The URL can be used to link to this page

Home My WebLink About4170 Indian Neck Ln RESOLUTION 2018-891 ADOPTED DOC ID: 14542 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2018-891 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 9,2018: RESOLVED that the Town Board of the Town of Southold hereby ratifies and approves the issuance of a fireworks permit by the Town Clerk to Pyro Engineering, Inc, for a fireworks display at 9:OOPM, Saturday, October 6, 2018 at 4170 Indian Neck Lane, Peconic,New York upon payment of the 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 RESULT: ADOPTED [UNANIMOUS] MOVER: James Dinizio Jr, Councilman SECONDER:Louisa P. Evans, Justice AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Evans, Russell guFFO[,� ELIZABETH A.NEVILLE,MMC ®� c®�jy Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 ca Southold,New York 11971 REGISTRAR OF VITAL STATISTICS � Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �O,( , �� 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: PYRO ENGINEERING INC. A PERMIT FOR THE PUBLIC DISPLAY OF FIREWORKS by said organization in accordance with the provisions of Section 405.00 of the Penal Law of the State of New York, on the time and place set forth in the application therefore, as follows: October 6,2018 at 9:00 PM (Rain Date: None) at 4170 Indian Neck Road Peconic, New York 11958 ON CONDITION THAT the bond (indemnity insurance)required shall continue in full force and effect in favor of the Town of Southold, and PROVIDED that the actual point at which the fireworks are to be fired shall be at least two hundred feet from the nearest building, public highway or railroad, or other means of travel, and at least fifty feet from the nearest,above ground telephone or telegraph line, trees or other overhead obstruction; that the audience at such a display shall be restrained behind lines at least one hundred and fifty feet from the point at which the fireworks are discharged and only persons in active charge of the display shall be allowed inside these lines; that all fireworks that fire a projectile shall be so set up that the projectile will go into the air as nearby as possible in a vertical direction, unless such fireworks are to be fired from the shore or a lake or other large body of water, then they may be directed in such a manner that the falling residue from the deflagration will fall into such lake, or body of water; that any fireworks that remain unfired after the display is concluded shall be immediately disposed of in a way safe for the particular type of fireworks remaining; that no fireworks display shall be held during any wind storm in which the wind reaches a velocity of more than thirty miles per hour; that all persons in actual charge of firing the fireworks shall be over the age of eighteen years, competent and physically fit for the task, that there shall be at least two such operators constantly on duty during the discharge and that at least two soda-acid or other approved type fire extinguishers of at least .two and one-half gallons capacity each shall be kept at such widely separated points as possible within the actual area of the display. Elizabeth Q. Neville, Town Clerk Town of Southold Suffolk County,New York (TOWN SEAL) Date: October 5, 2018 THIS PERMIT IS NOT TRANSFERABLE CHIEF OF DEPARTMENT Craig Goldsmith � � txQ � t�xzxjtQxY FIRST ASSISTANT CHIEF P.O.Box 1469 SECRETARY Peggy Killian 55135 Main Road Teresa L.Rich Southold,New York 11971 SECOND ASSISTANT CHIEF (631) 765-3385 •Fax(631)765-5009 TREASURER C.E. (Ty)Cochran Jr. Chiefs'(631)765-1240 Teresa L.Rich October 5, 2018 RECEIVED Town of Southold OCT 5 20 Elizabeth A. Neville,Town Clerk 53095 Route 25 Southold Town Clerk Southold, NY 11971 Attention Elizabeth A. Neville: The Southold Fire Department has reviewed the site plan provided by Pyro Engineering for a . fireworks display located at 4170 Indian Neck Lane, Peconic, NY on Saturday, October 6, 2018 at 9pm. We approve the plans, as submitted, and will be providing a fire engine and firefighters to stand by at this event. Please feel free to contact me at 631-926-3970 if you have any questions. Thank You, Craig Goldsmith Chief of Department Town of Southold P.0 Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 10/05/18 Receipt#: 248870 Quantity Transactions Reference Subtotal 1 Fireworks 100618 $100.00 Total Paid: $100.00 Notes: Payment Type Amount Paid By CK#16742 $100.00 Pyro, Engineering Inc Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Pyro, Engineering Inc 999 S Oyster Bay Road Suite 111 Bethpage, NY 11714 Clerk ID: BONNIED Internal ID 100618 10/4/2018 FedEx Ship Manager-Print Your Label(s) rn o o� ii. bi r,�r zc� • -�,��.�� C/) M --I --1 m :MI C r C*p�oZmz —1 Cn Z Z o-f CM)zM,-o Zr 'rl _I mg D 0 CI) CD _ Z /� r CI) MC OTZ > 0 � -�"' N — Mm g o y 0 o s - CDm 0 m T �n2 Go ' - = o �2— m CD C" o 27-0-1 CO M 0 -04 —1 -0 Z N D N M o �� _ � M n 0 fD r82118031501w ® 552J1MFBIDCA5 After printing this label: 1. Use the'Print'button on this page to print your label to your laser or inkjet printer. 2. Fold the printed page along the horizontal line. 3. Place label in shipping pouch and affix it to your shipment so that the barcode portion of the_label can be read and scanned. Warning: Use only the printed original label for shipping. Using a photocopy of this label for shipping purposes is fraudulent and could result in additional billing charges, along with the cancellation of your FedEx account number. Use of this system constitutes your agreement to the service conditions in the current FedEx Service Guide, available on fedex.com.FedEx will not be responsible for any claim in excess of$100 per package,whether the result of loss,damage,delay, non- delivery,misdelivery,or misinformation, unless you declare a higher value,pay an additional charge,document your actual loss and file a timely claim.Limitations found in the current FedEx Service Guide apply.Your right to recover from FedEx for any loss, including intrinsic value of the package, loss'of sales, income interest, profit,attorney's fees, costs,and other forms of damage whether direct, incidental,consequential,or special is limited to the greater of$100 or the authorized declared value. Recovery cannot exceed actual documented Ioss.Maximum for items of extraordinary value is$1,000, e.g.jewelry, precious metals, negotiable instruments and other items listed in our ServiceGuide.Written claims must be filed within strict time limits,see current FedEx Service Guide. hftps://www.fedex.com/shipping/shipmentConfirmationAction.handle?method=doContinue 1/1 so ELIZABETH A.NEVILLE,RMC,CMC '` ® Town Hall,53095 Main Road TOWN CLERK 6 P.O.Box 1179 REGISTRAR OF VITAL STATISTICS N Southold,New York 11971 MARRIAGE OFFICER ® a0 Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Tit, Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER Owl, southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD INSTRUCTIONS FOR DISPLAY OF FIREWORKS 1. Name of body sponsoring fireworks display. 2. The date and time of day at which the fireworks display is to be held. Display must be concluded by 10:00 p.m. if held Sunday through 'Thursday, 11:00 p.m. if held Friday or Saturday, and there shall be no time restriction if held on July 4. 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 and a copy of a valid certificate of competency as a pyrotechnician for the individual supervising the firing of the display 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. Detailed diagram showing location of fireworks discharge and minimum separation distances in accordance with the applicable requirements of Penal Law Section 405 (2). 8. Copy of the contract with fireworks display company. 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. Certificate of Insurance naming the Town of Southold as additional insured with coverage limits of' $2,000,000.00 for public liability and $2,000,000.00 for property damage. 10. The Town Clerk of the Town of Southold must have the insurance policy in her possession before the fireworks permit is issued. The named insured must read: TOWN OF SOUTHOLD. 11. Application for a fireworks permit must be made at least 30 days in advance of the date of the fireworks display. 12. All applications for a fireworks permit shall be subject to an application fee in an amount of$100.00, together with a processing fee in an amount to be determined by the Town Board to cover the Town's costs for monitoring and enforcing compliance with the Penal Law. (I'he above instiuctions aie ui accoidance with the Penal Law,Article 405-Ucensinng and othlel piovisims Ielating to fireworks o�aSt1fFDCkao' -.. ELI�,t�!$ETHA;'NEVILLEj,MMO ��, �. Ibw&HaH,`63095MainRoaa- =2"0VN'=HK PO.Box 1179 N Southola,NewYork 11971 REGISTRAR OF VVAL STATISTICS,O �' Fax(681):786=6145 ;14fAItR at OJMCER � aQ�.. 'itiIeplione.($31y766-18U0 RECORDS OI'_MANAGEMENT`_OFFICER 1' �• souEholdtowa.norEhfdfk riet iEraly�ciF. lroiTzoN orcERl. OFFICE OF THE"TOWIN 0-t- RK. `!'OWN'6F'SWItOL`D APPLICATION' pEltIV1TT-TD YlTSPY,AY-F)<REVti!ORK� APPL-WATIQN IS MREBY MAAb-E',•pursuant,to,,,6e=provisions of,Section-405.od ,af the Penal-Law of the State of New Yoik;far`a=P&hAt,to display fireworks ash ereinafter;specif o DISPLkVI5'TO;]BE5PQNSURED$Y Fyro Engineeflrjg Inc. PRINCIPAL OFFICE AT_'999.S. Qyster Bay Rd.,,Suite 11'1, Bethpage,.NY 1='171'4 >Dmt&..TIME OF:DISPLAY 1A/6%I'8 @ approxiniafely 9:00 pm v EXACT,z OCAT N61MMPLAY 1?iivatP �Psicl .n ,n 4'17.0-Indian Neck Rd; Peconic NY SUFFOLI COUNx`Y TA7 :'ivtAP'ftW R.FORSITE- L000--98-1-27:1 RAI N'DATE&'TIME N/A The1ollawing persons aceto_Loin-charge=of theactual sboofingvf'the_firew_oirks:z 'Name Age' Experience physical Cdndition William.;Lotterho8 4_ 3 years _-5 :years; +„ Health: Excenent" CbrisGoglier Acierno' 43 years 5 yea"r"s + Health:, Excellent .William;Razenson.: _ 35` yea..'rs--_5. years+ Health' Excelleri't (A iiditional names-4ndJrifb#A4tioifm0a:be subm_itted;,on an°attached'sheet Number airidtype.offireavorks;is as follows:- - 40-& - -i1-1 inert-ins: . 