City_Council_Agenda_05-03-2023_-_Item_No._9_Redacted — Calexico City Council, May 3, 2023

AGENDA
ITEM
9 CITY COUNCIL

CALEXICO

AGENDA STAFF REPORT
DATE: May 3, 2023
TO: Mayor and City Council
APPROVED BY: Esperanza Collo, City Manager
PREPARED BY: Diego Favila, Fire Chief
SUBJECT: Approval of Pre-Qualified Applicants for the 2023 Sale of Safe and Sane Fireworks
========= ======
Recommendation:

Approve the following list of prequalified applicants for the sale of Safe and Sane Fireworks for 2023:

1. Ministerio In Accion Mas Que Vencendores

2. Christ Community Church of Imperial Valley
Background:

From March 1 through April 3, 2023 the city of Calexico accepted applications for permits to sell safe and sane fireworks. Permits are issued only to nonprofit organizations and such fireworks shall be sold only at outdoor sales stands. Upon approval by council the applicant will be notified by May 23 of the granting or rejection of their application. This is all in accordance of Calexico Municipal Code Chapter 15.24.

Qualifying nonprofit organizations were required to have been organized and established in the city's corporate limits for a minimum of one year prior to filing an application. Eligible nonprofits also were required to have a principal and permanent meeting place in the city and a bona fide membership of at least 20 members. A majority of the members must have been residents of the City of Calexico. The nonprofit must conduct activities primarily for the benefit of the city and its residents, or must serve more city residents than non-city residents AGENDA
to be eligible to receive a permit. No nonprofit organizations would be ITEM
granted more than one permit.

The above listed non-profit groups submitted all the required application forms and fees and have been prequalified by the Fire Chief and City Manager for your consideration. The City Council shall, in its sole discretion, determine the nonprofit organizations to which permits will be granted in accordance with Chapter 15.24 of the Calexico Municipal Code. Such determination shall be made at a regular or special meeting of the City Council in accordance with procedures established by the City Council. Only nonprofit organizations prequalified by the City Manager pursuant to Section

15.24.080 shall be considered.

Fiscal Impact:

None.

Coordinated With:

None.

Attachment:

1. Application for Ministerio In Accion Mas Que Vencendores.

2. Application for Christ Community Church of Imperial Valley.

MINISTERIO EN ACCION MAS QUE VENCEDORES

PART III

APPLICATION FORMS

APPLICATION & ATTACHMENTS A-G

IN ADDITION TO THE APPLICATION & ATTACHMENTS A - G, THE APPLICANT SHALL SUPPLY COPIES OF THE FOLLOWING DOCUMENTS AS PART OF THEIR COMPLETED APPLICATION PACKAGE:
• APPLICANT SHALL SUPPLY THE FOLLOWING DOCUMENTS:
• PROOF OF 501(c)(3) OR 2370d DESIGNATION FOR NONPROFIT FEDERAL TAX EXEMPT STATUS
• PROOF OF STATE TAX EXEMPTION: SEC. 214 OF REVENUE AND TAXATION CODE • CERTIFICATE OF LIABILITY INSURANCE
• TEMPORARY SELLER'S PERMIT- 2023
• STATE FIRE MARSHAL RETAIL FIREWORKS LICENSE-2023
• PROPER IDENTIFICATION AND SIGNATURE OF THE PERMIT APPLICANT • PLAN FOR STAFFING THE STAND DURING THE PROPOSED DAYS AND HOURS OF

OPERATION
• DETAILED STATEMENT OF EACH AND EVERY KIND OF FIREWORKS PROPOSED TO BE SOLD
2023 FIREWORK APPLICATION PACKET:

Christ Community Church - Calexico
Fireworks Stand Permit Application

Page 3 of 3 ends

For City Use Only - Attachments and Payments Received
$835.00 Fireworks Stand Permit Application Fee (Refundable if application denied) Date Paid:
$500.00 Temporary Use Permit Application Fee (From Distributor) Date Paid:

Attachment A - Plot Plan (Sketch) Staffing Plan for the stand Attachment B - Property Owner/Lessee Consent
Attachment C - Agreement to Comply with the Calexico Fire Department Requirements Attachment D - Roster of Current Members
Attachment E - Report of Disbursements of Net Proceeds from Sale of Fireworks - Attachment F - Not Due Until September 1, 2023 N/A
Attachment G - Temporary Use Permit Application (Filed by Distributor) Proof of 501(c)(3) or 23701d Nonprofit Designation for Federal Tax Exempt Status Proof of State Tax Exemption: Sec. 214-Revenue & Taxation Code Certificate of Insurance for $1,000,000 Liability
Copy of Current Temporary Seller's Permit from State Board of Equalization Copy of California State Fire Marshal Retail Fireworks License Rev. 2/2012
CAL
EXICO
100 YEARS
PATE DEPT Calexico Fire Department

APPLICATION FOR FIREWORKS STAND PERMIT
Complete and return the required application documents no later than 12:00 p.m. Noon on March 31, along with a check in the amount of $835.00 made payable to: City of Calexico. This amount is refundable if your application is not approved.

The fireworks distributor/wholesaler named in this application is required to file an application for a Temporary Use Permit (TUP) and pay the required fee simultaneous with filing your Fireworks Stand Permit application. The TUP fee shall be paid by a separate check made payable to: City of Calexico in the amount of $835.00 Please Print or Type

CHRIST COMMUNITY CHURCH - CALEXICO
Name of Organization:

Principal and Permanent Meeting Address: 341 E. FIRST ST. CALEXICO, CA. 92231 Mailing Address: 590 WEST ORANGE AVENUE
EL CENTRO Zip Code: 92243 760 , 337-9400
City: Telephone #: (
Individual in Organization Applying for this Permit:

FRANK ZAZUETA Title: PASTOR
Name:
590 WEST ORANGE AVENUE
Mailing Address:
, EL CENTRO 92243 760, 427-2795
City: _ Zip: Telephone # (
Emergency Contact Number: ( 760, 455-0799
Information on Three (3) Principal Officers of the Organization:

Name Title Address Phone
Bus. 590 WEST ORANGE AVE., EL CENTRO Bus 760-37-9400

WALTER COLACE SENIOR PASTOR
Res. Res.

BuS. 590 WEST ORANGE AVE., EL CENTRO Bus. 760-337-9400

FRANK ZAZUETA PASTOR
Res. Res.

Bus. 590 WEST ORANGE AVE., EL CENTRO Bus. 760-337-9400

CHRIS NUNN PASTR
Res. Res.

Fireworks Stand Permit Application

Page 2 of 3 ends

Status of Organization (Religious, Charitable, etc.): [Also attach copy of 501(c)(3) or 23701d designation]

RELIGIOUS (CHURCH)
Date organization came into existence: _ Length of continued existence: years) Purpose of Organization: RELIGIOUS ORGANIZATION
Intended use of funds realized from sale of fireworks: CHURCH NEEDS /COMMUNITY OUTRENCH Proposed location of fireworks stand: 2540 ROCKWOOD AVENUE, CALEXICO, CA Proposed Dates and Hours of Operation of the fireworks stand: 6/28 (NOON), 6/29-74 (9AM-10PM) Number of Employees who will work at the fireworks stand 8-12 (VOLUNTEERS) (Attach copy of the plan for staffing the stand during the proposed days and hours of operation) State Board of Equalization Seller's Permit #: SEE ATTACHED COPY [Attach copy of Sellers Permit] Current Certificate of Tax Exemption #: _ [Attach Sec. 214-Rev. & Tax Code] Property Owner Information: [Also complete the attached Property Owner Consent form] Name of Property Owner: WALMART STORES INC.

