HomeMy WebLinkAboutRECEIPT - 08-00247 - BYUI Spirit Week Fireworks Showcc X Wull
Operational /Fireworks Display ���REXBUR� e C I T Y OF
Permit Application REXBURG
19 East Main City of Rexburg :;e .- .-- _..___.___.__ (, --- ..._...____.
Phone: 208.359.3020 America's Family Community
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
ermit #: i
$50.00 F P /NO P RMIT APPROVED: YES /NO
BY: 1 ATE:
Application for permit to operate a display of outdoor fireworks in conformance with adopted codes and ordinances
of the City of Rexburg shall be made in writing on forms provided by this city. All requested information must be
provided, incomplete applications will be denied. This display permit allows the discharge of fireworks by qualified
persons only. Completed applications must be received a minimum of 7 days prior to the event.
Name of Applicant /Company: 6 Y V - --I-
Contact Person:
Contact Telephone Number: 49 tp- 2 i b9 Cell: 313 - y 3 13
Name of Organization Applicant Represents:
Proposed Date and Time of Display: MAY 3 I-C : 3 P.--•
Rain Date:
Name of Person Conducting Display: KC iJ L - LN.►s
(Please provide copy of State licenses) 11
Size fi reworks dischar L- �tN C o �
Type, S c and amount •f fircw� s t� Lc disc a gcd• r
Storage location of fireworks: 9% -74 LIST
Exact location of display:
(Please provide a map of the area)
Owner of property where display is to be located: iSY u = �o
Phone: 4910 - Z411
Liability insurance covering event: (attach copy of policy)
Company: Cb a ---aft 5 zrwr .c."---,�
Coverage Period:
Name of Agent:
Signature of Code Official Verifying Coverage
Policy #: 11 a 8Z 4 337 /no 7
Policy Limits:
Agent Phone #:
Name of Insurance Co. Representative Providing
Information
9
i
SITE PLAN
Please provide an accurate drawing of the following items:
1) Fireworks discharge area
2) Distance between discharge area and any structures on or to be placed on property
3) Distance between spectators and discharge area
4) Location of fire safety and first -aid equipment
Consent of Property Owner
I /We �R". '' >'._.A. , owners of the above described property, hereby expressly
give my /our consent to the use of my /our property for the event applied for in this application.
Signature of Property Owner
Printed Name
Address: rj25 S , er�L �3u2c•��o.
- b3Ae n - w soo
Telephone: [�� yq to - Zt k4
If the display is to take place on property belonging to The Church of Jesus Christ of Latter Day Saints, a letter of
authorization from a representative of the church shall be provided with this application.
OTHER REQUIREMENTS
1. A minim of two (2) 2A10BC fire extinguishers shall be present at the site during the fireworks display.
2. A minimum of two (2) qualified persons shall supervise the actual firing at all times during the display.
3. A copy of the approved permit must be on -site during the display.
4. If a burn ban or winds exceeding 20 miles per hour exist at the time of the display the show will be
cancelled.
My signature indicates that I understand and will comply with all requirements to ensure a safe and legal discharge of
fireworks.
Applicant Check List
This form filled out in its entirety
_ Certificate of Insurance
Payment of permit fee
5IZ - h OZS
Date
Copy of State License
')c,- Detailed site plan
_ Consent of property owner
3
• 0
50 %/50% Show #
FIREWORKS DISPLAY CONTRACT AND PURCHASE ORDER
THIS CONTRACT, entered into on Brigham Young University Idaho and between
LANTIS PRODUCTIONS, INC. (a Utah corporation hereinafter referred to as LANTIS), and
of (hereinafter referred to as CLIENT).
WITNESSETH: LANTIS agrees to furnish the CLIENT, in accordance with the terms
and conditions hereinafter set forth, a Fireworks Display Show as per our proposal made a
part hereof, including the services of a licensed and trained Pyrotechnician to take charge of
and fire the Display.