1:.3_G:Firewo'rks _2;-3,_inefin shells=app3 3 - -p3=us- total=4'52. Requestink-lire Department ;on rsite ,with brush 'Trucks. Wafter and place -of'storage of ;fireworks ;prior to display: D.elivery,df pOdwctwill be..day of display: Attached hereto:and made•a,Part-of hereof is a•diagram.Of the grounds On Wl cl 'the�display is-Iw be-held. Also attached::is a:certificate,'or#olic�.ofNsuranc 'caoerage.- NOTICE:,Written permissioni�witb'§ignatiure;of the, "r[y-Owner.;indst'be,suliinitted,with the Application.. Pyro Engineering I-nc. FEE: $100; Id_a ne offtariization ;See 'policy ifvr additional lnforimti6n Jo-Anne_Tfiolo._ By . ,rJnte ame of -pp — 11 - . . 1h,6a&, ignature of A 'can e-mail address joanne@bay*eworks•.com. leto hone Number P 5'f.6-597-5'500 bate=af Application, SPONS,ORt, Scalammtdre party Pireworks;Company Pyro Engineering,:lnc. dba Bay, Fireworks 999 S. Oyster Ray Rd., Siete°1,11 Bethpage,NY 11,7,.14' P:=5, 16-597Z500/'F: 516-597-5507 Show Date(*,1'0/6/.1.8 'Raiti.Date(s):' -n/a JLocatiom 41.701ndian,.Neek Rd-Te_conic,NY = Time:�'9:00 pin 1:;Total.number of`Class B shells being_u'seci: � & }�= per.r�leaie�x�s .Sizes between: linches-and-3-inches'in diameter. 2. All shells=are°DOT approved. 3. Display,wilfbe:fired eleotrically,and/or manually. A. D`eliv6ry to site will`be approximatelq 12':00 noon.-Se up will:;take approximately 4=5 hours. 5., Alldisplays.will.complg with°all requirements as sethtth jn:NYS Penal, Code 4Q5,andNFPA l 123,,1`12"4. 6., Pyro`,Engineering,Inc:has,c,omplete;understanding of.all,-rules And'regulations, �goyerning public fireworks displays and this,display vAll,be_ in accordance"with those rules and regulations. 7; Personnel'-representing_fireworks„display company: Lead: Christopher�Acierno (NYS'DOL PRA 77)-, William Lotter hos (NYS DOL PIR 98)' :William._Raz,enson (NYS-DOL.PR-7(, 8. Technician(s): tbd U _ Signe = Fire rks, omPany. ”'presentative t STAT£0I` I4pw yoRk- FAR.I ME 161E EAI;SJR a1 ROTECHNICIAN CEf:1lPICa'� OF Cd II'EiEI�CE WIWAM F RAZENSON CUES:A ANY DISPLAY THIS CARD MUST BE CARRIED t WHEN USING PYROi f t NYC &WS CfR11fFICAMONS, RI Q IRW IN NYC r tnnun�a+a�nttirra� ' o��gUFFO�,��oG Ei VABETE(A.)EVILLE,MMC �.Z. Zbwn Hall,53095 Main Road TOWN CLERK p P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p Fax(681)765-6145 MARRIAGE OFFICERRECORDS OF MANAGEMENT OFFICER y��j �`a0� Telephone n.nort631) fork. 0 FREEDOM OF INFORMATION OFFICER southoldtown.norEhfork.net OFFICE OF THE TOWN CLER,IK TOWN OF SOUTHOLD APPLICATION PERMIT TO DISPLAY FIREWORKS APPLICATION IS HEREBY MADE, pursuant to the provisions of Section 405.00 of the Penal Lava of the State of New York,for a permit to display fireworks as-hereinafter specified. DISPLAY IS TO BE SPONSORED BY Pyro Engineering Inc. PRINCIPAL OFFICE AT 999 S. Oyster Bay Rd., Suite 111, Bethpage, NY 11714 DATE&TIME OF,DISPLAY 10/6/18 @ approximately 9:00 pm EXACT LOCATION-OF DISPLAY Pr;vate r _s;den . 4170 Indian Neck Rd Peconic NY SUFFOLK COUNTY TAX MAP NUMBER FOR SITE 1000-98-1-27.1 RAIN DATE&TIME N/A The following persons are to be in charge of the actual shooting of the fireworks: Name Age Experience Physical Condition William Lotterhos 43 years 5 years + Health: Excellent Christopher Acierno 43 years 5 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: 2-3 inch shells=approximately 700 plus illuminations. Requesting -Fir'e Department on site with brush Trucks. Manner and place of storage of fireworks prior to display: Delivery of product will be 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 Prouerty Owner,must be submitted with the Application. Pyro Engineering Inc. FES: $100 Name of Organization See policy:fog additional information Jo-Anne Triolo By Printed ame of Applicant ignature of A ican e-mail address: Joanne@bayfireworks.com Telephone Number 516-597-5500 Date of Application Ota � f 1.0 E W Q K K S E N G I N E E R I N G WVV,V1'II,VYCIRCWORKSCOM VuYV'fJ. '(.!f'X.cuc?M October 2, 2018 RE: SCALAMANDRE PARTY 4170 INDIAN NECK LAND PECONIC, NY To Whom it May Concern; Please allow this letter to serve as permission Pyro Engineering dba Bay Fireworks to use my property for a firework display to take place Saturday, October 611 2018. The fireworks will start at our around 9:OOPM and last 3—5 minutes. Should you have any further questions, please feel free to contact me directly. Sincer ly, Ernes Scalamandre 999 South Oyster Bay Rd., Suite 111 I Bethpage,New York 11714 1 Phone: 516-597-5500 1 Fax: 516-597-5507 i ;.I , j 1 SpF�gT SCALAMANDRE O EVENT 3" MAX SIZED SHELLS FIREWORKS 150'RADIUS l ,. 300' RADIUS ILLUMINATIONS l 150' RADIUS 300'RADIUS v Sol 41 01 29 N ` ' V E 72 27 19 W ORO® DATE(MM/DD/YYYY) AC CERTIFICATE OF LIABILITY INSURANCE 10/02/2018 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 Shaunna Marquis NAME: Clark Insurance HOE Ext, (860)430-3700 A Nu: (860)430-3730 180 Glastonbury Boulevard ADDRESS: smarquis@mayboneeclark.com Suite 401 INSURER(S)AFFORDING COVERAGE NAIC# Glastonbury CT 06033 INSURERA, Lexington Insurance Company 19437 INSURED INSURERB, Liberty Mutual Insurance Company 23043 Pyro Engineering Inc. INSURERC' 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 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 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 INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR - INSD WVD POLICY NUMBER MM/DD MM/DDNYYY X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED' CLAIMS-MADE �OCCUR PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ A 023627358 02/15/2018 02/15/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY❑JERa F—]LOC PRODUCTS-COMP/OPAGG $ 2.000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acadent ANYAUTO BODILY INJURY,(Per person) $ OWNEDSCHEDULED BODILY INJURY(Per aaadent) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ X UMBRELLALIAB OCCUR EACH OCCURRENCE $ 9,000,000 A EXCESS LIAB HCLAIMS-MADE 023627359 02/15/2018 02/15/2019 AGGREGATE $ 9,000,000 DED I I RETENTION$ $ WORKERS COMPENSATIONX STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN EL EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBEREXCLUDEDI ❑ N/A WC5-39S-387471-018 02/15/2018 02/15/2019 (Mandatory In NH) E L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) Liberty Mutual Workers'Compensation States:CT,GA,NC,NV,SC,VA Date of Display:October 6,2018 LOCATION,OF DISPLAY:4170 Indian Neck Rd.,Peconic,NY Mr.Ernest Scalamandre;Town_of_Southold;Suffolk County are Included as additional insured's as respects to the General Liability policy per written agreemenUcontract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN Mr.Ernest Scalamandre ACCORDANCE WITH THE POLICY PROVISIONS. 4170 Indian Neck Rd. AUTHORIZED REPRESENTATIVE Peconic NY 11958 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I ® DATE(MM/DDIYYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 10/02/2018 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 Jo Ann Decker NAME: The Decker Agency Inc arc°NNo Ext• (716)883-1455 J)C No: (716)883-6210 37 Elmwood Avenue E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Buffalo NY 14201-2018 INSURER A: National Continental Insurance Company 10243 INSURED INSURERS: - Pyro Engineering Inc,DBA 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 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 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMBS LTR INSD WVD POLICY NUMBER MM/DD MM/DD COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE E OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL$ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER* GENERAL AGGREGATE $ POLICY E JET F LOC - PRODUCTS-COMP/OPAGG $ OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED ASCHEDULED CNY0004909233-8 02/15/2018 02/15/2019 BODILY INJURY(Per accident) $ AUTOS ONLY LITS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acadent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORMARTNER/EXECUTIVE ❑ N/A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If yes,describe 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) Operations of the named insured Date of Display:October 6,2018 Location of Display 4170 Indian Neck Rd.Peconic,NY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Mr.Ernest Scalamandre ACCORDANCE WITH THE POLICY PROVISIONS. 4170 Indian Neck Rd. AUTHORIZED REPRESENTATIVE /q� Peconlc NY 11958 a. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SPONSOR: Scalamandre party 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): 10/6/18 Rain Date(s): n/a Location: 4170 Indian Neck Rd. Peconic,NY Time: 9:00 pm 1. Total number of Class B shells being used: approximately 700 plus illuminations. Sizes between: 2 inches and 3 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: Christopher Acierno (NYS DOL PR-177) William Lotterhos (NYS DOL PR-98) 8. Technician(s): tbd Signe Fire rks ompany presentative STATE,OF.t EbV.'fC7RK:-D0ARf�#NT:bF,-LASORl MOTECHNICI41 CE'kilP!lr,R'iTE OF C t?WE TEh CE CHRISTOPHER AC1ERNO ANY DISPL;4 f TN(S CARD MUST;BE"CRftR1Ep a° VKUSINGTYROT CRT#P:',.-777. i NYC'&NYS•CtknFl(:AT16NS REQUIREt)I,N-wc ' _.. ._.__ .' .�• � �,_ __�;,irn�uiumc�inulogra�.t "f, w, S,a NA ` 2 s'''"" '"�'"" s-1 'q'Yy' w``+• sn vsF � :? ,r vire 3 3 r '- ` '` s', '"•`,, '., a o x' +1'tq" 5' '" �''"•r x1' s s< ,.... "' $+ �qz'`^t 2li "', =...3 1+ x,+ rr�z" ^z '�• `�"ym� �} ' 'iX. 44. rL a7',c,Y .44"� � 1'•?'a � i�5r �� A•;x �` f e� aos�� n � r {R� '�i, t°.� �'+ ��a` a4'`g � •c fi`7 �u� ,'� d s x u as:• i ,�,'.. 2• s a x � �i,.x't' 'r� ^, s, WX � � °'C 3. � .y s � F¢;to�; � 4��.x aPe x •.t ,. '� tt;4� '� ��s• •" � x �: v �"w b +'i" �'�: �.r s4 '� a..'' " _ `+'. x t' k +fit Y.rr� 'vx` dg"Lr !Y 3 ffih, gax 55"yyNi "k•S'k. .` `" `; �' L 4`' #h i; { � e .. ,n, �,.