Address of Property Owner: 702 WEST 8TH STREET, BENTONVILLE, AR 72716 Partnership Information:

If you will be partnering with another eligible organization to sell fireworks at the above location, please complete the following:

Organization Name: Address.

Contact Person: Telephone # ( ).

Fireworks Distributor/Wholesaler Information:

Company Name: INT FIREWORKS Address 555 N. GILBERT ST., FULLERTON, CA 92833 Contact Person: STEVE BENNETT Telephone # ( 714, 738-1002 I declare under the penalty of perjury that the above information contained herein is, to the best of my knowledge and belief, true and correct. I further declare that / have read the Rules and Regulations, which concern the retail sale and storage of fireworks in the City of Calexico and will abide by the contents therein. Subject to the issuance of a license, / agree to provide full accounting of the use and distribution of funds realized from holding such a license.
/ also certify that our organization has a principal and permanent meeting place in the City of Calexico and have been established for at least one year prior to the filing of this application; and that we have a bona fide membership of at least 25, the majority of whom are residents of Calexico. 3-24-23
Signature of Applicant Date

ATTACHMENT A

CITY OF CALEXICO
\PLOT PLAN (SKETCH) AND STAFF PLAN OF PROPOSED FIREWORKS STAND LOCATION Pursuant to the provisions of the Health and Safety Code, State of California, and the City of Calexico Municipal Code:

I/We hereby make application for permit to sell as a retailer; "Safe and Sane Fireworks" as defined by the California State Health and Safety Code, at: Calexico, California.

The following Plot Plan (Sketch) of the proposed selling location shows where the fireworks stand will be placed on the property, the location and distance of all adjacent building(s) on-site, streets, driveways, parking spaces, and property lines in relation to the fireworks stand. (If insufficient space to diagram location; attach a separate page.) The staffing plan should include the name of the members or the spouses or adult children of such members of the nonprofit organization to sell or otherwise participate in the sale of fireworks at such stand during the purposed day and hours of operation per Calexico Municipal Code 15.24.

SEE ATTACHED

SEE ATTACHED
I/We hereby certify that all fireworks now on hand are not "dangerous fireworks" as defined in the above- mentioned Health and Safety Code and that any merchandise hereafter purchased and/or offered for sale by me/us shall be in strict compliance with the provisions of said Code and/or local laws or ordinances as INe understand that storage and sales of all fireworks shall be subject to such restrictions as may be deemed advisable by the City of Calexico Fire Department.

Signature of Applicant Date Name of Organization

TNT FIREWORKS

SALES ASSOCIATE BENNETT CITY CALEXICO
LOCATION# XXX2540 ORGANIZATION CHRIST COMMUNITY CHURCH-CALEXICO SIZE 6 X 32 TYPE OPM BACK DOORS 1 A-FRAMES 1
SET-UP 6/22 DOWN 7/6 LIGHTS OPM
ADDRESS 2540 ROCKWOOD AVE. (WALMART)
INTERSECTION NWC ROCKWOOD/ HWY 111 AND COLE RD.

THOMAS GUIDE - COUNTY IMP PAGE GRID
SPECIAL INSTRUCTIONS SET STAND AS SHOWN, IN CENTER OF PARKING SPOTS.

FACE STAND TOWARDS THE REST OF THE WALMART
PARKING LOT.

WALMART
PANDA

EXPRESS

ROCKWOOD AVE

PROPOSED GAS

STATION

CONSTRUCTION
2022
HWY 111

COLE RD
DocuSign Envelope ID: 1973D494-2C2D-4894-8954-E6CED49EEEDF STORE # 1859
TO WHOM IT MAY CONCERN:

Permission is hereby granted to American Promotional Events, Inc., d.b.a. TNT Fireworks ("TNT"), through its local customer CHis outco, an organization the exclusive right to use the property located at 2150 Rockwood Ave, in the City of Calexico, CA for their 2023 July 4th Fireworks Season stand.

TNT shall ensure that the sale of consumer fireworks from the Fireworks stand will be conducted in accordance with all City, County and State regulations, and the property left clean and free of debris.

Walmart In find try:

By: Pute Rose
Date: 9/6/2022
Pete Rosen
Manager Il- Walmart Retall Services Chain
Loc # XXX2540

ATTACHMENT C

Page 1 of 2 ends

AGREEMENT TO COMPLY
With
Calexico Fire Department

REQUIREMENTS FOR FIREWORKS STANDS
1, FRANK ZAZUETA , an authorized representative or officer of CHRIST COMMUNITY CHURCH - CALEXICO _, a nonprofit organization, agrees to comply with the following requirements set forth herein:
(a) No person shall fire, discharge, set off, or use any fireworks of any kind within the City. No parent, guardian, or other Serson having the legal care and custody of any minor child shall allow such child to violate the provisions of this (b) Notwithstanding the above, "safe and sane fireworks" may be discharged during the hours of 12:00 p.m. noon to 10:00 p.m. on June 28, and from 9:00 a.m. to 10:00 p.m. on June 29 through and including July 4, by adults or by minors under the direct supervision of an adult.
(c) No person shall sell any fireworks in the City other than safe and sane fireworks, except during the hours of 12:00 p.m. noon to 10:00 p.m. on June 28, and from 9:00 a.m. to 10:00 p.m. on June 29 through and including July 4. No person shall sell fireworks within the City limits without having first obtained a permit from the City to do so, as provided in Chapter 15.24 of the Calexico Municipal Code, and then only upon the terms and conditions specified in the granting of such permit. No person less than 18 years of age may sell, purchase, possess, use, or discharge "safe and sane (d) No holder of a permit shall sell or distribute any type of fireworks which fall within the State Fire Marshal's definition of a "flare" or "California candle."
(e) All applicants, at the time of application, must have in their possession a valid "Retailers' License" issued by the State Fire Marshal.

After the permit application has been approved by the City Manager's Office, permits shall also be obtained from the City of Calexico Building Department or the installation of any electrical equipment required for such stands. For the purpose of this part, every premise or structure form which the fireworks are sold is hereby defined as a "fireworks (g) No fireworks stand shall be located within 25 feet of another building, within 25 feet of a generator, within five feet of a curb line, nor within 100 feet of any gasoline pump.
(h) All fireworks stands shall be pre-assembled metal stands only with no more than 256 square feet. All fireworks stands will be pre-wired for interior and exterior lighting. All stands will have attached metal floors to enhance security and waterproofing.
(i) Every fireworks stand shall be equipped with signs bearing the words "No Smoking" in red lettering at least four inches in height. Such signs shall be visible to every person working in the stand and every customer while being served. (i) All electrical must be conduits. The breaker boxes will be GFI breakers. The manufacturer must have installed all wiring. Absolutely no wiring allowed at the stand site. (k) Each stand must have at least two exits, approximately equal distance apart, and in no case shall the distance between exits exceed twenty-four (24) feet.
(1) There shall be no signs except for the signs that come with the pre-assembled stands. (m) Each stand shall be provided with two (2), two-and-one-half (2 1/2) gallon water pressure type fire extinguishers, underwriter approved, IN GOOD WORKING ORDER, and easily accessible for use in case of fire.

