By-Law 2011 Schedule "A"

Essex Fire and Rescue Services

Application to Hold a Fireworks or Pyrotechnic Display Event

Event Information:

Site Plan Map:

You are required to provide a site plan map of the event area detailing the location of the proposed fireworks/pyrotechnic display, the access to be provided for fire and emergency vehicles, and the free zone of clear distance between the point of launch and an occupied area. 

Insurance Information:

All Fireworks Displays are required to provide a certificate of liablity insurance with an minimum coverage of $5,000,000 with the Corporation of the Town of Essex named as an additional insured. 

Please Note: The Corporation of the Town of Essex's municipal address for service is: 33 Talbot St. S., Essex, ON N8M 1A8

Fireworks Supervisor Information

By completing the information below the Fireworks Supervisor or Pyrotechnician is certifying that they have completed a course for a fireworks supervisor and/or are a certified pyrotechnician (if pyrotechnic special effect fireworks are to be used), and that I have read, understand and will be guided by the principles and safety rules of the fireworks manual, all applicable municipal by-laws (Essex By-Law 2011), as well as all specific instructions of the fireworks manufacturer governing a particular firework, and any specific additional requirements set by the Essex Fire Chief or designate. 

Acknowledgement of Fireworks Supervisor

In lieu of a signature, by typing my full name below, I certify that I have completed a course for Fireworks Supervisors and that I have read, understand, and will be guided by the principles and safety rules of the Fireworks Manual, any applicable municipal By-Laws, as well as by specific instructions of the fireworks manufacturer governing a particular firework.

Release and Indemity

Release, waiver, and assumption of risk: I hereby acknowledge that fireworks, including, but not limited to, the storage, handling, use, and discharge of fireworks can be dangerous, exposing anyone involved to various risks and hazards are inherent in fireworks themselves and others may result from human error and negligence on the part of fireworks handlers and users, or on part of organizers of fireworks events and activities.

In consideration of being granted a Fireworks Display Permit by the Town of Essex, I acknowledge and agree as follows:

1. I hereby forever release and discharge, indemnify, and hold harmless The Corporation fo the Town of Essex and all its servants, agents, officers, and employess, (hereafter collectively called the "Releases"), from any and all liabilites, proceedings, claims, and causes of action of any kind whatsoever, including, but not limited to, all personal and other insuries or damage to property of any kind, and any and all legal fees and legal costs which I or anyone else may suffer or incur, arising out of or connected in any way directly or indirectly to this application for a Fireworks Display Permit, including the storage, handling, use, and discharge of fireworks, notwithstanding that such injuries, damages or costs may have been caused solely or partly by the negligence of any of the Releaseees,
2. I declare that I know of no physical issue or other reason which should keep me from obtaining or making use of a Fireworks Display Permit, and I understand and agree that I am solely responsible for any and all injuries, harm, or damage to property of any kind that I or others may sustain as a result thereof,
3. I further acknowledge and agree that this Release and Indemnity limits my rights and those of others to compensation should I or they have any claim or cause of action of any kind against The Corporation of the Town of Essex; and I further understand I have the right to independent advise before signing this agreement,
4. I further acknowledge and agree that it is in my best interest to have insurance coverage in place with respect to any aspect of this matter, 
5. I have read and understood all of the above statements and in lieu of affixing a signature, by marking yes in the appropriate box and by typing in my name below, I hereby confirm my consent to and agree with all of the statements within this section.