• „# "�z+ie r '� *may A t w t"�. _ �,� 8� �� ._ #;•.ss, ��, ��v: '�=_ a �ars L€ k" x„= zc° s wp'-gee TT �,Py �� x^�'�^tri"" >'1"•''^ r -. F ta r +}'4 4.4„ 71 • • • • • - -�• •.� - 11' 11111.1 FAA/Air Traffic Organization 1701 Columbia Avenue low Ea§tem Service Center College Park,GA 30337 U.S. Department of Transportation Federal Aviation Administration Dear Fireworks Proponent: FAA-Peconic, NY 10/6/18 Thank you for informing us of your proposed fireworks display. Although there are currently no federal regulations specific to fireworks 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 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 ifthe display will exceed 500 feet Above Ground Level (AGL),contact Leidos Flight Service at 1-877-4-US-NTMS (1-877-487-6867)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) o Maximu n 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-Fireworks cr,faa.gov. Sincerely, Ryan W. Almasy Manager, Operations Support Group Eastern Service Center, Air Traffic Organization " all 999 South Oyster Bay Road a Suite 111 Bethpage, NY 11714 T: 516:597.5500 a F:516.597.5507 E N G I N E E R I N G www.ppkfx.com wtvwbgfirewozlcs.com World Class Productions Date: 10/3/18 FAX: 631-765-5009 ri PHONE: 631-765-3385 :tr _ Southold Fire Department 55135 Main Road Fireworks Symposium P.O. Box 1469 at Walt Disney World America's 400th Anniversary Southold,NY 11971 Casinos.Bally's,Caesars;CI_aridge Major Theme Parks Dear Chief: NASA's 50th Anniversary Universal Orlando Resort Centennial I Milestone Events Pyro Engineering Inc. dba Volt Live will be conducting a firework display for a private event located at 4170 Indian Neck_ Lane, Peconic NY. Time of display is 9:00 pm Major Sporting Events We respectfully request a"Stand-By Pumper"to be on site during the display time. I have enclosed a map of the fireworks launch site. Please call our office at 516-597-5500 to confirm receipt of this letter. Thank you. Major League Baseball t U.S.Olympic Committee. incerely, State Games of America National Football League Minor League Baseball o-Anne Triolo PGA 1 LPGA Courses&Events joanne@bavfireworks.com Goodwill Games I Concert Tours.Close Proximity Ultra,Music Fest•Miami Electric Daisy Carnival-Las Vegas Kaly Perry•One Direction Alice Cooper-Swedish House Mafia Stadium,Stage,Concerts Theatrical Events Theme Parlt Design-Consultation NATIONAL:800-606-3716 U NY CT PA MO VA SC GA K TX NV CA r;. New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,2ND FLR,MELVILLE,NEW YORK 11747-3166 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE � D A A A A A A 753044987 BOSTON INSURANCE BROKERAGE 28 STATE ST FL 22 BOSTON MA 02109 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER PYRO ENGINEERING INC MR.ERNEST SCALAMANDRE DBA BAY FIREWORKS 4170 INDIAN NECK RD. 999 S.OYSTER BAY RD, STE 111 PECONIC NY 11958 BETHPAGE.NY 11714 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2437 559-4 112405 02/27/2018 TO 02/15/2019 10/2/2018 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 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://WWW.NYSIF.COM/CERT/CERTVAL.ASP.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 AND/OR 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 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: 1046663732 U-26.3 I ® DATE(MMIDD/YYYY) ,d►CR® CERTIFICATE OF LIABILITY INSURANCE 10/03/2018 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 Shaunna Marquis NAME: Clark Insurance AICNNo Ext• (860)430-3700 IX C No)' (860)430-3730 180 Glastonbury Boulevard E-MAILSS, smarquls@mayboneeclark com Suite 401 INSURER(S)AFFORDING COVERAGE NAIC# Glastonbury CT 06033 INSURERA Lexington Insurance Company 19437 INSURED INSURER B. Liberty Mutual Insurance Company 23043 Pyro Engineering Inc 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 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMBS LTR INSD WVD POLICY NUMBER MM/DD MM/DD _ X COMMERCIAL GENERAL LIABILITY _ _ EACH OCCURRENCE $ 1,000,000DAMAGE TO RENTED _ CLAIMS-MADE �OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ A 023627358 02/15/2018 02/15/2019 PERSONAL a ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER GENERAL AGGREGATE $ 2.000,000 X POLICY JET F—]LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acadent H $ X UMBRELLA LIAB OCCUR _ EACH OCCURRENCE $ 9,000,000 A EXCESS LIAB HCLAIMS-MADE 023627359 02/15/2018 02/15/2019 AGGREGATE $ 9,000,000 DED I I RETENTION$ $ WORKERS COMPENSATIONX STATUTE ERH AND EMPLOYERS'LIABILITY YIN 1,000,000 B ANY PROPRIETORIPARTNER/EXECUTIVE ❑ NIA WC5-39S-387471-018 02/15/2018 02/15/2019 EJ_EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ If yes,descnbe under 1,000,000 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) Liberty Mutual Workers'Compensation States.CT,GA,NC,NV,SC,VA Date of Display.October 6,2018 LOCATION OF DISPLAY.4170 Indian Neck Rd.Peconlc,NY Aurelian Farms LLC dba Indian Neck Farms,Mr.Ernest Scalamandre;Town of Southold,Suffolk County are Included as additional insured's as respects to the Genera(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 Aurelian Farms LLC dba Indian Neck Farms ACCORDANCE WITH THE POLICY PROVISIONS. 4170 Indian Neck Lane AUTHORIZED REPRESENTATIVE Peconic NY 11958 1_J_J @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ® DATE(MM/DD/YYYY) A�v CERTIFICATE OF LIABILITY INSURANCE 10/03/2018 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND 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 Jo Ann Decker NAME: The Decker Agency Inc A!14 Etl. (716)883-1455 A No, (716)883-6210 37 Elmwood Avenue E-MAIL ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# Buffalo NY 14201-2018 INSURER A: National Continental Insurance Company 10243 INSURED INSURER B: Pyro Engineering Inc,DBA.Bay Fireworks INSURER C. 999 S Oyster Rd Suite 111 INSURERD' INSURER E: Bethpage NY 11714 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 MASTER REVISION NUMBER: _-THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD - INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS - CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMBS LTR - INSD WVD POLICY NUMBER MWDD MM/DD COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ CLAIMS-MADE FlOCCUR - PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $ POLICY F—]JET F—]LOC PRODUCTS-COMP/OPAGG $ OTHER - $ AUTOMOBILE UABILiTy COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED CNY0004909233-8 02/15/2018 02/15/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acadent UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ NIA EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Operations of the named insured Date of Display October 6,2018 Location of Display:4170 Indian Neck Rd Peconic,NY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Aurelian Farms LLC dba Indian Neck Farms ACCORDANCE WITH THE POLICY PROVISIONS. 4170 Indian Neck Lane AUTHORIZED REPRESENTATIVE Peconlc NY 11958 ©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&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,2ND FLR,MELVILLE,NEW YORK 11747-3166 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE. ^^^A^^ 753044987 BOSTON INSURANCE BROKERAGE 28 STATE ST FL 22 a .' BOSTON MA 02109 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER PYRO ENGINEERING INC _ AURELIAN FARMS LLC DBA INDIAN DBA BAY FIREWORKS NECK FARMS 999 S.OYSTER BAY RD, STE 111 4170 INDIAN NECK LANE BETHPAGE NY 11714 PECONIC NY 11958 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD- DATE H2437 559-4 114819 02/27/2018 TO 02/15/2019 10/3/2018 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 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://WWW.NYSIF.COM/CERT/CERTVAL.ASP.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 AND/OR 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 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:788769383 U-26.3 y Neville, Elizabeth From: Neville, Elizabeth Sent: Friday, October 05, 2018 11:17 AM To: Flatley, Martin;Verity, Mike; Fisher, Robert; info@southoldfd.com Cc: Duffy, Bill; Hagan, Damon; Silleck, Mary, 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 Subject: FW:4170 Indian Neck Rd. Peconic firework display application 10/6/18 Attachments: Scalamandre-updated.pdf Importance: High The fireworks application has been updated identifying the lead tech and shell count for Saturdays display...please see attachment. I have just spoken with Southold Fire Department Chief Craig Goldsmith who said they have approved the fireworks display and will provide on-site coverage. He will be e-mailing a letter to this effect shortly which will be passed onto you. I have advised the applicant from this point on they must correspond with the Town Attorney's Office with regard to procuring the permission of the Supervisor and Town Board to proceed with this event tomorrow evening. 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 From: Jo-Anne Triolo [mailto:joanne@bayfireworks.com] Sent: Friday, October 05, 2018 10:13 AM To: Neville, Elizabeth Subject: Re: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 Good morning, I've updated the lead tech and shell count for Saturdays display...please see attached. Thank you. Jo-Anne On Thu, Oct 4, 2018 at 5:14 PM,Neville,Elizabeth<E.Nevillena,town.southold.n, .us>wrote: OK, after the Fire Dept. It will have to get the approval of the Town Board andthe Town Attorney 1 y Sent from my Verizon, Samsung Galaxy smartphone -------- Original message -------- From: Jo-Anne Triolo <joanne@bUfireworks.com> Date: 10/4/18 12:10 PM(GMT-05:00) To: "Neville,Elizabeth" <E.Neville@town.southold.n�us> Subject: Re: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 Southold FD Chief Craig Goldsmith just called me. I sent him the formal letter of request for "stand by" and a site map. He will bring it to the District meeting tonight and call me in the morning. On Thu, Oct 4, 2018 at 11:57 AM, Jo-Anne Triolo <ioanne@bayfireworks.com<mailto:joanne@bayfireworks.com>>wrote: Hi Betty, I've reached out to the Southold FD to obtain approval from the Fire Chief. The fire house is trying to contact the Chief,to contact me; so that I can explain the specifics. Jo-Anne On Thu, Oct 4, 2018 at 10:35 AM,Neville, Elizabeth <E.Neville@town.southold.ny.us<mailto:E.Neville@town.southold.ny.us>>wrote: Jo-Anne, I am working on it. I will let you know as soon as possible when all of the reviews come in. From: Jo-Anne Triolo [mailto:ioannenbayfireworks.com<mailto:joanne&bayfireworks.com>] Sent: Thursday, October 04, 2018 10:33 AM To: Neville, Elizabeth Subject: Re: 4170 Indian Neck Rd. Peconic<https://mgps.google.com/?q=4170+Indian+Neck+Rd.+Peconic&entry=gmail&source=g>firework display application 10/6/18 Good morning Elizabeth, Just a follow up on the application for a private display this Saturday at 4170 Indian Neck Rd., Peconic<https://maps.goo gle.com/?q=4170+Indian+Neck+Rd.,+Peconic&entry=gmail&source=g>. I'd like to reach out to the Southold Fire Department directly to request a pumper on site during the display, but I don't want to do so if the display application won't be approved. In addition, I have the $100 permit check here on my desk. Should I overnight that to you as well? Please advise. Thank you very much Sincerely, 2 Jo-Anne On Wed, Oct 3, 2018 at 12:31 PM, Jo-Anne Triolo <Joanne@bayfireworks.com<mailto:joanne@bayfireworks.com>>wrote: Good afternoon Elizabeth, Attached is the Town of Southold firework permit application for a private event at 4170 Indian Neck Rd., Peconic,NY<https://maps.google.com/?q=4170+Indian+Neck+Rd.,+Peconic,+NY&entry=gmail&source=g>.. Time of display is 9:00 pm. I will contact you to confirm receipt...thank you. Sincerely, Jo-Anne Jo-Anne Triolo Pyro Engineering Inc. dba Bay Fireworks 999 South Oyster Bay Road, Suite 111<https•//mgps.g_oogle.com/?q=999+South+Oyster+Bay+Road+Suite+111+%OD%OA+%OD%OA+%OD%O A+Bethpage,+NY+11714&entry--gmail&source=g> Bethpage,NY 11714<https•//maps google.com/?q=999+South+Oyster+BU+Road,+Suite+111+%OD%OA+%OD%OA+%OD% OA+Bethpage,+NY+11714&entry=gmail&source=a> 516-597-5500 Phone/ 516-597-5507 Fax Jo-Anne Triolo Pyro Engineering Inc. dba Volt Live 999 South Oyster Bay Road, Suite 111<https://maps.google.com/?q=999+South+Oyster+Bay+Road,+Suite+111+%OD%OA+%OD%OA+%OD%O A+Bethpage,+NY+11714&entry=gmail&source—g> Bethpage,NY 11714<https://mgps.google.com/?q=999+South+Oyster+Bay+Road,+Suite+111+%OD%OA+%OD%OA+%OD% 0A+Bethpage,+NY+11714&entry=gmail&source=g> 516-597-5500 Phone/516-597-5507 Fax Jo-Anne Triolo Pyro Engineering Inc. dba Volt Live 999 South Oyster Bay Road, Suite 111 Bethpage,NY 11714 516-597-5500 Phone/516-597-5507 Fax 3 r y Jo-Anne Triolo Pyro Engineering Inc. dba Volt Live 999 South Oyster Bay Road, Suite 111 Bethpage,NY 11714 516-597-5500 Phone/ 516-597-5507 Fax Jo-Anne Triolo Pyro Engineering Inc. dba Volt Live 999 South Oyster Bay Road, Suite 111 Bethpage,NY 11714 516-597-5500 Phone/516-597-5507 Fax 4 Neville, Elizabeth From: Neville, Elizabeth Sent: Friday, October OS, 2018 11:21 AM To: joanne@bayfireworks.com Cc: Duffy, Bill; Hagan, Damon; Silleck, Mary Subject: Fireworks 10/618 As I mentioned on the telephone this morning,from this point forward you will have to contact the Town Attorney's Office regarding the Scalamandre Fireworks Permission/Approval for Saturday 10/6 William Duffy,Town Attorney Damon Hagan,Assistant Town Attorney Tele. 631765-1939 Phone(631)765-1939 Fax(631)765-6639 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: Duffy Bill Sent: riday, October 05, 2018 2:27 PM To: Jo-Anne Triolo; Hagan, Damon Cc: Silleck, Mary; Neville, Elizabeth; Rudder, Lynda; Doroski, Bonnie Subject: RE: Fireworks 10/618 We have received authority from the Town board to issue the permit. The application has been granted. You can contact the clerk's office to obtain the permit. William M. Duffy, Esq. Town Attorney Town of Southold Southold Town Annex 54375 Route 25 (Main Road) P.O. Box 1179 Southold, New York 11971-0959 Office: 631.765-1939 Fax: 631.765.6639 Email: billd@southoldtownny.gov 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. From: Jo-Anne Triolo [maiito:joanne@bayfireworks.com] Sent: Friday, October 05, 2018 12:34 PM To: Duffy, Bill; Hagan, Damon Cc: Silleck, Mary; Neville, Elizabeth Subject: Re: Fireworks 10/618 Good afternoon Mr. Duffy, I'm following up on the status of the firework application for tomorrow nights private display at 4170 Indian Neck Place, Peconic at 9:00 pm. We have obtained approval from the Southold Fire Chief for the display. The FD will be on site with stand by equipment. Thank you. i Sincerely, Jo-Anne On Fri, Oct 5, 2018 at 11:20 AM,Neville, Elizabeth<E.Neville@town.southold.ny.us>wrote: As I mentioned on the telephone this morning, from this point forward you will have to contact the Town Attorney's Office regarding the Scalamandre Fireworks Permission/Approval for Saturday 10/6 William Duffy, Town Attorney Damon Hagan, Assistant Town Attorney Tele. 631765-1939 Phone(631)765-1939 Fax(631)765-6639 Elizabeth A. Neville, MMC Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel. 631765-1800,Ext.228 Fax 631 765-6145 Cell 631466-6064 Jo-Anne Triolo Pyro Engineering Inc. dba Volt Live 999 South Oyster Bay Road, Suite 111 Bethpage,NY 11714 516-597-5500 Phone/ 516-597-5507 Fax 2 i' 4 Rudder, Lynda From: Jill Doherty - Forward_ Sent: Friday, October 05, 2018 1:24 PM To: Bob Ghosio Cc: Duffy, Bill; Neville, Elizabeth; Silleck, Mary; Doherty, Jill; Doroski, Bonnie; Ghosio, Bob; Hagan, Damon;Jim Dinizio; Standish, Lauren; Louisa Evans; Rudder, Lynda; Russell, Scott;Tomaszewski, Michelle;William Ruland Subject: Re:4170 Indian Neck Rd. Peconic firework display application 10/6/18 I'm fine with it now that the fire dept has been properly notified. Sent from my iPhone On Oct 5, 2018, at 1:08 PM, Bob Ghosio Jr. <rgopher2@ mail.com>wrote: I'm fine with it. Sent from my iPhone On Oct 5, 2018, at 11:11 AM, Duffy, Bill <billd@southoldtownnoy>wrote: Dear Board Members, Since this event is prior to the next town board meeting I advised Betty the best way to proceed would be to have at least 4 town members sign off on this event in an email and then we could ratify the issuance of the permit on Tuesday. To that end, please respond as soon as possible as to whether you support the issuance of the permit or not. Given limited time available, I will also be asking Mary to contact by phone. Thanks, Bill William M. Duffy, Esq. Town Attorney Town of Southold Southold Town Annex 54375 Route 25 (Main Road) P.O. Box 1179 Southold, New York 11971-0959 Office: 631.765-1939 Fax: 631.765.6639 Email: billd@southoldtownny.go_v 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. 1 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. From: Neville, Elizabeth Sent: Friday, October 05, 2018 11:17 AM To: Flatley, Martin; Verity, Mike; Fisher, Robert; info@southoldfd.com Cc: Duffy, Bill; Hagan, Damon; Silleck, Mary; 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 Subject: FW: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 Importance: High The fireworks application has been updated identifying the lead tech and shell count for Saturdays display...please see attachment. I have just spoken with Southold Fire Department Chief Craig Goldsmith who said they have approved the fireworks display and will provide on-site coverage. He will be e- mailing a letter to this effect shortly which will be passed onto you. I have advised the applicant from this point on they must correspond with the Town Attorney's Office with regard to procuring the permission of the Supervisor and Town Board to proceed with this event tomorrow evening. 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 631 765-6145 Cell 631466-6064 From: Jo-Anne Triolo [mailto:joanne(cbbayfireworks.com] Sent: Friday, October 05, 2018 10:13 AM To: Neville, Elizabeth Subject: Re: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 Good morning, 2 I've updated the lead tech and shell count for Saturdays display...please see attached. Thank you. Jo-Anne On Thu, Oct 4, 2018 at 5:14 PM,Neville, Elizabeth <E.Nevillegtown.southold.n�us>wrote: OK, after the Fire Dept. It will have to get the approval of the Town Board andthe Town Attorney i Sent from my Verizon, Samsung Galaxy smartphone -------- Original message -------- From: Jo-Anne Triolo <joanne@bayfireworks.com> Date: 10/4/18 12:10 PM (GMT-05:00) To: "Neville, Elizabeth" <E.Neville@town.southold.ny.us> Subject: Re: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 Southold FD Chief Craig Goldsmith just called me. I sent him the formal letter of request for "stand by" and a site map. He will bring it to the District meeting tonight and call me in the morning. On Thu, Oct 4, 2018 at 11:57 AM, Jo-Anne Triolo <Joannegbayfireworks.com<mailto:joanne@,bayfireworks.com>>wrote: Hi Betty, I've reached out to the Southold FD to obtain approval from the Fire Chief. The fire house is trying to contact the Chief,to contact me, so that I can explain the specifics. Jo-Anne On Thu, Oct 4, 2018 at 10:35 AM,Neville, Elizabeth <E.Neville@town.southold.ny.us<mailto:E.Nevillena town.southold.ny.us>> wrote: Jo-Anne, I am working on it. I will let you know as soon as possible when all of the reviews come in. From: Jo-Anne Triolo [mailto:]oanne@bayfireworks.com<mailto:j oannenbayfireworks.com>] Sent: Thursday, October 04, 2018 10:33 AM To: Neville, Elizabeth Subject: Re: 4170 Indian Neck Rd. Peconic Rd.