Mine Lopezy
City of Gonzales
Manterey Crum, FIREWORKS SALES PERMIT
Name of Applicant: Shield Bearers Inc. rep. Eddy Ramirez Applicant's Mailing Address: PO Box 680
Gonzales Ca 93926
851 5th st.
Location of Fireworks Stand(s):
In Front of Starbucks and McDonalds, across st. from Taco Bell (Please attach a map showing the location of the stand and storage) Permit Fee - $25.00:
Sales Dates and Times: June 28 at noon through July 4t at 8 pm.
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 the 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 articles 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.
No one under the age of 18 years may sell fireworks.
8. Stand or sales location may not encroach upon the 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 • 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 bullding, 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.
The applicant has read, understands, and agrees to abide by all conditions and restrictions of this permit.
-
Applicant: Date: 4-17-2025
Signature
This permit was approved by the Gonzales City Council on Jason Muscio, Fire Marshall
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 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).
PRODUCER Lockton Companies, LLC
3280 Peachtree Rd. NE, Ste. 1000
(404) 460-3600
INSURERS) AFFORDING COVERAGE NAIC E
INSURERA: Century Surety Company 36951
INSURED INSURER B: Arch Specialty Insurance Company 21199 1359665 American Promotional Events, Inc.
DBA TNT Fireworks, Inc. INSURER C: Arch Indemnity Insurance Company 30830 555 North Gilbert Avenue INSURER D: Arch Insurance Company 11150 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 POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY (MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY N EACH OCCURRENCE $ 1,000,000 A CCP1219465 12/1/2024 13/1/2025
X OcCUR DAMAGE TO RENTED
CLAIMS-MADE PREMISES (Ea occurrence) $ 100,000
MED EXP (Any one person) $ Excluded
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LABILITY NOT APPLICABLE COMBINED SINGLE LIMIT Fa accident) 5 XXXXXXX
ANY AUTO BODILY INJURY (Per person) $ XXXXXXX
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ XXXXXXX
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident) $ XXXXXXX
$ XXXXXXX
B X UMBRELLA LIAB X OCCUR Y N UXP0056189-11 12/1/2024 11/1/2025 EACH OCCURRENCE $ 5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE
$ 5,000.000
DED RETENTION $ = XXXXXXX
WORKERS COMPENSATION N X STATUTE
AND EMPLOYERS' LIABILITY 11/20 /1/201
Y/ N 1/20 /1/201
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N NIA
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEES 1,000.000 DESCRIPTION OF OPERATIONS bOON E.L. DISEASE - POLICY LIMIT $ 1,000.000 ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 12082540 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
The City of Gonzales
Ram an Corals Stoping Coater AUTHORIZED REPRESENTATIVE, © 1988-2016 ACORD CORPORÁTION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
HAIN PROTE
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): 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. 8753
Valid Through
Physical Address (Street Address, City, CA, Zip): P.O. Box 647, Gonzales, CA, 93926 06/28/2025-07/06/2025 03/04/2025
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- 412940D
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 2025 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.
ocusigned by:
11/28/24
Date:
Robert Balmen.
Print:
P. O. Box 30874
Santa Barbara, CA 93130
(805) 453-8990
[email protected]
CNM5606
Shield Bearers
rework Boot
12 Ball
oHUS Hwy Garcia's Market
NAtta Ro
NAPA Auto Parts
- Gonzales Tire & Auto
Shield Bea
ontainer Gonzales
Irrigation Systems
NAita Rd John Henry Liquorg
& Food Mart
Frame Welding
NAtta Rd old us Hay Tot
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
203251296 - 00001 7
SHIELD BEARERS INC EFFECTIVE DATE:
851 5TH ST June 28, 2025 thru July 4, 2025
GONZALES CA 93926-9436
J
HEREBY AUTHORIZED TO ENGAGE IN THE BUSINESS C
OCANO TANGIBLE PERSONAL PROPERTY AT THE ABOV
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 (TTY:711) -OR 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 (TTY: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.
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.