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19-21347
CITY OF ZEPHYRHILLS , f 5335-8TH STREET (813)780-0020 21347 FIRE WORKS PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 21347 Address: 5953 GALL BLVD Permit Type: FIRE WORKS ZEPHYRHILLS, FL. Class of Work: FIRE WORKS Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 10-26-21-0020-00000-0030 Improv. Cost: OWNER INFORMATION Date Issued: 6/10/2019 Name: ZEPHYR LLC Total Fees: 529.00 Address: 7162 READING RD #730 Amount Paid: 529.00 CINCINNATI, OH. 45237-3845 Date Paid: 6/10/2019 Phone: Work Desc: TEMPORARY FIREWORK SALE JUNE 12, 2019 - JULY 7, 2019 CONTRACTORS APPLICATION FEES GALAXY FIREWURKS, ING FIRE PERMIT FEES 500.00 TEMPORARY SALES 29.00 1 -� � / / 71� �i Ins ections Required FIRE WORKSSITE INSPECTION Chapter 633, Florida Statutes, authorizes the City to charge and collect user fees to pay for the costs of fire prevention and protection related activities such as inspections, plan review, administrative fees,and other costs related to the aforementioned. Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final inspection shall be charged double permit fee per day of operation or a minimum of$100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "FIREWORKS" per Section 791.01, Florida Statutes are considered as any combustible or explosive composition or substance or combination of substances or, except as hereinafter provided,any article prepared for the purpose of producing visible or audible effect by combustion, explosion,deflagration, or detonation. CONTRACTOR SIGN URE PERMIT OFFIC PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041 Temporary Sales Checklist City of Zephyrhills 5335 Bch Street Zephyrhills,Fl.33542 Phone:813-780-0020/Fax:813-780-0021 REQUIREMENTS Detailed Plot Plan showing setup of location. Refer to Ordinance 1038-09,Sec 4 Notarized letter from property owner stating their approval. A flame retardant certificate is required IF a tent is involved.Inspection required once tent is erected and prior to opening for business. Approved certified fire extinguishers per NFPA 10. No Smoking signs must be placed outside entrances. IF there is a wire fence or chain link fencing must have at least 5 Ft setback from tent and at least 2 exits. IF tent has sides,the sides shall be in the up position unless there is inclement weather, then 2 sides must be in the up position. FIREWO QUIREMENTS-(In addition to the above) Proof of State License. Proof of Liability insurance. List of items to be sold at site. Copy of Drivers License and Social Security Number of all personnel dealing with the sale of fireworks at the tent location. FEES $30.00-City Registration(If Regulated by DBPR-Fee is Waived) $500.00-Fireworks fee-Fire Department fee $ 5.00-Temporary Sales Fee for,l-It two days $ 1.00.-Temporary Sales Fee per day for each consecutive day thereafter,.not to exceed duration of 7 consecutive days and no more than two occurrences during a 12 month period on same property Ord#1038-09,Sec 6 $60.00-Tent Fee(45.00/13D, 15.00*/FD)-(*$15.00 waived for Fireworks) $45.00-Electrical Fee(if applicable) Property Owner: Zephyr LLC Applicant: Galaxy Fireworks, Inc. Phone Contact: (813)234-2264 Address Site: 5953 Gall Boulevard ephyi•fii1 sl�lorida733 Date o Sale• _ Z - ZC/ 7 o y 7 zo/ Ordiri No. 1038-09(for additional requirements)] I May, 31. _2019 2:39PM GALAXY FIREWORKS No, 7025 P. 2 DATE(MMMDfYYM �'O, CERTIFICATE OF LIABILITY INSURANCE 5i2112019 THIS CERTIFICATE iS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the cartificate holder is an ADDITIONAL INSURED,the policy(ias)must be endorsed. if SUBROGATION 13 WAIVED,subject to the terms and conditions of the policy,cortain policies may require an endorsement A statement an this Cartifieate does not confer rights to the certificate holder in lieu ofsuch endomemen s. PRODUCER E; Britton Gallagher FAX One Cleveland Center,Floor 30 NC -71 1375 East 9th Street Cleveland OH 44114 , u G COVMAGE NArc a INSURERAftl Surplus InsCompany INSURED INSURER 8: Galaxy Fireworks Inc. INSURER C: 204 E.Martin Luther King Blvd NSURERC: Tampa FL 336D3 INSURER E: i INSURER F: COVERAGES CERTIFICATE NUMBER:1121001087 REVISION NUMBER: TK$IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TU THE INSURED WED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDINO 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 OY 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. AWL(NSR rmfOFINSURANCE POUCYNU taut WK CYEFF EPDMMD Ellp LIMITS B GENERALLIAmurf SISML00324.191 8170t2019 6110020 EACH OCCURRENCE $1,000,000 5 C011MERCWL GENERAL LL461LITY P.EMIT t n° ir• S50D.000 CL NMS-MADE D OCCUR MED EXP(Aft one pow) $ PZR60NA4aAOVVLURY S1.000.000 i ! GENRRALAGGREGATE $2.000 000 GEN'LAGflREQATfi UMITAPPLIES PER: PRODUCTS-COMP10PA00 I>2.000.000 POLICY TA4 x LOC I C AU7OMMLEIJASIUIY I 518CA00081-191 all"019 a/1=020 „ 1000000 ANY AUTO 50D4Y INJURY(Perpemn) S Abl 0 0 PULED BODILY INJURY(Pereagon I X MREDAVTOS X �t� o PR aryl t 6 S A VMeRELLA uAe X OCCUR Exeess plAd�r 6M0l2019 8/1012020 EACH OCCURRENCE S4.000.000 X ECCESS16" CLAIMS-MADE AGGREGATE sa,000.000 OED RETEMION I I IS WORKERS COMPENSA119N ALL OTIi• ANC ENPLOYERT LIABILITY I YIN PPOPRIUMPARTNERlEXECUTIVE NIA M E.L.EACH ACCIDENT I OFFICOWEMBEREXCLUDED? i fMeedetm in NM E.L.DISEASE.EA FJAPLOYEE I If DES°B6W�PT ON ONF OPERATIONS be16x I EL D18EAse-POLICY LIMIT I DESCRIPT)ON OF OPERATIONS I LDDATONS r%THICLES(AkahACORD 101,AOORIDm Ramaam ftbewle.itmm 5pm is mq ittd) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement Looation:5953 Gall Blvd,Zephythills Additional Insureds:City of Zephyrhills,Mark Ayer and all his agents,representatives and subsidiaries (Workmen Comp) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEABOVE DESCRiBED POLICIES BE CANCELLED BEFORE City Of Zephyrhiils THE EXPIRATION DATE THEREOF, NOTICE VRLL BE DELWERM IN 6907 Dairy Rd ACCORDANCE WITH THE POUCY PROVISIONS, Zephyrh)ils FL 33542 AUMR0W REPRESMffAWX 0)9988-2010 ACORD CORPORATION. All tights reserved. ACORD 25(2010105) The ACORD name and logo are reglatered marks of ACORD I l 813 780-0020 City of Zephyrhills"Fire- Fax-813780-0021 l Permit Application Date Received ' March 5, .0_1 9 Phone cCu�on5tact. o.r'PC ermit 81�3 �.2an3�4 2264 owner's Name Zephyr L JC owner's Phone Number 513 531 7997 Owner's Address 7162 Re !Oing,Rd STE 730 CINCINNATI•,OH 45237 Fee Simple?itleholderName I . Titleholder.Phone Number Fee Simple Titleholder Address ..:�!,�xes.