163-22 Exhibit - Fireworks at Montclair Golf Club - 2022.pdf

Exhibit “A”

TOWNSHIP OF WEST ORANGE \ Date: AS APPLICATION FOR PERMISSION TO CONDUCT FIREWORKS DISPLAY Application is hereby made pyManiclain Golf COutrot Wee ( Wour Oe ~___for permission to conduct a fireworks display or exhibition in conformity with the State of New Jersey. Type. S Permit Fee & ‘2s \ P When will fireworks be held? Quduy 2, Joga Fype—— emit YOu Never During what hours?_Q:20 _p.m.to__\O p.m. 2 Duly 3,08 Where will the display be held? Matin Cin\t (Qiu - 25 Dospect Pur Name(s) & Address(es) of the person(s), firm, Partnership, corporation, association or group of individuals making the display: Montelain Golf Clute Crondun Stocks Frewwts 2S Onspecr Pe Sk Cndim aco Week Ovanne, KV o10Se- Millington, NET 0 4Ho Where will the fireworks be stored prior to the holding of the display? Chandu Stato Fre ws Twice Where will the fireworks be stored during the progress of the display? State Firewrks Tne What safeguards will be arranged for the protection of private and public interests? Is this application accompanied by the Surety Bond required by Chapter 51 of the Laws of 1937? Is this application accompanied by a Hold Harmless Agreement & Insurance? LES. Application is hereby approved disapproved WA e Diregtor/Chief of Polcé Application is hereby approved VA disapproved ARM Fire Official { I All appropriate portions of N.F.P.A. 1123, 1126 and the International Fire Code of New Jersey Edition including Section 5608 shall be complied with.

_ MPBUPT a OOUE Saab PRE ARRAS AEE En arsnap ons corazon /Bso-a8texosans ARS} eal Montclair Golf Club info <info@gardenstatefireworks.com> Fri 8/28/2020 2:24 PM To:West Orange Fire Offical <FireOfficial@westorange.org>; ATTN: STEVE Subject: Montclair Golf Club Montclair Golf Club up to 8° shells https://owa,westorange.org/owa/ 9/2/2020

P.O. Box 194 Tel: 973-239-1800 1893 Montclair, New Jersey 07042 Fax: 973-239-3504 Tuesday, May 17, 2022 West Orange Fire Department Chief Anthony Vecchio (firechief@westorange.org 415 Valley Road West Orange, NJ 07052 RE: Letter of Intent - Annual Fireworks Display at Montclair Golf Club Dear Chief Vecchio, T hope this letter finds you well. Please be advised that we will be hosting our Annual Fireworks Display on Saturday, July 2nd with a rain date of Saturday, July 3“, 2022 The fireworks will be set off shortly after dusk at approximately 8:30 and could last as late as approximately 10:00pm. The display will take place on our Golf Course grounds and we approve Garden State Fireworks as our vendor to execute this wonderful display on our grounds. Please feel free to reach out with any questions or should you require any additional information. Sincerely, Zoltan Toth Clubhouse Manager Montclair Golf Club ztoth@montclairgolfclub.org 973.239.1800 x 151

DRAYTON INSURANCE BROKERS, INC. 2500 CENTER POINT ROAD, SUITE 301 POST OFFICE BOX 94067 BIRMINGHAM, ALABAMA. 35215 BIRMINGHAM, ALABAMA. 35220 PHONE: (205) 854-5806 EMAIL: dib@draytonins.com FAX: (205) 854-5899 CERTIFICATE OF INSURANCE NO. 215087 We certify that insurance is afforded as stated below. This Certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by the insurance policy and the insurance afforded is subject to all the terms, exclusions and conditions of the policy. INSURER Admiral Insurance Company POLICY NO. CA000016477-11 NAMED INSURED Garden State Fireworks, Inc. ‘New Vernon Fireworks P.O. Box 403 Millington, NJ 07946 POLICY TERM March 1, 2022 to March 1, 2023; Both Days 12:01 A.M. Standard Time COVERAGE Commercial General Liability: XX] Occurrence Basis C1 Claims Made Basis LIMIT OF LIABILITY $5,000,000 each occurrence, $10,000,000 general aggregate, $6,000,000 products/completed operations aggregate ‘The limit of liability shall not be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS Public fireworks display and special effects contractor It is certified that, if named below, this policy includes as Additional Insureds 1) the sponsor(s), promoter(s), organizer(s) (including other entities having similar interests), of insured pyrotechnic events and/or 2) the owner(s) of real property (or barges) at which insured pyrotechnic events are held and/or 3) the owner(s), manager(s), tenant(s), mortgagee(s) (including other entities having similar interests), of buildings, stadiums, arenas and similar facilities at which insured pyrotechnic events are held and/or 4) the licensing or permitting authority, or other authority having jurisdiction, issuing licenses/permits for insured pyrotechnic events and/or 5) any other entity for which the insurance is required to be afforded under written contract. Coverage applies only as respects the legal liability of such Additional Insured(s) for bodily injury and property damage caused by the operations of the Named Insured. The insurance afforded any Additional Insured excludes liability for bodily injury or property damage arising from the Additional Insureds own negligent acts or omissions or from the failure of such Additional Insured to fulfill its obligations specified in its contract with the Named

