of Family,LLC are Included as additional insured as respect to the General Liability policy per written agreement/contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Maltituck Environmental ACCORDANCE WITH THE POLICY PROVISIONS.- 800 ROVISIONS:800 Wickham Avenue AUTHORIZED REPRESENTATIVE Mattituck NY 11652 ��1 I 1 . ©1988-2015 ACORD CORPORATION.ION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD DATE(MMIDUNYYY) ACORV CERTIFICATE OF LIABILITY INSURANCE Q31oa12018 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 pal-9cy(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 NAMEc Jo Ann Decker The DeckerAgency Inc NCNt o E,): (716)883-1455 Alc,No: (716)983-6210 37 Elmwood Avenue ADDRESS: INSURERS)AFFORDING COVERAGE NAIC 0 Buffato NY 14201-2018 INSURER A. National Continental Insurance Company 10243 INSURED INSURER B: Pyro Engineering Inc.DSA:Bay Fireworks INSURER C: 999 S Oyster Rd Suite 111 INSURER D; INSURER E: Bethpage NY 11714 INSURER F- 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 REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. SR Y EXP TYPE OF INSURANCE IND VWD POLICY NUMBER MPMlDD LICY FFFPMN LTR LIMITS COMMERCIAL GENERALL%BILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE D OCCUR PREMISES Ea occurronce $ MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENI.AGGREGATELIMITAPPLIESPER. GENERAL AGGREGATE $ POLICY E]JECT E—]LOC PRODUCTS-COMPIOPAGG S OTHER: $ AUTOMOBILE LIABILITYCEO aee'.ED SINGLE LMT $ 1,000,000 ANYAUTO BODILY INJURY(Perpe:son) S A OWNED SCHEDULED CNYOD04909233-8 02/15/2018 02/15/2019 130DILYINJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY P.' accldenl S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION ST TUTE ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTLVEE.LEACHACCIDENT $ ❑ OFFICERIMEMBEREXCLUDEDI N!A (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD tel,Additional RoemAs Schedule.may be attached if more space 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 Matlituck Environmental ACCORDANCE WITH THE POLICY PROVISIONS. 800 Wickham Avenue AUTHORIZED REPRESENTATIVE ,� f Mattituck NY 11952 a. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD New York State Insurance Fund Workers'Compensation&DisabilityBeneftts Specialists Since 1914 8 CORPORATE CENTER DR,2ND FLR,WIELVILLE,NEW YORK 11747-3166 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^A AA" 753044987 BOSTON-INSURANCE BROKERAGE 24 FEDERAL ST FL 4 0 - BOSTON MA 02110 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER 7/4-9205 SKUNK LANE PYRO ENGINEERING INC MATTITUCK ENVIRONMENTAL DBA BAY FIREWORKS 800 WICKHAM AVENUE 999 S.OYSTER BAY RD, STE 111 MATTITUCK NY 11952 BETHPAGE,NY 11714 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2437 559-4 331912 02/27/2018 TO 02/15/2019 3/9/2018 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 I INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S 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:IIWWW.NYSIF.COWCERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE IS ISSUED AS A 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:922865244 U-26.3 SPONSOR: Mattituck Environmental Fireworks Company Pyro Engineering,Inc. dba Bay Fireworks 999 S. Oyster Bay Rd., Suite 111 Bethpage,NY 11714 P: 516-597-5500/F: 516-597-5507 Show Date(s): 7/4/18 Rain Date(s): 7/7/18 Location: 9205 Skunk Lane,Cutchogue,NY Time: 9:30 pm 1. Total number of Class B shells being used: 1,024. Total Cakes= 27. Maximum shell size=2.5 inches in diameter. 2. All shells are DOT approved. 3. Display will be fired electrically and/or manually. 4. Delivery to site will be approximately 12:00 noon. Set up will take approximately 4-5 hours. 5. All displays will comply with all requirements as set forth in NYS Penal Code 405 and NFPA 1123, 1124. 6. Pyro Engineering, Inc. has complete understanding of all rules and regulations governing public fireworks displays and this display will be in accordance with those rules and regulations. 