Supporting Documentation · Aug 7, 2018
180-18 Exhibit A - Fireworks at Rock Spring at Montclair Golf Club for Labor Day Celebration - 2018.pdf
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BODILY INJURY (Per person) | 3 aoe | SCHEDULED BODILY INJURY (Per accidant)| $ (X_| vireo autos |X _ | woros NE? PRSeERTE PCE 5 } s lA Tompretta vias ry (o0082304-6 gnao1e | 812019 _| eacH OCCURRENCE $5,000,000 i | EXCESS UAB CLAIMS-MADE | AGGREGATE $5,000,000 RETENTION S 3 WORKERS COMPENSATION Wo Sia’ on AND EMPLOYERS’ LIABILITY er — ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT 5 ‘OFFICERIMEMBER EXCLUDED? NIA — (Mandatory in NH) ELL DISEASE - EA EMPLOYEE $ yas, describe under DESCRIPTION OF OPERATIONS botow E.L. DISEASE - POLICY LIMIT | $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space ls required) CERTIFICATE HOLDER CANCELLATION en SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Municipal Excess Liability Joint Insurance Fund THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Campus Drive, Suite 4 ACCORDANCE WITH THE POLICY PROVISIONS, Parsippany NJ 07054 "AUTHORIZED REPRESENTATIVE ~ © 1988-2010 AGORD CORPORATION. All rights reserved. AGORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
— Ye ACORD a ‘DATE (MMIODIYYYY) CERTIFICATE OF LIABILITY INSURANCE 610512017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ‘AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS THIS CERTIFICATE OF INSUI COVERAGE AFFORDED BY THE POLICIES BELOW, AUTHORIZED EXTEND OR ALTER THE IRANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDE! IMPORTANT: If the certificate holder is ADDITIONAL INSURED, the policy(ies) must be endorsed. terms and conditions of the policy, certain policies may require an endorsement. A statement on Tf SUBROGATION IS WAIVE! ‘subject to the is certificate does not confer rights to the certificate holder in lieu of such endorsement{s). PRODUCER 2. ne" MICHAEL J. POLLER COVER ME INSURANCE AGENCY OF NJ, INC. Ff eu, 908-587-2500 TFBS, ney 908-587-1681 610.618 W. ST. GEORGES AVENUE : LINDEN, NJ 07036 __INSURER(S) AFFORDING COVERAGE 5 NAIC a PH: 908-587~2500 FAX: 908-587-1681 INSURER A: TRAVELERS INSURANCE CO. INSURED INSURER 8: GARDEN STATE FIREWORKS, INC. INSURER © P,O.BOX 403 INSURER 0: MILLINGTON, NJ 07948 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 771689 REVISION NUMBER; Fis IS TO CERTIFY INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY THAT THE POLICIES OF INSURANCE TISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ‘ABOVE FOR ‘OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH SNSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT HAVE BEEN REDUCED BY PAID CLAIMS. THe POLICY PERIOD RESPECT TO WHICH THIS TO ALL THE TERMS, INR TYPE OF INSURANCE eae POLICY NUMBER Finan LIMITS COMMERCIAL GENERAL LIABILTY EACH OCCURRENCE A |_| _] cuaims.mace occur BES crcatrence) | s |_| MED EXP (Any one person)_| $ |_| PERSONAL & ADV INJURY _|$ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE __|$ poucy |_] SBS mi PRODUCTS - COMPIOP AGG | $ ___|__Lomer: $ AUTOMOBILE LIABILITY Qa ts (| AMY AUTO BODILY INJURY (Per person) | $ |_| AeeyNe? Royegutee BODILY INJURY (Por accident| |_| nireo Autos noregyne? oe ee s 3 UMBRELLA LIAB OocUR EACH OCCURRENCE s |__| excess L1ag CLAIMS-MADE] AGGREGATE. $ ozo] | Retentions: 5 ice gr ee XT Eiiiae 1_TE A | ANY PROPRIETORIPARTNERMEXECUT weal 2£870369UB 6/10/2017 | 6/10/2018 | EL EACH ACCIDENT s
EACH OCCURRENCE s |__| excess L1ag CLAIMS-MADE] AGGREGATE. $ ozo] | Retentions: 5 ice gr ee XT Eiiiae 1_TE A | ANY PROPRIETORIPARTNERMEXECUT weal 2£870369UB 6/10/2017 | 6/10/2018 | EL EACH ACCIDENT s 1,000.000 OFstGSen in Nee ail EL DISEASE - EA EMPLOYEH S 4,000,000 te Gate ade anions blow EL owease-poucyumm [s 1,000,000 SESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, ‘Additional Remarks Schedule, | LONGSHOREMEN'S L&H COVERAGE - ADDED EFFECTIVE: 07/07/2015 Tay be attached If mare spaca Is required) | CANCELLATION CERTIFICATE HOLDER rc MUNICIPAL EXCESS LIABILITY JOINT INSURANCE FUND 9 CAMPUS DR., STE. 16 PARSIPPANY, NJ 07054 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN [ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) @ 1588-2014 ACORD CORPORATION. All rights raserved, The AGORD name and logo are registered marks of ACORD
