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E-7. Fireworks Display Permit for Chan High School Homecoming0 CITY OF CHANHASSEN 7700 Market Boulevard PO Box 147 Chanhassen, MN 55317 Administration Phone: 952.227.1100 Fax: 952.227.1110 Building Inspections Phone: 952.227.1180 Fax: 952.227.1190 Engineering Phone: 952.227.1160 Fax: 952.227.1170 Finance Phone: 952.227.1140 Fax: 952.227.1110 Park & Recreation Phone: 952.227.1120 Fax: 952.227.1110 Recreation Center 2310 Coulter Boulevard Phone: 952.227.1400 Fax: 952.227.1404 Planning & Natural Resources Phone: 952.227.1130 Fax: 952.227.1110 Public Works 7901 Park Place Phone: 952.227.1300 Fax: 952.227.1310 Senior Center Phone: 952.227.1125 Fax: 952.227.1110 Web Site www.ci.chanhassen.mn.us MEMORANDUM TO: Todd Gerhardt, City Manager FROM: Mark Littfin, Fire Marshal DATE: September 22, 2014 SUBJ: Approve Fireworks Display Permit, Pyrotechnic Display Fireworks PROPOSED MOTION: "The Chanhassen City Council approves the request from Pyrotechnic Display Fireworks to conduct a fireworks display on Friday, September 26, 2014 at Chanhassen High School. Approval requires a simple majority vote. BACKGROUND Staff has received a request from Pyrotechnic Display Fireworks Company on behalf of Chanhassen High School to conduct a fireworks display on Friday September 26, 2014. The display will be in conjunction with the school's homecoming events. The applicant has met the requirements of the Fire Code, insurance requirements and scene security. The Chanhassen Fire Department will be providing a standby crew as well. RECOMMENDATION Approval is recommended. ATTACHMENTS 1. Application 2. Insurance Certificate g: \safety\ml \chs fireworks display 9- 26- 14.docx Chanhassen is a Community for Life - Providing for Today and Planning for Tomorrow APPLICATION FOR OUTDOOR DISPLAY OF FIREWORKSIPYROTECIINIC SPECIAL EFFECTS Applicant instructions: This application must be completed and returned at least 15 days prior to date of display. Name of applicant (Sponsoring Organization): Chanhassen High School Storm Chasers Booster Club Address of applicant: 2200 Lyman Blvd, Chanhassen. Minnesota Name of authorized agent of applicant: P otechnic Dis lay, irtc. Address of agent: 9405 River Road SE Clear Lake MN 55319 Telephone number of agent: 320 - 743 -6496 Ext. 1 Date of display: September 26, 2 014 Time of display: about 7pm & 8:30pm Location of display: Chanhassen Hiffh School Football field. Chanhassen Minnesota Manner and place of storage of fireworks /pyrotechnic special effects prior to display: Delivery and storage in truck on day of display Type & number of fireworks /pyrotechnic special effects to be discharged: 1.3G product - up to 3 inch aerial shells & Multi -Shat Box Items Minnesota State lazy requires that this display be conducted under the direct supervision of a pyrotechnic operator certified by the State Fire Marshal. Name of supervising operator: Dale Nowak Certificate No.: B 0246 Required attachments. The following attachments must be included with this application: i . Proof of a bond or certificate of insurance in amount of at least S 5,000,000.00 2. A diagram of the grounds at which the display will be held. This diagram (drawn to scale or with dimensions included) must show the point at which the fireworks/pyrotechnic special effects are to be discharged; the location of ground pieces; the location of all buildings, highways, streets, communication lines and other possible