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D-5. St. Hubert's Fireworks PermitCITY OF CHMNSEN 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 Website www.ci.chanhassen.mn.us MEMORANDUM TO: Todd Gerhardt, City Manager FROM: Mark Littfin, Fire Marshal DATE: July 21, 2015 • SUBJ: Private Fireworks Display for St. Hubert's Catholic Community Harvest Festival PROPOSED MOTION: "The City Council approves the fireworks display permit from RES Specialty Pyrotechnics Inc., on behalf of St. Hubert's Catholic Community, to conduct a fireworks show from 8201 Main Street, Chanhassen. Approval of this request requires a simple majority vote of the City Council. Staff has received a request from RES Specialty Pyrotechnics, on behalf of the St Hubert's Catholic Community, to conduct a fireworks show from St. Hubert's Catholic Community. RECOMMENDATION Staff recommends approval of the request from RES Specialty Pyrotechnics for a fireworks display permit on September 12, 2015 at St. Hubert's Catholic Community, 8201 Main Street, with the conditions noted above. Approval requires a simple majority vote of the City Council. ATTACHMENT 1. Application for Display of Fireworks 2. Certificate of Liability Insurance g:\safety\inl\sthubertsfireworkdisplaymemo.doe Chanhassen is a Community for Life - Providing for Today and Planning for Tomorrow ` ''�a C" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ DD /YYYY) 07/20/2015 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 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 MCGRIFF, SEIBELS & WILLIAMS, INC. P.O. Box 10265 Birmingham, AL 35202 CONTACT NAME: A/C, No No. :800-476-2211 FAX No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :James River Insurance Company 12203 000376886 IN R E S S E S Specialty Pyrotechnics INSURER B :National Liability & Fire Insurance Company 20052 INSURER C: 21595 286th Street Belle Plaine, MN 56011 MED EXP (Any one person) $ EXCLUDED INSURER D: INSURER E: INSURER F: VUVChCAVC� trtK1 II-1GAI E NUMBER:EFYLV5MY RFVISI[)N NI IMRFP- 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_]OCCUR 000376886 04/01/2015 04/01/2016 EACH OCCURRENCE $ 1,000,000 DAMA TOR NTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ EXCLUDED PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F PRO- LOC JECT GENERAL AGGREGATE $ 5,000,000 PRODUCTS - COMPJOP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY 73APS055781 04/01/2015 04/01/2016 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS X AUTOS BODILY INJURY (Per accident) $ NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ $ A UMBRELLA LIAB X OCCUR 000376906 04/01/2015 04/01/2016 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Display Date: September 12, 2015 Location: St. Hubert Catholic Church, 8201 Main Street, Chanhassen, MN City of Chanhassen, MN; St. Hubert Catholic Community Above listed is/are included as Additional Insured respects to the General Liability policy as required by written contract. Certificate Holder is Additional Insured under General Liability as required by written contract. k;hK I I1-1GATE HOLDER CANCELLATION St. Hubert Catholic Community 8201 Main Street 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 F'age 1 of 1 U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD APPLICATION FOR DISPLAY OF FIREWORKS/PYROTECHNIC 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): St. Hubert Catholic Community Address of applicant: 8201 Main Street, Chanhassen, MN 55317-9647 Name of authorized agent of applicant: RES Specialty Pyrotechnics Inc. Address of agent: 21595 286th Street, Belle Plaine, MN 56011 Telephone number of agent: 952-873-3113 Date of display: September 12, 2015 Time of display: Approx. 10:00 PM Location of display: St. Hubert Catholic Church, 8201 Main Street, Chanhassen, MN Manner and place of storage of fireworks/pyrotechnic special effects prior to display: N/A - Delivered Day of Show. Type & number of fireworks/pyrotechnic special effects to be discharged: (25) — multishot cakes Minnesota State law requires that this display be conducted under the direct supervision of a pyrotechnic operator certified by the State Fire Marshal. Name of supervising operator: Kent Orwoll Certificate #: B-0140 I understand and agree to comply with all provisions of this application 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: July 20, 2015 Required attachments: The following attachments must be included with this application: 1. Proof of a bond or certificate of insurance in the amount of at least $1,000,000.00 2. A diagram of the grounds, or facilities (for indoor displays), 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. For proximate audience (e.g. indoor) displays, the diagram must also show the fallout radius for each pyrotechnic device used during the display. 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: Signature of fire chief/county sheriff: Date: Signature of issuing authority: 7 � 9 �`� g g y Date. FIREWORKS OPERATOR CERTIFICATE - Certificate Type.0, P Certificate No. 0140 Kent A. Orwoll 1194 Wildwood Ct. Chaska, MN 55318 Effective Date Expiration Date - 01/01/2012 12/31/20115