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HomeMy WebLinkAbout21-3147IMPOV.4 Address: 204 E Martin Luther King Blvd TAMPA, FL 33603 City of Zephyrhills 7� 5335 Eighth Street Zephyrhills, FL 33542 FIRE-003147-2021 Phone: (813) 780-0020 Fax: (813) 780-0021 Issue Date:_ Permit Type: Fire Class of Work: Fireworks Building Valuation: $0.00 Electrical Valuation: Mechanical Valuation: Plumbing-Taluation: Total Valuation: $0.00 Total Fees: $532.00 Amount Paid: $532.00 Date Paid: 12/1/2021 12:22:20PM 5953 Gall Boulevard REINSPECTION FEES: (c) With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c) the local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or first reinspection, whichever is greater, for each subsequent reinspection. Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permit required from other governmental entities such as water management, state agencies or federal agencies, 23133#�� Tim= T1T7TT"T-'W;XT -7 accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. CONTRACTOR SIGNATURE PE IT OFFICEC) PERMIT EXPIRES IN "ONTHS WITHOUT APPROVED INSPECTION T-3 C1 Temporary Sales Checklist City of Zephyrhills 5335 81h Street Zephyritills, Ft. 33542 Phone: 813-780-0020 / Fax: 813-780-0021 Detailed Plot Plan showing setup of location, Refer to Ordinance 1038-09, See 4 Notarized letter from property owner stating their approval. A flame retardant certificate is required JE a tent is involved. Inspection required once tent is erected and pri :pr 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. jF 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. FIREWORK REQUIREMENTS - (In addition to the above) Proof of State License. M= 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. 00-i-0-0 - City Registration (If Regulated by DBPR - Fee is Waived) $500.00 - Fireworks fee - Fire Department fee $ 5.00 --Temporary Sales Fee for I,' two days $ LOO - Temporary Sales Fee per day for each consecutive day thereafter, not to exceed duration of 7 consecutive days and no more than LwQ occurrences during a 12 month period on same property Ord #1038-09, See 6 $ 60.00 - Tent Fee (45.00/1313, 15.00*/FD) -(*$15.00 waived for Fireworks) $ 45.00 - Electrical Fee (if applicable) IM 0 Applicant: Gal�axFireworks, Inc. Phone Contact: ___L811_3) 234-?g64________---- Address Site: 5953 Gall Boulevard, Zephyrhills, Florida 33542 Date(s) of Sale: Temporary Tent sale of Fireworks December 10,2021 to January 8,2022 Ordinance No. 1038-09 (for additional requirements) No Fireworks Discharge L 0 Fire Extinguisher NO Fire Works Diafge t Exit,"' 0 Enig./Exit Light II No Fireworks Discharge Fire Extinguisher 10 E/Exit UT. 0 tight REVIEW DATE F %C ia arY O FIRE MO LIFE SAFE7y EXAMINEk.,e� (INo Fireworks Discharge L�_1 C� Erng.lExit tight Exit 44" QF➢re Extinguislaerm- L NO IIiI('�'II�I! Fire t_....1 Works No Discharge Fireworks Discharge Exit 44" Exit 44" 0 0 Emg /Exit Fire Extinguisher Emg./Ex➢t Light 0 Light No Fireworks Discharge �� �� ��\���� � \�� /�\ :ar.