overhead obstructions; and the lines behind which the audience will be restrained 3. Names and ages of all assistants that will be participating in the display. Marshall Puts, 54 Cert# 0164 The discharge of the listed fireworks on the date and at the location shown on this application is hereby approved, subject to the following conditions, if any: I understand and agree to comply with all provisions of this application, MN Statute 624.20 through 621,25, ivIN State Fire Code, National Fire Protection Association Standard 1123 (2006 edition), applicable federal law(s) and the requirements of the issuing authority, and will ensure that the fireworks/pyrotechnic special effects are discharged in a manner that will not endanger persons or property or constitute a nuisance. Signature of applicant (or agent):, Date of application: --1 - Iq Signature of Fire Chief: Date: / ® y Printed name of above official: N 4-jL ( Phone: '9fd -,2d %- /1 S/ Signature of issuing authority: Date: Printed name of above official: phone: A4C4SI`Rff CERTIFICATE OF UAMLITY INSURANCE DATE (MM=NYYY) 1 812812013 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement[s). PRODUCER CONTAC Britton Gallagher PHONE FAX 5 One Cleveland Center, Floor 30 _0_0 �Lc N -71 E-MAIL 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURER(SWFOROING COVERAGE NAIC 4 INSUREP-A:LeXLn MjMtirap gL _,C§I_C_() INSURED -!N–su–mm- q--Axis-S.vrPjus-1ns-CPnwny,-- Pyrotechnic Display Inc. INSURER CQranjte _StaL e j Insurance CO 23 8450 W. St. Francis Road -!t!Sq-A-1E—R,O _MN WC Insurers —A55-Q#orL Frankfort IL 60423 INSURER E: INSURER F' COVERAGES CERTIFICATE NUMBER; 1134639999 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 We POLICY ErF —P.0—Ut-Y' E-X'P-" LTR TYPE OF INSURANCE INSR WVQ POLICY NUMBER (MMIDONYYY) (MM(DOIYYYY) LIMITS A I GENERAL LIABILITY 33056807-03 91301,2012 913012013 EACH OCCURRENCE 31,4000,000 'X 0 %G COLVERCIAL GENERAL LIABILITY ws5o.ow CL. AP.1$4morr X OCCUR 'AED EXP iAny one perwro i$ f— PERSONAL & ADV INJURY S1,000,000 GF'!& �LAGG -EGAft :2,000000 �GEN L AGGREGATE LIMIT APPL4IES PER. PRODUCTS- _`YJPOPAGG $2,000,000 POLICY x PR(,- .1CT LOC AUTOMOBILE LIABILITY CA196568833 3, 2 �'2 30,2013 CCIASNED SiNGt-F 1-10 1 S1.000,000 .x ANY AUTO ALL OWNER SCHEDULED AUTOS AUTOS S03fLY 114JURY IPLr actcernj X HIRED AUTOS X NON-ONNED AUTOS B UMBRELLA UAB x OCCUR EAU733983 0 302012 1913012043 EACH OCCURRENCE 54,000.000 :X EXCESS LIAB CLA,MS4AADF? AGGREGATE S4.OD0.000 OED.: RETENTION$ WORKERS COMPENSATION MNAR0000019718(MN) 9,30,2012 P130!2013 WCSTATU-. 91H- AND EMPLOYERS! LIABILITY YIN' -?�� ANY PROPRIETORiPARTNERIEXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICEROAEMBER EXCLUDED? .NiA (Mandatary In UK) E.L. DISEASE - EA EMPLOYEE II es. dmnbe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE -POLICY DMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES {Attach ACORD 1001, Additional Remarks Schedule, a more space is required) DISPLAY DATE: September 20, 2013 LOCATION: Chanhassen High School - 2200 Lyman Blvd, Chanhassen, Minnesota ADDITIONAL INSURED: Chaska School District; City of Chanhassen, Minnesota; Storm Chasers Booster Club, Chanhassen High School, Chanhassen, Minnesota Chanhassen High School Storm Chasers Booster Club Attn: Ms. Torre Kemble 2200 Lyman Blvd Chanhassen MN 55317 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 .91AM-1r.—M 0 1988-2010 ACORD CORPORATION. All richts reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD