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FIREWORKS SALES PERMIT
Name of Applicant: _ Shield Bearers Rep. Eduardo Ramirez Applicant's Mailing Address:_P.D. BOX 480
Gonzales. CA. 93926
851 5M St.
Location of Fireworks Stand(s):
Gonzales C4.93926
In front of starbucks i McDonalds. Acrostfrom Taco Bell (Please attach map showing location of stand and storage) Permit Fee - $25.00:
Sales Dates and Times: Noon-June28 to 8:00pm-TWlu 4th
(California Code Regulation Title 19, Chapter 6, Article 3, Sec 981.3) From NOON, June 28, to NOON, July 6, of the year indicated 8:00 a.m. to 8:00 p.m.
Conditions and Restrictions of Permit
1. Follow all provisions of the City Ordinance on Fireworks (attached).
2. File a Certificate of Insurance with the City Of Gonzales.
3. Location of stand and storage along with conditions of operation must be approved by Fire Marshal and Public Safety Director.
4. A sign must be posted per Section 9.16.30 of GMC, to read: No person shall light or cause or permit to be lighted any fireworks or other combustible article within any such stand or within ten feet thereof.
5. A fire extinguisher of at least 2½ gallon capacity in good working order and condition and of a type approved by the Fire Marshall must be maintained in the stand
6. No sale of fireworks to anyone under the age of 18 years.
7. No one under the age of 18 years may sell fireworks.
8. Stand or sales location may not encroach upon public right-of-way.
9. Inspection of stand/booth erection and storage area will be completed prior to commencing sales.
10. Except during the periods when fireworks are being sold, they shall at all times be maintained in a safety container that meets the approval of the Fire Marshal. The safety container shall be located either outside of the City or if within the City, at a location within the Industrial zoning district. The address of the storage site shall be provided to the City and access for inspection shall be available upon request. No storage of fireworks shall be permitted at any other locations within the City of Gonzales. The applicant shall make any changes to the container or location that may be requested for safety purposes by the Fire Marshal.
• siurage lo pe no less ınan Tuu teet trom innadiea Dulldings • Storage to be no more than 1000 pounds of fireworks
• Type of approved storage containers:
• Type 1 Magazines shall be a permanent structure such as a bulding, igloo, tunnel or dugout. It shall be bullet resistant, fire resistant, weather resistant, theft resistant and ventilated. • Type 2 Magazine shall be a box, trailer, semitrailer or other mobile facility. It shall be bullet resistant, fire resistant, weather resistant, thett resistant and ventilated.
• Type 3 Magazine shall be a "day box" or other portable magazine.
It shall be theft resistant, fire resistant and weather resistant. • Type 4 Magazine shall be a permanent, portable or mobile structure, such as a bulding, igloo, box, semitrailer or other mobile container, which shall be fire resistant, theft resistant and weather resistant.
11. Clear vegetation from parking lot to road base no less than 100 feet.
Provide a water supply at site.
Applicant has read, understands, and agrees to abide by all conditions and restrictions of this permit.
Applicant: I 22 5-9-2022
Date:
Signature
This permit was approved by the Gonzales City Council on René L. Mendez, City Clerk
F: \Planning Department1Fireworks Sales Permit.doc 5/2009
• 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 AN CALIFORNIA
241226688 - 00001 7
SHIELD BEARERS INC
SHIELD BEARERS INC EFFECTIVE DATE:
851 5TH ST June 28, 2022 thru July 7, 2022
GONZALES CA 039269436 J
YOU ARE REQUIRED TO OBEY ALL FEDERAL AND
STATE LAWS THAT REGULATE OR CONTROL
OUR BUSINESS. THIS PERMIT DOES NOT ALLOV
LOCATION. 'OU TO DO OTHERWISE
PLEASE RETAIN THIS DOCUMENT FOR YOUF
RECORDS
R INFORMATION ON YOUR RIGHTS, CONTACT THE TAXPAYERS* RIGHTS ADVOCATE OFFICE AT 1-888-324-27 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 8:00 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.
SHIELD 3 BEARERS
PO Box 680 Gonzales Ca, 93926 FootballBoosterClub.com
May 1, 2022
To Whom it may concern,
My name is Steve Romero and I am the President of Shield Bearers, the Non Profit Booster Club for Gonzales High School Football. Our organization is a nonprofit 501(c) (3) entity and we are proud to serve the community of Gonzales.