� :��.�.. .:... ..� � �� : © <� � � � ° �s «� ? d� �� : . .. �. . . `2 �� k }� \\\ ? y .� ~ \\k />� : � �:. � :m �� .�:arm>s, �� y� ©�- . . . � � © �� � � y: 2<\ w� « a:a . :a, » �.td��� ©+. x t�?ks ' s rtl r t r i S t 31 c F )- r s +rt 3 �� �� ;� ° .5•s r r �� i3JttP.,x t 3 fit} SAI st _ _ 1144 t �F 5 �y, . � '4 �W*f .: i � fi � : t ° [ � i it - yy y 5 ., t 'tt.=.tx� ;;,, ,r y.r i s r'. y.. •. r y - - f��f I { v ' }�'$rtt ''�z-�5.s 'fil,� = 5���_. �}��. �� ��:t •.'c - -�`t �Si�`�r4J{$ � ��; 3 . . #s M AIR IN u �3e - < tt i t H T t t # t L � tfir t- .t , ABC,Tents Mark Chapter 16, verses Into aff the warld and preach the gospel to every cry .,.. ,6, H r' a rs u 4 e 54 'S p * 54 u� Location Inventory for Permitting Galaxy Fireworks, Inc. This location has consumer fireworks products from the following list on site forsales to the u li : 000000000103 o et ollection 18/1 000000000111 Cosmic Cluster 8/1 0000107 os is ont n 4J1 fl00000O116Final nt 6'/1 09Q000000106 t f r i 24/1 0 1 Ines /1 000O00109a 'ti a 5/1 000 1 t r azor 24/1 000000000113 r e .754471202011 7th Heaven 6/1 705108310500 Acrobatic Monkey 411 7051033 4103 rillia t ower n. 484 706 34 2072 ulk ones 3 nic 18/4 761507118062 ulk Cones#5 USA SDrinqBlossom 96/1 1200215 California r in' . 754471 11 CaliforniaSunrise 36/1 754471 17 Call of the Wild 36/1 676551050216 24/6 754471201410Electric Rainbow o 12/1 754471 1113 Far ut 12/1 oOO000000231 Fire lnvioable 12/3 705108302703 Gadzooks 12/6 754471202219ran Illusion 6/1 754471201212 Havana eat 18/1 0 Asst. o in 36/4 000 3 sst. ou taro 18/4 000Q 0€9 3 sst. untain 18/4 676 51 1 of oll 1611 754471 01311 Just Another tin in Fountain 24/1 000000305illr ees 24/4 8052 .3114. 1 _- 6/1 36/1 4471199816 alibu a ess 8/1 75447/202 1 ystic ain 6J1 754471 151 uiet it 18/1 7Q 1 3 1 7 tar lu 24J1 754471199717 §Star ust Ftn. 24/1 175447'1 201 Stars er. erica 48/6 0000 0 0 2 4 iistlin ixie hx"tail r " ss't. tn) 18/1 8052531137801 orl s Mli hest F untain 18/1 253113794 orl tr n est ountain Location Inventory for P@rmitting Galaxy Fireworks, Inc. 2 676551051442 Groun loo to er ( ri11a) 20/12 000000000513 pinnin Wheel 12/6 000000000514 Tri otatin eeL 24/12 Irw # TI .' . 676551033479 Black Snake 15/48 000000000519 g Balls 16/12/6 000000000507 a op rs a ne 12/72 676551033431 nap-n- o 6/40 000000000510 Tanks 40/12 676551033486 Mammoth oke 6/24/1 676551033462 Smoke Balls color, l2 pk. 20/6/12 676551 33 Smoke all (w it , 1 pk. 20/6/12 000000000602 Smoke Grenades 12/48/1 nv.#'.' 0000 00007 #10 Color parkler 24/12/8 00000Q007177 #1 old parkler 24/12/8 000000000701 #8 Color Sarkier 24/12/6 000000.000700 #8 old Sparkler 24/12/6 000 0007 10" ornin lories 24/12/6 000000000704 14" Morning lories 15/8/12 705834480034 36" alaxy ornin lories 48/1 000000000810 Alien Attack 6/1 000000000801 Cosmic Countdown 4/1 000000008133 Collection 8/1 000000008003 Galax "s Next eneraion 6/1 000 000 Ni ht Fire 1/1 000 00811 aturn's even a 4/1 8052531326410 8/1 000000000931 !j g !2 18/2 805253633056 Out 12/1 805 31333111 urn ut 12/1 ..70510 512508 B2beL . 