+Peconic&entry=g 3 r mail&source=g> firework display application 10/6/18 Good morning Elizabeth, Just a follow up on the application for a private display this Saturday at 4170 Indian Neck Rd., Peconic<https://mates.google.com/?q=4170+Indian+Neck+Rd.,+Peconic&entry=g mail&source=g>. I'd like to reach out to the Southold Fire Department directly to request a pumper on site during the display,but I don't want to do so if the display application won't be approved. In addition, I have the $100 permit check here on my desk. Should I overnight that to you as well? Please advise. Thank you very much Sincerely, Jo-Anne On Wed, Oct 3, 2018 at 12:31 PM, Jo-Anne Triolo <joanne@bayfireworks.com<mailto:joanne@bayfireworks.com>>wrote: Good afternoon Elizabeth, Attached is the Town of Southold firework permit application for a private event at 4170 Indian Neck Rd., Peconic, NY<https //mks goole com/?q=4170+Indian+Neck+Rd.,+Peconic,+NY&entry =gmail&source=g>.. Time of display is 9:00 pm. I will contact you to confirm receipt...thank you. Sincerely, Jo-Anne Jo-Anne Triolo Pyro Engineering Inc. dba Bay Fireworks 999 South Oyster Bay Road, Suite 111 Suite+111+%0 D%OA+%OD%OA+%OD%OA+Bethpage+NY+11714&entry=gmail&source=g> Bethpage,NY 11714 Suite+111+ %OD%OA+%OD%OA+%OD%OA+Bethpage+NY+11714&entry=gmail&source= g> 516-597-5500 Phone/ 516-597-5507 Fax 4 Jo-Anne Triolo Pyro Engineering Inc. dba Volt Live 999 South Oyster Bay Road, Suite 111<https://maps. 0000gle.com/?q=999+South+Oyster+Bay+Road,+Suite+111+%0 D%OA+%OD%OA+%OD%OA+Betlhpage,+NY+11714&entry=gmail&source=g> Bethpage,NY 11714<https://maps.google.com/?q=999+South+Oyster+Bay+Road,+Suite+111+ %OD%OA+%OD%OA+%OD%OA+Bethpage,+NY+11714&entry=email&source= 9> 516-597-5500 Phone/ 516-597-5507 Fax Jo-Anne Triolo Pyro Engineering Inc. dba Volt Live 999 South Oyster Bay Road, Suite 111 Bethpage,NY 11714 516-597-5500 Phone/ 516-597-5507 Fax Jo-Anne Triolo Pyro Engineering Inc. dba Volt Live 999 South Oyster Bay Road, Suite 111 Bethpage,NY 11714 516-597-5500 Phone/ 516-597-5507 Fax Jo-Anne Triolo Pyro Engineering Inc. dba Volt Live 999 South Oyster Bay Road, Suite 111 Bethpage,NY 11714 516-597-5500 Phone/ 516-597-5507 Fax 5 Neville, Elizabeth From: Jim Dini io_.1 Sent: Thursday, October 04, 2018 10:19 AM To: Russell, Scott Cc: Hagan, Damon; Neville, Elizabeth; Duffy, Bill; Silleck, Mary; Doherty,Jill; Ghosio, Bob; Standish, Lauren; Louisa Evans; Noncarrow, Denis;Tomaszewski, Michelle;William Ruland Subject: Re:4170 Indian Neck Rd. Peconic firework display application 10/6/18 If Mike Verity and Bob Fishers schedule doesn't permit timeUo do the prover inspection then turn it down. Sterlingtelcom.com >On Oct 4,2018,at 8:57 AM, Russell,Scott<scottr@southoldtownny.gov>wrote: >good point. I would think the issue is if Mike Verity and Bob Fisher think they have been given the time to review the site >Sent from my Verizon,Samsung Galaxy smartphone >--------Original message-------- > From:Jim Dinizio<jim@jamesdinizio.com> > Date: 10/4/18 8:44 AM (GMT-05:00) >To: "Hagan, Damon"<damonh@southoldtownny.gov> >Cc: "Russell,Scott" <scottr@southoldtownny.gov>, "Neville, Elizabeth"<E.Neville@town.southold.ny.us>, "Duffy, Bill" <billd@southoldtownny.gov>, "Silleck, Mary"<marys@town.southold.ny.us>, "Doherty,Jill" <jill.doherty@town.southold.ny.us>, "Ghosio, Bob" <bob.ghosio@town.southold.ny.us>, "Standish, Lauren" <Lauren.Standish@town.southold.ny.us>, Louisa Evans<Ipevans06390@gmail.com>, "Noncarrow, Denis" <denisn@southoldtownny.gov>, "Tomaszewski, Michelle"<michellet@town.southold.ny.us>,William Ruland <rulandfarm@yahoo.com> >Subject: Re:4170 Indian Neck Rd. Peconic firework display application 10/6/18 >I suppose we could turn it down because they were not timely. But what do we gain if they tell us 5 days or 3 days in advance? >Sterlingtelcom.com >>On Oct 3,2018,at 5:21 PM, Hagan, Damon<damonh@southoldtownny.gov>wrote: >>We could not pass a local law to prohibit fireworks. Subsection 5 of penal law 405.00 prevents an outright ban of fireworks by the local municipality. It states'Al local ordinances regulating or prohibiting the display of fireworks are hereby superseded by the provisions of this section.' Neville, Elizabeth From: j, Flatlev. Martin Sent: Thursday, October 04, 201810:07 AM To: Neville, Elizabeth;Verity, Mike; Fisher, Robert Subject: RE:4170 Indian Neck Rd. Peconic firework display application 10/6/18 1 have no objections to this application being approved as long as the Fire Department approves it and ra=andb for _ 1 the display. Martin Flatley,Chief of Police Southold Town Police Department 41405 State Route 25 Peconic,New York 11958 631-765-3115 . F f From: Neville, Elizabeth Sent:Thursday, October 04, 2018 9:56 AM To: Flatley, Martin<mflatlev@town.southold.nv.us>;Verity, Mike<Mike.Verity@town.southold.nv.us>; Fisher, Robert <Robert.Fisher town.southold.ny.us> Subject: FW:4170 Indian Neck Rd. Peconic firework display application 10/6/18 Importance: High Please review this"Fireworks Application" as soon as possible and send your comments. Not sure what is going to happen with it. I think the Town Board would like to know if all of you would approve of it in order to make their decision. Betty *1 am going to forward a couple of e-mails to you to give you a little background on this. 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 From: Neville, Elizabeth Sent: Wednesday, October 03, 2018 2:40 PM To: Duffy, Bill; Hagan, Damon; Silleck, Mary Cc: Doherty,Jill; Doroski, Bonnie; Ghosio, Bob; James Dinizio; Lauren Standish; Louisa Evans; Neville, Elizabeth; Noncarrow, Denis; Rudder, Lynda (lynda.rudder(&town.southold.ny.us); Russell, Scott; Tomaszewski, Michelle; William Ruland 1 Neville, Elizabeth From: Neville, Elizabeth Sent: Thursday, October 04, 2018 10:14 AM To: 'info@southoldfd.com' Subject: ?Approval for Fireworks Application?? P Attachments: Firework permit appi 10-6-18.pdf 16 Importance: High Chief Goldsmith, Attached, please find an application for a "Fireworks Permit". Please review and let me know if you would approve of _ /this event;and also if the Southold Fire Department would be available to stand by for this event. _ The event is for this Saturday. So,time is of the essence. 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: Russell, Scott Sent: Thursday, October 04, 2018 8:58 AM To: Jim Dinizio; Hagan, Damon Cc: Neville, Elizabeth; Duffy, Bill; Silleck, Mary; Doherty,Jill; Ghosio, Bob; Standish, Lauren; Louisa Evans; Noncarrow, Denis;Tomaszewski, Michelle;William Ruland Subject: Re:4170 Indian Neck Rd. Peconic firework display application 10/6/18 good point I would think the issue is if Mike Verity and Bob Fisher think they have been given the = time to review the site Sent from my Verizon,Samsung Galaxy smartphone -------- Original message -------- From: Jim Dinizio <jim@jamesdinizio.com> Date: 10/4/18 8:44 AM (GMT-05:00) To: "Hagan, Damon" <damonh@southoldtownny.gov> Cc: "Russell, Scott" <scottr@southoldtownny.gov>, "Neville, Elizabeth" <E.Neville@town.southold.ny.us>, "Duffy,Bill" <billd@southoldtownny.gov>, "Silleck,Mary" <marys@town.southold.ny.us>, "Doherty, Jill" <jill.doherty@town.southold.ny.us>, "Ghosio, Bob" <bob.ghosio@town.southold.ny.us>, "Standish, Lauren" <Lauren.Standish@town.southold.ny.us>, Louisa Evans <lpevans06390@gmail.com>, "Noncarrow, Denis" <denisn@southoldtownny.gov>, "Tomaszewski, Michelle" <michellet@town.southold.ny.us>, William Ruland <rulandfarm@yahoo.com> Subject: Re: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 I suppose we could turn it down because they were not timely.But what do we gain if they tell us 5 days or 3 days in advance? Sterlingtelcom.com >On Oct 3,2018,at 5:21 PM,Hagan,Damon<damonh@southoldtownny.gov>wrote: >We could not pass a local law to prohibit fireworks. Subsection 5 of penal law 405.00 prevents an outright ban of fireworks by the local municipality. It states'All local ordinances regulating or prohibiting the display of fireworks are hereby superseded by the provisions of this section.' >In the immediate case we would not be prohibiting the display due to a local ordinance,we would be denying the permit based on the failure of the applicant to follow the requirements of the NY State Penal Law 405.00(3)where it requires that the application'shall be made at least five days in advance of the date of the display'. >On Oct 3,2018 4:53 PM,"Russell, Scott" <scottr@southoldtownny.gov>wrote: >We tried limiting or banning fireworks displays on several occasions in the past.Both code amendments were submitted to NYS by parties who opposed them.NYS found that we were pre-empted from banning them but merely had the authority to require permits and evaluate sites for compliance with State codes.In another instance,we opted to increase fees for the permits instead,however, NYS found the fees we proposed exceeded what we were permitted to set.Back then,I believe the limit set was nominal. >If things changed since then,great.I would love to limit displays and increase fees. >There may be old code drafts and correspondence in the Attorney's records 1 � r Neville, Elizabeth From: Neville, Elizabeth Sent: Thursday, October 04, 2018 9:57 AM To: Flatley, Martin;Verity, Mike; Fisher, Robert Subject: FW:4170 Indian Neck Rd. Peconic firework display application 10/6/18 Importance: High FYI From: Hagan, Damon Sent: Wednesday, October 03, 2018 5:22 PM To: Russell, Scott Cc: Neville, Elizabeth; Duffy, Bill; Silleck, Mary; Doherty,Jill; Ghosio, Bob; Jim Dinizio; Standish, Lauren; Louisa Evans; Noncarrow, Denis;Tomaszewski, Michelle; William Ruland Subject: Re: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 We could not pass a local law to prohibit fireworks. Subsection 5 of penal law 405.00 prevents an outright ban of fireworks by the local municipality. It states ' All local ordinances regulating or prohibiting the display of fireworks are hereby superseded by the provisions of this section.' I n the immediate case we would not be prohibiting the display due to a local ordinance, we would be denying the permit based on the failure of the applicant to follow the requirements of the NY State Penal Law 405.00 (3) where it requires that the application's hall be made at least five days in advance of the date of the display'. On Oct 3, 2018 4:53 PM, "Russell,, Scott" <scottr@southoldtownny.gov>wrote: We tried limiting or banning fireworks displays