�""+�"`.3`.�r "�'te'Rig':�a. Z���';`ss%�:aur�,!''�":e";�....� sY�": � Job Address 5953 Gal Boulevard, Zephyrhills Lot# 0 Sub Division Shoppin ' Center Parcel# 10-H-21-0020-00000-0030 -��> .avw Bio-Hazard Wa ,�, Storage—ANNUAL Fumigation Tent Comm Exhaust tchen Hood/Duct Hazardous Material(Tier II or'RQ Facility)ANNUAL ' Controlled Bum Hood Installation Emergency Genrator <30 kw LP/Natural Gas-Installation Emergency Gar Lim>30 kw LP/Natural Gas-ANNUAL Sale Fire Protection P lifitenance-ANNUAL Places of Assembly-ANNUAL rU ry" em ®npinu, Sprinkler ❑ ❑ ❑ ❑ Recreational Bum 1 Fire Alarm j:. ❑ ❑ ❑< ❑ ❑ —&sadcle� Hood Cleaning ❑ ❑ ❑ ❑ ❑ Sprinkler System Installations Hood Suppress) i h ❑' '❑ ❑ ❑ Standpipes(Sprinkler Sys) Fire'Alarm Insta 1ption Torch Roofingffar Kettle s Waste Tire Storage ANNUAL 'X Fire Works ---Flammable App ication-ANNUAL 750 Valuation Of Project Fuel Tanks Q Other: �..t"tt;m°'=1"m 3n..�:.i�,..cm' ,i..:..��+. ::s�aa. _.,r..w - ��.. ".LaF•'s�'�`u`€$9.r"��.rn."'". '� "�""� ;1�'tY " i': �:ASSn:..s_��n�-`-�k-+r��mxsszyti., 5::_xi Contractor �^` Company Signature V V \(e�� / Registered Y/N Fee Current Address License# ELECTRICIAN j Company Signature j Registered Y/N Fee Current Y/N Address i License# PLUMBER i Company Signature { Registered Y/N Fee Current Y/N Address _j License# MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address License# OTHER ! Company Signature Registered Y/N Fee Current Y/N Address License# +w^ -ec.�..va�.x:rs..xaz,.�.:xa:.r,..a,v .,_ .- .-.:.�;,�i,�•a'�'-�"zs.�m.` ,i.,.<..v. _,..,_aa:.v�,.:.._-a..=..,xr�::�aw�--.uw^vu.'_^,..z� 'n`�'x=-" 1 Direcbons: Fill out application com I�tely. Owner&Contractor sigback of application,notarized(Or,copy of signed contract with owner) If over$2500,a Notice&Commencement is required.(Mechanical work over$5000) Supply two(2)sets of d wings with applicable documentation Allow 10-14 days for rei iew after submittal date. Parcel.#-obtained from Property Tax Notice(http://appraiser.pascogov.com) 1 i f' NOTICE OF:DEED-REST iCTIONS: The undersigned understarids..that this permit may-be•subject`to-"deed":2estrictions"-- which may be mbreYe§tricl ive than County regulations. The-.undersigned.assumes responsibility:for:compliance-.with any .applicable deed restriction ij , e -UNLICENSED:CONTRACT ORS.AND;CONTRACTOR RESPONSIBILITIES: If-the owner has -hired-za-•contractor or - Contractors-to undertake w irk, they may be required to lie licensed iri accordance.with state anc! local regulations. If the contractor is not licensed_ s required.by law, both the.owner:and_contractor may be cited-For A-misdemeanor violation under"state law. If the ow' :�er or intended contractor are uncertain.as to what licensing requirements may:apply for the ..intended work,they are advised to coritact the=Pasco County Building Inspection Division—Licensing Section.at'727-847- 8009. Furthermore, if th ;owner has hired_:a contractor or contractors, he is advised.to have-the contractor(s) sign portions of the"contractor lock".of-this application-for which-they will be responsible. 'If you, as-the owner-sign as the contractor, that may be an indication that he is not properly licensed and is not entitled-to permitting.privileges in Pasco County. .. CONSTRUCTION LIEN,-LAW.(Chapter7'13, Florida Statutes,ms:amended): If valuation of work is$2;500.00 or more, I certify that 1, the applica have been provided with a copy of-the "Florida'Construction Lien Law---Homeowner's Protection Guide" prepare iby-the Florida Department of Agriculture and Consumer Affairs. If the applicant is-someone other than the"owner", I c :,ify that I have obtained a copy of the above described document and promise in good faith to deliver it to the"owner"pric f,to commencement. CONTRACTO 'S/OWNER'S•AFFIDAVIT: I certify that all the information in this application is accurate and that all work ill be done in.compliance with all applicable laws regulating construction, zoning and land development.. Application is hereby made,to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and-that all work will be performed to meet standards-' of all laws regulating construction, County and City codes, .zoning regulations, and land development r,gulations in the jurisdiction. I also certify that I understand that the regulations of other --.government ag ;ncies may apply to the intended work, and that it is my responsibility to identify what actions I must take to bE in compliance. If I am the AGENT FORTE E OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to comm`Pcing construction. I understand that a;separate permit may be required for electrical work, plumbing, signs, wells, po Is, air conditioning, gas, or other installations not specifically included in the application: A permit issued shall be con trued to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of error's in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or 'bandoned for a period of six(6) months after the time the work is commenced. An extension may be requested, in writi g, from the Building Official,.for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the exhinsion. If work ceases for ninety(90)consecutive days,the job is considered abandoned. WARNING TO OWNER: OUR FAILURE TO RECORD A'NOTICE'OF-COMMENCEMENT MAY-'RESULT IN YOUR PAYING TWICE FOR IMP OVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING_YOUR NOTICE OF COMMENCEMENT. FLORIDA JU (F. .117. %�l OWNER OR AGENT _ CONTRACTOR S dbed and swom to(or affi e o e m this Subscribed and sworn to(or affirme a me this Is/are ona y cno o m ior has/have produced Who s/a ersona y nown o me or has/have produced S identification. as identification. i Notary Public � Notary Public Commission No. Commission No. �����_� flame of Notary typ tinted or E `mped Name of Notary typed!pr nted or stamped oG, PETER M.OGG •'� "`r'• PETER M.OGG ,o. MY COMMISSION#GG f0025 ? MY COMMISSION#.GG 070025 2021 EXPIRES:February 6, 021 EXPIRES:February 6,lwmi i -,. •...