12/1 000 0000 Cloud ra 18/2 000000000923 Grov .e 12/1 676551050490 ColorPearl-48 shot 20/4 66551050728 olor earl $112 10/4 805253131774 ! !Lx itin 12/1 70510 12201 ye Can 8/1 61 2037206067 Galaxy"sWarrior 72/1 000000000939 reen oo 18/2 705834231773 Flap y Firevwork-1 shot 48/1 Location Inventory for Permitting Galaxy Fireworks, Inca 3 705834231780 shot 24/1 000000000906 ales osco a 50/1 805253013018 Lan of the Free 18/1 8052531330813 Mean Machine 24/1 705108513000e a Ci 10/1 705108513109 Mexican Wave 10/1 805253632462 Motor Mouth ` 12/1 805253132009 putter Splatter 18/1 8052530136614 StadiuPride 12/1 805253132375 Tall Gator 24/1 805263131293 reckless 12/1 000000000919 Yellow Bees 18/2 lnvr . 754471293712 Above the Law 4/1 61 . 7677 Act of o 6/1 705108531707 Amain allet 1/1 612030642251 America The Beautiful 4/1 705108541300 3/1 805253150126 Breathless 3/1 8 315 Can You Handle It 2/1 612037541496 Carnival Attack 6/1 8052531514206 CHAOS 6/1 805253150393 Crazy citin n ter s s 4/1 805253131279 xtre a Machine 4/1 80525302902 analcon 211 000000015271 alax 's esire 4/1 000000015264Galax 's a ener 4/1 000000001600 alai 's Golden StaL 8/1 612130664321 alai 's Thunder 6/1 000000015233 Galaxy a is 4/1 8052531512011 an ter 4/1 8052531521204 IU 6/1 805253151610 he i ht 2/1 805 301 Inde endence aeries r. k 4/1 612030658856 dforS eed 12 4/1 805253132238 in Yard 4/1 805253029019 One Bad Mother 3" 2/1 805 3131 ne ad .other 4/1 805253150379 One Bad Mother in Law 4/1 805253150867 Oriental ra on 500ra 6/1 80525315060 150 0 oltin Thunder 2/1 7051 5345 . A on uerr _1/1 000000001526 Winter Blast 1/1 Inv. , 680140008823 ad o Crackers 100/100 Location inventory forPerrritting Galaxy Fireworks, Inc. 4 000000001001 ele ration Crackers-1388 12/1 000000001002 CelebrationCrackers-2492 6/1 805253005242 Firecrackers-I 6O00s 1/1 000000001010 Firecrackers-2000s 8/1 1_000000001007 Firecrackers- 8/10 000000001004 Firecrackers /1 (Gorilla) 24/40 000000001011 Firecrackers 's 4/1 000000001012 Firecrackers 's 2/1 000000001515 Gorilla Burst 12/1 000000001527 Junior Burst 12/12 000000001017 M-1000,Assorte { la ) 40/36 lawRoman. .. es .. 000000001129 0 00011 lue Thunder er 24/6 0200000014007 alaxSpecialSeclalRoni andle / 36/4 00 00111Roman Candle Ball 48/6 00 00001111 Roman Can l ® all /rpt) 72/4 000000011140 Roman Candle 10 Bafi 24/6 1_0000000011150R an Gan le 1 ll /r t) 36/4 000000001113 o an Gan le 11 ( /r t) 54/4 00 0111Romanm Can le- Ball 48/6 705834250392 Smash Tactic Candle 24/4 705108400409 ala n l 18/4 16932352130019 Turbo Boost 24/4 000000001103 om in Planes 60/6 705108508303 Military Parachute 24/2 000000001106 ReconnaissancePlane 60/6 000000001119 Two Color S pace Ship 36/6 Ins::# MISSILES 676551050018 Saturn Battery 25 shot 120/1 000000001117 Saturn atte -1 s o 30/1 000000015028Saturn ante shot 12/1 000000015356 Saturn att -7 shot 2/1 nv: 000000001200 Bottle k rilla) 25/12 000000001212Cluster Bee 72/6 000000001228 Emerald Meteor 96/6 000000001215Fjn Color Butterfly 72/6 612026121210 laxy lorer 10/9 8052 3001411 Need for Speec1RccRocket 24/4 000000001221 Parachute Rocket 96/6 000000001213 Red eer oct 96/6 805253001428 in hell Rocket 24/6 00 001 Rock 4ozGalaxy) 36/12 0000000012060Rockets 6o Galax ) 36/12 Location Inventory for Permkffing GalaxAWM3MMj@M Location Inventory for Permitting Galaxy Fireworks, Inca This location has consumer fireworks products from the following list on site for sales the u lic: lnv . 000000000103 Comet Collection 18/1 000000000111 os is Cluster 8/1 000000000107 os is Countdown 4/1 000000000116 Final Countdown 611 • 000000000 1,06 Just for Kids 24/1 000000000108 Ninja 6/1 000000000109 Party Time 5/1 O000000000100 tar aaar 24/1 �-. 000000000113 Warp Speed 12/1 . 75447120 11 7th Heaven 6/1 705108310500 Acrobatic Monkey 4/1 70510 304103 Brilliant Shower Ftn, 48/1 705834220722 Bulk Cones #3 Conic 18/4 6 761 0711 0 2 Bulk Cones #5 USA Spring Blossom 96/1 754471200215 California Dream in 24/1 . 754471 11 California Sunrise36/1 75447120 017 Call of the Wild 36/1 676551050216 24/6 754471201410 EjicRain o 12/1 754471 01113 F9 __ 12/1 0JQ999922QL Fire Inviable 12/3 7051 083027 3 Gadzooks 12/6 71202219 Gran Illusion 6/1 754471201212 avana Heat 18/1 000000000302 HN-60 Asst. oun in 36/4 000000000303 N .asst. Fountain 18/4 000000000304 • 0 Asst. ount in 18/4 676551001669Hot oll 16/1 754471201311 Just Another Stinkin Fountain 24/1 000000000305 illerBe!s 24/4 8052 63114 1 Lav!Lam _ 6/1 754471199816 Malibu Madness 36/1 754471202912 y ain ____ 8/1 75447/201 1 uiet i t 8/ 70 10 3 1 7 tar lu 13/1 7544711 717 StarDustFtfl. 24/1 17544712019 Stars OverAmerica 24/1 000@00 0 204 histlin iie ll r ss°t. ) 4$/6 8052531137801 orl s i hest untain 18/1 8052.53113? 4WorldsStrongest ountain Location inventory for Permitting Galaxy Fireworks, Inc. 2 Jnv 676551051442 B'oom Flower(Gorilla 20/12 000000000513 Spinnin Wheel 12/6 000000000514 Tri- otatin Wheel 24/12 1. � NOVELTIES.. . . 676551033479 Black Snake 15/48 000000000519 Crackling Balls 16/12/6 000000000507 Party Po ers Champagne 12/72 616551033431 nap- - +� 6/40 000 0 .0051 Tanks 40/12 1 : 0 , 676551033486 Mammoth Smoke 6/24/1 676551033462 SSmoke alls ( lor, 1 k.) 20/6/12 676551033509 Smoke alls ite, 1 .) 