CLIENT shall pay LANTIS the sum of five thousand dollars and No /100 ($5000.00)
DOLLARS, in United States Currency, according to the following terms and conditions:
1. Due upon execution of contract $ 2500.00 '►�
2. Check due time of show $ 2500.00
All sums due herein shall be mailed directly to the corporate offices of Lantis
Productions Inc., P.O. Box 491, Oraper, Utah 84020; unless otherwise directed in writing.
Note: Balance due at time of show must be given to the authorized representative of LANTIS
before said show will be commenced.
The said display is hereby scheduled to be performed on May 31, 2008. The display
may be cancelled by CLIENT up to ten (10) days before display's date. At this time only the
cost of the set pieces (if applicable) and permit fees will be paid for by CLIENT. If for reasons
other than adverse weather conditions the display shall be cancelled within the ten (10) days
prior to the show date, the CLIENT agrees to pay an amount equal to one -half of the total
contract amount as a cancellation fee.
If the scheduled presentation of the show is delayed due to adverse weather conditions,
or other circumstances beyond the reasonable control of either LANTIS or CLIENT, each
shall bear an equal share (i.e., 50 %) of all "out -of- pocket" expenses incurred by LANTIS due
to the delay. Such expenses shall include, but shall not be limited to, additional lodging, meals,
Pyrotechnician fees, permits, vehicle rentals, and equipment rentals (if any) incurred by
authorized representatives of LANTIS necessary to present the show.
CLIENT hereby agrees that any show so delayed must be presented within 10 calendar
days of the originally scheduled date without incurring additional expenses except as detailed
in the paragraph above. If the presentation of the show is delayed beyond ten (10) calendar
days from the originally scheduled date, this contract shall be subject to renegotiation between
LANTIS and CLIENT.
CLIENT agrees to provide and furnish a suitable place to display the said fireworks.
LANTIS, on behalf of CLIENT, will secure all required state and /or local fireworks permits.
Any required marine permits will be obtained by LANTIS on behalf of the CLIENT. CLIENT
will obtain any required event permits, and will arrange for any security bonds as required by
law, in CLIENT'S community when necessary. CLIENT agrees to furnish necessary and
adequate police and /or private security, fire and other necessary protection for proper crowd
control, auto parking control, and proper security around the designated safety area during
the set -up, during firing, and for a minimum of thirty minutes following show completion.
Any vehicles or personal property located within the designated safety area shall be
removed at the CLIENT'S Expense. Any damage or destruction of vehicles or personal
property left remaining in the designated safety area shall be the sole responsibility of the
CLIENT.
CLIENT hereby acknowledges and agrees that the LANTIS Pyrotechnician, the
CLIENT, or Local Fire Authority, shall have the right to delay the start of, or terminate the
firing of, the Fireworks Display Slow if, in any one of the individuals' reasonable judgment,
unsafe conditions exist as detailed in the LANTIS Safety Procedures Manual, NFPA 1123
Guidelines, or other applicable local law or regulation.
LANTIS shall provide insurance coverage for the following amounts and specified
risks only:
Bodily Injury and Property Damage, including Product Liability of $2,000,000.00.
Under the provisions of our insurance coverage, this protection shall be extended to the
CLIENT and additional insured only upon receipt by LANTIS of a properly executed
original copy of this contract.
It is agreed that this contract shall be governed by the laws of the State of Utah. Should
any legal action be� brought to enforce or interpret the terms or provisions of this Contract, any
court of competent jurisdiction shall be proper venue for such an action. Interest at 2% per
month (AN ANNUAL PERCENTAGE RATE OF EIGHTEEN PERCENT PER ANNUM
A.P.R. 24 %) will be charged on all accounts past due, and the Client agrees to pay the same. If
any legal action is brought to enforce or interpret the terms or provision of this Contact, the
prevailing party shall be entitled to reasonable attorney's fees and costs in addition to any
other relief they may be entitled to.
It is further agreed that nothing in this Contract shall be construed as forming a
partnership, the parties hereto being severally responsible for their own separate debts and
obligations, and neither party shall be held responsible for any agreement not stated in this
Contract. The parties hereto do mutually and severally guarantee the terms, conditions and
payments of this Contract and these articles shall be binding on the parties themselves and on
their heirs, executors, administrators, successors and assigns. CLIENT further warrants that
the signature affixed hereto on their behalf is properly authorized to execute such documents
and incur such obligations on behalf of the CLIENT. CLIENT further agrees that none of the
provisions of this contract may be changed or modified in any way without the express written
permission of LANTIS.