•oer %;o....$ BondedThru Notary Public UndervrtitcYs Bonded ThN Notary PubllC U 1 . . - LEASE AGREEMENT This Lease Agreement is entered into as of the 1& day of March 2011 -by and between the undersigned Lessor and Galaxy Fireworks,Inc.a Florida Corporation,having its principal place of business at 204 East Dr.Martin Luther King,Jr,Boulevard,Tampa Florida 33603 ("Lessee's)")for the purpose of establishing the terms and conditions by which Lessor leases certain property to Lessee. In consideration of the following covenants and conditions,and of other consideration the receipt and sufficiency ofwhich are acknowledged,Lessor and Lessee agree as follows: 1.Premises Location:The property that is the subject of this Lease Agreement(the"Premises")is located at the following address 5943 Gall Blvd,Zenhrvhills Fl 2.Occupancy:Lessor represents and warrants that it owns the Premises,and Lessor hereby grants Lessee the exclusive right to occupy and use the Premises undisturbed during each Term(as hereinafter defined),access thereto(including the right to cross surrounding property belongingto Lessor,if any),along with all other rights provided to a tenant under the laws of the state of Florida. 3.'Perm% The periods during which Lessee will be entitled to occupy the Premises("Terms")are as follows: Term 1 is from June 15th 20I 1 until July 7th,2011:Term 2 is from Dec.15th 20I I until Januarv7°52012,("Initial Lease Period")2011- 2916. Thereafter occupancy will be determined by Lessee's election pursuant to Section 11, This Agreement shall continue in full force and eftectuntil the Option Periods identified in Section I I below expire; 4. Use:Lessee may use the Premises to sell seasonal products,including but not limited to fireworks and items incidental thereto. 5. Bent Lessee will pay Lessor the sum of_$2,000.00 for Term 1 and SI,500.00 for term 2 which will be due and payable on the first day of the applicable Term. 6. Permits:Lessee agrees to acquire any and all permits required by governing authorities for Lessee's intended use ofthe Premises. Ifthe permits are not approved for any reason,this Agreement will be null and void,and all deposits will be refunded to Lessee.If;after any necessary permits have been issued to Lessee,Lessee is prevented from using the Premises for the intended purpose of selling fireworks during any part ofa Term because ofan act of God,war,executive order,ordinance,change in law,or other reason beyond Lessor's or Lessee's control,Lessee will be relieved of its obligation to pay rent for that Term,and any rent paid for that Term will either be refunded to Lessee or applied to the next Term,as Lessor chooses. Lessor shall make that choice and notify Lessee within ten days.of being informed by Lessee that it has been prevented-from using the Premises. 7. Indemnification:Lessee shall indemnify and hold Lessor harmless from any and all actions and claims resulting directly and solely from Lessee's use of the Premises,including but not limited to claims by Lessee's licensees,or invitee,and trespassers. 8. Fixtures:All structures(including tents)shall be placed on the Premises under the approval of Lessor. Any placement shall not interfere with Lessor's use of property surrounding the Premises. Any installation shall not damage any of the Lessor's improvements on the Premises. 9. Insurance:Lessee shall provide Lessor with proof of liability insurance before the Term begins. Liability insurance shall be in an amount ofnot less than$1,000,000.for each occurrence. 10. Maintenance:Lessee shall maintain the Premises-in an orderly manner and will Haul away any and-all trash made by Lessee,its customers,and vendors prior to vacating the Premises. 11. Option:Following the Initial Lease Period,this Agreement will remain in effect for an additional five years("Option Period"). However,if Lessee notifies Lessor 30 days in advance of a particular year during the Option Period that Lessee elects to not exercise its option for that year,Lessee will not be required to pay rent for that year,and Lessor will be free to rent the Premises to someone else for that year,subject to Lessee's right of first refusal set forth below. Such election will not affect subsequent years. In the event that Lessee elects to not exercise its option for a particular year,Lessee has the exclusive right of refusal to match any and all offers to lease the Premises during that year. Lessor shall notify Lessee in writing of any such of r andthe terms thereof,and provide Lessee thirty days to elect to exercise or waive the right of first refusal. 12. Non-compete:Lessor agrees to not sell or permit the sale of fireworks by anyone other than Lessee on any property owned or leased by.Lessor within 2 miles of the Premises. 13. Cancellation: If the Premises is sold,master leased on along term basis other than for the sale of fireworks,or the law is changed to prohibit the sale of fireworks for all remaining Terms,this Agreement may be canceled by either party providing thirty.days written notice to the other party. iN WITNESS WHEREOF,Lessor and Lessee have each caused this Agreement to be executed and to take effect as of the date first above written,,as evidenced by the signatures of their respective duly authorized representatives appearing below. y Fireworks,Incorporated(Lessee) f2— I--L4', (Lessor) 'By: (� Signature --., Signature p Ricky Johnson,Vice-President Na a and Title Name and Title Date Signed tom. Date Signed . Ag,&/ Before me,the undersigned Notary Public,personally appeared known to me to be the person who . executed the foregoing Lease Agreement,and she/he acknowledged to and be ore me that she/he executed such instrument and agrees to fully comniv ACORO® CERTIFICATE OF LIABILITY INSURANCEF5121/20MIDD19 /YYYY) 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 endorsement(s). PRODUCER CONTACT NAME: Britton Gallagher PHONE FAX One Cleveland Center, Floor 30 A/C No E t 216- 5 - 1 A/c No:2 - - E-MAIL 1375 East 9th Street ADDRESS: Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC# INSURERA:AXiS INSURED INSURERB:EVerest Indemnity Insurance Co. 10851 Galaxy Fireworks Inc. INSURER C:EVereSt National Insurance Company 10120 204 E. Martin Luther King Blvd INSURERD: Tampa FL 33603 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1121001087 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 S. INSR TYPE OF INSURANCE ADDL SUBR POLIC F POL CY EXP LIMITS LT R INSR WVD POLICY NUMBER MM/D /YYYY MM/DD/YYYY B GENERAL LIABILITY S18ML00324-191 6/10/ 019 6/10/2020 E CH OCCURRENCE $1,000,000 X AMAGE TO RENTED COMMERCIAL GENERAL LIABILITY REMISES Ea occurrence $500,000 CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PROEC� X LOC I $ C AUTOMOBILE LIABILITY S18CA00081-191 6/10/2019 6/10/2020 Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTO S AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ $ A UMBRELLA LIAR X OCCUR Excess binder 6/10/2019 6/10/2020 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU-RY LIMITS OTH- AND EMPLOYERS'LIABILITY Y/N T ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Location: 5953 Gall Blvd,Zephyrhills Additional Insureds: City of Zephyrhills, Mark Ayer and all his agents, representatives and subsidiaries (Workmen Comp) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Zephyrhills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 6907 Dairy Rd ACCORDANCE WITH THE POLICY PROVISIONS. Zephyrhills FL 33542 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD AGENT AFFIDAVIT 1). Pursuant to the attached agreement, I/we have been granted the authority by the owner of the real property located at 5953 GALL BLVD , Ricky Johnson to act as agent in an application to CITY OF ZEPHYHILLs for a temporary vendor permit. 2). If for any reason it is later determined by that CITY OF ZEPHYHILLs I/we did not have the authority to apply to CITY OF ZEPHYHILLs for a temporary vendor permit, I/we will hold CITY OF ZEPHYHILLs harmless for any liability which results and defend in any action which CITY OF ZEPHYHILLs may be brought by the owner or any third parties. 3). The owner of said real property understands that any code enforcement action brought by as a CITY OF ZEPHYHILLs result of any temporary vendor activity inures to the owner of said real property and not to me/us as a temporary vendor. 4). I/we understand that this affidavit is only valid during the term of this temporary vendor permit. FURTHER AFFIDAVIT SAYETH NOT. s �nature j RICKY JOHNSON , Galaxy Fireworks, Inc. 204 E. M.L. King Jr. Blvd. Tampa, FL 33603 STATE OF FLORIDA COUNTY OF HILLSBOROUGH The foregoing instrument was acknowledged before me this kdayJ�t of 20�Yby J'6,4 nsCP\ He he 'spersonally known to me r has produced as Identification an 1 i n Signature• ^ . Name (typed,printed or stamped): PETER M.OGG MY COMMISSION#GG 070026 oe EXPIRES:February 6,2021 '' o..;0.. Bonded Thru Notary Public Undery ftM Due to a software conversion, changes in ownership and sales may be delayed. Data Current as Of: Weekly Archive - Saturday, January 12, 2019 Parcel ID 10-26-21-0020-00000-0030 (Card: 001 of 006) Classification 16 - Shopping Centers Community Mailing Address Property Value ZEPHYR LLC Ag Land $0 7162 READING RD STE 730 Land $168,359 CINCINNATI OH 45237-3845 Building $328,894 Physical Address - See All 4 Extra Features $8,897 addresses (First Shown) 5951 GALL BOULEVARD Just Value $506,150 ZEPHYRHILLS, FL 33542 Assessed (Non-School Amendment 1) $490,384 Legal Description (First 4 Lines) PINE GROVE PB 2 PG 15 COM SW COR LOT 10 TH NO2DG 02' 12"W Non-School Taxable Value $490,384 313.00 FT FOR POB TH CONT School District Taxable Value $506,150 NO2DG 02' 12"W 306.96 FT TH Warning: A significant taxable value increase may occur when Jurisdiction sold. City of Zephyrhills Click here for details and info. regarding the posting of exemptions. Land Detail (Card: 001 of 006) ... _...... .............................. _ . .. r........:.._. Price Condition ;Value Line !Use_ £Description :Zoning iUnits �ype ___ ..__._.. _._ . SHOPNG CTR, OOSD i 12,000.00 SF $ ._ ..... _.. ;.___._..._r. .-._..._ 2 1600 SHOPNG CTR, OOSD 38,000.00 SF $2.80 0.65 $69,160 3 1600 SHOPNG CTR; OOSD 37,145.00 I SF $2.25 0.65 $54,343 Additional Land InformationFEMA _ Acres 2.00 Tax Area 30ZC Code X� Commercial Code M3012AQ Building Information - Use 16 - Shopping Center Local (Card: 001 of 006) Year Built 1969 Stories 1.0 Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 None Roof Structure Rigid Frame w/Bar Joist Roof Cover Built-Up Tar and Gravel Interior Wall 1 Plywood Panel Interior Wall 2 Drywall Flooring 1 Cork or Vinyl Tile Flooring 2 Carpet Fuel Electric Heat Forced Air - Ducted /C Central Baths 2.0 Line (Description Sq. Feet [Repl. Cost New 1 SPA 1,100 $82,935 2 SDA 400 3 CAN 300 ! $7,983 Extra Features (Card: 001 of 006) _._......_... ....._......._..__..._........_....._........ .... ..... .....P..._...._._._...__-_.......__............._..._.. _................ Line _ }Descri tion Year 1! nits Value 1 �; PAV ASP 1969 ? 22,800 $6,669 Sales History - See All 4 sales Previous Owner: HUESING JAMES R Month/Year Book/ ._. . . 