ATTACHMENT C

Page 2 of 2 ends

(n) All weeds and combustible material shall be cleared from the location of the stand to a distance of at least 25 feet. (0) Each stand must have an adult in attendance and in charge thereof while fireworks are stored therein. Each stand must have security personnel at least 21 years of age on site during non-operating hours. Sleeping or remaining in the stand after close of each business day is forbidden.
(p) All unsold stock and accompanying litter shall be removed from the location by 5:00 p.m. on July 5. (9) No fireworks stand shall be erected more than three (3) calendar days prior to the time on which fireworks may lawfully be sold. The fireworks stand shall be removed from the temporary location by 12:00 p.m. noon the 6th day of July and all accompanying litter shall be cleared from the location by said time and date. (г) For each day or portion thereof that a fireworks stand is erected, maintained, or left standing contrary to the provisions of these requirements, the permittee may be subject to an administrative citation. (s) The Chief of the Calexico Fire Department and/or his designated representative shall have the power to suspend or revoke the permit of any permittee who is operating a fireworks stand in violation of any state law, local ordinance, or these permit requirements, or which, in his opinion, constitutes or creates a condition contributing to the cause or spread of fire.
(t) The decision of the Fire Chief or his designee to suspend the permit of any permittee shall be subject to review by the Administrative Hearing Officer, forthwith. In view of the limited sales period each year, for suspensions affecting such sale period, a hearing shall be held at the earliest possible time that the permittee, the Administrative Hearing Officer or his designee, and the Fire Chief or his representative can schedule a meeting for such review for suspensions after the sale period. The hearing shall be held within one month after the request for hearing, which request must be made within fifteen (15) days after notice of the suspension. The Administrative Hearing Officer or his designee is authorized to set aside the suspension, or to modify the suspension by limiting its effect to only one or more days, or by setting aside the forfeiture of priority status for future years. The decision of the Administrative Hearing Officer or his/her designee shall be final.
(u) The Calexico Fire Department will conduct an operator safety seminar for those individuals staffing the fireworks stands. Once the stand is stocked with fireworks, a member of the organization who has attended the seminar must be present during the business hours.
(v) The Calexico Fire Department shall inspect the stand prior to its opening to the public. Periodic inspections will be conducted to ensure the safe operation of the stand
f3135 3-24-23
Signature of Authorized Representative Date

FRANK ZAZUETA
Print Name

ATTACHMENT D

CITY OF CALEXICO

FIREWORKS STAND PERMIT APPLICATION

MEMBERSHIP ROSTER
INSTRUCTIONS: The applicant has a choice of using this form or supplying the information on a form of their choosing providing the members' complete name and mailing address is provided. If additional pages are needed to document the nonprofit organization's membership, please reproduce this form.

NAME OF MEMBER MAILING ADDRESS

JOE TORNERO

ARIANA TORNERO

ENRIQUE MARTINEZ

BLANCA RAMIREZ

HECTOR RAMIREZ

ROBERT DAVILA

VIRGINIA GOMEZ

JOSHUA LOPEZ

LISAIAS VALENZUELA

NORMA VALDEZ

CARLOS HERNANDEZ

CYNTHIA VARGAS

DAVID WALLACE

ATTACHMENT E

CITY OF CALEXICO

FIREWORKS STAND PERMIT APPLICATION

REPORT OF DISBURSEMENTS OF NET PROCEEDS
FROM SALE OF FIREWORKS IN 2023
INSTRUCTIONS: This form must be filed on or before April 1, 2023, concurrent with filing the required application documents for a fireworks stand permit in 2012. Use the backside of this form to itemize the expenditures if additional space is needed.

Net Fund Balance from Fireworks Sales Reported to the City on 3-31-22 $ Net Proceeds from 2022 Fireworks Sales reported to the City on 9-1-22 (Line 4) $ SUBTOTAL OF FUNDS AVAILABLE $
*ITEMIZED EXPENDITURES: (Expenditures made between 9-1-22 filing date and 4-1-23) LOCATION RENT (WALMART PARKING) 5_ 3,200
STAND SERVICE FEE $ 650
STAND SERVICE SALES TAX 55.00
FIRE EXTINGUISHER RENTAL 50. 00
STATE FIRE MARSHAL PERMIT 153:00
ADERTIZING - COUPON PROGRAM 50.00
CITY LICENSE 835.00
TUP PERMIT 13500
SECURITY 300
PORTABLE TOILETS 150
TOTAL EXPENDITURES: $ 5,528
NET FUND BALANCE: $
*Must be completed in detail. Each line item expense must be listed. Failure to do so will result in rejection of this filing.

I certify that all expenditures of net proceeds from the sale of fireworks were expended solely for charitable purposes within the City of Calexico.

SUBJECT TO AUDIT
PASTOR
Signature Title
CHRIST COMMUNITY CHURCH - CALEXICO 3-24-23
Organization Date

INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASU
P. 0. BOX 2508
CINCINNATI, OH 45201
Emolover Identification Number:

Date: M. 9...

DIN:

CHRIST COMMUNITY CHURCH OF IMPERIAL Contact person:

VALLEY INC RAY PILCHER ID# 95218
C/O WALTER COLACE Contact Telephone Number:
428 S 5TH STREET (877) 829-5500
EL CENTRO, CA 92243
Accounting period Ending:

Form 990 Required:

Addendum Applies:

Dear Applicant:

Based on information suppiied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from federal income tax under section 501(a) of the Internal Revenue Code as an organization described in section 501(c; (3).

We have further determined that you are not a private foundation within the meaning of section 509(a) because you are an organization described in sections 509 (a) (1) and 170(b) (1) (A) (i).

If your sources of support, or your purposes, character, or method of operation change, please let us know so we can consider the effect of the change on your exempt status and foundation status. In the case of an amend- name or address.

As of January 1, 1984, you are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more you pay to each of your employees during a calendar year. This does You are not liable for the tax
imposed under the Federal Unemploynent Tax Act (FUTA).

Since you are not a private foundation, ycu are not subject to the excis‹ • axes under Chapter 42 of however, if you are involved in an excess bencfit transaction, that transaction might be subject to the excise taxes of, section 4958. Additionally, you are not automatically exempt from other excise taxes. If you have any questions about excise, employment, or other federal taxes, please contact your key district office.

Grantors and contributors may rely on this determination unless the lose your sectior 509la) (li status, a grantor or contributor may not rely Internal Revenue Service publishes notice to the contrary. on this delermination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or material change on the Letter 947 (DO/CG;
- 2 -

CHRIST COMMUNITY CHURCH OF IMPERIAL
part of the organization that resulted in your loss of such status, or if he c she acguired knowledge that the Internal Revenue Service had given notice that you would no longer be classified as a section 509(a) (1) organization.

Donors may deduct contributions to you as provided in section 170 of the devises, transfers, or gifts to you or for your use
God deductibie for federal estase and gist tax purposes if they meet the applicable provisions oi Code sections 2055, 2106, and 2522.