We are thankful for the opportunity to be considered to sell fireworks and are submitting our application with this letter. We would like to also request that you consider waiving all related city fees in consideration of our nonprofit status.
Please call, text, or email me with any questions you may have.
Sincerely,
Steve Romero
831 776-0945
[email protected]
ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
11/1/2022 10/29/2021
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 ADDITONAL 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).
PRODUCER Lockton Companies CONTACT
NAME
3280 Peachtree Road NE, Suite #250 PHONE
(A/C, No, Ext): (AC, 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 1359665 American Promotional Events, Inc.
DBA TNT Fireworks, Inc. INSURER C: Berkshire Hathaway Homestate Ins Co 20044 555 North Gilbert Avenue
INSURER D:
Fullerton CA 92833
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: 12082540 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 ADDL SUBR POLICY EFF
LTR TYPE OF INSURANCE INSDWVD POLICY NUMBER LIMITS
COMMERCIAL GENERAL LIABILITY N EACH OCCURRENCE $ 1,000,000 A SI8GL00242-211 11/1/2021 11/1/2022
X OCCUR DAMAGE TO RENTED
CLAIMS-MADE 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 IFCT XI LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER:
AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT $ XXXXXXX (Ea accident
ANY AUTO BODILY INJURY (Per person) $ XXXXXXX
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ XXXXXXX
HIRED NON-OWNED
AUTOS ONLY AUTOS ONLY $ XXXXXXX
$ XXXXXXX
UMBRELLA LIAB X OCCUR NUXP0056189-08 11/1/2021 11/1/2022 EACH OCCURRENCE $ 5,000.000
EXCESS LIAB AGGREGATE
CLAIMS-MADE $ 5,000,000
DED RETENTION $ $ XXXXXXX
WORKERS COMPENSATION N STATUTE
C AND EMPLOYERS' LIABILITY AMWC243357 11/1/2021 11/1/2022 Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N NIA
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedufe, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
12082540
The City of Gonzales SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Robert Palmer-Gonzales Shopping Center THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 30774
Santa Barbara CA 93130
AUTHORIZED REPRESENTATIVE
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
STATE OF CALIFORNIA
FRANCHISE TAX BOARD
FTB PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 1/7/2022
ESL ID: 3546534855
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.
Entity ID: 4121148
Entity Name: SHIELD BEARERS, INC.
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.
5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.
Important Information
• This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&T Sections 23304.1, 23304.5, 23305a, 23305.1).
• The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).
Connect With Us
Web: ftb.ca.gov
Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States
TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019)
SHIT A FRE PHOTICI
CAL STATE OF CALIFORNIA, NATURAL RESOURCES AGENCY
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): Broussard, Milton Phone Number:
Mailing Address (Street Address, City, CA, Zip): 8151 POWER RIDGE ROAD, SACRAMENTO, CA, 95826 Local Contact Person and Phone Number (if different from Licensee above): Milton Broussard, (916) 704-3473
STAND INFORMATION
Group Name: Shield Bearers INC
Physical Address (Street Address, City, CA, Zip): 851 Fifth Street, Gonzales, CA, 93926 County of Stand Location: Monterey
WHOLE SALE FIREWORK VENDOR INFORMATION
Business Name: AMERICAN PROMOTIONAL EVENTS-WEST License No.: W-1081 Contact Name: Broussard, Milton Phone Number: 9167043473 FIRE AUTHORITY HAVING JURISDICTION CAL Fire Validation No.
Fire Department: Gonzales Volunteer Fire Dept.
R-0527
Physical Address (Street Address, City, CA, Zip): P.O. Box 647 , Gonzales, CA, 93926 02/22/2022
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 White-Licensee Yellow-Fire Authority Pink-SFM File
TO THE CITY OF GONZALES,
Permission is hereby granted to Shield Bearers, INC and American Promotional Events Inc.- West for the right to use the property located at 851 Fifth Street in the City of Gonzales for their 2022 Fireworks stand.
It is understood that this sale will be conducted in accordance with all City, County, and State regulations. This permission is contingent on receiving proof of insurance for the operating period.
-DocuSigned by:
By: Date: 9/14/2021
Print:
P. O. Box 30874
Santa Barbara, CA 93130
(805) 453-8990
[email protected]
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