03/2000 j 4341 / 1041 Quit Claim Deed Improved Multi-Parcel Sale 09/1987 1661 / 1677 Warranty Deed ' Improved $0 02/1985 1394 / 0304 Warranty Deed Improved $0 V41"Am"MI a � ttt:aiattr.Rrt� . . . tgtweo av. . tELtCATtON Tamps Tcs;t&Ramat Ca;tac. hats tirst6d,ot " ti*tltCt2RN Np. 21#2 w..Wacers Avv. Tam`',_FL 3360t manarniciared O7/�IIOUi- Then fs tci certify ttrat,ttie rrtaterra(s described an this ceftcate have be fXame4etardant treated car ntrerenffy nonOAr Wi6&s ai, .in ero smpplted to; NAMt Tisitan Ttn#a lDnta�Cd.r.tnc.: .. AT I6z yk°%VIM AW. . COY T+mm $TAIE Flodda. 33tiu C&t is hereby,made that: Ttie;artidies,des&ibeci 6n tt is Certificate have been treated with a flame-retardant approved chemical and JF Olt the said chemical:was dane.in contormence with Fedecat Spec�icatbn 5pecif`tca£iarr .. . Method:of.appticatii>ri IrduirendyhotitisdnmabM,. Trade hai*ie:'of,f Aniia=esistant tabtic car Material used l ' . t?l�1t.131iYQ;�1" tom. C#iemtcal.Re istraan:Nitrtber F-taut ; :THE , .,. RETARDAW,PROCESS,USED VkgL ;NOT 8E REAAAt�VEQ;BY WASHING AND IS QDOC►F{!R THE UPE OF THE FASM.". RENEWAL CERIM ICAT"..I.S UNNECESSARY. Color:arid weight of fabric: :�� 13 ouaat Descriptican iif tem:certifferti: E . ntent Sayswer.Mtttactiin�Ci; ay Mama of Appt#cator or FrodvuEtan s**i#nf#i`Wmf Kns t#tt AssliGtfl4tt Jimmy Patronis Casia Sinco CHIEF FINANCIAL OFFICER BUREAU CHIEF Julius Halas DIVISION DIRECTOR Keith McCarthy •� SAFETY PROGRAM MANAGER FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Gaines Street -Tallahassee,Florida 32399-0342 Tel.850-413-3.644 Fax.850-410-2467 CERTIFICATE OF REGISTRATION WHOLESALER OF SPARKLERS OFFICIAL COPY THIS CERTIFIES THAT: Galaxy Connection Inc. 204 E Martin Luther King Blvd Tampa FL 33603 Has registered pursuant to the provisions of Florida Statues to engage in-the business of selling sparklers to a retailer. Issue Date: 02/01/2019 Type: 07 Class: 62 . County: Hillsborough License/Permit#: 725841-0001=2006 Expiration Date: 01/31/2020 Chief Financial Officer Jimmy Patronis Casia Sinco CHIEF FINANCIAL OFFICER BUREAU CHIEF Julius Halas Keith McCarthy DIVISION DIRECTOR SAFETY PROGRAM MANAGER FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Gaines Street -Tallahassee,Florida 32399-0342 Tel.850-413-3644 Fax.850-410-2467 CERTIFICATE OF REGISTRATION RETAILER OFFICIAL COPY THIS CERTIFIES THAT: Galaxy Fireworks 204 E Martin Luther King Blvd Tampa FL 33603 Has registered pursuant to the provisions of Florida Statues to engage in the business of selling sparklers to consumers at retail at the following fixed place of business: 5953 Gall Blvd Zephyrhills Fl Hillsborough Issue Date: 02/01/2019 Type: 07 Class: 64 County: Hillsborough License/Permit 186104-0008-2010 Expiration Date: 01/31/2020 Chief Financial Officer Jimmy Patronis Casia Sinco CHIEF FINANCIAL OFFICER BUREAU CHIEF Julius Halas Keith McCarthy DIVISION DIRECTOR SAFETY PROGRAM MANAGER I *W8 FLOMA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Gaines Street -Tallahassee,Florida 32399-0342 Tel.850-413-3644 Fax.850-410-2467 CERTIFICATE OF REGISTRATION WHOLESALER OF SPARKLERS OFFICIAL COPY THIS CERTIFIES THAT: Galaxy Fireworks Inc. 204 E Martin Luther King Tampa FL 33603 Has registered pursuant to the provisions of Florida Statues to engage in the business of selling sparklers to a retailer. Issue Date: 02/01/2019 Type: 07 Class: 62 County: Hillsborough License/Permit#: 725840-0001-2006 Expiration Daze: 01/31/2020 J Chief Financial Officer o No Fireworks Discharge Emg./Exit Light Exit 44" Fire Extinguisher No Fire Works No Discharge Fireworks Discharge Exit 44" Exit 44" 0 10 Emg./Exit Fire Extinguisher Emg./Exit Light 0 Light No Fireworks Discharge This site meets the following requirements as set forth in the Florida Fire Prevention Code: 1. Tent is not within 300' of any above ground bulk storage or bulk dispensing areas for flammable or combustible liquids, flammable gas, or flammable liquefied gas per NFPA 1, Section 65.11.3.12.6(1)through 65.11.3.12.6(3). 2. No Smoking and No Fireworks Discharge signs placed near the entrances as required by NFPA 1, Section 65.11.3.11.1, 65.11.3.11.2 and NFPA 1, Section 65.11.4.6.3 respectively. All text will be in accordance with the State Fire Code. 3. Tent is not within 50' of any motor vehicle dispensing station dispensers (NFPA 1, Section 65.11.3.12.2), above ground storage tanks for flammable or combustible gas, or flammable liquefied gas, compressed natural gas dispensing station dispensers, or retail propane dispensing station dispensers per NFPA 1, Section 65.11.3.12.1(1)through. 65.11.3.12.1(3). 4. This tent meets all clearance criterion regarding buildings, combustibles, other tents, stands, generators (and their applicable fuel storage location), as well as any storage location for consumer fireworks. Tent parking shall be identified as located not less than 10' from the tent. See NFPA 1, Section 65.11.4.9.2.2, Section 65.11.4.9.2.3, and Table 65.11.4.7.2. 5. Interior of this tent follows the diagram provided above and meets all aisle width, exit width, aisle placement and arrangement criterion as noted at NFPA 1, Section 65.11.4.8.1, 65.11.4.8.1.2, 65.11.4.8.5, 65.11.3.14.3.1.1 through 65.11.3.14.3.1.4. There are no dead-end aisles. 6. This facility is equipped with two emergency/exit light sets per NFPA 1, Section 65.11.4.8.3 and 65.11.4.8.4. Hours of operation are suggested as from 9:00 AM through 12:00 AM. This varies as it gets closer to the holiday sales event. 7. All battery operated equipment, electrical equipment, and electrical cords in this facility are used in accordance with their listing per NFPA 1, Section 65.11.4.9.1. 8. All temporary wiring in the tent shall comply with NFPA 70 (2005 Ed.)article 590 "Temporary Wiring"and shall be secured to prevent damage caused by civilian or vehicular traffic per NFPA 1, Section 65.11.4.9.1.1. 9. Generators (if applicable)used at this location operates on a Class II or Class III combustible fuel. Specifically, any generator utilized at this location operates on diesel fuel. IN: Due to a software conversion, changes in ownership and sales may be delayed. Data Current as Of: Weekly Archive - Saturday, January 12, 2019 Parcel ID 10-26-21-0020-00000-0100 (Card: 001 of 004) Classification 16 - Shopping Centers Community Mailing Address Property Value ZEPHYR LLC Ag Land $0 7162 READING RD STE 730 Land $272,148 CINCINNATI OH 45237-3845 Building $530,947 Physical Address - See All 4 Extra Features $9,489 addresses (First Shown) 5915 GALL BOULEVARD ZEPHYRHILLS, FL 33542 Just Value $812,584 Assessed (Non-school Amendment 1) $678,048 Legal Description (First 4 Lines) PINE GROVE PB 2 PG 15 COM SW COR LOT 10 FOR POB TH NO2DG Non-School Taxable Value $678,048 02' 12"W 172.00 FT TH N88DG School District Taxable Value $812,584 28' 05"E 623.71 FT TH S02DG Warning: A significant taxable value increase may occur when Jurisdiction sold. City of Zephyrhills Click here for details and info. regarding the posting of exemptions. Land Detail (Card: 001 of 004) ..........-.................................. .......... Line ;Use Description Zoning Units Condition jValue _Type Price _$_ '_' 00 ____1600 SHOPNG CTR; OOSD f2,dOE. 0 Sf 69,0 1 1600 SHOPNG CTR: OOSD 38,000.00 SF $2.80 1.00 $106,400 .............. 3 1600 SHOPNG CTR; OOSD 42,999.00 SF $2.25 i 1.00 $96,748 Additional Land Information Acres i 2. Commercial Code 1 M3012A C F M47 LOZ C 14 Tax Area ode Building Information - Use 16 - Shopping Center Local (Card: 001 of 004) Year Built 1969 Stories 1.0 Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 None Roof Structure Rigid Frame w/Bar Joist Roof Cover Built-Up Tar and Gravel Interior Wall I Plywood Panel Interior Wall 2 Drywall Flooring 1 Carpet Flooring 2 Cork or Vinyl Tile Fuel Electric Heat Forced Air - Ducted A/C Central Baths 3.0 Line Description Sq. Feet lRepi. Cost New ............... BAS 1 $1,408,384 2 LAN 1 276 $7,654 Extra Features (Card: 001 of 004) Line Description Year 'iUnits ........... ........... ............ ........... EAV'ASP 1969 2-2,860, $6,669 2 LIGHTTC 196 2 $1,650 3 u D_U-M Sales History Previous Owner: HUESING JAMES R .......... 6 int-h-,-/-"Y-,-e--a'...r—*-- B--o--,o-k—/-P--a--g--,e,**"----- --------- 14 Type DOR Code Condition mount 03/2000 4341 / 1041 Quit Claim Deed .......... Improved Multi-Parcel Sale 09/1987 1661 / 1677 Warranty Deed j Improved ........................... 02/1985 1394 / 0304 Warranty Deed Improved $0 Department Description Qty, Unit Wt. Case DOT Ship (kg) Ct. EX Number(s) 2003080242, 2003070148, ASSRT(SS) Cosmic Cluster 1 CASE 18.0 8/1 2003070245, 2003070066, 2003070334 2003070063, 2000090015, ASSRT(SS) Final Countdown 1 CASE 17.0 6/1 2003080242, 2003090071, 2003070066 2003090071, 2003070065; ASSRT(SS) Just for Kids 2 CASE 20.0 24/1 2003070066, 2003070334, 2003070335 2003070063, 2003070147, ASSRT(SS) Ninja (S/S) 1 CASE 15.0 6/1 2003070146, 2003070245, 2003070334 2003070151, 2003070326, ASSRT(SS) . Star Gazor 1 CASE 14.0 24/1 2003070066, 2003070334, 2003060091 ASSRT(SS) Super Nova S/S 1 CASE 25.0 2/1 See packing box 2003070147, 2003080238, ASSRT(SS) Warp Speed . 2 CASE 30.0 12/1 2003080237, 2004020078, 2003070333 FOUNT Cuckoos, 2 CASE 30.0- 24/6 2003070149, 20,10101263 FOUNT Fire Storm 1 CASE 14.0 36/1 2010120746 FOUNT_. Galaxy Reloadable Fountain 1 ' CASE 10.0 12/1 2011030961 FOUNT. HN89 Assorted(Spring Peach)Fountain 1 CASE, 9.0 . 18/4 2003070159, 2011011041" FOUNT Just'Because 1 CASE 11.0. -24/1 2011010794 : . FOUNT , : , Killer Bees 1 CASE 10,0 24/4 2006010185 FOUNT Passion and Fire 1 CASE 13.0 12/1 2010121299 FOUNT Snow Cone 1 CASE 10.0 8/1 2015090843 FOUNT Sword From Hell,Galaxy Sword 1 CASE 12.0 60/1 2011070425 2 FOUNT The Skull 1 CASE 7.0 12/1 FC12520161200 26 FOUNT Zap Gun Fountain 1 CASE 9.0 48/1 FC1112018033094 GENERAL Fuse Packages 20 PIECE 1.5 375/1 2001120164 NOVEL Black Snake 2 PACK 0.8 15/48 8308113 NOVEL Black Snake 48 PIECE 0.4 15/48 8308113 NOVEL Galaxy Tanks(With Star) 20 PACK 6.5 40/12 2010100025 NOVEL Galaxy Tanks(With Star) 24 PIECE 0.7 40/12 2010100025 NOVEL Legend Hot Racer 36 PACK 7.5 72/1 2010110877 NOVEL Mandarin Cracker Snaps 1 CASE 14.0 10/30 2013090438 NOVEL Party Popper(6pk) 3 PACK 1.3 12/24 2007120309 NOVEL Party Popper(6pk) 24 PIECE 0.4 12/24 2007120309 NOVEL Punk(PK-10) 10 PACK 2.0 100/1 N/A NOVEL Snap-N-Pops-(6/40) 2 CASE 16.0 6/40 2005070402 S&W Galaxy Ground Bloom Flower 1 CASE 14.0 20/12 2005060058 S&W Galaxy Ground Bloom Flower 10 PACK 7.0 20/12 2005060058 S&W Galaxy Ground Bloom Flower 24 PIECE 1.4 20/12 2005060058 SMOKE Mammoth Smoke 2 PACK 3.3 6/24 2010050151 SMOKE Mammoth Smoke 24 PIECE 1.7 6/24 2010050151 SMOKE Smoke Balls(Color, 12 pk.) 1 CASE 8.0 20/6 2003080236 SMOKE Smoke Balls(White, 12 pk.) 1 CASE 8.0 20/6 2003060092 SPARK #10 Color Sparkler 1 CASE 14.0 24/12 2005060250, 2012091051 SPARK #10 Color Sparkler 36 PIECE 1.8 24/12 2005060250, 2012091051 SPARK #10 Gold Sparkler 2 CASE 28.0 24/12 2005060252 SPARK #10 Gold Sparkler 36 PIECE 1.8 24/12 2005060252 SPARK #8 Color Sparkler 1 CASE 7.0 24/12 2005060249 SPARK #8 Color Sparkler 36 PIECE 0.9 24/12 2005060249 SPARK #8 Gold Sparkler 1 CASE 7.0 24/12 2005060251 SPARK 10" Morning Glories 1 CASE 7.0 24/12 2003070326 SPARK 36" Morning Glory(72/1) 2 CASE 32.0 72/1 2003070327 3 SPARK Neon Sparklers 2 CASE 14.0 100/1 2011080842 2003010211, 2005080245, ASSRT(FC) Alien Attack(F/C) 1 CASE 20.0 6/1 2005070402, 2005070399, 2005070459 2005060056, 20050070660, ASSRT(FC) Galaxy Collection 1 CASE 15.0 8/1 20050050114, 2005080239, 2003030161 2005060056, 2005070658, ASSRT(FC) Galaxy's Next Generation 1 CASE 15.0 6/1 2005050114, 2005070447, 2006020318 ASSRT(FC) Little Big 1 CASE 15.0 6/1 2004080207, 2011020863 ASSRT(FC) Mission From Mars F/C 1 CASE 24.0 4/1 2014110063 2005080345, 2005070404, ASSRT(FC) Night Fire 2 PIECE 60.0 2004060315, 2004070063, 2007050072 2003050193, 2003050192, ASSRT(FC) Saturn's Revenge(WL) 1 CASE 24.0 4/1 2005070406, 2005080345, 2005060060 2011011073, CAKES Bad Like Crab 1 CASE 15.0 12/1 2011060710, 2014030354 CAKES Big Snow 1 CASE 11.0. 36/1 2005070455, 2010090088 CAKES Boogie Woogie 1 CASE 15.0 12/1 2011050614, 2011060710 CAKES Chains of Fire 1 CASE 21.0 12/1 2011021733 CAKES Coconut Grove(6 Pk.) 2 CASE 24.0 6/1 2011011568, 2011050412 CAKES Color Pearl-96 shot 2 CASE 32.0 40/1 2006020626 CAKES Crackling Color Palm 1 CASE 25.0 12/1 2011020471 CAKES Galaxy's Warrior 2 CASE 36.0 72/1 2006120182, 2011011457 CAKES Green Bamboo 1 CASE 11.0 36/1 2010090091 CAKES Happy Fireworks-16 shot 1 CASE 13.0 48/1 2003050193 4 CAKES . Happy,Fireworks-36 shot 2 CASE 36�.0 24/1 2003050192, 2016090359' CAKES Kaleidoscope 1 CASE 12.0 50/1 2011010305." CAKES Wild One 1 CASE 13.0 12/1 2015060367 CAKES Yellow Bees " 1. CASE 11.0 36/1. 2010090089 CAKES500G Act of God(6-Pack) 3 CASE 66.0 6/1 2009080151'; CAKES50OG Amazing Ballet 3 CASE 12.0 1/1 2004090173 CAKES500G Army Honor 1 CASE 18.0 4/1 FC10220151100 80 CAKES500G Bad Boy 2" 1 CASE 13.0 3/1 2012070651 CAKES50OG Boss of the Bayou 1 CASE 20.0 4/1 FC11020141100 27 CAKES500G Captain American 1 CASE 20.0 3/1 2012070651 CAKES5000 Carnival Attack(6-Pack) 3 CASE - 57.0 6/1 2009080151 CAKES50OG Double Dealing 1 CASE •: 12-0 2/1 2012110560" CAKES500G Galaxy's Thunder(6-Pack) 3 -CASE 69A` 6/1 2009080151 CAKES500G Great America 1 CASE 16.0 2/1 2010060128 CAKES500G Mega Storm 1 CASE 14.0 3/1 2017070119 CAKES50oG ..: Mr."Sandman :.;: 2" CASE 32.0 4/1 20.13070,685.. " CAKES500G Pyro Monster 1 CASE 14.0 4/1 2012090787 CAKES500G Shake It Off 1 CASE 8.0 2/1 2016100259 CAKES500G. The New Frontier(6=Pack) . . 3 CASE.` 69,'0 6/1 2009080151 CAKES50OG USA Conqueror 2 CASE 30.0 1/1 2005020558 CAKES5000 Wild,Fire 1 CASE• 12.0 6/1 2013090687 CAKES500G Winterblast 3 CASE 48.0 1/1 2003090214, 2013021276 FC Celebration Crackers-1388 6 PIECE 9.5 12/1 1983060087 2007010363, FC Celebration Crackers-804 10 PIECE 10.0 20/1 FC11020151100 04 2011010567,20 09035231,2007 FC Firecrackers-100 1 CASE 19.0 8/20 010363, FC11020151100 04 F.C. Firecrackers-40/16 7 CASE;; 133.0 '24/40 2010110896, 2007010363, FC11020151100'04, 2013070336 5 2007010363, FC Gigantic Firecracker 10000 1 CASE 22.0 2/1 FC11020151100 04 FC Gorilla Firecracker Box 1 CASE 18.0 6/100 FC11020141200 52 FC M1000,Assorted (36) (M5000, M-500) 1 CASE 14.0 40/36 2004060311 FC M1000,Assorted (36) (M5000, M-500) 72 PIECE 0.7 40/36 2004060311 MISSILE Saturn Missile Battery- 100 shot 2 CASE 38.0 30/1 2005070406 MISSILE Saturn Missile Battery-25 shot 2 CASE 38.0 120/1 2005070406 2005070406, MISSILE Saturn Missile Battery-300 shot 3 CASE 66.0 12/1 FC1102015010015 MISSILE Saturn Missle 750 1 CASE 19.0 2/1 2005070406, 2011031853 RC American Legend Candle (Assorted Candle) 1 CASE 10.0 12/1 2010060012 RC Blue Thunder 1 CASE 15.0 36/1 2010121334, 2011020359 RC Dark Breaker Candle Barrage 196 Shot 2 CASE 28.0 12/1 2012100672 RC Lightning Bolt 140 Shot 2 CASE 28.0 12/1 2010060508 RC Roman Candle-10 Ball w/Report 1 CASE 13.0 36/1 2006110243, 2011090897 RC Roman Candle-5 Ball w/Report 2 CASE 28.0 72/1 8307004 RC Roman Candle-8 Ball 1 CASE 14.0 48/1 2005060059 RC Roman Candle-8 Ball w/Report(54/4) 1 CASE 14.0 54/1 8307002, 2005060059 RC Super Charged Candle 1 CASE 16.0 12/1 RELOAD Artillery Shell 3 CASE 24.0 12/1 2005080345, 2007010365 RELOAD Black Whirlwind 2 CASE 26.0 1/1 2012030205 RELOAD Bombs From Hell 1 CASE 12.0 1/1 2012070468 RELOAD Crackling Artillery(Whistling) 3 CASE 24.0 12/1 FC11020150800 01, 2007010365 RELOAD Dyno Claws 2 CASE 16.0 6/1 FC11020150500 02 RELOAD Fierce 3 CASE 24.0 2/1 2012030207, 2016120531 RELOAD Galaxy Exterminator 3 CASE 84.0 4/1 2009120322 RELOAD Galaxy's Extreme Caution 1 CASE 18.0 1/1 2008080198 6 2008080198, FC10120161200 RELOAD Galaxy's Gorilla 4 CASE 80.0 4/1 16/1012016120 024/101201612 0029 2004060315, 2011030537, FC11020150800 01, RELOAD Gorilla 12 Shot Artillery 2 CASE 18.0 12/1 2012030207, FC11020150800 01 RELOAD Gorilla Canister Shell Kit 2 CASE 26.0 8/1 FC11020150100 17 RELOAD Jurassic Artillery 2 CASE 16.0 12/1 FC11020150500 02 RELOAD Max Power 1 CASE 18.0 2/1 2012030205 RELOAD Neon Shells 1 CASE 12.0 2/1 FC11020150500 02 RELOAD Ninja Shells. (Galaxy Evil Balls) 4 CASE 32.0 12/1 2004070063, 2007010365 2007010365, RELOAD Power Man 12 3 CASE 39.0 6/1 FC11020150500 02 RELOAD Pyro Idol 1 CASE 10.0 6/1 FC11020150500 02 RELOAD Race Day 1 CASE 15.0 4/1 FC11120150601 18 RELOAD Small Festival Ball 4 CASE 48.01 15/1 2005060060, 2007010365, FC11020150800 01 RELOAD Super Bomb 1 CASE 9.0 6/1 1999090112 RELOAD Taste My Venom 2 CASE 52.0 4/1 FC1102015010017 RELOAD The Bad Azz Punisher(Galaxy) 1 CASE 19.0 3/1 2008080198 2005060055, ROCKET Bottle Rockets 6 CASE 54.0 25/12 2011020282, 2012080726 2005060055, ROCKET Bottle Rockets 36 PIECE 1.1 25/12 2011020282, 2012080726 ROCKET Discovery Shuttle 1 CASE 11.0 20/1 2006120185 ROCKET Flying Color Butterfly 1 CASE 8.0 72/1 2003070141 ROCKET Rockets 6oz 18 PIECE 7.5 36/1 2004060260 ROCKET Rockets 8oz 1 CASE 16.0 36/1 2004060261 ROCKET Smile Rockets 1 CASE 12.0 20/1 FC11020150800 02 ROCKET Tri-Whistling Bottle Rockets 1 CASE 8.0 20/12 2005100021 ROCKET Wild Geese 1 : CASE ' 7.0 '48/1 2003070145 W&P _ Bombing Planes 1 'CASE 8.0 60/6 2008020023 ' W&P Military Parachute 6 PACK 5.0 24/2 2000070128 W&P Two Color Space Ship(Boomer) 12 PACK 4.3 36/6 2010101066 Total Items Shipped: 701 $48,919.31 Total Weight: 2,777 kg 6,109 Ibs Gary connection, Inc. ` 204 E.Martin Luther King,Jr. Blvd Tampa,FL 33603 813.234.2264 Phone 800.334.2264 Toll-Free 813.234.1516 Fax AC40® CERTIFICATE OF LIABILITY INSURANCE DA,E(MM.DD",,,,,Y' 6/6/2019 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 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 endorsement(s). PRODUCER CONTACT NAME ERIC TREEND ACRISURE LLC PHONE . (800)607-4711FAX AI No 1375 FAST 9TH STREET,30TH FLOOR,SUITE 3000 ADORFSS: ERIC.TREEND@BRITTONGALLAGHER.COM INSURERS AFFORDING COVERAGE NAIC# CLEVELAND OH 44114 INSURERA: FWCJUA INSURED INSURER B GALAXY FIREWORKS INC INSURER C 204 E MARTIN LUTHER KING BLVD INSURER D: TAMPA FL 33603 INSURERE: FEIN:593092878 INSURERF: COVERAGES CERTIFICATE NUMBER: 1906060016 