property damage arising from the Additional Insureds own negligent acts or omissions or from the failure of such Additional Insured to fulfill its obligations specified in its contract with the Named Insured. NAME(S) OF ADDITIONAL INSURED(S) MONTCLAIR GOLF CLUB PO BOX 194 MONTCLAIR, NJ 07043 TOWNSHIP OF WEST ORANGE 66 MAIN STREET WEST ORANGE, NJ 07052 DISPLAY LOCATION DISPLAY DATE(S) CLUB GROUNDS JULY 2, 2022; RAID DATE JULY 3, 2022 It is certified that this policy requires a 30 day mutual notice of cancellation between the Insurer and the Named Insured. In the event of such cancellation we will endeavor to mail 10 days written notice to the Additional Insured(s), whose name and address is shown hereon, but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer and/or the undersigned. DRAYTON INSURANCE BROKERS, INC. MAY 16, 2022 SF es DATE OF ISSUE 4cd. STRINGER, PRESIDEN?

Ey —_, STATE OF NEW JERSEY : BUSINESS REGISTRATION CERTIFICATE DEPARTMENT OF TREASURY/| IVISION OF REVENUE 252 a a ESSE E) TAXPAYER NAME: TRADE NAME: —. GARDEN STATE FIREWORKS, INC. TAXPAYER IDENTIFICATION#: . SEQUENCE NUMBER: 222.808-574/000 0537204 ADDRESS: ISSUANCE DATE: 383 GARLTON RD MILLINGTON Nu 07946-0403 ale EFFECTIVE DATE: § 07/08/88 Acti Director FORM-BRC(08-01) ‘This Certificate is NOT assignable or transferabll It must bé IOP Certification 8614 CERTIFICATE OF EMPLOYEE INFORMATION REPORT RENEWAL This is to certify that the contractor listed below has submitted an Employes information Report pursuant to NAC. 17:27-1.1 et, Seq. and the State Treasurer has approved sai! report. This approval will remain in eifect for the period of 15~JUN-2019 . to 15~JUMN-2026 GARDEN STATE FIREWORKS. tic. eet 383 CARLTON ROAD Ms MILLINGTON No 07946" *=! ELIZABETH MAHER MUOIO State Treasurer

4coniy! CERTIFICATE OF LIABILITY INSURANCE yosjez 03/03/22 THIS CERTIFICATE IS ISSUED AS A MATTER CERTIFICATE DOES NOT AFFIRMATIVE! 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 ndorsement(s). PRODUGER Ras DRAYTON INSURANCE BROKERS INC PHONE (205)854-5806 I FAX (205)854-5899 2500 Center Point Rd #301 cuits. Beorgine@draytonins.com Birmingham, AL 35215 INSURER{S) AFFORDING COVERAGE NAICS insurer a: ADMIRAL INSURANCE COMPANY 24856 INSURED —_ Garden State Fireworks, Inc. INSURER 8: New Vernon Fireworks INSURER: P.O, Box 403 INSURER D: Millington, NJ 07946 INSURER E- INSURERE: COVERAGES CERTIFICATE NUMBER: REVISION_NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASOVE 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. mE PROD POLICY EFF TOV EXE, ue TYPE OF INSURANCE ssp | wo POLICY NUMBER wanvoon vv lanai Luis X | COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s_5,000,000 DAMAGE TO RENTED | camsmace [3X] occur PREMISES (ea aseurence) 18 100,000 MED EXP (Anyone person) |S __ NONE SS 1s 4/2: A cA000016477-11 8/9/22 8/1/23 eensona. aaovnwuey ]s 5,000,000 fe GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 XJ poucy |_] 58 Loc pRooucts-covpror ass | s 6,000,000 OTHER: si "AUTOMOBILE LIABILITY SNBINED SINGLELINIT |g ANYAUTO BODILY INJURY (Perperson) | § f 7] owen. SCHEDULED x fo une ay ‘SCHED BODILY INJURY (Peraccident) | § HIRED NON-OWNED ROPERTY DAMAGE ry foe} AUTOS ONLY ‘AUTOS ONLY [er accident) 5 |__| UMBRELLA LIAB occur EACH OCCURRENCE $ EXCESS LIAB cLams.mape| AGGREGATE s veo | Trerenmiow: = os WORKERS COMPENSATION iN gine ‘AND EMPLOYERS’ LIABILITY iAure |_| es ANY PROPRIETORIPARTNERMEXECUTIVE EL cach accioenr. s aracemrsaaapee= C4, {Mandatory In NH) EL DISEASE - EA