on several occasions in the past. Both code amendments were submitted to NYS by parties who opposed them. NYS found that we were pre- empted from banning them but merely had the authority to require permits and evaluate sites for compliance with State codes. In another instance, we opted to increase fees for the permits instead , however, NYS found the fees we proposed exceeded what we were permitted to set. Back then, believe the limit set was nominal. If things changed since then, great. I would love to limit displays and increase fees. There may be old code drafts and correspondence in the Attorney's records Sent from my Verizon,Samsung Galaxy smartphone -------- Original message -------- From: "Hagan, Damon" <damonh@southoldtownny.gov> Date: 10/3/18 4:14 PM(GMT-05:00) To: "Russell, Scott" <scottr@southoldtownny.gov>, "Neville, Elizabeth" <E.Neville@town.southold.ny.us>, "Duffy,Bill" <billd@southoldtownny.gov>, "Silleck, Mary" <marys@town.southold.ny.us> I r Cc: "Doherty, Jill" <jill.doherty@town.southold.ny.us>, "Ghosio, Bob" <bob.ghosio@town.southold.ny.us>, Jim Dinizio <jim@jamesdinizio.com>, "Standish, Lauren" <Lauren.Standish@town.southold.ny.us>, Louisa Evans<lpevans06390@gmail.com>, "Noncarrow, Denis" <denisn@southoldtownny.gov>, "Tomaszewski, Michelle" <michellet@town.southold.ny.us>, William Ruland<rulandfarm@yahoo.com>' Subject: RE: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 Under 405.00 subsection 1 the Town does have permit authority for firework displays and is specifically listed as the appropriate party for the issuing of the same within the Town in the statute. An application submitted less than 5 days before the event does not abide by the requirements for granting a permit under 405.00 subsection 3. This is also listed in bold on the sample 'General Pyrotechnic Permit Application'the State Department of Labor has provided local municipalities for the regulation of firework displays in their Towns and Villages. Should the Town deny this application based on the applicants failure to timely file the permit application,the Town would be acting in accordance with the conditions set forth in Penal Law 405.00. 1 do not believe this would be a preempting,superseding or otherwise restricting an action regulated by the state,this would be in keeping with the Statute and educational literature that the State has distributed to municipalities. Yours Truly etc., Dainon A.Hagan Assistant Town Attorney Town of Southold Town Hall Annex 54375 Route 25 PO Box 1179 Southold,NY 11971-0959 Phone(631)765-1939 Fax(63 1)765-6639 2 . . This electronic mail transmission may contain confidential m privileged information. Ifyou believe that you have received the message inerror, please notify tile sender bvreply transmission and delete the message without copying or disclosing it. From: Russell, Scott Sent: Wednesday, October O3, 2O183:17PM To: Neville, Elizabeth; Duffy,� Bill; Hagan, Damon; SU|eck. Mary Cc: Doherty, Jill; Ghosio, Bob; Jim D|n|z|o; Standish, Lauren; Louisa Evans} Noncarnow, Oanis; 7lomaszevxsN, Michelle; VNUiam0uland Subject: RE: 4170 Indian Neck Rd. Peconkc firework display application 10/6/18 While it may be a less than ideal area for a fireworks display, I believe that,while towns have the authority to require permits, I do not thinkthat a town's denial of a permit means that the fireworks display can be stopped. Generally, fireworks are regulated by NYS Law and, 8i||, correct me if am wrong,towns are pre-empted from restricting actions regulated by the State. However,the Chief Building Inspector/ Fire Marshall can review it on a site specific basis and deny itonpublic, health and safety concerns. We tried this in the past and Mike and Bob Fisher were the only ones that could address it and that was based on site specific safety issues. From: Neville, Elizabeth Sent: Wednesday, October O3, 2O183:O6PM To: Duffy, Bill; Hagan, Damon; SiUack' Mory Cc: Doherty, Jill; DorosW, Bonnie; Ghosk, Bob; Jim 0nizio; Standish, Lauren; Louisa Evans) Noncarrovv Denis; Rudder, Lynda; Russell, Scott; Tomaszewski, Michelle; William Ru|and Subject: RE: 4170 Indian Neck Nd. Peconkc firework display application 10/6/18 The town has the authority to issue Fireworks Permits under the NYS Penal Law Section 405.00 which now states"All applications for the display offireworks shall bemade otleast five (S) days inadvance ofthe date nfthe display. This application was just submitted today by e-mail at2:40PK4. | don't believe it can meet this criteria. Please advise. Betty Neville From: Neville, Elizabeth Sent: Wednesday, October 03, 2018 2:40 PM To: Duffy, Bill; Hagan, Damon; Silleck, Mary Cc: Doherty, Jill; Doroski, Bonnie; Ghosio, Bob; James Dinizio; Lauren Standish; Louisa Evans; Neville, Elizabeth; Noncarrow, Denis; Rudder, Lynda (lynda.rudder@town.southold.ny.us); Russell, Scott; Tomaszewski, Michelle; William Ruland Subject: FW: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 Importance: High Bill I am in receipt of an "Application for a Fireworks Display"for this Saturday October 6, 2018. Please review the application and the Fireworks Instructions& Policy and advise if this can be done as a ratification. Thank you Betty Neville Elizabeth A.Neville, MMC Southold Town Cleric,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel.631765-1800,Ext.228 Fax 631 765-6145 Cell 631466-6064 From: Jo-Anne Triolo [mailto:joanne@bayfireworks.com] Sent: Wednesday, October 03, 2018 12:32 PM To: Neville, Elizabeth Subject: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 Good afternoon Elizabeth, 4 Attached is the Town of Southold firework permit application for a private event at 4170 Indian Neck Rd., Peconic,NY.. Time of display is 9:00 pm. I will contact you to confirm receipt...thank you. Sincerely, Jo-Anne Jo-Anne Triolo Pyro Engineering Inc. dba Bay Fireworks 999 South Oyster Bay Road, Suite 111 Bethpage,NY 11714 516-597-5500 Phone/ 516-597-5507 Fax 5 Neville, Elizabeth From: Neville, Elizabeth Sent: Thursday, October 04, 2018 9:56 AM To: Flatley, Martin;Verity, Mike; Fisher, Robert Subject: FW:4170 Indian Neck Rd. Peconic firework display application 10/6/18 Attachments: Firework permit appl 10-6-18.pdf,Instructions&Policy Re_20181003142902.pdf Importance: High Please review this"Fireworks Application" as soon as possible and send your comments. Not sure what is going to happen with it. I think the Town Board would like to know if all of you would approve of it in order to make their decision. Betty *1 am going to forward a couple of e-mails to you to give you a little background on this. Elizabeth A.Neville, MMC Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOB-Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel.631765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 From: Neville, Elizabeth Sent: Wednesday, October 03, 2018 2:40 PM To: Duffy, Bill; Hagan, Damon; Silleck, Mary Cc: Doherty, Jill; Doroski, Bonnie; Ghosio, Bob; James Dinizio; Lauren Standish; Louisa Evans; Neville, Elizabeth; Noncarrow, Denis; Rudder, Lynda (lynda.rudder@town.southold.ny.us); Russell, Scott; Tomaszewski, Michelle; William Ruland Subject: FW: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 Importance: High Bill I am in receipt of an "Application for a Fireworks Display"for this Saturday, October 6,2018. Please review the application and the Fireworks Instructions& Policy and advise if this can be done as a ratification. 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 631 765-6145 Cell 631466-6064 1 y From: Jo-Anne Triolo [mailto:joanne@bayfireworks.com] Sent: Wednesday, October 03, 2018 12:32 PM To: Neville, Elizabeth Subject: 4170 Indian Neck Rd. Peconic firework display application 10/6/18 Good afternoon Elizabeth, Attached is the Town of Southold firework permit application for a private event at 4170 Indian Neck Rd., Peconic,NY.. Time of display is 9:00 pm. I will contact you to confirm receipt...thank you. Sincerely, Jo-Anne Jo-Anne Triolo Pyro Engineering Inc. dba Bay Fireworks 999 South Oyster Bay Road, Suite 111 Bethpage,NY 11714 516-597-5500 Phone/ 516-597-5507 Fax 2 - - ,o�ag11FF0��pG ELT�ABfITA.,Nl VILLE,,MKO 7bv ilatl,.ssossMainRoaa TU•Wi1T, o. P.O:Box"1 79 _ &uthold,•NowYori 11971 `Fax(8$1)765.6145 GE`QMCER !f' O� lephorte(631)765-1800 < RECORDS.bI~'2�9N'L�GE�'Ok`l:`IO]�t �� "`�� eoutliolatown.riort�iforlcnet, F�E}�OM QF YAT}?ORMATION OFF10Eii O + + CE 0E- TM TOWN, CLERK, TOW OF SOUTHOLD, - APPLICATION P)MOT TQ DISPLAY,FIREWORKS APPLICATION TS:I ERLBY.,MADE, pursuant to:the provisions of Section 40S,tf b of the;Penal,,Late► of the State of Neer York,for a permit-;a display fimwprl s as hereinafter specified: DISPLA'Y't$TO^-BE SPONSOR+'D BY Pyro"Engineering Inc. PRIIYCIi'A><, FFYCE T 999-S: Oyster Bay Rd.,-quite 111, Bethpage, NY 11714 `DATE c&.TPME,,43F`DISPIAY 1'0/6/18 Q approximately'9:00 pm _ =ACT LOC,ATIONaF'DISPLAY,privatP r�G�d�P (� 4170'Indian Neck Rd 'Peconic 'NY -SUFI+'QLK'COIJiV�'�t"Tt�:7i;MAP-N>�INIBh{RFOR'SZTE. 1000-9$-1=27.1 ` . . . RAW',DATIE&TfMIE; N/A . Thepfollowing,pereons afwto--be•m•charge;of#wucteiiits>inoting of the tireworke: i+iame Age Experience P_liysieal.Cxiridition jJil atn,LoCCia hos„ 43; yep# 5 yeaks + Healthe Exeel'lent Christopher Aaeixio— 43>.years years. + • Health:. Excellent (Additional"Ammand'ioorm4tion may be-submittetl';on-an attached sheet lVpuiber aud`typ-of works is As follows: 1:3G Firewo-rks: 2^3 `iuciz sh@I.,-s,=approximately 700 Pius—i-llum natiwi, :Requesf3rg, Fire kDepaxtYnerit._oii .sat raitli:°,liriisYi Tiucks:.- goner and place OU-storage: of fireworks prior tq �lisp)!ay: Delivery of productw911 b6 day°afdisptay. Atiached hierato and made a part-of hereofis a diagft of#hegrounds en whick the display kio be held: Also attached;is a cerofteate or policy of imuraaee.coverage: .N�: WAtteWpermission..with signature of the Praberty Owner,mus#be snlimitted with the P ro Engineering Inc, FEE:' $1U0 Name of Organization See p6licy4of additiona_l' :Information Jo Anne Tri olo _ By Printed Nam-e, Pt Applicantignature ofA 'can " - 'e-mail.:address:jaanne ba firework§.com Telephone Number 516.597=5500 - �� ``f hr Dafe of.Applicatioin >w f�:A � �w�a �l { �r � j(�j( 0 yj j ♦� jff/f � � , a �/ • f {"f v c r i D �� tx 3. yl 31 �.