PHANTOM Received
APR 0 6 23
FIREWORKS
City of Gonzales
8341 Demetre Avenue • Sacramento, CA 95828
(800) 554-8955 • (916) 388-1479 • fax (916) 388-1476 • www.fireworks.com www.facebook.com/fireworkssacramento
April 4, 2023
City of Gonzales
Attn: Alejandra Flores
147 Fourth St.
Gonzales, CA 93926
Re: Fireworks Licensing for Spartan 300 Club
Greetings Alejandra,
Please find enclosed the required documents for Spartan 300 Club who will be partnering with Phantom Fireworks for the 2023 fireworks fundraiser.
Included are:
1. Signed Permit App
2. Fireworks Stand Booth Placement
3. State Fire Marshal License
4. Certificate of Insurance
5. CDTFA Temporary Seller's Permit
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 , Docusign Envelope ID: 27A53DA8-0594-44E2-8729-42A8A387B74A
HINE CAPITAL
O% COMPAR
City of Gonzales
MONTEREY COUNT FIREWORKS SALES PERMIT
Received
Name of Applicant: Spartan 300 Club
APR 0 6 23
Applicant's Mailing Address: P.O. Box 1624 Gonzales CA 93926 City of Gonzales
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:
28 Sales Dates and Times: June 25 at noon through July 4*h 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: 27A53DA8-0594-44E2-8729-42A8A387B74A • 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, 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, theft 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 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: R Date: 3/14/2023
1155F310cSignature
This permit was approved by the Gonzales City Council on Jason Muscio, Fire Marshall Received
APR 0 6. 23
City of Gonzales
Property Name: Address: City/State/Zip:
Easement between Taco Bell & Chevron 800 5th St. Gonzales, CA 93926 Stand Size: Wings: Special Notes:
Provide Own No
Received
APR 0 6 23
City of Gonzales
WALK-WAY
NO CARS
ALLOWED
TACO
BELL
CHEVRON
FIFTH ST.
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. 3231
Valid Through
Physical Address (Street Address, City, CA, Zip): P.O. Box 647, Gonzales, CA, 93926 06/28/2023-07/06/2023 01/25/2023
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 ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
11/2/2022
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 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. PHONE
One Cleveland Center, Floor 30 (A/C. No, Ext): 216-658-7100 FAC, No): 216-658-7101 E-MAIL
1375 East 9th Street ADDRESS: [email protected] Cleveland OH 44114
INSURER(S) 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: 1326711168 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 SUBA POLICY EFF
LTR TYPE OF INSURANCE INSR, WVR POLICY NUMBER LIMITS
A l GENERAL LIABILITY Y SIBGL00643-221 10/30/2022 10/30/2023 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES (Ea occurrence) $ 500,000
_ CLAIMS-MADE X OCCUR MED EXP (Any one person) $
X 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 [POLICY X Loc $
AUTOMOBILE LIABILITY Y Y SI8CA00095-221 10/30/2022 10/30/2023 COMBINED SINGLE LIMIT (Ea accident) 51.00.000
X ANY AUTO BODILY INJURY (Per person)
ALLOWED SCHEDULED BODILY INJURY (Per accident) S
AUTOS
x NON-OWNED PROPERTY DAMAGE $
_ HIRED AUTOS AUTOS (Per accident
$
UMBRELLA LIAB OCCUR UXP0057739-08 10/30/2022 10/30/2023 EACH OCCURRENCE $4,000,000
X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000
DED RETENTION
WORKERS COMPENSATION PHWC334634 10/30/2022 10/30/2023 X TORTIES (OTH-
AND EMPLOYERS' LIABILITY Y/ N ER
N/ A E.L. EACH ACCIDENT $ 1,000,000
LESCRISTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE $ 1,000,000 EL. DISEASE - POLICY LIMIT $1,000,000
Excess Liability #2 Y P-001-000046155-05 10/30/2022 10030/2023 Total Loci Agregate 000,0 0,000,0
LOCATION: EASEMENT BETWEEN TACO BELL & CHEVRON - 800 5TH STREET, GONZALES, CA 93926 MUNICIPALITY: CITY OF GONZALES
ADDITIONAL INSURED: EASEMENT BETWEEN TACO BELL & CHEVRON / CITY OF GONZALES
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
EXPIRATION NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
SPARTAN 300 CLUB
P.O. BOX 1624
GONZALES CA 93926 AUTHORIZED REPRESENTATIVE
© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) 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
250798112-00001 7
SPARTAN 300 CLUB
SPARTAN 300 CLUB
800 5TH ST EFFECTIVE DATE
June 28, 2023 thru July 4, 2023
GONZALES CA 93926-9493 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.
OR GENERAL TAX QUESTIONS, PLEASE CALL OUR CUSTOMER SERVICE CENTER AT 1-800-400-7115 (CRS:711 OR INFORMATION ON YOUR RIGHTS, CONTACT THE TAXPAYERS' RIGHTS ADVOCATE OFFICE AT 1-888-324-2791 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.
ur toll-free Customer Service Center at 1-800-400-7115 (CRS:711). Customer service representatives re available Monday through Friday from 7:30 a.m. to 5:00 p.m. (Pacific time), except state holidays are required to manan these bols and records for no less khan dour years a rude them asperso You Inspection by ra alri Donation of Tax and red are or use tax ate, ding anytial and distic taxes. 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. you would like to know more about your rights as a taxpayer, or if you are unable to resolve an issue with DTFA, 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.
Property Permission Use
To: City Clerk, Local Fire Agency, and/or Other Interested Parties THE UNDERSIGNED OWNER AND/OR CÔNTROLLING PARTY OF THE PROPERTY LISTED BELOW HEREBY GRANTS PERMISSION TO:
Spartan 300 Club and Phantom Fireworks Western Region LLC, Organization Name
The EXCLUSIVE use of the property located at:
Easement between Taco Bell & Chevron 800 5th St.
Location Name Address
Gonzales, CA 93926 Monterey
City, State, Zip County
FOR THE FIREWORKS SEASON OF:
2023 2024 2025 2026
PLEASE INITIAL YEARS OF APPROVAL
THE ORGANIZATION AND/OR PHANTOM FIREWORKS, AGREE TO SEE THAT THE
PROPERTY LISTED ABOVE WILL BE CLEARED OF ALL STANDS AND REFUSE WITHIN 5-10 DAYS OF THE CLOSE OF THE SEASON.
Please Complete in Entirety for Insurance Certificate:
CITY of GONZALES
Property Owner/Controller of Property
PO BOX 647 GONZALES CA 93926
Mailing Address City, State, Zip
831-675-5000 [email protected]
Phone Number Email Address
DED UK DOZENS 4/26/2023
PATRICK DOBRINS
Print Name
Each individual signing expressly represents and warrants that they are authorized by the entity for which they sign o commit that entity to the terms set forth herein.
Notes:
Phantom Fireworks Western Region LLC
8341 Demetre Avenue
Sacramento, CA 95828
916-388-1479
916-388-1476 fax