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1f Firework Permit LakeMNwashtaCITYOF CHANHASSEN 7ZOO Maker Boulevard PO Box 147 Ohanhassen MN 55317 Administration P~ope (152227 1100 >rix: 9522271110 Building Inspections Phone: 9522271180 Fax 952227 1190 Engineering Pr~one 9522271160 Fax 952 2271170 Finance P'xne 952.227 !140 Fax 95222? 1110 Park & Recreation Phorle: 952227 1120 Fax 9522271110 Recreation Center 2310 Coulter Boulevard Phone: 9522271400 Fax: 952 2271404 Planning & Natural Resources R'one: 952227 !130 Fax 952 22711!0 Public Works 1591 Park Road Phone 952 227 1300 Fax 9522271310 Senior Center P~lcnr~ 952 227 1125 Fax 952 227 1110 Web Site ,w,w ci cr~ar~hasser~ rx~n us MEMORANDUM TO: Todd Gerhardt, City Manager FROM: Mark Littfin, Fire Marshal DATE: June 15, 2004 SUB J: Private Fireworks Display at Lake Minnewashta on July 4, 2004 This office has received a request from Americana Fireworks Display Company on behalf of the Lake Minnewashta Fireworks Committee to conduct a fireworks display from Minnewashta Regional Park on July 4th. This application is similar to what has occurred for the past four years and it meets Fire Code regulations. A meeting with all concerned parties is plam~ed in the near future, and the Fire Department will have a stand-by crew available at the site. Additionally, the group has provided a $1 million liability insurance policy covering this event. RECOMMENDATION Staff recommends approval of the request from Americana Fireworks Display Company for a fireworks display permit on July 4, 2004 at Lake Minnewashta Regional Park. The City of Chanhassen· A growing comnnunity wilb dean lakes quality scl~oois a cna~rmr'.G dovx~to','~ tl~r ~'m.q bus~n{ sse~-, ',.',~~'ii,~ q t'a !s ~rd ~'~,eau~ifsi psrks ;~ ',rp~ ,,, [~si:~,, .... ~,, ,~ ,',, r,~ and p'.a¥'. Americana Fireworks Display Co. P.O. Box 0456 Excelsior, MN 55331-0456 612-378-7515 320-279-2098 Fax 952-470-2117 June 11, 2004 Attention: City Clerk City of Chanhassen 690 City Center Drive P.O. Box 147 Chanhassen, MN 55317 Dear City Clerk, Attached please find a permit application for a display of fireworks on July 4th, same as last year, at Lake Minnewashta Regional Park. The sponsor has met with Marty Waish, director of Lake Minnewashta Regional Park. A new certificate of insurance will be forward directly by our insurance company today or tomorrow as the one included expires on the 19th. Thank you. Kindest Regards, Shannon MacFarlane APPLICATION FOR DISPLAY OF FIREWORKS Thi.~'./i~rm is./~r Ibc com~c/~ic~zcc q/'lhc i,~'.~'ui~z~ ho~ly, olhcr./brmx u~zd ~' /¢[lcrx m~zy he ucccpl~zb/c. Name of applicant (Sponsoring Organization): Ms. Beth Ginther Lake Minnewashta Fireworks Committee 3611 Ironwood Road Excelsior, MN 55331 Name of authorized agent of applicant: AMERICANA FIREWORKS DISPLAY CO. P.O. Box 0456 Excelsior, MN 55331~0456 PHONE 952-435-3978, FAX 952-470-2117 Signature of issuing authority COPY MAIIJ OR FAX ]'O: AMERICANA FIREWORKS FAX 952/470-2117 P.O. Box 0456 Excelsior, MN 55331-0456 Proof of certificate of insurance Diagram of grounds All assistants will be 18 years of age or older Date Included: 1.) 2.) 