Additional Provisions:
IN WITNESS WHEREOF, the parties hereto, by and through their duly authorized
agents, have set their duly authorized signatures and seals the dates and places indicated
below.
LANTIS
Executed on behalf of LANTIS PRODUCTIONS INC. on 5 -8 -08 at Fairfield, UT.
Lantis Productions Inc.
nneth L. Lan , resi en
CLIENT
Executed on behalf of this day of
at,
by:
Title:
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Combined Specialties International, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE
8362 Tamarack Village DOES NOT AMEND, EXTEND OR LATER THE COVERAGE AFFORDED BY THE
Suite 119 POLICIES BELOW.
Woodbury Minnesota 55125 INSURERS AFFORDING COVERAGE
INSURER A: Underwriters, Lloyds of London
INSURED INSURER B:
Lantis Productions, Inc. INSURER C:
P.O. Box 491
Draper Utah 84020
INSURER D
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NAMED INSURED ABOVE FOR THE 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 INCLUDING, BUT NOT LIMITED TO THOSE FOLLOWING: LIMITS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS. ADDITIONAL CONDITIONS AND EXCLUSIONS: 1) THE INSURANCE EVIDENCED BY THIS CERTIFICATE IS LIABILITY INSURANCE ONLY, IT IS
NOT A BOND OR ANY FORM OF SURETY AGAINST WHICH SOMEONE OTHER AN "INSURED" MAY ASSERT A CLAIM OR BRING ANY ACTION. SUBJECT TO
POLICY TERMS, CONDITIONS, DEFINITIONS AND EXCLUSIONS THE INSURANCE ONLY INDEMNIFIES AN INSURED AGAINST CERTAIN LEGAL LIABILITY. 2)
THE INSURANCE DOES NOT COVER CLAIMS FOR BODILY INJURY OR PROPERTY DAMAGE OF THE NAMED INSUREDS SHOOTER(S) ASSISTANT(S) OR
ANY OTHER PERSON(S) INCLUDING ANY VOLUTEER(S) PARTICIPATING IN ANY WAY IN ANY DISPLAY OR SPECIAL EFFECT PERFORMED OR EXECUTED
BY THE NAMED INSURED. 3)COVERAGE DOES NOT APPLY TO CLAIMS FOR BODILY INJURY OR PROPERTY DAMAGE ARISING OUT OF THE INSUREDS
FAILURE TO FOLLOW NFPA OR OTHER APPLICABLE REQUIREMENTS, LAWS OR RECOMMENDATIONS, INCLUDING THOSE RELATING TO POST DISPLAY
OR SPECIAL EFFECT SEARCHES OR CLEAN UP.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM/DD/YY) DATE (MM /DD/YY)
A GENERAL LIABILITY 1148234337/007 July 29, 2007 July 29, 2008 EACH ACCIDENT $1,000,000
CLAIMS MADE MEDICAL EXP $5,000
(any one person)
FIRE LEGAL LIABILITY $50,000
GENERAL AGGREGATE $2,000,000
PRODUCTS - COMP /OPS AGG $1,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY $
ANY OWNED AUTO (Per person)
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY $
NON -OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per person)
EXCESS LIABILITY EACH ACCIDENT $
FOLLOWING FORM AGGREGATE $
WORKERS COMPENSATION WC STATU- OTHER
AND TORY LIMITS $
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
E.L. DISEASE -EA EMPLOYER $
E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
Brigham Young University Idaho is Additional Insured as respects the May 31, 2008 Fireworks Display at
�Ow.Q►E 1.e�
CERTIFICATE HOLDER CANCELLATION
Brigham Young University Idaho SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
525 South Center Street THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE
Rexburg, Idaho 83460 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, IT'S AGENTS OR REPRESENTATIVES
AUTHORIZED REPRESENTATIVE