Contribution deductions are allowable to donors only to the extent that their contributions are gifts, with no consideration received. and similar payments in conjunction with fundraising events may not necessarily qualify as deductible contributions, depending on the circum- stances. See Revenue Ruling 67-246, published in Cumulative Bulletin 1967-2, table e 104 which sets forth quidelines regarding the deductibility, as chari contributions, payments made by taxpayers tor admission to participation in fundraising activities for charity.

In the heading of this letter we have indicated whether you must file Form 990, Return of Organization Exempe From Income Tax.
are required to file Form 990 only if your gross receipts each year are normally more than $25,000. However, if you receive a Form 990 package in the file the return even if you do not exceed the gross receipts test box in the heading to indicate that your annual gross receipts aré normally simply attach the label provided, check the maximum penalty charged cannot exceed $10, 000 or
of your gross receipts for the year, whichever is less. organizations with gross receipts exceeding $1, 000,000 in any year, the penalty 12: 02 00 2a1 no exand 0, 00c30 3 penalty nage into sear delay a organizaticn with gross receipts exceedino This penalty may also be charged if a
return is not complete, so be sure your return is complete before you file it..

The law requires you to make your annual return available for public exemption application, any supporting documents and this exemption any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for che copied materials. The law does not require you to provide copies of public inspection documents that are made widely available, such as by posting them on the Internet (world wide Web). lou may be liable for a penalty of $20 a day or ca taxim de so made in ese coceer sandal retur public inspect 10? up to a maximun of sid
Letter 947 (DO/CG)

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
) PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 3/29/2017
ESL ID
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID:

Entity Name: CHRIST COMMUNITY CHURCH OF IMPERIAL VALLEY, INC.

1. The entity is in good standing with the Franchise Tax Board. • 2. The entity is not in good standing with the Franchise Tax Board.

3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701d. • 4. We do not have current information about the entity.

The above information does not necessarily reflect:
• The entity's status with any other agency of the State of California, or other government agency • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or the entity did business in California at a time when it was not qualified or not registered to do business in California:

The status or voidability of any contracts made in California by the entity at a time when the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1).

For entities revived under R&TC Section 23305b, any time limitations on the revivor or limitation of the functions that can be performed by the entity.

Internet and Telephone Assistance
Website: ftb.ca.gov
Telephone: 800.852.5711 from within the United States
916.845.6500 from outside the United States
TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (NEW 02-2012)

DATE (MM/DD/YYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE
11/1/2023 11/1/2022
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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 endorsements).

CONTACT
PRODUCER Lockton Companies NAME:

PHONE FAX
3280 Peachtree Road NE, Suite #250 (A/C. No. Ext): (A/C, No):

Atlanta GA 30305 E-MAIL
ADDRESS:
(404) 460-3600
INSURERS) AFFORDING COVERAGE NAIC *
INSURER A : Everest Indemnity Insurance Company 10851
INSURED INSURER B: Arch Specialty Insurance Company 21199 American Promotional Events, Inc.
1359683 DBA TNT Fireworks, Inc.

INSURER C:
555 North Gilbert Avenue INSURER D:

Fullerton CA 92833
INSURER E :

XXX2540
INSURER F:

COVERAGES CERTIFICATE NUMBER: 14584622 REVISION NUMBER: XXXXXXX

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 IADDL SUBR POLICY EFF POLICY EXP

LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY(MM/DD/YYYY LIMITS

INSD WVD
I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A N S18GL00242221 11/1/2022 11/1/2023

DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 500,000
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO-
POLICY LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: $

NOT APPLICABLE COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY (Ea accident) $ XXXXXXX
ANY AUTO BODILY INJURY (Per person) 5 XXXXXXX
OWNED SCHEDULED BODILY INJURY (Per accident)S XXXXXXX

AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident) $ XXXXXXX
$ XXXXXXX
UMBRELLA LIAB OCCUR NUXP0056189-09 11/1/2022 11/1/2023 EACH OCCURRENCE $ 5,000,000 X X
EXCESS LIAB CLAIMS MADE AGGREGATE $ 5,000,000
DED RETENTIONS 5XXXXXXX

WORKERS COMPENSATION NOT APPLICABLE

AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? N/ A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEES XXXXXXX
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMITS XXXXXXX

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 14584622 ACCORDANCE WITH THE POLICY PROVISIONS
Chry or Calexico i appointed cleat Valley and the
officials, employees, representatives & volunteer AUTHORIZED REPRESENTATIVE. ya falls.
© 1988-2016 ACORD CORPORATION. All rights reserved.

ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD

DISPLAY THIS PERMIT CONSPICUOUSLY AT THE PLACE OF BUSINESS FOR WHICH IT IS ISSUED

CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION

TEMPORARY SELLER'S PERMIT

PERMIT NUMBER
202559520 - 00001 7

CHRIST COMMUNITY CHURCH-CALEXICO
FRANK ZAZUETA EFFECTIVE DATE:
2540 ROCKWOOD AVE June 20, 2023 thru July 4, 2023
CALEXICO CA 92231-4406
J

YOU ARE REQUIRED TO OBEY ALL FEDERAL AND

STATE LAWS THAT REGULATE OR CONTROL
YOUR BUSINESS. THIS PERMIT DOES NOT ALLOV

YOU TO DO OTHERWISE

PLEASE RETAIN THIS DOCUMENT FOR YOUR

RECORDS
THIS PERMIT IS VALID FOR THE PERIODS SHOWN AND IS NOT TRANSFERABLE.

OR GENERAL TAX QUESTIONS, PLEASE CALL OUR CUSTOMER SERVICE CENTER AT 1-800-400-7115 (CRS:71 OR INFORMATION ON YOUR RIGHTS, CONTACT THE TAXPAYERS' RIGHTS ADVOCATE OFFICE AT 1-888-324-279 CDTFA-442-ST REV. 9(2-22)

A MESSAGE TO OUR PERMIT HOLDER
As a permitee, you have certain rights and responsibilities under the Sales and Use Tax Law. For assistance, we offer the following resources:
: Our website at www.cdtfa.ca.gov.

Our toll-free Customer Service Center at 1-800-400-7115 (CRS:711). Customer service representative:
are available Monday through Friday from 7:30 a.m. to 5:00 p.m. (Pacific time), except state holidays As a permittee, you are expected to maintain the normal books and records of a prudent businessperson. You are required to maintain these books and records for no less than four years, and make them available for inspection by a California Department of Tax and Fee Administration (CDTFA) representative when requested.

You are also required to know and charge the correct sales or use tax rate, including any local and district taxes.

You must notify us if you are buying, selling, adding a location, or discontinuing your business; adding or dropping a partner, officer, or member; or when you are moving any or all of your business locations. This permit is valid only for the owner specified on the permit. A person who obtains a permit and ceases to do business, or never commenced business, shall surrender their permit by immediately notifying CDTFA in writing at this address: California Department of Tax and Fee Administration, Field Operations Division, P.O. Box 942879, Sacramento, CA 94279-0047. You may also surrender the permit to a CDTFA representative.