3.) Date of display: July 4, 2004 Time of display: 10:00 p,m. Location of display: Lake Minnewashta Regional Park Manner and place of storage of fireworks prior to display: NO STORAGE~ DELIVERED DAY OF THE EVENT. Type and number of fireworks to be discharged: UP TO 6" AERIAL DISPLAY SHELLS. Name of supervising operator: Leonard Bonander OR OTHER LICENSED OPERATOR Certificate No.: B0161 Signature of applicant (or agent) ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIOD/YY) 03/23/04 PRODUCER Britton-Gallagher & Associates, Inc. 6240 SOM Center Road Solon, OH 44139 Eric Treend INSURED Americana Fireworks Display, Co. P.O. BOX 0456 Excelsior, MN 55331 1-440-248-4711 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURERA: Lexington Insurance Company INSURERB:Granite State Insurance Co. INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER DATE tMMIDDIyy) DATE tMM/DD/YYI GENERAL LIABILITY 9911370 06/19/03 06/19/04 EACH OCCURRENCE $ 1000000 i COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) X $ 5 000 0 [ PERSONAL_& AOV INJURY , $ 1000000 L AGGREGATE LIMIT APPDES PER GENERAL AGGREGATE_ 2000000~(}(}000 'GEN' : ! PRODUCTS- COMP/OP AGG POLICY JEQT LOCI~ B AUTOMOBILE LIABILFrY IcA62644571 06/27/03 06/27/04 I COMBINED SINGLE LIMIT $ 1000000 : (Ea accident) 'X'I ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) i $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) ! $ PROPERTY DAMAGE (Per accident) $ ~RAi~ L~ITY AUTO ONLY - EA ACODENT $ i EA ACC $ ~ iOTHER THAN AUTO ONLY: AGG L $ A EXCESS LIABILITY 5642607 ~ 06/19/03 06/19/04 | EACH OCCURRENCE $ 4000000 _?__j OCCUR ~ CLAJMS MADE ! ~AGG_REGATE_ _ $ 4000000 ~ $ ~ RETENTION $10000 t $ ]WORKERS COMPENSATION AND ' I WC STATU- ] lOTH* I TORY LIMIT~ [! ER i EMPLOYERS' LIABILITY , E-L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ ! E.L DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Display Date: July 4, 2004 Location: Lake Minnewashta Regional Park Additional Insureds: Ms. Beth Ginther, Lake Minnewashta Fireworks Committee, Lake Minnewashta Regional Park Contributors, City of Chanhassen, Carver County Parks CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETI'ER: Lake Minnewashta Fireworks Committee Ms. Beth Ginther 3611 Ironwood Road Excelsior, MN 55331 CANCELLATION USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITI'EN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25-S (7~97) J~RIC~A 1709314 PoweredBYcertificatesNow~M (~ ACORD CORPORATION 1988 ~S 1 A 1 E PIKI~ MAK;bHAL - l~IreworKs ~perator LI(2UIISU ~U~IruII Dy ~'~U~C ~XC~U~t~ rage ~ ~ ~ STATE FIRE MARSHAL Fireworks Operator License Search By Name Results Name STEPANIAK, ANTHONY J Your search for resulted in 1 hits Certificate Type Certificate # Outdoor Only 0552 Records 1 to 1 of 1 [NEW SEARCH] Issue Date 6/22/2001 Expiration Date 6/22/2005 Last Modified:June 14, 2004. For additional information, contact Robert Dahm, Minnesota State Fire Marshal Division, at Ro_b~e_d_.__D~hm~s_tat_e.~m_n._ u~or (651)215-0500. Minnesota State Fire Marshal Division 444 Cedar St., Suite 145 St. Paul, MN 55101-5145 651-215-0500-voice 651-215-0525-fax 651-282-6555-TDD http://www~dps~state~mn~us/fmarsha~/C~ntract~rs~FWNam~Resu~ts~asp?L-NAME=STEPA~.. 6/14/2004 DIAGRAM OF FIREWORKS DISPLAY SITE / LAUNCH SITE AREA TO BE MAINTAINED CLEAR OF PEOPLE DISTANCE FROM CROWD 420' LARGEST DIAMETER SHELL 6" FOOT RADIUS (A) SI 2,179~117 c,y of