20/6/12 000000000602 moke Grenades 12/48/1 000000000709 #10 olor arler 24/12/8 000000007177 #10 old arkl r 24/12/8 000000000701 #8 for rkler 24/12/6 000000.000700 #8 old par lr 24/12/6 000000000705 1Morning Glories 24/12/6 000000000704 14" rnin lories 15/8/12 70 3448 34 6" Gala Morning Glories 48/1 000000000810 lien Attack 6/1 000000000801 Cosmic Countdown 4/1 000000008133Galaxy ollection 8/1 000000008003 Galaxy's Next Generation 6/1 000000000809 i ht Fire 1/1 000000000811 Saturn's Revenge 4/1 8052531326410 Beware 8/1 000000000931 i now 18/2 805253633056 Bu gin Out 12/1 8052531333111 urn ut 12/1 " ..705108512508 Cher o er 12/1 000000000938 lu rag n 18/2 000000000923 Grove 12/1 676551050490 dolor earl-4 shot 20/4 105 for earl- shot 10/4 805253131774 Crazy Excitinci 12/1 705108512201 E e atn 8/1 612037206067 al 's WarrioL 72/1 1_000000000939reen Bamboo 18/2 . 705834231773 Happy Firework-1 6 shot 48/1 Location-I nventory for Permitting Galaxy Fireworks, Inc. 3 705834231780 y Fire rkstl3 sh t 24/1 000000000906 aieidoscope 50/1 805253013018 Land of the Free 18/1 8052531330813 can Machine 24/1 705108513000 a i 10/1 705108513109 Mexica ave 10/1 805253632462 otor Mouth ' 12/1 805253132009 iittr l er 18/1 8052530136614 tadi Pride 12/1 805253132375Tail ator 24/1 805253131293 reckless 12/1 000000000919 Yello ees 18/2 mv # . 5 , 754471293712 ABove the Law 4/1 612037567793 ct of o 6/1 705108531707 Amazing BAmazinci Ballet 1/1 1ö0642251AmericaTheBeautifUl 4/1 7051 413 Big they fucker 3/1 805253150126 reathless 3/1 805253150523 Can You Hanle It 2/1 612037541496 arnival Attack 6/1 8052531514206 CHAOS 6/1 805253150393Crazy citin ter i s 4/1 805253131279 Extreme Machine 4/1 80525302902 Fanaticon 2/1 000000015271 alaxy's Desire 4/1 000000015264 alay' ye Opener 4/1 000000001600 alaxy's of en tar 8/1 612130664321 Galaxys Thunder 6/1 15233 2x is 4/1 31 1 11 an Gangster 4/1 31 1 ICU /1 805253151610 Ignite The i ht 2/1 8052530156605 Independence eries 500 Gr. a 4/1 612030658856 Need for Speed 12 hot 4/1 13 of in Yr 4/1 L Q253029019 Mother " /1 i 3053131859ne ad' other 4/1 805253150379 One Bad Mother in Law 4/1 805253150867 Oriental D ra o r 6/1 3 315060 n Thun er 2/1 7051 34500 USA COnuerer 1/1 0001526 ter last 1/1 lcty. 680140008823a Crackers 100/100 Location inventory for Permitting Galaxy Fireworks, Inc. 4 0000 0 1 ele ration rac er -1 12/1 000000001002 el ration Cracke,s2492 6/1 805253005242 Firecrackers-1 6000s 1/1 000000001010 Firecrackers- 's 8/1 000000001007 Firecrackers 's 8/10 000000001004 Firecrackers 11 rilla) 24/40 000000001011 Firecrackers 's 4/1 i 000000001012 Firecrackers 's 2/1 a 000000001515 Gorilla Burst 12/1 000000001527 Junior Burst 12/12 0000 001 17 40/36 lir7 Roman. .. .Candles. 000000001129 Blue Thunder 24/6 0200000014007 ataxy ecil . a i ( /4) 36/4 000000011105 RomanCandle -5 Ball 48/6 00 001111 Rv an n l - all /r 72/4 000000011140 RomanCandle 10 all 24/6 00 0111 o an ndle 1 alt /r t 36/4 000000001113 o an CandleBall /r tj 54/4 000000011129 o an an le Ball 48/6 705834250392 Smash Tactic Candle 24/4 705108400409 Su erGalaxy CalaxyCandHe 1814 16932352130019 Turbo Boost 24/4 00 011Bombing Planes 60/6 705108508303 illtParachute 24/2 000000001106 Reconnaissance Plane 60/6 00 0111 Tw for ace hi 36/6 q a 11= 676551050018 