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Home My WebLink About08-7886 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT N~~ Jl'~ ~ ~"j 7886 Permit Number: 7886 Permit Type: TEMPORARY SALES Class of Work: SPECIAL EVENT Proposed Use: NOT APPLICABLE Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: Address: 5935 ALL BLVD ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 10-26-21-0020-00000-0050 5/30/2008 519.00 519.00 5/30/2008 Phone: TEMPORARY SALES EVENT FIREWORKS-JUNE 17TH THRU JULY 5TH Name: ZEPHYR PLAZA Address: 5935 GALL BLVD ZEPHYRHILLS, FL 3542 FIRE PERMIT FEES 500.00 QJo~ . '1/ 1--i)13 REINSPEC110N FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d) work not ready for inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible. 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 permits required from other governmental entities such as water management, state agencies or federal agencies. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property, If you intend to obtain financing, consult with your lender or an attorney before recording your notice of commencement." t/9~ ~ CONTRACTOR SIGNATURE PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 7886 Permit Number: 7886 Permit Type: TEMPORARY SALES Class of Work: SPECIAL EVENT Proposed Use: NOT APPLICABLE Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: Address: 5935 ALL BLVD ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 10-26-21-0020-00000-0050 Name: ZEPHYR PLAZA Address: 5935 GALL BLVD ZEPHYRHILLS, FL 3542 519.00 519.00 5/30/2008 Phone: TEMPORARY SALES EVENT FIREWORKS-JUNE 20TH THRU JULY 5TH P L FIRE PERMIT FEES 500.00 REINSPEC110N FEES: Reinspection fees will comply with Florida Statute 553,80 (2)( c) when extra inspection trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d) work not ready for inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible. 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 permits required from other governmental entities such as water management, state agencies or federal agencies. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before recording your notice of commencement." ~-~ CONTRACTOR SIGNATURE PERMIT OFF I PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 7886 ermlt umber: 7886 Permit Type: TEMPORARY SALES Class of Work: SPECIAL EVENT Proposed Use: NOT APPLICABLE Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Phone: Work Desc: TEMPORARY SALES EVENT FIREWORKS-JUNE 20TH THRU JULY 5TH Address: 5935 GALL BLVD ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 10-26-21-0020-00000-0050 Name: ZEPHYR PLAZA Address: 5935 GALL BLVD ZEPHYRHILLS, FL 3542 519.00 ( REINSPEC110N FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d) work not ready for inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible, 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 permits required from other governmental entities such as water management, state agencies or federal agencies. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before recording your notice of commencement." CONTRACTOR SIGNATURE PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER TENTNENDOR CHECKLIST The AHJ shall be pennitted to regulate all outdoor events such as carnivals and fairs as it pertains to access for emergency vehicles~ access to fire protection equipment~ placement of stands, concession booths, and exhibits~ and the control of hazardous conditions dangerous to life and property. NFPA 1, Section 10.16.2 v / v Plot Plan showing setup. Notarized letter from property owner stating their approval. If tent is greater than 10 x 10, flame retardant certification is required. If multiple lOX 10 tents are placed together to create one large space under canopy, than a flame retardant certification shall be required on all tents. No smoking signs must be placed outside entrances. If there is to be wire fencing or chain link fencing, this fence shall be set back from the tent at least 5 feet and have at least 2 exits. If tent has sides, the sides shall be in the up position unless there is inclement