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 16, 2024
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 2024 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
6. Check #654165 for $25.00
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: 90DE0E74-6346-4B52-BBD2-4831AA659941
WINE CAPITA
City of Gonzales
HOMEREY 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 4* 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.
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: 90DE0E74-6346-4B52-BBD2-4831AA659941 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: ŽR Date: 4/8/2024
- 1165F310cBignature
This permit was approved by the Gonzales City Council on Jason Muscio, Fire Marshall
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
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 $150.00 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 LLC
Contact Name: DASSONVILLE, JENNY Phone Number: 9163881479 FIRE AUTHORITY HAVING JURISDICTION CAL Fire Validation No.
Fire Department: Gonzales Volunteer Fire Dept. 5754
Valid Through
Physical Address (Street Address, City, CA, Zip): P.O. Box 647, Gonzales, CA, 93926 06/28/2024-07/06/2024 02/02/2024
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
8/30/2023
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:
Acrisure, LLC dba Britton Gallagher & Associates PHONE
One Cleveland Center, Floor 30 A/C, No, Ext): 216-658-7100 [AC, No): 216-658-7101 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: 1588726627 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
ILTR TYPE OF INSURANCE INSR. WVD POLICY NUMBER LIMITS
A GENERAL LIABILITY Y SI8GL00643-231 10/30/2023 10/30/2024 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES (Ea occurrence) $ 500,000
_ CLAIMS-MADE 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 RO $
POLICY LOC
ECI
AUTOMOBILE LIABILITY Y SI8CA00095-231 10/30/2023 10/30/2024 OMBINED SINGLE LIMP Ea acciden
X ANY AUTO BODILY INJURY (Per person) $ 2.00000
ALL OWNED SCHEDULED BODILY INJURY (Per accident) s
AUTOS AUTOS
NON-OWNED ROPERTY DAMAG
HIRED AUTOS AUTOS Per accide
E UMBRELLA LIAB X OCCUR UXP0057739-09 10/30/2023 10/30/2024 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000
DED RETENTION S
WORKERS COMPENSATION Y PHWC334634 10/30/2023 10/30/2024 WC STATU OTH-
AND EMPLOYERS' LIABILITY TORY LIMIT ER
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/ A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 i yes, describe under
DESCRIPTION OF OPERATIONS belov ELL. DISEASE - POLICY LIMIT $ 1,000,000 Excess Liability #2 Y P-001-000046155-06 10/30/2023 10/30/2024 Foral Loc/ Aggregate 35000000
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
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
SPARTAN 300 CLUB
P.O. BOX 1624 AUTHORIZED REPRESENTATIVE
GONZALES CA 93926
9055
© 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
224705696 - 00001 7
257-35-6736
SPARTAN 300 CLUB EFFECTIVE DATE:
800 5TH ST June 25, 2024 thru July 4, 2024
GONZALES CA 93926-9493
IS HEREBY AUTHORIZED TO ENGAGE IN THE BUSINESS OF
SELLING TANGIBLE PERSONAL PROPERTY AT THE ABOVE YOUR BUSINESS. THIS PERMIT DOES NOT ALLOW YOU TO DO OTHERWISE.
PLEASE RETAIN THIS DOCUMENT FOR YOUR
RECORDS.
FOR GENERAL TA QUESTIONS, PLEASE CALL OR SOME SEE TATE (CRS:71.
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 representative re 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 spection by a California Department of Tax and Fee Administration (CDTFA) representative when requestec ou 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.