If you would like to know more about your rights as a taxpayer, or if you are unable to resolve an issue with CDTFA, please contact the Taxpayers' Rights Advocate Office for help by calling 1-888-324-2798 or by faxing 1-916-323-3319.

As authorized by law, information provided by an applicant for a permit may be disclosed to other government agencies.

STATE OF CALIFORNIA, NATURAL RESOURCES AGENCY
CAL

FIRE DEPARTMENT OF FORESTRY AND FIRE PROTECTION
SINCE 1885 RETAIL FIREWORKS LICENSE APPLICATION
FWX-15 (REV. 12/18)
Complete and return all copies to the Office of State Fire Marshal with the required fee of $50.00 made payable to "CAL FIRE". Applications must be received prior to June 15th of the current year.

Fire Engineering
Office of the State Fire Marshal
PO Box 944246, Sacramento, CA
94244-2460
(916) 568-2948

LICENSEE INFORMATION
Name (Last, First): Deeth, Terese Phone Number:

Mailing Address (Street Address, City, CA, Zip): 555 N. Gilbert St., Fullerton, CA, 92833 Local Contact Person and Phone Number (if different from Licensee above): STEVE BENNETT, (714) 738-1002

STAND INFORMATION
Group Name: CHRIST COMMUNITY CHURCH OF IMP - XXX2540
Physical Address (Street Address, City, CA, Zip):2540 ROCKWOOD AVE, CALEXICO, CA, 92231 County of Stand Location: Imperial

WHOLE SALE FIREWORK VENDOR INFORMATION
Business Name: AMERICAN PROMOTIONAL EVENTS-WEST License No.: W-1081 Contact Name: Deeth, Terese Phone Number: 7147381002
FIRE AUTHORITY HAVING JURISDICTION CAL Fire Validation No. 3670
Fire Department: Calexico Fire Dept.

Valid Through
Physical Address (Street Address, City, CA, Zip): 430 E. 5th St, CALEXICO, CA, 92231 06/28/2023-07/06/2023 дат 02/24/2023
Signature of Fireworks Program Coordinator Signature of Licensee Date -NOTICE-

COPY OF THIS NOTICE MUST BE POSTED AT STAND WITH A COPY OF THE LOCAL PERMIT A validated license has been issued to the organization shown above for the sale of Safe and Sane fireworks at the location indicated. After a permit has been issued by the authority having jurisdiction this license allows the sale of only classified "Safe and Sane" fireworks at the approved location from NOON, June 28th to NOON, July 6th, of the year indicated. NOTE: Retail licensees are required to be atleast 21 years of age, employees of fireworks stand must be at least 18 and fireworks may not be sold to anyone under age of 16 For CAL FIRE DAO Use Only: Index-5942, PCA-59420, Source Code- 4129400 GL Cost Center: 51101
AMERICAN PROMOTIONAL EVENTS Check No. - 20171089
WEST
NIE diba TNT Fireworks
PO BOX 1318 Check Date - 2/15/2023
4511 Hetton Drive Industrial Park
Florence, AL 35630 Stub - 1 of 1
INVOICE NO. DATE DESCRIPTION GROSS DEDUCTIONS AMOUNT PAID XXX2540/515/J23/130 2/15/23 Permitting Fees 835.00 $35.00 835.00 835.00
THIS CHECY 18 VOIE WITHOUT & RED & GRAY BORDER AND BACKROUND PLUS A KNIGHT & FINGERPRINT WARRMARK ON THE BACK - HOLD AT ANGLE TO VIEW

AMERICAN PROMOTIONAL EVENTS WELLS FARGO BANK, NA
WEST 20171089
36-382 CHECK NO.
dba TNT Fireworks 412
PO BOX 1318
4511 Helton Drive Industrial Park
Florence, AL 35630 VENDOR

DATE AMOUNT
2242867 2/15/2023 $*******835.00
****
PAY EIGHT HUNDRED THIRTY FIVE AND 00/100**
REQUIRES 2 SIGNATURES
CITY OF CALEXICO Genice Nelson
TO THE
608 HEBER AVENUE
ORDER OF Eindy Mon
CALEXICO CA 92231
2023 FIREWORK APPLICATION PACKET:

Ministerio En Accion Mas Que
Vencendores
Fireworks Stand Permit Application

Page 3 of 3 ends

Attachment A - Plot Plan (Sketch) Staffing Plan for the stand Attachment B - Property Owner/Lessee Consent
Attachment C - Agreement to Comply with the Calexico Fire Department Requirements Attachment D - Roster of Current Members
Attachment E - Report of Disbursements of Net Proceeds from Sale of Fireworks Attachment F - Not Due Until September 1, 2023 N/A
Attachment G - Temporary Use Permit Application (Filed by Distributor) Proof of 501 (c)(3) or 23701d Nonprofit Designation for Federal Tax Exempt Status Proof of State Tax Exemption: Sec. 214-Revenue & Taxation Code Certificate of Insurance for $1,000,000 Liability
Copy of Current Temporary Seller's Permit from State Board of Equalization Copy of California State Fire Marshal Retail Fireworks License Rev. 2/2012
IN CA
LICO
100 YEARS
Calexico Fire Department

MINISTERIO EN ACCION MAS QUE VENCEDORES
Name of Organization:

Principal and Permanent Meeting Address: 711 PIERCE AVENUE, CALEXICO, CA 92231 2325 CLINTON AVENUE, APT 105
Mailing Address:
. CALEXICO 760 562-2190
City: Zip Code: 92231 Telephone #: ( )
Individual in Organization Applying for this Permit:

Name: SAUL GARCIA Title: CEO/PASTOR
Mailing Address: 2325 CLINTON AVENUE, APT 105
City: CALEXICO Zip: 92231 760 562-2190
Telephone # ( )
Emergency Contact Number: (760 562-2190
)
Information on Three (3) Principal Officers of the Organization:

Name Title Address Phone
Bus.

Bus. 711 PIERCE STREET, CALEXICO

SAUL GARCIA CEO/PASTOR
Res. Res.

BuS. 711 PIERCE STREET, CALEXICO Bus.

CYNTHIA GARCIA SECRETARY
Re Re
Bus. Bus

MERCEDES PARTIDA TREASURER
Res Res
Fireworks Stand Permit Application

Page 2 of 3 ends

Status of Organization (Religious, Charitable, etc.): [Also attach copy of 501(c)(3) or 23701d designation]

RELIGIOUS (CHURCH)
Date organization came into existence: 1/8/2009 Length of continued existence: _ year(s) Purpose of Organization: RELIGIOUS ORGANIZATION
Intended use of funds realized from sale of fireworks: CHURCH NEEDS Proposed location of fireworks stand: 1407 IMPERIAL AVE Proposed Dates and Hours of Operation of the fireworks stand: 6/28 (NOON), 6/29-7/4 (9AM-10PM) Number of Employees who will work at the fireworks stand 8-12 (VOLUNTEERS) (Attach copy of the plan for staffing the stand during the proposed days and hours of operation) State Board of Equalization Seller's Permit#: SEE ATTACHED COPY _ [Attach copy of Sellers Permit] Current Certificate of Tax Exemption #: . [Attach Sec. 214-Rev. & Tax Code] Property Owner Information: [Also complete the attached Property Owner Consent form] Name of Property Owner: B & H CORP
Address of Property Owner: 1451 DOVE STREET, SUITE 175, NEWPORT BEACH, CA 92660 Partnership Information:

If you will be partnering with another eligible organization to sell fireworks at the above location, please complete the following:

Organization Name: Address
Contact Person: Telephone # ( )
Fireworks Distributor/Wholesaler Information:

Company Name: INT FIREWORKS Address 555 N. GILBERT ST., FULLERTON, CA 92833 Contact Person: STEVE BENNETT Telephone # ( 714) 738-1002 / declare under the penalty of perjury that the above information contained herein is, to the best of my knowledge and belief, true and correct. I further declare that / have read the Rules and Regulations, which concern the retail sale and storage of fireworks in the City of Calexico and will abide by the contents therein. Subject to the issuance of a license, / agree to provide full accounting of the use and distribution of funds realized from holding such a I also certify that our organization has a principal and permanent meeting place in the City of Calexico and have been established for at least one year prior to the filing of this application; and that we have a bona fide membership of at least 25, the majority of whom are residents of Calexico. 3/29/25
Signature of Applicant Date

ATTACHMENT A

ITY OF CALEXIC

PLOT PLAN (SKETCH) AND STAFF PLAN OF PROPOSED FIREWORKS STAND LOCATIO Pursuant to the provisions of the Health and Safety Code, State of California, and the City of Calexico Municipal IWe hereby make application for permit to sell as a retailer, "Safe and Sane Fireworks" as defed by the California State Health and Safety Code, at: Calexico, California.

The following Plot Plan (Sketch) of the proposed selling location shows where the fireworks stand will be placed on the property, the location and distance of all adjacent building(s) on-site, streets, driveways, parking spaces, and property lines in relation to the fireworks stand. (If insufficient space to diagram location; attach a separate page.) The staffing plan should include the name of the members or the spouses or adult children of such members of he nonprotit organization to sell orotherwise participate in the sale of fireworks at such stand during the urposed day and hours of operation per Calexico Municipal Code 15.24.

SEE ATTACHED

SEE ATTACHED
I/We hereby certify that all fireworks now on hand are not "dangerous fireworks" as defined in the above- mentioned Health and Safety Code and that any merchandise hereafter purchased and/or offered for sale by pertus sha the lostrict compliance with the provisions of said Code andior local laws or ordinances as IMe understand that storage and sales of all fireworks shall be subject to such restrictions as may be deemed advisable by the City of Calexico Fire Department.

Signature of Applicant Date Name of Organization
INSPECTION DATE: 6/26 TNT FIREWORKS

SALES ASSOCIATE BENNETT CITY CALEXICO
LOCATION# CLX1407 ORGANIZATION MINISTERIO EN ACCION
SIZE 6 X 32 TYPE OPM BACK DOORS OPM A-FRAMES O
SET-UP 6/22 DOWN 7/6 LIGHTS OPM
ADDRESS 1407 IMPERIAL AVENUE (FOOD4LESS)
INTERSECTION NWC BIRCH/ HWY 111 (IMPERIAL)

THOMAS GUIDE - COUNTY IMP PAGE GRID

SPECIAL INSTRUCTIONS FACE STAND TOWARDS RITE AID, SET STAND IN MIDDLE OF PARKING AREA AS PICTURED. CLOSE
TO THE ISLAND THAT IS TOWARD HIGHWAY 111.

N
FOREVER 21 RIGHWAY 111/
STAND
5 PE P
FooD + LESS
11AMPERIAL
RITE
AID

BIRCH S
boale
DocuSign Envelope ID: 17F22FOC-0103-4A45-A596-0AC03CA22162

PROPERTY PERMISSION FORM FOR CITY
TO WHOM IT MAY CONCERN:

Permission is hereby granted to MINISTERIO EN ACCION MAS QUE VEN and AMERICAN PROMOTIONAL EVENTS, INC. - WEST, d.b.a., TNT FIREWORKS, for the exclusive right to use the property located at 1407 IMPERIAL AVE. in the City of CALEXICO for their 2023 Fireworks stand.

It is understood that this sale will be conducted in accordance with all City, County and State regulations, and the property left clean and free of debris.

BIRCH CORP. C/O R.H. PROPERTIES, LLC
-Docusigned by:

By: (Sign), Ron. Haley
009947342901
Print Name: Ron Holley
12/14/2022
Date:

Loc # CLX1407

ATTACHMENT C

Page 1 of 2 ends

AGREEMENT TO COMPLY
With
Calexico Fire Department

REQUIREMENTS FOR FIREWORKS STANDS
1, SAUL GARCIA , an authorized representative or officer of MINISTERIO EN ACCION MAS QUE VENCEDORES , a nonprofit organization, agrees to comply with the following requirements set forth herein:
(a) No person shall fire, discharge, set off, or use any fireworks of any kind within the City. No parent, guardian, or other Serion having the legal care and custody of any minor child shall alow such child to violate the provisions of this (b) Notwithstanding the above, "safe and sane fireworks" may be discharged during the hours of 12:00 p.m. noon to 10:00 p.m. on June 28, and from 9:00 a.m. to 10:00 p.m. on June 29 through and including July 4, by adults or by minors under the direct supervision of an adult.
(c) No person shall sell any fireworks in the City other than safe and sane fireworks, except during the hours of 12:00 p.m. noon to 10:00 p.m. on June 28, and from 9:00 a.m. to 10:00 p.m. on June 29 through and including July 4. No person shall sell fireworks within the City limits without having first obtained a permit from the City to do so, as provided in Chapter 15.24 of the Calexico Municipal Code, and then only upon the terms and conditions specified in the granting of such permit. No person less than 18 years of age may sell, purchase, possess, use, or discharge "safe and sane fireworks."
(d) No holder of a permit shall sell or distribute any type of fireworks which fall within the State Fire Marshal's definition of a "flare" or "California candle."
(e) All applicants, at the time of application, must have in their possession a valid "Retailers' License" issued by the State Fire Marshal.
(f) After the permit application has been approved by the City Manager's Office, permits shall also be obtained from the City of Calexico Building Department or the installation of any electrical equipment required for such stands. For the stand se of this part, every premise or structure form which the fireworks are sold is hereby defined as a "fireworks (g) No fireworks stand shall be located within 25 feet of another building, within 25 feet of a generator, within five feet of a curb line, nor within 100 feet of any gasoline pump.
(h) All fireworks stands shall be pre-assembled metal stands only with no more than 256 square feet. All fireworks stands will be pre-wired for interior and exterior lighting. All stands will have attached metal floors to enhance security and waterproofing.
(i) Every fireworks stand shall be equipped with signs bearing the words "No Smoking" in red lettering at least four inches in height. Such signs shall be visible to every person working in the stand and every customer while being served. (i) All electrical must be conduits. The breaker boxes will be GFI breakers. The manufacturer must have installed all wiring. Absolutely no wiring allowed at the stand site. (k) Each stand must have at least two exits, approximately equal distance apart, and in no case shall the distance between exits exceed twenty-four (24) feet.
(1) There shall be no signs except for the signs that come with the pre-assembled stands. (m) Each stand shall be provided with two (2), two-and-one-half (2 1/2) gallon water pressure type fire extinguishers, underwriter approved, IN GOOD WORKING ORDER, and easily accessible for use in case of fire.