7. Personnel representing fireworks display company: Lead: Robert Ceely(NYS DOL license PR-51) 8. Technician(s): tbd Signed Firew Company epr tative Neville, Elizabeth From: Sepenoski,John Sent: Tuesday,June 19, 2018 8:05 AM To: Neville, Elizabeth Subject: FW: Emailing: fireworks permit-7_20180601095051 Betty, See below, it appears you were not copied on this. John Sep From:Aaron C Virgin fmailto:acvirgin eastendenvironment.org] Sent: Monday,June 18,2018 12:40 PM To:Sepenoski,John<iohnsep@town.southold.ny.us> Cc: Doroski, Bonnie<Bonnie.Doroski@town.southold.nv.us>; Blasko, Regina <rblasko@town.southold.ny.us>; Doroski, Melanie<Melanie.Doroski@town.southold.nv.us>; Duffy, Bill <billd@southoldtownny.gov>; Fisher, Robert <Robert.Fisher@town.southold.ny.us>; Flatley, Martin<mflatley@town.southold.ny.us>; Kruszeski, Frank <fkruszeski@town.southoId.ny.us>; Norklun,Stacey<Stacey.Norklun@town.southold.ny.us>;Silleck, Mary <marys@southoldtownny.gov>; Spiro, Melissa<Melissa.Spiro@town.southold.nv.us>; Dinizio,James <lames.dinizio@town.southold.nv.us>; Doherty,Jill<sill.doherty@town.southold.nv.us>; Ghosio, Bob <bob.ghosio@town.southold.nv.us>; Louisa Evans<lpevans06390@gmail.com>; Russell,Scott <scottr@southoldtownny.gov>;Standish, Lauren<Lauren.Standish@town.southold.nv.us>;Tomaszewski, Michelle <michellet@town.southold.nv.us>;William Ruland<rulandfarm@vahoo.com> Subject: Re: Emailing:fireworks permit-7_20180601095051 Dear John et al. We have an active Piping Plover(PIPL)pair on the south section of Little Creek. As of today, our steward noted 2 of the 4 chicks that were seen with 2 adult PIPL. Based on the hatch date of 6/6%18, we are confident that the chicks will likely fledge by the date of the fireworks display, and therefore we see no reason at this time to halt planning activities. Thank you, Aaron Aaron Virgin Vice President I Group for the East End Office: 631-765-6450 x218 Mobile: 631-377-1303 Email: acvirgin@eastendenvironment.org Web: www.GroupfortheEastEnd.org Protecting the nature of the Place you love On Jun 1, 2018, at 3:42 PM, Sepenoski, John<johnsep@town.southold.ny_us>wrote: I am replying to all and adding Aaron Virgin of the Group for the East End. GFEE manages the Town's beach nesting program and Aaron may have comments. John Sep -----Original Message----- From: Doroski,Bonnie Sent: Friday, June 1, 2018 9:52 AM To: Blasko, Regina<rblasko@town.southold.ny.us>; Doroski, Melanie <Melanie.Doroski@town.southold.ny.us>; Duffy, Bill <billd@southoldtownny.gov>; Fisher, Robert<Robert.Fisher@town.southold.ny.us>; Flatley,Martin <mflatley@town.southold.ny.us>; Kruszeski,Frank<fkruszeski@town.southold.ny.us>; Norklun, Stacey<Stacey.Norklun@town.southold.ny.us>; Sepenoski, John <johnsepktown.southold.ny.us>; Silleck, Mary<marys@southoldtoMg1W.gov>; Spiro, Melissa <Melissa.Spiro@town.southold.ny.us> Cc: Dinizio, James<james.dinizio a,town.southold.ny.us>; Doherty, Jill <jill.doherty@town.southold.ny.us>; Ghosio, Bob <bob. hghosioQtown.southold.ny us>; Louisa Evans <lpevans06390@gmail.com>; Russell, Scott<scottr@southoldtownny.gov>; Standish, Lauren<Lauren.Standish@town.southold.U.us>; Tomaszewski, Michelle <michellet o,town.southold.ny.us>; William Ruland<rulandfarmkyahoo.com> Subject: Emailing: fireworks permit-7_20180601095051 Please review the attached application from Mattituck Environmental for a fireworks display. If you have any comments/concerns,please advise this office. Thank you. Your message is ready to be sent with the following file or link attachments: fireworks permit-7_20180601095051 Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. <fireworks permit-7_20180601095051.pdf> 2 Neville, Elizabeth From: Neville, Elizabeth Sent: Monday,June 18, 2018 4:24 PM To: 'Leslie Fernandez' Subject: Orient Harbor Fireworks Attachments: Laserfiche Documents.zip Leslie, Attached, please find the copy of the approvals and fireworks permit for Orient Harbor July 4th Festivities Committee. 