�4� ��r � � ly t� ;� �� .. � '�' � � �. f #u Fit'�'EWQKKS FN' c5iN 'rERfNG 111%NR111:11MV(jRi. CONI October 2, 2018 RE:SCALAMANDRE PARTY 4170 INDIAN NECK LAND PECONIC, NY To Whom it May Concern; Please allow this letter to serve as permission Pyro Engineering dba Bay Fireworks to use my property for a firework display to take place Saturday, October 6th 2018.The fireworks will start at our around 9:OOPM and last 3—5 minutes. Should you have any further questions, please feel free to contact me directly. Sincer iy, v Ernes Scalamandre 999 South Oyster Bay Rd.,Suite 111 Bethpage,New York 11714 1 Phone: 516-597-5500 J Fax. 516-597-5507 ® DATE(MM/DDIYYYY) ACORl7 CERTIFICATE OF LIABILITY INSURANCE 10/02/2018 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 Shaunna Marquis NAME: Clark Insurance ArCNao Ext): (860)430-3700 PAX ac,No; (860)430-3730 180 Glastonbury Boulevard E-MAIL SS: smarquis@mayboneeclark.com ADDRE Suite 401 INSURER(S)AFFORDING COVERAGE MAIC# Glastonbury CT 06033 INSURERA: Lexington Insurance Company 19437 INSURED INSURER 0: Liberty Mutual Insurance Company 23043 Pyro Engineering Inc 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 CERTIFYTHATTHE 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. POLICY EFF POLICY EXP LIMnS rA TYPE OF INSURANCE INSO WVD POLICY NUMBER MMiDD MM/DD COMMERCIAL GENERALLIABILI Y EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR _PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) S 023627358 02/1612018 02/1512019 PERSONAL&ADV INJURY 5 1.000,000 MOTHER. LAGGREGATE LIMITAPPLIES PER GENERALAGGREGATE $ 2,000.000 POLICY❑PRO- ❑LOC 2,000,000 JECT PRODUCTS-COMPlDPAGG $$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per poison) S OWNED SCHEDULED BODILY INJURY(Per amdent) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY Id AUTOS ONLY Par acadenl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 9,000,000 A EXCESS LIAR HCLAIMS-MADE 023627359 02/15/2018 02/15/2019 AGGREGATE $ 9.000.000 DED RETENTIONS $ WORKERS COMPENSATION X SER OT AND EMPLOYERS'LIABILITY Y r N ER ANY PROPRIETORIPARTNER/EXECUTIVE EL EACHACCIDENT $ 1,000,000 B OFFICERfMEMBEREXCLUDED? NIA WG539S-387471-018 D2/1512018 02/15/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1.000,000 If yes,describe under1000000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S , , DESCRIPTION OF OPERATIONS r LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Liberty Mutual Workers'Compensation States.CT,GA,NC,NV,SC,VA Date of Display October 6,2018 LOCATION OF DISPLAY.4170 Indian Neck Rd.,Pecanic,NY Mr.Ernest Scalamandre;Town of Southold;Suffolk County are included as additional insured's as respects 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 Mr.Ernest Scalamandre ACCORDANCE WITH THE POLICY PROVISIONS. 4170 Indian Neck Rd. AUTHORIZED REPRESENTATIVE Peconic NY 11958 �wi /Y ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Act® CERTIFICATE OF LIABILITY INSURANCE DATEtMM/ODIYYYY) 10!02/2018 THIS CERTIFICATE IS ISSUED ASA 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 Jo Ann Decker NAME: The Decker Agency Ince N (716)883-1455 AxNe: (716)883-6210 37 Elmwood Avenue All ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p Buffalo NY 14201-2018 INSURERA: National Continental insurance Company 10243 INSURED INSURERS: Pyro Engineering Inc,DBA:Bay Fireworks INSURER C 999 S Oyster Rd Suite 111 INSURER D: INSURER£: 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 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 AUUL bUMI POLICY EFF POLICY EXP LTR TYPEOFINSURANCE INSD WVD POUCYNUMBERMMID MMlDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR RINTRu- PREP611SE5 Ea occurrence $ MED EXP(Any one person) $ PERSONAL BADV INJURY $ z GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $ POLICY D JECT 0 LOC PRODUCTS-COMPlOPAGG $ OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ 1,000,000 Ea=dent _ x ANYAUTO BODILY INJURY(Per parson) $ A OWNED SCHEDULED CNY0004909233-8 02115/2016 02/15!2019 BODILY INJURY Peracadent) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Par arradent $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE. AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION I PER OTH- ANDEMPLOYERS'LtABILITY YIN STATUTE ER ANY PROPRIETOR)PARTNERlEXECUTIVE N 1 A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? .._ (Mandatory In If yes,describe ander E.L.DISEASE-EA EMPLOYEE $ under - DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Operations of the named insured Date of Display:October 6,2018 Location of Display:4170 Indian Neck Rd.Peconic,NY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Mr.Ernest Scalamandre ACCORDANCE WITH THE POLICY PROVISIONS. 4170 Indian Neck Rd. AUTHORIZED REPRESENTATIVE Pecon(c NY 11958 AQt, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD New York State Insurance Fund ff orkers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,2ND FLR,MELVILLE,NEW YORK 11747-3166 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 R1 A A A A A A 753044987 BOSTON INSURANCE BROKERAGE 28 STATE ST FL 22 O BOSTON MA 02109 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER PYRO ENGINEERING INC MR.ERNEST SCALAMANDRE DBA BAY FIREWORKS 4170 INDIAN NECK RD. 999 S.OYSTER BAY RD, STE 111 PECONIC NY 11958 BETHPAGE NY 11714 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2437 559-4 112405 02127/2018 TO 02/15/2019 1012/2018 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE 1S INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2437 5594, 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 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,/IWWVIW.NYSIF.COM/CERTICERTVAL.ASP.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 AND/OR 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 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: 1046663732 U-26.3 DATE{MMIDDl1 YYY) ACo CERTIFICATE OF LIABILITY INSURANCE 10/03/2018 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 Shaunna Marquis Clark Insurance AICNt o Exti: (860)430-3700 FAX[AICxe: (860)430-3730 180 Glastonbury Boulevard AEDDREss: smarquis@mayboneeclark.com Suite 401 INSURER(S)AFFORDING COVERAGE NAIC A Glastonbury CT 06033 INSURER A: Lexington Insurance Company 19437 INSURED INSURER B: Liberty Mutual Insurance Company 23043 Pyro Engineering Inc. INSURER C 999 S.Oyster Bay Rd. INSURER D: Suite 111 INSURERE: Bethpage NY 11714 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER10D 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 ADDL SUOR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POUCYNUMBER MMIDD MIDO LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DMAGE70 RENTED CLAIMS-MADE ©OCCUR PREMISES Ea occurrence $ 100.000 MED EXP(Any one person) $ A 023627358 02/15/2018 02/15/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY ❑1E,T -LOG PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER, $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) E OWNED SCHEDULED (P INJURY BODILY ) AUTOS ONLY AUTOS (Per acadenl $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per.cadent $ X UMBRELLAL(AB OCCUR EACH OCCURRENCE $ 9,000,000 A EXCESS UAB HCLAIMS-MADE 023627359 02/15/2018 02/15/2019 AGGREGATE $ 9,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER B ANY PROPRIETORIPARTNEWEXECUTIVE E L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N/A WC5-39S-387471-018 02/15/2018 02/15/2019 (Mandatory In NH) E,L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,descdbo under DESCRIPTION OF OPERATIONS below E.LDISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD iftt,Additional Remarks Schedule,may be attached if more space Is required) Liberty Mutual Workers'Compensation States.CT,GA,NC,NV,SC,VA Date of Display:October 6,2018 LOCATION OF DISPLAY.4170 Indian Neck Rd.Pecomc,NY Aurelian Farms LLC dba Indian Neck Farms;Mr.Ernest Scalamandre;Town of Southold,Suffolk County are included as additional insured's as respects 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 DELNERED IN Aurelian Farms LLC dba Indian Neck Farms ACCORDANCE WITH THE POLICY PROVISIONS. 4170 Indian Neck Lane AUTHORIZED REPRESENTATIVE Pecomc NY 11958 �f�w� It /1% f ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AC®RU® DATE(MM1DONYYY) CERTIFICATE OF LIABILITY INSURANCE 10r0312016 THIS CERTIFICATE IS ISSUED ASA 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 Jo Ann Decker NAME: The Decker Agency Inc PHicNr o Ell), (716)883-1455 aC,No: (716)883-6210 37 Elmwood Avenue E AI ADDRESS: INSORER(S)AFFORDING COVERAGE MAIC q Buffalo NY 14201-2018 INSURER A: National Contmentat Insurance Company 10243 INSURED INSURER B: Pyro Engineering Inc,DBA.Bay Fireworks INSURER C: 999 S Oyster Rd Suite 111 INSURER 0. INSURER E Bethpage NY 11714 INSURER F COVERAGES CERTIFICATE NUMBER: 18-19 MASTER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OFINSURANCE POLICYEFF POLICY EXP LTR IVSD NND POLICY NUMBER MMIDD MMIOb LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ N CLAIMS-MADE OCCUR PREtv9SES(Ea occurrence) S MED EXP(Any one person) $ PERSONAL B ADV INJURY S GEN'L AGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $ JECT LOC PRODUCTS-COMPIOP AGG 5 POLICY 1:1 OTHER. S AUTOMOBILE LIABILITY MBINED SINGLE LIMIT $ 1,000,000 CO Ea acadent ANY AUTO BODILY INJURY(Per person) S A OWNED SCHEDULED CNY0004909233-8 02(1512018 02/15/2019 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY PeracudentI S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE S DED I I RETENTION 5 S WORKERS COMPENSATION ER AND EMPLOYERS'LIABILITY YIN STATUTE ERH ANY PROPRIETOPJPARTNER/EXECUTIVE ElNIA E L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E,L DISEASE-EA EMPLOYEE S If yes,desmbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Operations of the named Insured Date of Display October 6,2018 Location of Display.4170 Indian Neck Rd.Peconlc,NY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Aurelian Farms LLC dba Indian Neck Farms ACCORDANCE WITH THE POLICY PROVISIONS. 