Saturn a::a . ... . Shot 120/1 000000001117 SaturnBattery100shot 30/1 000000015028 atr tte sot 12/1 000000015356atrn e 7 sh t 2/1 lnv. 000000001200 le Rockets Gotilla) 25/12 000000001212 lusterBee 72/6 Ob0000001228 EmeraldMeteor 96/6 00.0000001215 Flyin olor tte ly 72/6 612026121210 ataxy x lorr 10/9 805253001411 Need forspeed R22ket 24/4 000000001221Parachute Rocket 96/6 000000001213 Red Meteor Rocket 96/6 805253001428 in hell ocket 24/6 000000001205 Rocke 4 z ala 36/12 000000001206 ocke 6o (Gala y 36/12 Locatior Inventory for Permitting Galaxy Fireworks, Inc. DATE (MMIDD CERTIFICATE OF LIABILITY INSURANCE F W1372OD21 I I I �Lm­ REAVAIM RAWL'i- PRODUCER ACRISURE LLC 1375 EAST 9TH STREET, 30TH FLOOR, SUITE 3000 ERIC TREEND I I --- ­­­­ --- - ----- ---- (800) 748-0351 FAX ERIC,TREEND@BRITTONGALLAGHER.COM CLEVELAND OH 44114 INSURER A: FWCJUA INSURED INSURER GALAXY FIREWORKS INC - -- ----------------- - INSURER C 204 E MARTIN LUTHER KING BLVD JNEYRERD' TAMPA FL 336030000 INSURER E: FEIN:593092878 INSURER F: COVERAGES CERTIFICATE NUMBER: 2102030026 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, ------- TYPE OF INSURANCE POLICY NUMBER 1 -- --- ------- -- ­ 1111, .__­ POLId Y tFF POLICY— 0 V�A 1"U1nnrVVyV1 LIMITS :i COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE !$ CLAIMS -MADE OCCUR qq MEp P (Any ono person) $ PERSONAL & ADV INJURY $ ------ --- --- -- -- 9EN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGRE $ POLICY PRO - Po LOU JECT PRODUCTS - COMP/OP AGO $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ JEAA 0'__ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE_ AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCURRENCE $ ESS LIAR M- GATE $ WORKERS COMPENSATION PER EOTTH ��_1'416TPTE, ER AND EMPLOYERS'LIABILITY AIVD YIN AN PROPRIETORIPARTNER/EXECUTIVE NIA' 2E637021 A OFFYICER/MEMBER EXCLUDED? --- --- EL CH ACCIDENT 1$ S00,000.00 1/19/2021 1/1912022 I (Mandatory In NH) E.L, DISEASE - EA EMPLOYEE! $ 500,000�00 ------------------- --- - if es, describe under E.L. DISEASE - POLICY LIMIT $ 500'000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedute, may be attached It more space to required) 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 I ACCORDANCE MTH THE POLICY PROVISIONS. Zaphyrhills FL 33542 AUTHORIZED REPRESENTATIVE Phone Number: (813) 780-0000 1988-2015 AD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD • iii iu ilk ATE IDACOOR" CERTIFICATE OF LIABILITY INSURANCE li li 1 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 CERTIFICATEHOLDER. 