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: Neville, Elizabeth Sent: 1 18, 2018 10:01 AM To: =Response Subject: d Attachments: it-7_20180601095051.pdf Follow Up Flag: Follow up Flag Status: Flagged Bob, To date, I do not believe that we have received a response from you. Please respond as soon as possible. Thank you. Betty Neville 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 Doroski, Bonnie From: Doroski, Bonnie Sent: Friday,June 01, 2018 9:52 A To: Blasko, Regina; Doro elanie;�n; ill; Fisher, Robert; Flatl artin; Kruszeski, Frank; Norklun, Stacey; Sepenilleck, Mary; Spi e issa Cc: Dinizio, James; Doherty,Jill; Ghosio, Bob; Louisa Evans; Russell, Scott; Standish, Lauren; Tomaszewski, Michelle;William Ruland Subject: Emailing:fireworks permit-7_20180601095051 Attachments: fireworks permit-7_20180601095051.pdf Please review the attached application from Mattituck Environmental for a fireworks display. If you have any comments/concerns, please advise this office. Thank you. Your message is ready to be sent with the following file or link attachments: fireworks permit-7_20180601095051 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 Neville, Elizabeth From: Spiro, Melissa Sent: Monday,June 18, 2018 10:10 AM To: Neville, Elizabeth Cc: Sepenoski,John Subject: RE: Fireworks Permit I did respond; although with a question. I guess I wasn't clear that I was deferring my response to comments by GFEE. °t,`,,r:- "rPia6�tYJ3,�iS 3Q:55'�Sri Shiro,,Melissa- U Mattittuk On ironmentai To Rud�er;.Lynda? 1'bi�6,1teglnat Dsrn's ci?tesan:e:Fis#er,i;ob a;Fl tte,,'tvocUn:Fier#dttn,.Siacs}°:J3afTp,W4,Hbgan,baron;,sl,lert;,Mwy Ccpes�ssk,it fiR It is,my:uiiaer'starid ng'that 1ohn-, ep'sent:thi`s requesf,to, 'a`r'ori virg'in_of.GF E: Fias`ti�=,resporrded7 1'am replying.ta atUand-addingAaron Vir-6of_ttie;`droup:f6r tke;Easi End., GFEE�manages.the Townis.lbea- ne -j)hn Sep ==Original Message---- ,From:�Riidddr,,Lynda Sent: Chursday,-June:07;'2i}18.1Q'i52 AM nTo Btaska,Reg'ina;:<r3�fa'ska.,g�towri.soutftold.ny.us�;=Daroski 'Melanie;SfVfeianie�Doros&i�tor�r,'i_sduthe�l`d.ny;us>;,,Ers(ier,Rohert:<_R tmfiatley u+t'awn:scsuthoid s�y:tis>;;�Iorklun,Stacey<Stacc� :ltinrkl�rnt t�ati+n:soti`thald:ii >;Sofro,Melissa�Iti+feli sa:S'iairo to+ rt.s <billd s'outholdtoWnnvr.,RoVa;Haan,Damon-<damob KRscautftaidtoevnn�;gcav>;Silleck,.Mary<nia s' soutFiQlc3tovunn '. ov_> .Subject:Mattit'uck�Enbiroriment'al ;Plea"s'6:1 iovideihis,office with,c'omments:thank'you From: Neville, Elizabeth Sent: Monday,June 18, 201810:05 AM To:Spiro, Melissa<Melissa.Spiro@town.southold.nv.us> Subject: FW: Fireworks Permit Importance: High Melissa, To date, I do not believe that we have received a response from you. Please respond as soon as possible. Thank you. Betty Neville To date, I do not believe that we have received a response from you. Please respond as soon as possible. Thank you. Betty Neville i Doroski, Bonnie From: ✓Flatley, Martin Sent: Friday,June 01, 2018 10:20 AM To: Doroski, Bonnie; Blasko, Regina; Doroski, Melanie; Duffy, Bill; Fisher, Robert; Kruszeski, Frank; Norklun, Stacey; Sepenoski,John; Silleck, Mary; Spiro, Melissa Cc: Dinizio,James; Doherty,Jill; Ghosio, Bob; Louisa Evans; Russell, Scott; Standish, Lauren; Tomaszewski, Michelle;William Ruland Subject: RE: Emailing:fireworks permit-7_20180601095051 I have no objections to this event being held Martin Flatley, Chief of Police Southold Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 -----Original Message----- From: Doroski, Bonnie Sent: Friday,June 01, 2018 9:52 AM To: 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.