ao SRST STATE OF NEW JERSEY BUSINESS REGISTRATION CERTIFICATE *- * woe NAME: TRADE NAME: GARDEN STATE FIREWORKS, INC. . TARPAYER IDENTIFICATIONS: -Seouence NUMBER: 222-896-374/000 - 0537204 ADDRESS: . ISSUANCE DATE: = 383 CARLTON RD 9 MILLINGTON NJ 07946-0403 ooeiog EFFECTIVE DATE: 07/08/88 /-BRCOa-O1} ay2 a above agdesse
» FAAVAir Traffic Organization 1701 Columbia Avenue Easter Service Center College Park, GA 30337 US. Department of Transportation Federal Aviation Administration Dear Fireworks Proponent: 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 Tequire notice to the FAA as a condition of approval of a fireworks permit, We acknowledge your notification and have no objection to the fireworks display provided it is conducted in a manner that does not create a hazard to other persons, or their property. To enhance the safety of your event, we recommend the following actions: © Fireworks staff should remain vigilant to ensure that no aircraft are in the area prior to beginning the fireworks display. tf your event is within 5 miles of a public use airport, or if the display will exceed 500 feet Above Ground Level (AGL), contact Lockheed Martin 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: © Name and address of the person filing the NOTAM 2 Date. time(s), and event location (City, State. and location in reference to the airport) Maximum altitude of the display ro) 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. Ryan W. Almasy Manager. Operations Support Group Eastern Service Center, Air Traffic Organization
Certification CERTIFICATE OF EMPLOYEE INFORMATION REPORT This is to certify that the contractor listed below has submitted an Employee Information Report pursuant to NJ.A.C. 17:27-1.1 et. seq, and the State Treasurer has approved said report. This approval will remain in effect for the period of 15-JUN-2012 GARDEN STATE FIREWORKS ,INC. 383 CARLTON RD. BOX 403 MILLINGTON NJ 07946 15-JUN-2019 hy A Andrew P. Sidamon-Eristoff State Treasurer
GARDEN me STATE FIREWORKS THE SANTORE BROS. WORLD CHAMPIONS February 2, 2018 Mr. Joseph Hrubash Municipal Excess Joint Underwriting Fund 9 Campus Drive Parsippany, N.J. 07054 Dear Mr. Hrubash: With reference to your Bulletin MEL 17-08. Garden State Fireworks, Inc. agrees that we will make a thorough search of the firing area and fall out area, after all fireworks displays, and we will dispose of any and all unfired materials. Under NEPA 1123, 2000 edition, section 4-2.12 states: that following the display, the firing crew shall conduct an inspection of the fallout area for the purpose of finding any unexploded aerial shells or live components. This inspection shall be conducted before any public access to the site shall be permitted. Also, enclosed are our automobile and compensation certificates for your review and approval. Please call our office at 1-800-999-0912 if you have any questions. Our fax number is 908-647-6258 Sincerely, 2 By b ooo Ouguel eA z. ; Augist N. Santore CEO AAPA Ke ay \ eee Main Office/Plant: P.O. Box 403, Carlton Road, Millington, NJ 07946 4-908-647-1086 1-800-999-0912 Fax: 1-908-647-625€ Regional Offices: 6873 Joejeff Street, North Port, FL 34286 1-941-426-0869 Fax: 4-941-426-4669 Hemet, CA 1-909-223-0454, New Jersey 4-908-864-3996 Visit our website at: www.gardenstatefireworks.com
DEPARTMENT OF JUSTICE Bureau of Alcohol, Tobacco, Firearms and Explosives ‘Martinsburg, WV 25405, April 2, 2018 Garden State Fireworks, Inc 901090:CRR/CMS PO Box 403 5400 Millington, NJ 07946 File Number: 8-NJ-00166 Premises Address: 383 Carlton Rd, Millington, NJ 07946 Dear Sir/Madam: This letter acknowledges receipt of your timely application to renew your Federal explosives license/permit. The Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) is not able to process your application prior to the expiration date of your license/permit. However, Federal law allows you to continue operations under your current license/permit until such time as ATF completes processing your application. See 5 U.S.C. § 558. This letter, or as explained below, a follow-up letter, will serve as your license/permit until we complete action on your renewal. It is referred to as a Letter of Authorization (LOA). Since we have not completed processing your application, you may supply a copy of this letter to other licensees/permittees, ¢.g., your distributors, for the next six months (or until we complete action on your renewal, if that occurs in less than six months) as evidence of your licensed/permitted status. If we have not completed processing your application for renewal within six months of the date of this letter, we will send you another letter, which will also be valid for six months (or until we complete action on your renewal, if that occurs in less than six months). This is of course contingent upon your remaining entitled to continue operations under your current license/permit. Please direct questions or concerns regarding this letter to Chanon Shipman (304)616-4436. Sincerely, CBtepher b flears Christopher R. Reeves Chief, Federal Explosives Licensing Center ATF web address: www.alf.gov
State of New Jersey Department of Community Affairs Division of Fire Safety 101 S, Broad St. P.O, Box 809 Trenton, NJ 08625-0809 (609) 633-6132 Fax (609) 633-6330 Cee tend mss 0] Seen DISPLAY COMPANY REQUIREMENTS Provide total number of shells and sizes (U.S. diameter) being used. Provide types and amounts of ground (set pieces) or low level devices (cakes,candles) to be used. . For displays fired from barges or roof tops, provide documentation, including all calculations that the discharge area meets or exceeds the requirements of NFPA 1123 (2000 Edition) Section 4.3.1 or 4.4.1 Indicate method in which display will be fired. If it is an electrically-fired display, provide name of N J Department of Labor licensed operator. Operator must have valid license in their possession at display site. Provide timetable of: delivery of fireworks to site; set-up; live load. Provide Certificate of Insurance (general and auto liability) in the amount of not less than $500,000.00. Certificate must be valid for duration of event, including rain dates. The use of salutes/reports larger than 3” is prohibited. No display shall be fired if winds exceed 25 MPH. Provide the name of the lead operator who will be representing the display company. Provide a post-display report within 48 hours of display. Report must include the following: display information; time search of fallout zone was conducted and results; any product malfunctions; and any injuries, Provide a letter attesting to the understanding of all of the above requirements as well as requirements set forth in Chapter 33 of the 2006 International Fire Code — New Jersey Editions and NFPA 1123, 1124, and 1126 and that the display will be in compliance with the same. Ceapuet Y tes 219-18" Display Company Representative Date ALL REQUIRED INFORMATION MUST BE PROVIDED WITH THE PERMIT APPLICATION. FAILURE TO PROVIDE THE REQUIRED INFORMATION WILL RESULT IN DELAYS WHICH COULD AFFECT THE PROCESSING OF THE PERMIT. SPECIFIC CODE SECTIONS MAY BE VIEWED BY GOING TO THE FOLLOWING WEBSITE: WWW.ECODES.BIZ MUNICIPAL/SPONSOR REQUIREMENTS ARE ON THE REVERSE SIDE OF THIS FORM. Revised 7/9/09
DIVISION OF FIRE SAFETY STATE OF N.J. FIREWORKS COMPANY REQUIREMENTS-2018 ROCK SPRING CLUB, SEPT. 1, 2018 1. TOTAL NUMBER OF SHELLS ARE LISTED ON THE FIRE PERMIT APPLICATION AS BID IN REQUEST FOR BID 2. TOTAL, IF ANY, ARE LISTED ON THE FIRE PERMIT APPLICATION 3. NOT APPLICABLE 4. DISPLAY TO BE HAND FIRED AND OR ELECTRICAL FIRE CERTIFIED OPERATOR NICK DE THOMASIS, RON PADUGANAO & CREW 5. DELIVERY TO SITE WILL BE APPROXIMATELY 1:00-3:00 P.M.. COMPLETION OF SET UP AT APPROXIMATELY 8:00 P.M. 6. INSURANCE CERTIFICATE ISSUED AND ON FILE WITH THE PROPER OFFICIAL 7. AGREED AND UNDERSTOOD 8. AGREED AND UNDERSTOOD 9 NICK DE THOMASIS, RON PADUGANAO & CREW 10. AGREED AND UNDERSTOOD 11, WE ATTEST TO THE UNDERSTANDING OF ALL RULES AND REGULATIONS LISTED ON THE DISPLAY COMPANY DOCUMENTS AS WELL AS REQUIREMENTS SET FORTH IN CHAPTER 33 OF THE 2006 INTERNATIONAL FIRE CODE — NEW JERSEY EDITIONS AND NFPA 1 123, 1124 AND 1126 AND THAT THE DISPLAY WILL BE IN COMPLIANCE WITH THE SAME Cueto kote 7-19-18 Displa\Company Representative Date
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