The following conditions have been communicated and agreed to by all concerned parties.

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1 MEMORANDUM CITY OF CHANHASSEN i'?oo Market Bouievarct PO Box 147 Chanhassen. MN Administration Phone: Fax: Building Inspections Phone: Fax: Engineering Phone: Fax: Finance Phone: Fax: Park &Recreation Phone: Fax: Recreation Center 2310 Coulter Boulevard Phone: Fax TO: Todd Gerhardt, City Manager FROM: Mark Littfin, Fire Marshal DATE: May 25, 2016 SUBJ: Private Fireworks Display at Lake Minnewashta on July 4, 2016 PROPOSED MOTION: "The City Council approves the fireworks display permit from Pyrotechnic Display Inc., on behalf of the Lake Minnewashta Fireworks Committee, to conduct a fireworks show from Minnewashta Regional Park on July 4, 2016, with the conditions noted in the staff report." Approval of this request requires a simple majority vote of the City Council. Staff has received a request from Pyrotechnic Display Inc., on behalf of the Lake Minnewashta Fireworks Committee, to conduct a fireworks show from Minnewashta Regional Park on July 4 1h. This application is similar to what has occurred for the past twelve years and meets Fire Code regulations. The following conditions have been communicated and agreed to by all concerned parties. 1. The fireworks display operator will be required to adjust the launch angle so as to aim over the lake in order to minimize drop-down matenal from landing in the wetland area resulting in grass/swamp fires. A plan must be submitted to the Fire Marshal to show how this will be accomplished. 2. Planning & Natural Resources Phone Fax: Public Works 7901 Park Place Pt1one Fax Senior Center Phone: Fax Website Staff will require the Fire Department to have a standby crew at the launch site. Additionally, a boat from either the Carver County Sheriffs Department Water Patrol Division or the Chanhassen Fire Department will be required on the lake to secure the fireworks drop-down zone. I will coordinate this as we get closer to July 4th. Additionally, the group has provided a certificate ofliability insurance policy covering this event. RECOMMENDATION Staff recommends approval of the request from Pyrotechnic Display, Inc. for a fireworks display permit on July 4, 2016 at Lake Minnewashta Regional Park 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\ml\mwshtafi reworkdisplaymemo.doc Chanhassen is a Community for Life - Providing 1or Today and Planning 1or Tomorrow

2 APPLICATION FOR OUTDOOR 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): Keeping America' s Birthday Observation over Minnewashta Address of applicant: 3611 Ironwood Road, Excelsior, Minnesota Name of authorized agent of applicant: ~P~yr~o~te~c=hni= c~d~is"""p'"""l"'"ay.._.,~in~c-.... Address of agent: 9405 River Road SE, Clear Lake, MN Telephone number of agent: Ext. 1 Date of display: ~J'"-"u=-ly,_4--'-','-=2=0-=-1 =-6 Time of display: about 10 pm Location of display: Lake Minnewashta Regional Park - please see attached site map 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: l.3g product - up to 5 inch aerial shells and Multi-Shot Box Items & Candles Minnesota State law requires that this display be conducted under the direct!lupervision of a pyrotechnic operator certified by the State Fire Mar&hal. Name of supervising operator: ~L=ae=l'"-"L=i=te=c=ky=.- Certificate No.: - ---'0"'---"'0=2-=-19"----- Required attachments. The following attachments must be included with this application: 1. Proof of a bond or certificate of insurance in amount of at least $ 5,000, 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. Eric Ostman, 48, Craig Armbrust, 35 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 through , MN 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. Signatureofapplimt(o<agent)' ~ Jk~ Date of application: May 18, Nc.t?U 4t/~ _J Signature of Fire ltref: --~---~-,._, -...+~ Date: Printed name of above official: /"k-,,./c., (:. 1f f _ Phone: Signature of issuing authority: --~-'-U--'-'-----~---~--~ Printed name of above official:~o.. ~-e k.~ ~/J '1/1'. I r;/ji//5. r Date: "-L...~- /l:,

~ ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/18/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.

3 ~ ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/18/2016 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 Britton Gallagher One Cleveland Center, Floor East 9th Street Cleveland OH FAX AIC No: NAIC# INSURED Pyrotechnic Display Inc W. St. Francis Road Frankfort IL INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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.,,. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER IMM/DD/YYYYl IMM/DD/YYYYl LIMITS B GENERAL LIABILITY Sl8ML /30/2015 9/30/2016 EACH OCCURRENCE $ DAMAGE TO RENTED x COMMERCIAL GENERAL LIABILITY PREMISES IEa occurrence\ $500,000 D CLAIMS-MADE ~ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 n POLICY lxl ~:;.p;: $ nloc c AUTOMOBILE LIABILITY Sl8CA /30/2015 9/30/2016 rea accidentl'"'"le LIMI I $1,000,000 x ANY AUTO BODILY INJURY (Per person) $ ALL OWNED ~ SCHEDULED BODILY INJURY (Per accident) $ - AUTOS - AUTOS NON-OWNED PROPERTY DAMAGE x HIRED AUTOS x $ AUTOS <Per accident) - $ A UMBRELLA LIAB H - EAU /30/2015 9/30/2016 OCCUR EACH OCCURRENCE $4,000,000 x EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 OED I I RETENTION $ $ D WORKERS COMPENSATION MNAR (MN) 9/30/2015 9/30/2016 x I WC STATU- I IOJ~- AND EMPLOYERS' LIABILITY TORY LIMITS Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE D E.L. EACH ACCIDENT NIA $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,D_OO,.Q.QQ g~st~f~ir~~ igi:igperations below EL DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. DISPLAY DATE: July 4, 2016 LOCATION: Lake Minnewashta Park, Chanhassen, Minnesota ADDITIONAL INSURED: City of Chanhassen, Minnesota; Carver County of Minnesota; Keeping America's Birthday Observation over Minnewashta CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) Keeping America's Bithday Observation Over Minnewashta Attn: Ms. Beth Ginther 3611 Ironwood Road Excelsior MN I 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 -.;::;.--<~ -.; C-9;_ -/ "~;.,.,,,,..,..,,.- I//" ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

4 DIAGRAM OF H RE\.VORKS DISPLAY SITE LAUNCH SITE AREA TO lbe MAINTAINED CLEAR Of PEOPLE pf5'1\~ce FROM CROWD ---'4= 20-=--'- - FOOT RADIUS (A) LJ\..Rl3sT D[AMETlER SHELL 6 91

5 AUDIENCE IS ON BOATS AND HOMES AROUND THE LAKE

6 PLEASE FORWARD THIS APPLICATION TO THE CORRECT PARTIES, HA VE IT SIGNED AND MAIL THE SIGNED -FORM BACK TO US AT: PYROTECHNIC DISPLAY, INC RIVER ROAD SE CLEAR LAKE, MN MARK HANSON Sales/Design Ext. 1 mhanson@pyrodisplay.com Becky Hanson MINNESOTA 9405 RIVER ROAD SE CLEAR LAKE, MN T xl F KENTUCKY 638 TUCKER LANE SPRINGFIELD, KY T x2 F BUSINESS OFFICE 8450 W. ST. FRANCIS ROAD FRANKFORT, IL T x3 F

CERTIFICATE OF LIABILITY INSURANCE

ACORD CERTIFICATE OF LIABILITY INSURANCE Date (MM/DD/YR) Today s Date THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES