Upon submission of this application, you will be required to upload the following documents:

· Name of vendor performing the fireworks display and their pyro technician license and Federal Explosives License/Permit.

· Certificate of Insurance listing the City of Rye 1051 Boston Post Rd. Rye, NY 10580 as an additional insured, with a minimum of $5,000,000 in all categories.

· Site plan of the location showing a minimum of 500 ft. radius to the location of the firework display. Please show the orientation to the surrounding buildings with measurements (Google map would be preferred.) Please include the launch area, spectator area, crowd control features and impact area. The actual distance at which the fireworks are to be fired shall be at least 200 feet from the nearest permanent building, public highway or railroad or other means of travel and at least 50 feet from the nearest above ground telephone line, tree or other overhead obstruction and the audience must be at least 150 feet from the point of fireworks discharge.

· Inventory list, description, and quantities of explosive items to be used.

· Affidavit from page 6 of the application

By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.

Signature HereClick to Sign

04/30/2025Click to Sign

Signature HereCity Clerk Will Sign Here

04/30/2025

I.N.Will Update Upon Signing

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

Full Legal Name

Your Initials

Signature Type

Type Draw Upload Custom

Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Additional Signatures Required

	Signer Details	Me?
Applicant
I'm not a signer listed above

City of Rye

Print Document

Create Your Signature

Upload Attachment(s)

Sign Now!

Please provide accurate information below to ensure the delivery of the signed copies of the document.

Listed Signers

Other Signers (The signers below will be invited to sign once the above signers have signed.)

Fire Captain

Commissioner of Public Safety

City Clerk