s veo | Trerenmiow: = os WORKERS COMPENSATION iN gine ‘AND EMPLOYERS’ LIABILITY iAure |_| es ANY PROPRIETORIPARTNERMEXECUTIVE EL cach accioenr. s aracemrsaaapee= C4, {Mandatory In NH) EL DISEASE - EA EMPLOYEE | § Iyes, dascrive under DESCRIPTION OF OPERATIONS peloy E.L. DISEASE - POLICY LINIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Adcitional Remarks Schedule, may be altachedif more space is required) ERTIFICATE HOLDER CANCELLATION, ‘ij iabilit ‘SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. Muntelpal Exenss Liability Joint THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Insurance Fund ACCORDANCE WITH THE POLICY PROVISIONS. 9 Campus Drive, Suite 16 Parsippany, NJ 07054 AUTHORIZED REPRESENTATIVE © 1988-21 ‘CORD CORPORATION. All rights 1 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACGRD

= CERTIFICATE OF LIABILITY INSURANCE avats 03/17/2022 , 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 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 COVER ME INS AGcY OF NZ Nae oe 610-618 W ST GEORGE (AIC, No, Ext}: (AIC, No}: ADDRESS: AbD! Zi LINDEN NI 07036 2953M INSURER(S) AFFORDING COVERAGE Nace INSURERAST. PAUL PROTECTIVE INSURANCE COMPANY INSURED INSURER B: GARDEN STATE FIREWORKS Inc : PO BOX 403 INSURER C: MILLINGTON NI 07946 INSURER 0: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: REDUCED BY PAID CLAIMS. NSA [ADDL] SUBR] POLICY EFF | POLIGY EXP LTR] TYPE OF INSURANCE Insp | wv POLICY NUMBER (MMW/DDIVYYY) |(mMDDIVYYY) LiniTs COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s DAMAGE TO RENTED |] evams.mape [occur PREMISES (Ea cccurrence) _|S MED EXP (Any one person) |S PERSONAL & ADV INJURY |S GENL AGGREGATE LIMIT APPLIES PER: GENERAL s BEECH | prosecr mr PRODUCTS — COMPIOP AGG |S s COMBINED SINGLE LinTT |AUTOMOBILE LIABILITY ay 5 [Tany auro JBODILY INJURY (Per person)_|s [—Jowneo autos SCHEDULED BODILY INJURY (Per accident) |S [hive auras \UTOS PROPERTY DAMAGE f—jONLY ADTOS ONES (Per accident) Ss is UMBRELLA LIAB ‘occur EACH OCCURRENCE Is EXCESS LIAB CLAIMS-MADE JAGGREGATE Is Deol [RETENTION § - Is WORKERS COMPENSATION PER A] 3 | AND EMPLOYERS LIABILITY (6SPPUB-6R28552-7-22) 03-01-22 |o3-o1-23 |*_[sranre_| [en ANY PROPRIETORIPARTNERIEXECUTIVE 1,000,000 OFFICER/MEMBER EXCLUDED? Yin} E.L. EACH ACCIDENT s 1,000, (Mandatory in NH) [Ly] na} ELDISEASE-EA EMPLOYEE|s 1,000,000 Ityes, déscribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE—POLICy uMiT}s 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is