DocuSign Envelope ID: FDEF9721-6F6F-468E-B6AB-9FA931FCDD3D
WINE CAPITAL
City of Gonzales
•
HOMERY COUNT FIREWORKS SALES PERMIT
Name of Applicant: Spartan 300 Club
Applicant's Mailing Address: P.O. Box 1624 Gonzales CA 93926 Easement between Taco Bell & Chevron
Location of Fireworks Stand(s):
800 5th Street Gonzales, CA 93926
(Please attach map showing location of stand and storage) Permit Fee - $25.00:
Sales Dates and Times: June 25 at noon through July 4th at 8pm.
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 2 ½ 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 will be completed prior to commencing sales.
10. Except during the periods when fireworks are being sold, they shall always 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 changes to the container or location that may be requested for safety purposes by the Fire Marshal.
• Storage to be no less than 100 feet from inhabited buildings
DocuSign Envelope ID: FDEF9721-6F6F-468E-B6AB-9FA931FCDD3D • 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 building, igloo, tunnel or dugout. It shall be bullet resistant, tire 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, theft resistant and ventilated.
• Tyso 3 Magei sial tay box or hetherable magazine.
• Type 4 Magazine shall be a permanent, portable, or mobile structure, such as a building, 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.
- DocuSigned by:
Applicant: L >R Date: 4/3/2022
1155F310S1gnature
This permit was approved by the Gonzales City Council on Jason Muscio, Fire Marshall
STRY A FARE PROTEALO
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): DASSONVILLE, JENNY Phone Number:
Mailing Address (Street Address, City, CA, Zip): 8341 Demetre Ave., Sacramento, CA, 95828 Local Contact Person and Phone Number (if different from Licensee above): Suzette Rosales, (916) 870-9002
STAND INFORMATION
Group Name: Spartan 300 Club
Physical Address (Street Address, City, CA, Zip): 800 5th Street, Gonzales, CA, 93926 County of Stand Location: Monterey
WHOLE SALE FIREWORK VENDOR INFORMATION
Business Name: PHANTOM FIREWORKS WESTERN REGION, License No.: W-0526 ILLC
Contact Name: DASSONVILLE, JENNY Phone Number: 916-388-1479 FIRE AUTHORITY HAVING JURISDICTION CAL Fire Validation No.
Fire Department: Gonzales Volunteer Fire Dept.
R-1111
Physical Address (Street Address, City, CA, Zip): P.O. Box 647, Gonzales, CA, 93926 03/21/2022
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
DISPLAY CONSPICUOUSLY AT PLACE OF BUSINESS FOR WHICH ISSUED
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
TEMPORARY SELLER'S PERMIT
Valid June 25, 2022 through July 9, 2022
ACCOUNT NUMBER
257356736 - 00001
Office of Control:
SPARTAN 300 CLUB Salinas Branch Office
SPARTAN 300 CLUB NOTICE TO PERMITTEE:
800 5TH ST You are required to obey allFederal and State laws that GONZALES CA 93926-9493regulate or control your
business. This permit does not allow you to do otherwise.
IS HEREBY AUTHORIZED PURSUANT TO SALES AND USE TAX LAW TO ENGAGE IN THE BUSINESS OF SELLING TANGIBLE PERSONAL PROPERTY AT THE ABOVE LOCATION. THIS PERMIT IS VALID FOR THE PERIODS SHOWN AND IS NOT TRANFERABLE.
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 or 1-916-324-2798.
CDTFA-442-ST REV. 7(5-18)
A MESSAGE TO OUR NEW PERMIT HOLDER
As a seller, you have rights and responsibilities under the Sales and Use Tax Law. In order to assist you in your endeavor and to better understand the law, we offer the following sources of help:
Visiting our website at www.cdtfa.ca.gov
Visiting an office
Attending a Basic Sales and Use Tax Law class offered at one of our offices Sending your questions in writing to any one of our offices Calling our toll-free Customer Service Center at 1-800-400-7115 (CRS:711) As a seller, you have the right to issue resale certificates for merchandise that you intend to resell. You also have the responsibility of not misusing resale certificates. While the sales tax is imposed upon the retailer, • You have the right to seek reimbursement of the tax from your customer You are responsible for filing and paying your sales and use tax returns timely • You have the right to be treated in a fair and equitable manner by the employees of the California Department of Tax and Fee Administration (CDTFA)
• You are responsible for following the regulations set forth by the CDTFA As a seller, 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 CDTFA representative when requested. You are also expected to 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. If it becomes necessary to surrender this permit, you should only do so by mailing it to a CDTFA office, or giving it 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 toll-free, 1-888-324-2798 or 1-916-324-2798. Their fax number is 1-916-323-3319.
Please post this permit at the address for which it was issued and at a location visible to your customers.
California Department of Tax and Fee Administration
Business Tax and Fee Division
ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/3/2021
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 ADDITIONAL INSURED, the policy(ies) must 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 CONTACT
NAME:
Britton-Gallagher and Associates, Inc.
HONI FAX, No): 216-658-7101
One Cleveland Center, Floor 30 No, Ext): 216-658-7100
E-MAIL
1375 East 9th Street ADDREsS: [email protected] Cleveland OH 44114
INSURERS) AFFORDING COVERAGE NAIC #
INSURER A : Everest Indemnity Insurance Co. 10851
INSURED INSURER B: Axis Surplus Ins Company 26620
Phantom Fireworks Western Region, LLC
2445 Belmont Avenue INSURER C: Berkshire Hathaway Homestate Insurance Company Youngstown OH 44505 INSURER D: Everest Denali Insurance Company 16044 INSURER E: Arch Speciality Ins Co 21199
INSURER F:
COVERAGES CERTIFICATE NUMBER: 454269335 REVISION NUMBER:
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 POLICY EXP
LTR TYPE OF INSURANCE INSR WVD. POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY LIMITS A GENERAL LIABILITY Y Y SI8GL00643-211 10/30/2021 10/30/2022 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 500,000 CLAIMS-MADE X OCCUR MED EXP (Any one person)
Non-Owned Stand PERSONAL & ADV INJURY $ 1,000,000
End't Included GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2.000,000 RO X
POLICY ECT LOC
AUTOMOBILE LIABILITY Y Y SI8CA00095-211 10/30/2021 10/30/2022 COMBINED SINGLE LIMIT (Ea accident) $ 1.000.000
X ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) S
NON-OWNED PROPERTY DAMAGE
X HIRED AUTOS AUTOS (Per accident)
UMBRELLA LIAB OCCUR UXP0057739-07 10/30/2021 10/30/2022 EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000
DED RETENTIONS
WORKERS COMPENSATION PHWC231340 10/30/2021 10/30/2022 TORS LATTS OTH-
AND EMPLOYERS' LIABILITY ER
NY PROPRIETOR/PARTNER/EXECUTIV E.L. EACH ACCIDENT $1,000,000 )FFICER/MEMBER EXCLUDED N/ A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1.000,000 DESCRIPTION OF OPERATIONS below. E.L. DISEASE - POLICY LIMIT $1,000,000 Excess Liability #2 P-001-000046155-04 10/30/2021 10/30/2022 Total Limi Aggregate 5,000,00
10.000.00
LOCATION: EASEMENT BETWEEN TACO BELL & CHEVRON - 800 5TH STREET, GONZALES, CA 93926 ADDITIONAL INSURED: EASEMENT BETWEEN TACO BELL & CHEVRON / CITY OF GONZALES
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
SPARTAN 300 CLUB
P.O. BOX 1624
GONZALES CA 93926 AUTHORIZED REPRESENTATIVE
9075%
© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Property: Easement Adjacent to Taco Bell Address: 800 5th Street City/State/Zip: Gonzales, CA 93926 Stand Size: Provide Own Wings: Provide Own
BELLENE
Stree
Walk-way no cars
5 PHANTOM
FIREWORKS
8341 Demetre Avenue • Sacramento, CA 95828
(800) 554-8955 • (916) 388-1479 • fax (916) 388-1476 • www.fireworks.com www.facebook.com/fireworkssacramento
April 8, 2022
City of Gonzales
Attn: Alejandra Flores or Anabel Amanza
147 Fourth St.
Gonzales, CA 93926
Re: Fireworks Licensing for Spartan 300 Club
Greetings Alejandra/Anabel,
Please find enclosed the required documents for Spartan 300 Club who will be partnering with Phantom Fireworks for the 2022 fireworks fundraiser.
Included are:
Signed Permit App
2. State Fire Marshal License
3. Certificate of Insurance
4. Fireworks Stand Booth Placement
The organization has applied for their temporary seller's permit, which will be provided once received. The organization has also stated that they will be submitting the $25.00 fee to your office.
Please feel free to contact me if there are any questions or concerns.
Thank you,
Suzette Rosales
Account Manager, Phantom Fireworks
[email protected]
Office: 916-388-1479
Cell: 916-870-9002
Phantom Fireworks Western Region LLC • Distributors of Phantom® Brand and Wolf Pack® Brand Fireworks