ATTACHMENT C

Page 2 of 2 ends

(n) All weeds and combustible material shall be cleared from the location of the stand to a distance of at least 25 feet. (0) Each stand must have an adult in attendance and in charge thereof while fireworks are stored therein. Each stand must have security personnel at least 21 years of age on site during non-operating hours. Sleeping or remaining in the stand after close of each business day is forbidden.
(p) All unsold stock and accompanying litter shall be removed from the location by 5:00 p.m. on July 5. (9) No fireworks stand shall be erected more than three (3) calendar days prior to the time on which fireworks may lawfully be sold. The fireworks stand shall be removed from the temporary location by 12:00 p.m. noon the 6' day of July and all accompanying litter shall be cleared from the location by said time and date. (г) For each day or portion thereof that a fireworks stand is erected, maintained, or left standing contrary to the provisions of these requirements, the permittee may be subject to an administrative citation. (s) The Chief of the Calexico Fire Department and/or his designated representative shall have the power to suspend or revoke the permit of any permittee who is operating a fireworks stand in violation of any state law, local ordinance, or these permit requirements, or which, in his opinion, constitutes or creates a condition contributing to the cause or spread of fire.
(t) The decision of the Fire Chief or his designee to suspend the permit of any permittee shall be subject to review by the Administrative Hearing Officer, forthwith. In view of the limited sales period each year, for suspensions affecting such sale period, a hearing shall be held at the earliest possible time that the permittee, the Administrative Hearing Officer or his designee, and the Fire Chief or his representative can schedule a meeting for such review for suspensions after the sale period. The hearing shall be held within one month after the request for hearing, which request must be made within fifteen (15) days after notice of the suspension. The Administrative Hearing Officer or his designee is authorized to set aside the suspension, or to modify the suspension by limiting its effect to only one or more days, or by setting aside the forfeiture of priority status for future years. The decision of the Administrative Hearing Officer or his/her designee shall be final.
(u) The Calexico Fire Department will conduct an operator safety seminar for those individuals staffing the fireworks stands. Once the stand is stocked with fireworks, a member of the organization who has attended the seminar must be present during the business hours.
(v) The Calexico Fire Department shall inspect the stand prior to its opening to the public. Periodic inspections will be conducted to ensure the safe operation of the stand
3/09/03
Signature of Authorized Representative Date

SAUL GARCIA
Print Name

ATTACHMENT D

CITY OF CALEXICO

FIREWORKS STAND PERMIT APPLICATION

MEMBERSHIP ROSTER
INSTRUCTIONS: The applicant has a choice of using this form or supplying the information on a form of their choosing providing the members complete name and mailing address is provided. If additional pages are needed to document the nonprofit organization's membership, please reproduce this form.

NAME OF MEMBER MAILING ADDRESS
Boni
FIVilA ortiz
Ana tunal
lyn burea
nissa turna
Dennisse Bernal
Joaquin Rangel
Manna sandon
Kalph Gun cia
backsel Garcia
Jese DuL
Jacqueline bus
rachel bull
Arellano
Mana Silide Dreniz
Andrew Finiero
Teresa Villanuevil
eyes lit
Alan Lot
Martha Villaniel
Anan Villndeva
Villanueva
Dinero
Minica Murtmor
Victor Marhom
Leil
Rene canez
Evana Carrer

ATTACHMENT E

CITY OF CALEXICO

FIREWORKS STAND PERMIT APPLICATION

REPORT OF DISBURSEMENTS OF NET PROCEEDS
FROM SALE OF FIREWORKS IN 2023
INSTRUCTIONS: This form must be filed on or before April 1, 2023, concurrent with filing the requirec application documents for a fireworks stand permit in 2012. Use the backside of this form to itemize the expenditures if additional space is needed.

Net Fund Balance from Fireworks Sales Reported to the City on 3-31-22 $.

Net Proceeds from 2022 Fireworks Sales reported to the City on 9-1-22 (Line 4) $ 9,444 SUBTOTAL OF FUNDS AVAILABLE $
*ITEMIZED EXPENDITURES: (Expenditures made between 9-1-22 filing date and 4-1-23) Laminate flaring $ - 8,500
Church impavements
paint, dars, peomes 944
TOTAL EXPENDITURES: $. 9,444
NET FUND BALANCE: $ Ф
*Must be completed in detail. Each line item expense must be listed. Failure to do so will result in rejection of this filing.

I certify that all expenditures of net proceeds from the sale of fireworks were expended solely for charitable purposes within the City of Calexico.

SUBJECT TO AUDIT

CEO/PASTOR
Signature Title
MINISTERIO EN ACCION MAS QUE VENCEDORES 3/29/23
Organization Date

INTERNAL PEVENUE SERVICE DEFARTMENT OF THE TREASURT
P. 0. B0X 2508
CINCINNATI, OH 45201
Employer Identification Number:
pace: FEB 0 5 2010
MINSTERIO EN ACCION MAS QUE Contact Person:

VENCEDOPES INC NANCY L HEAGNEY ID# 31306
C/O SAUL GARCIA Contact Telephone Number:
711 PIERCE AVE (877) 829-5500
CALEXICO, CA 92231
Accounting Period Ending:

December 31
Public Charity Status:
170(0) (1) (Al (1)
Fori: 990 Required:

No
Effective Date of Exemption:

January 8, 2009
Contribution Deductibility:

Yes
Addendum Applies:

Dear Appirant:

We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c) (3) Of the Internai Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records.

Organizations exempt under sectior 501(c)!3) of the Code are further classified as either public charities of private foundations. we determined that you ate a public charity under the Code section(s) listed in the heading of this letter.

Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt. organization.

Letter 947 (DO/C3)
- 2

MINSTERIO EN ACCION MAS QUE
Sincerely,
Robert Choi
Director, Exempt Organizations
Pulings and Agreements
Enclosure: Publication 4221- PC
Letter 947 (D0/CG:

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 3/24/2015
ESL ID:

According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID:

Entity Name: MINISTERIO EN ACCION MAS QUE VENCEDORES
X 1. The entity is in good standing with the Franchise Tax Board.

2. The entity is not in good standing with the Franchise Tax Board.

X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d.

4. We do not have current information about the entity.

The above information does not necessarily reflect:
• The entity's status with any other agency of the State of California, or other government agency • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or the entity lid business in California at a time when it was not qualified or not registered to do business in California:

The status or voidability of any contracts made in California by the entity at a time when the entity was suspended or forfeited (R&TC Sections 23304. 1, 23304.5, 23305a, 23305.1).

For entities revived under R&TC Section 23305b, any time limitations on the revivor or limitation of the functions that can be performed by the entity.

DATE (MM/DD/YYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE
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 have ADDITIONAL INSURED provisions or be endorsed.

