APPLICATION FOR PERMIT TO CONDUCT PUBLIC FIREWORKS DISPLAY INSTRUCTIONS I. Specific Instructions 1. This form is to be used for any time there will be a fireworks display pursuant to O.C.G.A. § 25-10-4. The form is to be completed by the person, firm, corporation, association, or partnership desiring to conduct a public exhibition or display of fireworks and filed in the Probate Court of the county in which the exhibition or display is to be held, no less than ten (10) days prior to the date of the proposed display. The permit must contain the license number issued by the Safety Fire Commissioner for the person, firm, corporation, association, or partnership that will cause the combustion, explosion, deflagration or detonation of pyrotechnics at the exhibition or display. Exhibits should be labeled at the bottom of each exhibit as Exhibit "A," Exhibit "B," etc. in consecutive order. The corresponding letter of each said exhibit should be inserted into the appropriate place in the form. The application must be accompanied by a bond of no less than $10,000.00 or such amount as the Probate Judge requires, if greater, or in the alternative, evidence that the applicant carries proper liability insurance in the amount of not less than $25,000.00 for each person and $50,000.00 for each accident and property damage no less than $25,000.00 for each accident and $50,000.00 aggregate, or such policy limits greater if the Probate Judge so requires, with an insurance company duly licensed by the Commissioner of Insurance. The bond or insurance certificate must name the permitting county's Board of Commissioners as a named insured for the specific event for which the application is made. Notice shall be sent to the Fire Department or Department of Public Safety that will provide the fire protection services during the display who may object or waive further notice. The local fire official responsible for the area where the display will be held shall make a determination of whether or not the site for the display meets his or her approval and is in compliance with all applicable codes and, if so determined, shall issue a certification that shall be returned to the probate court of such county. 2. 3. 4. 5. 6. 7. GPCSF 31 [i] Eff. July 2016 American LegalNet, Inc. www.FormsWorkFlow.com 8. The Judge of the Probate Court shall receive $30.00 for his or her services in granting or refusing the original permit and $1.00 for each copy issued, to be paid by the applicant pursuant to O.C.G.A § 15-9-60 (k) (11). The Judge of the Probate Court shall provide the Safety Fire Commissioner a copy of each permit granted prior to the proposed date of the exhibition or display. No permit shall be granted unless the applicant has met all the requirements of and is in full compliance with the rules and regulations promulgated by the Safety Fire Commissioner pursuant to O.C.G.A. § 25-10-4 and the display shall be of such character as to not be hazardous to persons or property. 9. 10. II. General Instructions General instructions applicable to all Georgia Probate Court Standard Forms are available in each probate court or at www.gaprobate.gov, labeled GPCSF 1. GPCSF 31 [ii] Eff. July 2016 American LegalNet, Inc. www.FormsWorkFlow.com IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA APPLICATION FOR PERMIT TO CONDUCT PUBLIC FIREWORKS DISPLAY ________________________________________________hereby applies for a permit to [Name of person or corporate entity] conduct a public fireworks display as provided under O.C.G.A. § 25-10-4. The public fireworks display is sponsored by __________________________________________________________ [Sponsoring organization] at ______________________________________________________________________ on the [Location of fireworks display] _______ day of____________________, 20_____, to begin at approximately____p.m., and last for approximately ________________ minutes. This application is being made at least 10 days prior to the proposed display. 1. The display will be conducted by __________________________________________, of [Operator/person who will discharge fireworks] _____________________________________________________, a competent and experienced [Fireworks or pyrotechnic company] operator who has conducted _______________________ displays over the past ________ years. [# of displays] A copy of the operator's ATF License (labeled and attached hereto as Exhibit "____") and/or the corporate entity's ATF License (labeled and attached hereto as Exhibit "____"). 2. This display will not be hazardous to persons or property. No persons other than the operator and the operator's employees will be allowed within ________ feet of the launching or detonation site. GPCSF 31 [1] Eff. July 2016 American LegalNet, Inc. www.FormsWorkFlow.com 3. The display (will) (will not) be a proximate audience display as defined by Georgia law. If the display is a proximate audience display, then a copy of the operator's Georgia License issued by the Safety Fire Commissioner, number ________, (labeled and attached hereto as Exhibit "_______") and the corporate entity's Georgia License issued by the Safety Fire Commissioner, number ___________, (labeled and attached hereto as Exhibit "_______"). 4. A. The site for the display is described as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ B. The fireworks and/or pyrotechnics to be used in the proposed display are described as follows or labeled and attached hereto as Exhibit "______". ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ C. The _____________________________________________ Fire Department or the [County/City] ________________________________________will provide the necessary and required [Name of Department or Entity that will provide services] fire protection services and the following special services: [list below] ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Attached hereto is a certification by the ______