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS TR POLICY NUMBER MMfDD MID COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S AGE TO RENTED CLAIMS-MADE OCCUR PREMISES SES occurrence S MED EXP(Anyone person) S PERSONAL 8 ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PEP: GENERAL AGGREGATE S POLICY EP T F I LOG PRODUCTS-COMPIOPAGG S OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S a accident ANYAUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAR HOCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS $ WORMERS COMPENSATION X STTATUTE OT AND EMPLOYERS'LIABILITY JER ANY PROPRIE10RIPARTNEREXECUTIVE YIN N E.L.EACH ACCIDENT S 500,00D.00 A OFFICERIMFMBER EXCLUDED? N/A 2E637021 1/19/2019 1/19/2020 (Mandatory on NM E.L.DISEASE-EA EMPLOYEE S 500,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E-L-DISEASE-POLICY LIMIT S 500,000.00 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 5335 8th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Zephyrhills FL 33542 AUTHORIZED REPRESENTATIVE Phone Number (813)780-0000 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD M ,a Tr Nor th 'fit_ ,. '.���y~ t"., �... `:` �i.r��►....,,."�'..... `.f.:,_i� Pt .r. ...r.-r+, �� S > is __-^•, t y Gory 41 or, kN IV p to 20,f cp \, Wort rom. y� y Let t Q .►. ..,.._ '~ � 'tip,. lb 44 71. �E f '� �'.K�!�! '` q tit ••��r9��s It�t =r ai £ f IM AWL , W�f i f .. :.».�'".»......... ....e,........,....w.,w�.m..r..5:...:.s-..ww..........«_,®.....,...®.e.................w..v...,.....�....e.�.. ..e.,...e... �Wlf AA DRIVER Llt'rNS'-CLASS E ' .. :MARIA J i a BRAY 38815 TUCKERRD - ZEPHY.RHILLS,-FL 33542 6744 OOB8 01-05.1959 SEX F I w ?ue b?dl0-2014mGrT_5 { Q ti5-2022.: OFetatton via motor vatucla consbhnss consent to any sobriety test"wed by 1- 1 t , CR.C�'JiyiOSlY3Ff + ,�r.. `-"-t•�'!�"o i�"�"'K t.Banc .� IN '� ��% ,� ,,�[[��7?+� N'�a�' �1rw SioFa ga 20•FCon _�ctaC", \• ' 595'3 -Ga11 B1x/ccl Lt ♦�� � uRa �a TM r� w � � ��'h. w . I w ,.r �.iw -*:..,...�.,,.;-T•.+,F,....,-sr.+-s.�h r*!oe�eT.s.-.S.wsG:.=.•r-. 4-T+:r-,- .w-r..nrW'w^s..ia�+�'M^y+"+a.-sa,..^mZ+ew_w'u+kTop--'' CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 21347 FIRE WORKS PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 21347 Address: 5953 GALL BLVD Permit Type: FIRE WORKS ZEPHYRHILLS, FL. Class of Work: FIRE WORKS Township: Range: Book: Proposed Use: COMMERCIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 10-26-21-0020-00000-0030 Improv. Cost: OWNER INFORMATION Date Issued: Name: ZEPHYR LLC Total Fees: 529.00 Address: 7162 READING RD #730 Amount P CINCINNATI, OH. 45237-3845 D e Phone: ork Desc: TEMPORARY FIREWORK SALE JUNE 12, 2019 - JULY 7, 2019 CONTRACTORS APPLICATION FEES G FIREWORKS,INC FIRE PERMIT FEES 500.00 TEMPORARY SALE 29.00 fly, FIRE WORKS SITE INSPECTION Ins ections Required Chapter 633, Florida Statutes, authorizes the City to charge and collect user fees to pay for the costs of fire prevention and protection related activities such as inspections, plan review,administrative fees,and other costs related to the aforementioned. Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final inspection shall be charged double permit fee per day of operation or a minimum of$100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "FIREWORKS" per Section 791.01, Florida Statutes are considered as any combustible or explosive composition or substance or combination of substances or, except as hereinafter provided,any article prepared for the purpose of producing visible or audible effect by combustion, explosion, deflagration,or detonation. CONTRACTOR SIGNATURE PERMIT OFFIC60 PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041 AID�® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYI) 616t2019 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 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 endorsement(s). PRODUCER CONTACT ERIC TREEND NAME: ACRISURE LLC PHON o . (800)607-4711 AJC X No 1375 EAST 9TH STREET,30TH FLOOR,SUITE 3000 E-MAIL ADDRES ERIC.TREEND@BRITTONGALLAGHER.COM S: INSURER( AFFORDING COVERAGE NAIC# CLEVELAND OH 44114 INSURERA: FWCJUA INSURED INSURER 8 GALAXY FIREWORKS INC INSURER C: __J_ 204 E MARTIN LUTHER KING BLVD INSURERD: — - — - TAMPA FL 33603 INSURERE: k FEIN:593092878 INSURERF: i COVERAGES CERTIFICATE NUMBER: 1906060016 REVISION NUMBER, THIS IS TO CERTIFY THAT-THE-POLICIES-OF INSURANCE MISTED 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. P-- ---CLAIMS.____._ tNSR' �� �ADDL?SUBR! � P6LtCY£fF i POLtGY EXP j LTR TYPE OF INSURANCE , POLICY NUMBER ! MMIDD/YYYY i MMIDDIYYYY , LIMITS COMMERCIAL GENERAL LIABILITY i i ` { 'I EACH OCCURRENCE ! S DAMAGE TO-RENTED CLAIMS-MADE i�OCCUR ' I PREMISES Ea occurrence ,.I S MED EXP(Any one person) S PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: ( GENERAL AGGREGATE I S POLICY I�PRO- JECT O #LOC I { iI I PRODUCTS-COMP/OP AGG !S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I S (Ea accident ANY AUTO { I BODILY INJURY(Per person) S OWNED ^l SCHEDULED + I j ! AUTOS ONLY AUTOS ( i ILY WJURY(Per accident) S HIRED �- NON-OWNED j i �110D PROPERTYDAMAGE -- AUTOS ONLY i_AUTOS ONLY i I Per accident S I I Is UMBRELLA LIAS I I OCCUR f EACH OCCURRENCE S EXCESS LIAB _17 CLAIMS-MADE AGGREGATE !S DED RETENTION S WORKERS COMPENSATION i I X i SPER TATUTE ' OTH- { AND EMPLOYERS'LIABILITY YIN I I �- i ER .ANY PROPRIETORIPARTNERIEXECUTIVE i 1 E.L.EACH ACCIDENT ,S 5d�>���•�0 A OFFICERIMEMBEREXCLUDED? NIAi i 2E637021 } 1/19/2019 , 1/19/2020 --- -- (Mandatory in NH) i i EI L.DISEASE-EA EMPLOYEE S 500,000.00 If yes,describe under 500,000.00 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT Is l I I I } DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Zephyrhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 5335 8th Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Zephyrhills FL 33542 AUTHORIZED REPRESENTATIVE Phone Number: (813)780-0000 � t Q 1988-2015 ACORD CORPORATION. All rights reserved.