PRODUCER Lockton Companies
3280 Peachtree Road NE, Suite #250
Atlanta GA 30305
(404) 460-3600
INSURERS) AFFORDING COVERAGE NAIC #
INSURER A : Everest Indemnity Insurance Company 10851
INSURED INSURER B: Arch Specialty Insurance Company 21199 American Promotional Events, Inc.
1359665 INSURER C: Berkshire Hathaway Homestate Ins Co 20044 DBA TNT Fireworks, Inc.
555 North Gilbert Avenue INSURER D:

Fullerton CA 92833
INSURER E :

CLX1407
INSURER F:

COVERAGES CERTIFICATE NUMBER: 12229692 REVISION NUMBER: XXXXXXX

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 ADDL SUBRI POLICY EXP
_TR TYPE OF INSURANCE IMSD WYD POLICY NUMBER LIMITS
COMMERCIAL GENERAL LIABILITY N 11/1/2022 | EACH OCCURRENCE $ 1,000,000 A S18GL00242221 11/1/2023

DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ 500,000
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X LOC PRODUCTS - COMPOP AGG $ 2,000,000
OTHER:

AUTOMOBILE LIABILITY NOT APPLICABLE OMBINED SINGLE LIMI $ XXXXXXX a acciden
ANY AUTO BODILY INJURY (Per persan) 5 XXXXXXX
OWNED SCHEDULED BODILY INJURY (Per accident) XXXXXXX

AUTOS ONLY

HIRED NON-OWNED
AUTOS ONLY Per PEND AMAGE $ XXXXXXX

AUTOS ONLY
$ XXXXXXX
X UMBRELLA LIAB X OCCUR N UXP0056189-09 11/1/2022 11/1/2023 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000

DED RETENTIONS S XXXXXXX
WORKERS COMPENSATION X| SEATUTE T
AND EMPLOYERS' LIABILITY NAMWC348084 11/1/2022 11/1/2023 Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/ A
(Mandatory in NH) ELL. DISEASE • EA EMPLOYEE $ 1,000,000 ESCRIPTION OF OPERATIONS bel E.L. DISEASE - POLICY LIMIT $1,000,000 abject to policy terms, conditions, and exclusior

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR 12229692 THEREOF, NOTICE WILL BE DELIVERED |

AUTHORIZED REPRESENTATIVE
0168E COR ATON. A HE Peared, we falte.

ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD

DISPLAY THIS PERMIT CONSPICUOUSLY AT THE PLACE OF BUSINESS FOR WHICH IT IS ISSUED

CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION

TEMPORARY SELLER'S PERMIT

PERMIT NUMBER
237424672-00001 7
MINISTERIO EN ACCION MAS QUE VENCEDORES EFFECTIVE DATE:
1407 IMPERIAL AVE W June 20, 2023 thru July 4, 2023
CALEXICO CA 92231-4812
J

YOU ARE REQUIRED TO OBEY ALL FEDERAL AND

STATE LAWS THAT REGULATE OR CONTROL
YOUR BUSINESS. THIS PERMIT DOES NOT ALLOW

YOU TO DO OTHERWISE

PLEASE RETAIN THIS DOCUMENT FOR YOUR
RECORDS.

THIS PERMIT IS VALID FOR THE PERIODS SHOWN AND IS NOT TRANSFERABLE.

FOR GENERAL TAX QUESTIONS, PLEASE CALL OUR CUSTOMER SERVICE CENTER AT 1-800-400-7115 (CRS:711).

FOR INFORMATION ON YOUR RIGHTS, CONTACT THE TAXPAYERS' RIGHTS ADVOCATE OFFICE AT 1-888-324-2798 CDTFA-442-ST REV. 9 (2-22)

A MESSAGE TO OUR PERMIT HOLDER
As a permitee, you have certain rights and responsibilities under the Sales and Use Tax Law. For assistance, we offer the following resources:

Our website at www.cdtfa.ca.gov.
: Our toll-free Customer Service Center at 1-800-400-7115 (CRS:711). Customer service representatives are available Monday through Friday from 7:30 a.m. to 5:00 p.m. (Pacific time), except state holidays.

As a permittee, you are expected to maintain the normal books and records of a prudent businessperson. You are required to maintain these books and records for no less than four years, and make them available for inspection by a California Department of Tax and Fee Administration (CDTFA) representative when requested.

You are also required to know and charge the correct sales or use tax rate, including any local and district taxes.

As authorized by law, information provided by an applicant for a permit may be disclosed to other government agencies.

CAL STATE OF CALIFORNIA, NATURAL RESOURCES AGENCY

Fire Engineering
Office of the State Fire Marshal
PO Box 944246, Sacramento, CA
94244-2460
(916) 568-2948

LICENSEE INFORMATION
Name (Last, First): Deeth, Terese Phone Number:

Mailing Address (Street Address, City, CA, Zip): 555 N. Gilbert St., Fullerton, CA, 92833 Local Contact Person and Phone Number (if different from Licensee above): STEVE BENNETT, (714) 738-1002

STAND INFORMATION
Group Name: MINISTERO EN ACCION MAS QUE VE -CLX1407
Physical Address (Street Address, City, CA, Zip): 1407 IMPERIAL AVE CALEXICO, CA, 92231 County of Stand Location: Imperial

Fire Department: Calexico Fire Dept. 3669
Valid Through
Physical Address (Street Address, City, CA, Zip): 430 E. 5th St, CALEXICO, CA, 92231 06/28/2023-07/06/2023 02/24/2023
Signature of Fireworks Program Coordinator Signature of Licensee Date -NOTICE-

COPY OF THIS NOTICE MUST BE POSTED AT STAND WITH A COPY OF THE LOCAL PERMIT A validated license has been issued to the organization shown above for the sale of Safe and Sane fireworks at the location indicated. After a permit has been issued by the authority having jurisdiction this license allows the sale of only classified "Safe and Sane" fireworks at the approved location from NOON, June 28th to NOON, July 6th, of the year indicated. NOTE: Retail licensees are required to beatleast 21 years of age, employees of fireworks stand must be at least 18 and fireworks may not be sold to anyone under age of 16 For CAL FIRE DAO Use Only: Index-5942, PCA-59420, Source Code- 4129400 GL Cost Center: 51101
AMERICAN PROMOTIONAL EVENTS Check No. - 20171088
WEST
TNI dba TNT Fireworks
PO BOX 1318 Check Date - 2/15/2023
4511 Helton Drive Industrial Park
Florence, AL 35630 Stub - 1 of 1
INVOICE NO. DATE DESCRIPTION GROSS DEDUCTIONS AMOUNT PAID CLX1407/515/J23/130 2/15/23 Permitting Fees 835.00 835.00 835.00 835.00
THIS CHECK IS VOID WITHOUT A RED & GRAY BORDER AND BACKGROUND PLUS A KNIGHT Ä FINGEAPRINT WATERMARK ON THE BACK - HOLD AT ANGLE TO VIEW AMERICAN PROMOTIONAL EVENTS WELLS FARGO BANK, NA 20171088 WEST 56-382 CHECK NO.
dba TNT Fireworks 412
PO BOX 1318
4511 Helton Drive industrial Park
Florence, AL 35630

VENDOR DATE AMOUNT
2242867 2/15/2023 $*******835.00
*******
EIGHT HUNDRED THIRTY FIVE AND 00/100*****
PAY

CITY OF CALEXICO GREG TE SONATURES
TÔ THE
608 HEBER AVENUE
ORDER OF Girdy Mon
CALEXICO CA 92231

Calexico City CouncilMay 3, 2023

Calexico City Council
May 3, 2023