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 • i 1PRODUCER CONTACT BrittonGallagherPHONEFAX ClevelandOne i♦ ♦ • i216-658-7101 1375 East* i•' INSURED INSURERB: Everest Indemnit Insurance Co. 10851 Galaxy Fireworks Inc. -- -� - - — _— -- 204 E. Martin Luther King Blvd INsu�ERe: Everest Denali Insurance Come - — -ra- - Tampa FL 33603 INSURER D INSURER E 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. T _----------------- WSRT iAUDL SUBR,,T POLICY EFF POLICY EXP - —- --- -----...._. i TYPE OF INSURANCE LTR ! POLICY NUMBER MM/DD/YYYY MM/DDlYYYY LIMITS B ,.. GENERAL LIABILITY ',, S18ML00324-211 j 6/10/2021 6/10/2022 EACH OCCURRENCE $ 1.000,000 X ' DAMAGE —TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 500,000 _ CLAIMS -MADE X OCCURi MED EXP (Anyone person) $ ~� PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGO $ 2,000.000 POLICY -• PRO X LOC ---- -- $ - -- - — --- -- C AUTOMOBILE LIABILITY SIBCA00081-211 6/10/2021 i 6/10/2022 COMBINED SINGLE LIMIT accident $ 1D_00 000 X ANY AUTO ; :: BODILY INJURY (Per person) $ �— ALL OWNED SCHEDULED —_AUTOS AUTOS I BODILY INJURY (Per accident) $ X 'HIRED X NON -OWNED PROPERTY DAMAGE $ AUTOS '_ AUTOS Jeer accident -_ ---- -- - $ A UMBRELLA LIAR X OCCUR P-001-000142177-03 6/10/2021 6/10/2022 EACH OCCURRENCE $ 4,000.000 — -— .— .._.. ---- X ;EXCESS LIABCLAIMS-MADE: : CLAIMS MADE',. I AGGREGATE ! $ 4 000,000 DED RETENTION $ $ wORKERS COMPENSATION I I WC STATU- OTH-i AND EMPLOYERS' LIABILITY YtN , ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT ' $ OFFICER/MEMBER EXCLUDED? N / A - --------------"------"- "---- " (Mandatary in NH) % E.L. DISEASE - EA EMPLOYEE $ If yes, describe under :; .--- .....-- ---a. -. ---------- -- DESGRIP710N OF OPERATIONS below E,L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS i 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) I # SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhills 6907 Dairy Rd Zephyrhills FL 33542 AUTHORIZED REPRESENTATIVE @ 1988-2010 ACORD CORPORATION. All rights reserved. ! ' • i 1 1 i ' ! name and logo are registered marks of ! • t Jimmy Patronis yap Casia Sinco CMEFFTNANCIAL,OFFICER BUREAU Jullits Halas Keith McCarthy ErMSTON DIRECTOR ROGRANAGER SAFETY PMMA FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Games Street - Ti-allahmee, Florida 32399-0342 Tel. 850,413-5,644 Fax. 950410-2467. m aAl ul-aval'ug'all THIS CERTIFIES THAT: Galaxy Connection Inc. 204 E Martin Luther King Blvd Tampa FL 33603 wholesaler. Type: Class: County: License/Permit Expiration Date: 02/01/2021 07 61, Hillsborou.gh 2 ?. J M d, vi, t �, " 0, �t 777,9 FAM11.1 CUMKOAAR . . . . . . . . . . . IMMAU-1-MI(IFI2 WHOLESALER OF SPAWMERSI OFFICIAL COPY Issue Date: Type: Class: County: Expiration Date: Jimmy Patronis Casin Sinco — CIREF FINANCIAL OFFICER BUREAU CRW Julius Halas Keith McCarthy DIVISION DIRECTOR SAFETY PROGRAM MANAGEW FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE I FIRE MARSHAL 200 Eas,t Giffies StrIcet - Ta,11aba'ssee, Florida.32399-0342 Tel. 850-413-3644 Fax. 850-410-2467 X WM -1 - A 1-0-IAXWO ".N_ OAV PW_ K"A TAIMI.P I 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 Issue Date: Type: Class: County: License/Permit #: Expiration Date: W1 02/01/2021 07 - 64 Pasco 186104-0008-2010 01/31/2022 39