Town Board — Documents

D:\localdoc\fireworks Town of Rutland Dane County, Wisconsin Fireworks Permit Date: 1/30/25 Issued in accordance with Wisconsin Statute 167.10, the undersigned, designated official of the Town of Rutland in the County of Dane, in the State of Wisconsin, hereby authorizes the following named organization and/or individual Madison Speedway, Inc Printed name 1122 Sunrise Rd Oregon WI 53575 Address City State Zip to purchase and use Class “C” fireworks, including, but not limited to firecrackers, torpedos, aerial rockets, roman candles, etc. on the following date(s): Friday June 20, 2025 AND Friday August 15, 2025 Rain Date(s): Friday August 22, 2025 This permit is restricted to the above named location and date(s). The Permit Holder further warrants that they will adhere to the following conditions. 1. You must notify the Oregon Fire Department and give a copy of this permit to them at least 2 days before the date of authorized use. 2. File with the Town Clerk, no later than 5 days before the scheduled event , a Certificate of Insurance under your home owner’s policy naming the Town of Rutland as an additional insured in the amount of at least $1,000,000 which will indemnify the Town of Rutland and other persons for any injuries to person or property arising out of the use of the fireworks. The permit holder further warrants that this hold harmless is binding on his/their heirs. ____________________________________ __________________________________ Town of Rutland, Chairman Permit Holder Signature