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Kruszeski, Frank<fkruszeski@town.southold.nv.us>; Norklun,Stacey <Stacey.Norklun @town.southold.nv.us>;Sepenoski,John <iohnsep@town.southold.ny.us>; Silleck, Mary <ma_rys@southoldtownny.gov>; Spiro, Melissa <Melissa.Spiro@town.southold.nv.us> Cc: Dinizio,James<iames.dinizio@town.southold.nv.us>; Doherty,Jill <iill.doherty@town.southold.nv.us>; Ghosio, Bob <bob.ghosio@town.southold.nv.us>; Louisa Evans<lpevans06390@gmail.com>; Russell, Scott <scottr@southoldtownny.gov>; Standish, Lauren <Lauren.Standish@town.southold.ny.us>;Tomaszewski, Michelle <michellet@town.southold.ny.us>;William Ruland <rulandfarm@vahoo.com> Subject: Emailing:fireworks permit-7_20180601095051 Please review the attached application from Mattituck Environmental for a fireworks display. If you have any comments/concerns, please advise this office. Thank you. Your message is ready to be sent with the following file or link attachments: fireworks permit-7_20180601095051 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: Rudder, Lynda Sent: Friday,June 15, 2018 1:45 PM To: Doroski, Bonnie Subject: FW: Mattituck Environmental -----Original Message----- / From: Duffy, Bill Sent: Friday,June 15, 2018 1:45 PM To: Rudder, Lynda Subject: RE: Mattituck Environmental 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: Rudder, Lynda Sent:Thursday,June 07, 2018 10:52 AM To: Blasko, Regina; Doroski, Melanie; Fisher, Robert; Flatley, Martin; Norklun, Stacey; Spiro, Melissa; Duffy, Bill; Hagan, Damon; Silleck, Mary Subject: Mattituck Environmental 1 Doroski, Bonnie From: ✓ Sepenoski,John Sent: Friday,June 01, 2018 3:43 PM To: Doroski, Bonnie; Blasko, Regina; Doroski, Melanie; Duffy, Bill; Fisher, Robert; Flatley, Martin; Kruszeski, Frank; Norklun, Stacey; Silleck, Mary; Spiro, Melissa;Aaron Virgin Cc: Dinizio,James; Doherty,Jill; Ghosio, Bob; Louisa Evans; Russell, Scott; Standish, Lauren; Tomaszewski, Michelle;William Ruland Subject: RE: Emailing:fireworks permit-7_20180601095051 Attachments: fireworks permit-7_20180601095051.pdf I am replying to all and adding Aaron Virgin of the Group for the East End. GFEE manages the Town's beach nesting program and Aaron may have comments. John Sep -----Original Message----- From: Doroski, Bonnie Sent: Friday,June 1, 2018 9:52 AM To: 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.ny.us>; Flatley, Martin <mflatley@town.southold.ny.us>; Kruszeski, Frank<fkruszeski@town.southold.ny.us>; Norklun, Stacey <Stacey.Norklun@town.southold.ny.us>; Sepenoski,John <iohnsep@town.southold.nv.us>;Silleck, Mary <marvs@southoldtownny.Rov>; Spiro, Melissa <Melissa.Spiro@town.southold.nv.us> Cc: Dinizio,James<lames.dinizio@town.southold.nv.us>; Doherty,Jill <fill.doherty@town.southold.ny.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:fireworks permit-7_20180601095051 Please review the attached application from Mattituck Environmental for a fireworks display. If you have any comments/concerns, please advise this office. Thank you. Your message is ready to be sent with the following file or link attachments: fireworks permit-7_20180601095051 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: Doroski, Bonnie Sent: Friday, June 01, 2018 9:55 AM To: 'cutfd@optonline.net' Subject: Emailing:fireworks permit-7_20180601095051 Attachments: fireworks permit-7_20180601095051.pdf Please direct the information in this attachment to the current Chief of the Cutchogue Fire Department. Under town regulations,the fire chief of the district that the display is held must review the application and send a letter of approval before a permit can be issued. Thank you for your assistance, Bonnie J. Doroski Deputy Town Clerk Your message is ready to be sent with the following file or link attachments: fireworks permit-7_20180601095051 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. c Neville, Elizabeth From: Neville, Elizabeth Sent: Thursday,June 01,201711:54 AM To: cutfd@optonline.net Subject: Fireworks Permit Application Referral Attachments: Fireworks Apl Matt Envir 20170601093011.pdf Please direct the information in this attachment to the current Chief of the Cutchogue Fire Department. Under town regulations,the fire chief of a district in which a "Fireworks Display"is to be held must review the application and send a letter of his approval before a permit can be issued., If anyone has any questions regarding this, please contact me at 631765-1800 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 0611631466-6064 i