4170 Indian Neck Lane AUTHORIZED REPRESENTATIVE n Peconic NY 11958 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ONew'York State Insurance Fund Workers'Coinpajsadon&_Msabl#fy Bene'flls,Spich!14&Sljz&1914 8 CORPORATE CENTER DR,2ND-FL-9,MELVli�Ei'NEW-Y'QRKI.,11717=3.166 CERTIFICATE OF,WORKItIRS"COMPENSAT116N lNsbilAWE 19. am A A A A A A 753044997 BQSTQWINSURANCE BROKERAGE 28 STATE STTL 22, I s BOSTON MA02109 SCM TO VALIDATE AND.SUBSCRIBE -POLICYHOLDER CERTIFICATE HOLDER PYRO ENGINEERING'ING AURA IAN fARM,5-1=Lp DBA INDIAN DBA BAY FIREWORKS Nkk,FARMS 999:S.OYSTER BAY RD; STE 111 4170 INDIAN NECK LANE BETHPAGE NY 11714 oEcbmc,N[y 54 POLICY NUMBER- CERTIFICATE NUMBER POLICY PERIOD DATE H2437 559-4 144819 v/15/2019, f-10/312016 lo THIS IS,TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW-YORK STATE]NSURANCE FUND UNDER POLICY NO. 2437'55S4 COVERING 'THE tNflREbBLI -'H �HOLI)Ek FOR 00,,QN OF 'THIS POLIC) . I WORKERS' COMPENSATION .UNDER TAE NEW YORK WORKERS'"COMPENSATION LAW' WITH RESPECT TO .ALL dmkAtibls[S IN tHE�stATE'OF-NEW YORK, EXCEOT AS .INDICATED BELOW, 'AND,-WlTH'RItt0ECT-TO OPERATIONS OUTSIDE-OF NEW YORK, TO THE POLICY!jQ41),EFM REGULAR NEW YORK STATE:EMP_pyE9S ONLY. If YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,II(tL0DJNG,ANV'NOTlFiqATiON OF cANCELLAtioNs, ,PR TOYALTI ATE STA I? INSURANCE N�i ItCERTIFICATE.ViSITO'iJR..WkEi§ITIEAtNtTOS i*.'M�.,NYOIF."d6MfdkRTi.ctRTVALA�90.THE,NEW YORk- E bRANCt`FljI4D IS-NC)T,L�iAdL-EtIN-fHE--ItVEkTOP FAILURE,-TO,GIVE-'SUCH ,NOTIFICATI & 'THE;POUCYINCLUDES,AWAIVER OFSUBROGATIC�O'END,ORSEMENT UNDER WHICH N`YSIFAAGREI56TOWAIVE`,ITSRIGHT OF.SUBROGATION TO BRING AN Att!O'N.AGAINST*THE'CIERTIFICAItHOLDER TO"ktodVikk AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR-MbibAL,bEWEFITS TOrbil ON 6EHALP-OF,AN llffMPLdYEE OPnUk 'INSURED IN THE EVENT"THAT,-PRIOR TO THE, DATE,OF THE,ACCIDENT, THE'CElRTIFtCATE,HOLDER_ HAS ENTERED iNT9'A yvkitrEt4 ,CONTRACT WITH OUR IkSUiAED THAT§EdbiRtS' HA-rs ktGf4TO#,sQbk&o" � A E T 0014 ijoN blt,,WAIV D., THiST CERTIFICATE IS ISSUED, AS A MATTER! OF w6llgAtiok ONLY AND CdNPtkS NO kidl-ft, NOR INSURANCE ,COVERAGE UPON THE CERTIFICATE HOLDER., THIS CERT!FICATg DOES NOT AMEND, WEND OR ALTER THE,COVERAGE AFFORDED BY THE POLICY. NEWYORK STATE INSURANCE FUND J te,_ dJRECT6R)NSURA_NtE FUND UNDERWRITING VALIDATION NUMBER:788769383 U-26.3 SPONSOR: Scalamandre party 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): 10/6/18 Rain Date(s): n/a Location: 4170 Indian Neck Rd. Peconic,NY Time: 9:00 pm 1.Total number of Class B shells being used: approximately 700 plus illuminations. Sizes between: 2 inches and 3 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: Christopher Acierno(NYS DOL PR-177) William Lotterhos (NYS DOL PR-98) 8. Technician(s): tbd Signe 62 Fire rks ompany Representative Pk'&4'iTECHNICIM CERT tKAR OF COWEEWNCE .:...,._ Y, CHRIS OPHER ACIERNO CLASS:A R ' ANY DISPLAY THIS CARD MUST BE CAMEO WHEN USING PYROT WC.&NYS CERTIFICATIONS REQURED IN NYC 6tifllHtA�ttit4f0fl® ' �r .,1 4, z''+n ° rL ='c J. 54�=t+. „wr.+. rL�r. +•,� :�t'u s",K...w ,�' rsk`J f t. '� `M+,� `b•`"`:R" r a..t...�''" .-{a J cr i:' '/ S''YeSh r+'2 5';�«t 'R; �st2Z`a�� ^Y�riu�'��sa\ 4'�S' S #'�'�xi �'..sY�.k�.^3ri s� 'r'_�,''�.• �' ,n�s�r �� aa� �y�,2" �'�}�s� �k` N ��-•.)r .�`'�t �tx -„t Ty a � � �,z y. ,eY nt'T�- S� S trx K��Y f��a't�.� �t 'K j rr'��n�'b �S se's 'sy.` x }s - _*2`�.tF-1 :.+ }4 L".rY�.X-+a zati,y�';t. Y-•SA` �tf y Y`°s3� Y �,S S"A dub r -mei r",. �-,t� ��45''x.n 7 Y�Y 'n�;;. S F `r w„ x r4 1 st ti t �s lT fi r t 1 x P -3 Js Y 4..c { a y t z.'.. 1> 1 �F :n•l �,� ? / SX t Y ,r. �.. ,u t r: -r�`i`fi4t R > cZE` s: ^A t'a✓4a y }t -:�}aS 3x txp�y� s 4 ) 1r, ,k Z._?1 J.� ✓ � i- F 3-� T} 'h Y� l � 1 K r 5 f�f"�� N(+t +�•£` tC#t��5a�L •`" t `S 5 '}� _� r'F r � ) '` � {t" P br ...5-S• �S•r .� k i^�t.�C.t- �t' Zir } rr, C A 5 `? i '? l " 4v+d� +'s �' ✓ �',f s •z -'�-�3 f . 4� e_ g+'r, r izV MIX w fi.�4y u F � is ' • { G u r v �, i h r r� RM.,�,s"��''�'t•+'s`�)�iss^ -.F»�rs�`'13,;,'�yr��"`��S',� t� t �., 2r• �� +.� '+#-r• � r 'fir � Y'�J n Nilauai�x'�, /k �nt4`yE �Iw s .-. � �y � a,..,' -.��'8� _ �'�tyn� -a�„yg3.-.`+r�^zr'•�'�y 4 r,�1\'`''74c�s�' d �'`' y. ivu �r �n p s r r { :-ter 4 f } I 4 { L 3 Y Y .y: � t S .-7. Y. .J f t h • • • • • - -1• •.• - 11' 111!1.1 re—? FAA/Air Traffic Organization 1701 Columbia Avenue Eastern Service Center College Park,GA 30337 U.S.Department of Transportation Federal Aviation Administration Dear Fireworks Proponent: FAA-Peconic, NY 10/6/18 Thank you for informing us of your proposed fireworks display. Although there are currently no federal regulations specific to fireworks displays,the Federal Aviation Administration(FAA)has been tasked with regulating the sate 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 it 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!f the display will exceed 500 feet Above Ground Level (AGL), contact Leidos Flight Service at l-877-4-US-NTMS (1-877-487-6867)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) o 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-Fireworks@faa.eov. Sincerely, ft--- Ryan W.Almasy Manager, Operations Support Group Eastern Service Center, Air Traffic Organization I 999 South Oyster Bay Road•Suite 11.1. Bethpage,NY 11.714 T:,516.591.5500 • F:516:597.5507 E N G I N E k I `N G wcvw.pei&_Com wm bayfireworka:com' World Class Productia»s ei Dater 1:013118: ;FAX':631-765-5009' .PHONE:_631-765a3585 SoufhoI Fire,Department-, 55135 Main Road 5retvaiks5yh tasiunr ' O.Sok 1469, at 1Yah Disney Vrorld Ampica's�i00thllmriversary Southold,NX 11971 Casinos-1131 y Caesars CtaridrdEi MilotThem Parks; 'Dear Gl d. NASA's 50th Universaty Upivcrsat Drimrdo Resort .Ceatanniailmoo.sione.Evenls Pyro Engineering Inc, dba.Volt,Live will be conducting a firework'd4lay for a private event located at 4170-Indian Neck Lane ,Peron G NY:. "Time,of display is 9:60 pm Major sportiitil Events V&,respeetfully request'a"Stand-By Pumper.'-'to be-.on if duirinig the :dasplay time Y:15ave enclosed amap of--the firewozks_launck site:, Please call our, office at 5.16-597-5500 to•confirmxreoeipt of this fetter; Thank you., klajottoagiia Baseball _ u.s.mq�t�rir"comntiuex cerely;_ State Games of Amedca National"Faatb5lt LequE 6RfnDi league t2asebag. L FtI18 TO 10 PGA)1P6ACanrses.&Euents loarme@ ayfireworks:com `GoodKiD Games CgdcertTours-Cld§e Proxlmiiy gyp,. Ultra Music Fest-Ming Electric naisy Carnival•tas Vegas Katy P,eny-Una Direction Alice Cooper-Swedish House IAaha stairum,Slag Concerts TheaGical Events Tiienre Park nesigri•Cansullation NATIONAL:800.606=3716 N NY CT PA MO VA SC GA- FL TX NV CA RESOLUTION 2010-474 ADOPTED DOC ID: 6016 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO.2010-474 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JUNE 29,2010: RESOLVED that the Town Board of the Town of Southold hereby amends Resolution No. 2008-536 dated May 20,2008 to read as follows: RESOLVED that the Town Board of the Town of Southold hereby adopts the following POLICY regarding the issuance of fireworks permits: 1. The Town may grant a permit for the pubie display of fireworks by municipalities, fair associations, amusement parks, erp sons or organizations of individuals. Penal Law Section 405.00(2). 2. An 'organization of individuals" is a religious, civic, or comparable organization. Op. Atty. Gen No. 2007-3. 3. The fir-eweriks displa�,must be ene intended fer-a publie audienee. The ability of-the publie te-see-an ether-wise private display dees-aer-ender-if a"publie display". Fir-ewe peFmits shall not issue for-weddings or- ether private paFtie . See Op. A45,Geii. Ne. 2007 4.3. Fireworks permits shall indicate that the display must be concluded by 10:00'p.m. if held Sunday-Thursday,.11:00 p.m. if held Friday or Saturday, and there shall be no time restriction if held on July 4. 4. No person shall engage in or allow the manufacture, assembly, storage or display of any fireworks or pyrotechnics display without first obtaining a permit issued by the Town Clerk. A completed application for display of fireworks must be received by the Town Clerk a minimum of 30 days prior to the date of display. The permit application for any fireworks or pyrotechnics display shall be accompanied by the following: (a) a copy of a valid certificate of competency as a pyrotechnician for the individual supervising the firing of the displace (b) Certificate of Insurance naming the Town of Southold as additional insured with coverage limits of$2,000,000 for public liability and $2,000,000 for property damage; (c) Detailed diagram showing location of fireworks discharge and minimum separation distances in accordance with the applicable requirements of Penal Law Section 405(2); Resolution 2010-474 Board Meeting of June 29,2010 (d) A copy of the contract with fireworks display company; and (e) All applications shall require the approval of the Fire Chief of the District in which the display will take place and the Fire Marshal before being presented for approval by the Town Board. 5. All applications for a fireworks permit shall be subiect to an application fee in an amount of$100.00,together with a processing fee in an amount to be determined by the Town Board to cover the Town's costs for monitoring and enforcing compliance with the Penal Law. a Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Albert Krupski Jr., Councilman SECONDER:Vincent Orlando, Councilman AYES: Ruland, Orlando, Talbot, Krupski Jr., Russell ABSENT: Louisa P. Evans Updated: 6/30/2010 10:43 AM by Lynda Rudder Page 2