Docusign Envelope ID: 317508E7-6E05-41E0-92A8-EBr5503158 →j unzales
FIREWORKS SALES PERMIT RECEIVED
ADD 17 2075
Name of Applicant: Spartan 300 Club City of Gonzales
Applicant's Mailing Address: PO Box 1624 Gonzales, CA 93926 Easement between Taco Bell and Chevron
Location of Fireworks Stand(s):
800 5th Street Gonzales, CA 9392
(Please attach map showing location of stand and storage) Permit Fee - $25.00:
Sales Dates and Times: June 28th at noon- July 4th at 8pm, 2025 (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.
Docusign Envelope ID: 317508E7-6ED5-41E0-92A8-EBF550E83156 " - ) 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 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, 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 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: 3/7/2025
- 1155F 3Sgplature
This permit was approved by the Gonzales City Council on_ René L. Mendez, City Clerk
F:lPlanning Department\Fireworks Sales Permit.doc 5/2009
ACORD DATE (MM/DD/AYYYY)
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
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
NAMEAT Taylor Burgess
RTI Insurance Services of Florida, Inc. PHONE
6901 Professional Pkwy, Suite 104 (ANC, No. ExI): 239-463-5200 FAC, No): 239-463-2367 E-MAIL
Sarasota FL 34240 ADDRESS: [email protected]
INSURERS) AFFORDING COVERAGE NAIC #
INSURERA: Lloyds of London 15792
INSURED PHANFIR-01
INSURER B: ENDURANCE AMER SPECIALTY INS CO 41718
Phantom Fireworks Western Region, LLC
2445 Belmont Ave INSURER C:
Youngstown OH 44505 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1431766802 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
LTF TYPE OF INSURANCE INSD WYD. POLICY NUMBER LIMITS
COMMERCIAL GENERAL LIABILITY Y CD2400818 10/30/2024 10/30/2025 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $100,000
MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO
POLICY JECT I LOC PRODUCTS - COMP/OP AGG $2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMI
Ea accident
ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED BODILY INJURY (Per accident) S
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE
AGGREGATE
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBEREXCLUDED?
E.L. DISEASE - EA EMPLOYEE $
ESCRIPTION OF OPERATIONS beld E.L. DISEASE - POLICY LIMIT $ Auto Excess Liability EXT30072156200 10/30/2024 10/30/2025 Limit of Liability $2,000,000 re cereal one is are a real are i set neer ail a were rear by i en contract subject to policy terms and LOCATION: EASEMENT BETWEEN TACO BELL AND CHEVRON - 800 STH STREET, GONZALES, CA 93926 MUNICIPALITY: CITY OIF GONZALES
AERONAL INSURED: EASEMENT BETWEEN TACO BELL & CHEVRON / THE CITY OF GONZALES OR ANY DEPARTMENT, OFFICER OR EMPLOYEE
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN
HE CITY OF GONZALES ACCORDANCE WITH THE POLICY PROVISIONS. 47 FOURTH STREE
GONZALES CA 93926 AUTHORIZED REPRESENTATIVE
USA
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
4/24/2025
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.
COME Taylor Burgess
RTI Insurance Services of Florida, Inc.
6901 Professional Pkwy, Suite 104 PAIN. EX: 239-463-5200 FAC, No): 239-463-2367 Sarasota FL 34240 ADDRESS: [email protected]
INSURERS) AFFORDING COVERAGE NAIC #
INSURER A : Lloyds of London 15792
INSURED PHANFIR-01 41718
INSURER B: ENDURANCE AMER SPECIALTY INS CO
Phantom Fireworks Western Region, LLC
2445 Belmont Ave INSURER C :
Youngstown OH 44505 INSURER D:
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: 193774680 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 EXE
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER LIMITS
X COMMERCIAL GENERAL LIABILITY CD2400818 10/30/2024 10/30/2025 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 100,000
MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY PRO-
JECT LOC PRODUCTS - COMP/OP AGG $2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMI
Ea accident
ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident)
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE
AGGREGATE
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBEREXCLUDED? N/ A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
describe under
YES REST UN OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Auto Excess Liability EXT30072156200 10/30/2024 10/30/2025 Limit of Liability $2,000,000 DEse erica der are a years are reape a eral Lain poic here real ray witten contract subject to policy terms and LOCATION: EASEMENT BETWEEN TACO BELL AND CHEVRON - 800 5TH STREET, GONZALES, CA 93926 MUNICIPALITY: CITY OF GONZALES
EMPLE THERED: EASEMENT BETWEEN TACO BELL AND CHEVRON / THE CITY OF GONZALES OR ANY DEPARTMENT, OFFICER OR
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
SPARTAN 300 CLUB ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 1624
GONZALES CA 93926 AUTHORIZED REPRESENTATIVE
USA
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
ASTRY & TIRE PROTECT DI STATE OF CALIFORNIA, NATURAL RESOURCES AGENCY CAL
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): Mier, Beverly Phone Number:
Mailing Address (Street Address, City, CA, Zip): 8341 DEMETRE AVENUE, SACRAMENTO, CA, 95828 Local Contact Person and Phone Number (if different from Licensee above): Amy Freeman, (916) 388-1479
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: Mier, Beverly Phone Number: 916-388-1479
FIRE AUTHORITY HAVING JURISDICTION CAL Fire Validation No.
Fire Department: Gonzales Volunteer Fire Dept. 7812
Valid Through
Physical Address (Street Address, City, CA, Zip): P.O. Box 647, Gonzales, CA, 93926 06/28/2025-07/06/2025 01/15/2025
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- 4129400 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.
SPARTAN 300 CUB
OFFSITE STORAGE
28493 NORTH ALTA
GONZALES, CA 93924
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
257875552 - 00001 7
SPARTAN 300 CLUB
SPARTAN 300 CLUB EFFECTIVE DATE:
800 5TH ST June 28, 2025 thru July 8, 2025
GONZALES CA 93926-9493
YOU ARE REQUIRED TO OBEY ALL FEDERAL AND
SEEN TANTRUE PESO PROPERTY AT THE A E STATE LAWS THAT REGULATE OR CONTROL YOUR BUSINESS. THIS PERMIT DOES NOT ALLOW
LOCATION. YOU TO DO OTHERWISE.
PLEASE RETAIN THIS DOCUMENT FOR YOUF
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).
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 (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.