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Arni CATION FOR FIREWORKS PM041T 7 C>jzl <br />VIUALIE; OF' OWAO, MINIii;SOTA <br />Date: June 11 1 y�5 Aplil los tlon Numbers <br />Name Roger 13. F.rommelt <br />Address 2805 Ca,7r.o Point Road, V `a, Minnesota 55391 <br />l,00ation of E'ireworks Display 2805 Casco Point Road, Wayzata, —MN 55391 <br />:eme of Persona and/or Organizations Handling Fireworks D1aplav_ <br />Roger 'l. Frommc . <br />Name of Company WAiere Vireworks will be Purchatiedl <br />Retail outlet in South Dakota <br />Heason or Purpose Fourth of July Party = <br />Type of F1r-ework s Class C: <br />or below <br />,.ate of L e July 4 <br />, 19 85 <br />qh,- 1.. <br />• � �.•nrks display would be cunducted <br />— <br />betwc.—, <br />:30 p.m, ai:- 10:00 p.m. on July 4, <br />Insurance Coverdg,e Personal <br />Liability <br />19K., <br />f, less than fifteen minutes, ir, our <br />front <br />(See attached consent of <br />Amount , 300, r100 <br />neicahl <br />ComNanY The North River Insura»ce Company <br />Copy of Insurance Certlfiont.es to be Submitted with th, -lloation. <br />I am aware of all applloable 3tats and ot► awe ro -a- 41.,e possession and use <br />of firew^.rk s and will abi a_e by same. I ., Id the Village of Orono <br />harales,4 from all lisbili Ulon that may h ,r indirectly from the <br />shooting of rlv*worKti approve(' by the s•, r-perml t. <br />Fee: S' .00 <br />"a Ph4 <br />i Y1 t <br />Check 4- , <br />CR eh_ _ <br />1n1 1.1 N1 e <br />f ri r.• use <br />tc- <br />RF.,COMMkMov:l): Yes_ No <br />. _ rc 'r "e y i re+: for <br />AI'll M)VP.D: Yee_ No <br />