weather, than 2 sides must be in the up position. Proof of liability insurance. Adjacent tents shall be spaced a minimum of five (5) feet to provide an area to be used as a means of emergency egress. If stake lines are used to secure the tent, than the five (5) feet shall be measured from the stake line. The ground enclosed by any tent and ground not less than 120" outside the tent shall be cleared of all flammable or combustible material or vegetation that is not used for necessary support equipment. If lighting is installed in tent, it shall be in the way that bulbs are not in direct contact with the tent. Bulb/lamp cages shall be used. If power is supplied by generator, generator shall be a minimum of 5 feet from the tent and shall be isolated from contact with the public by either physical guards, fencing, or an enclosure. Any extension cords used shall be placed or positioned to not cause a trip/fall hazard. A minimum of one portable fire extinguisher with a rating of not less than 2-A: lO-B:C shall be provided. If cooking is involved: A minimum of one Class K portable fire extinguisher shall be p . ed for each concession stand that utilizes vegetable or animal gr cooking ~~ or other process that produces grease laden vapo. I ,"\ Concession stands utiliz coo . ng shall have a minimum of 10ft (3 m) of clearance on two s d shall not be located within lOft (3 m) of amusement rides or . ces. If cooking is taking place under any tent, a flam certification is required. APPROV'ED . byF~ Marshal of Zcpbydaill.t </'2. llc?~ <""e,w'n)\.r Wl~; v,~"....:.......l.t"-'-"J codes of ~f'n::'n.tion Handbook . Zephyrbills Iffireworks are involved: v V ~ Proof of state license. List of all items to be sold. Copy of driver's license of personnel selling fireworks to conduct background check City registration fee of $20.00 rY~~~y'"\~ \>X-.~y '"E-'f.~~,,-~ ~~D -\v oynl ~ --\-c :tf\~p8~c.\('. ~S- ['<-~ f';:C-< 0~\o\\.C. \ ~ * Fire Chief Keith Williams ZEPHYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Bus (813)780-0041 Fax (813)780-0044 FIRE SERVICE USER FEES Occupancy No.: Plan No.: Oe-~D Business Name: Business Address: ___4j'j ~ C l'\-V\ Business Phone No.: Business Fax No.: Contact: PLAN REVIEW FEES o Site Plan N/C o Multi-Family/Commercial .06 sf (Minimum Charge $25.00 o Plan Revisions DBL SPRINKLER SYSTEMS D 0 - 25 Heads $50 o 26 plus Heads $100 STANDPIPE SYSTEM o Per Riser $50 FIRE PUMP o Per Pump FIRE ALARM SYSTEM o 0 - 25 Devices $50 o 26 plus Devices $100 SUPPRESSION SYSTEMS ~:~t : C02 $50 Other $50 KITCHEN EXHAUST o Hood/Ducts OTHER o LP Installation per lank o Fuel Tank Installation (Per Tank) o Natural Gas Installation (Per System) o Spray Booth PLANS TOTALc=I Comments: $100 INSPECTION FEES Annual N/C 1st Re-inspection N/C 2nd Re-inspection $100 3rd Re-inspection $250 4th Re-Inspection $500 (Business closed until violations corrected) SPRINKLER SYSTEMS ~ Hydro Undergrounds $45 Hydrostatic Test $65 persystem Acceptance Test $45 persystem Hydrant Flow $75 Contractor: t.h r Billing Address: Billing Phone No.: Billing Fax No.: Contact: PERMIT FEE $50 $50 $50 $50 $50 $50 $50 $50 FALSE ALARM FEE 1 st Alarm N/C 2nd Alarm N/C 3rd Alarm N/C 4th Alarm $100 5th Alarm $150 6th Alann $200 NON COMPLIANCE $150 Sprinkler Standpipes Fire Pump Hoods Fire Alarm LP Gas Natural Gas F!,JE!I Tanks- pertank Sparklers Fire Works Camp Fire Controlled Bum HoodIDuct Place of Assembly Fire Protection ~ $100 $50 $50 Annual $25 $50 Annual $50 Annual $100 150 Flammable Application Waste Tire Storage Generator < 'r<Y\I Generator >30 'r<Y\I Bio-Hazard Waste $100 Annual Fumigation Tenting $50 Torch Pot/Applied $50 Haz. Materials $100 Annual B .--A... FALSE ALARM PERMITTOTAL~.... TOTAL I J:;iD - FIRE ALARM SYSTEM B System Acceptance $50 Recall Acceptance $50 OTHER ~ Fire WalllSmoke Wall LP Gas Natural Gas $15 per wall $25 pertank $25 per system $50 ~ Tent 10'x1Q' or gfllllter Fire Pump Fire Suppression System Acceptance o Exhaust HoodIDuct ORe-inspection (other than annual) o Inspection scheduled DBL and cancelled less than 24 hours B Construction Insp. NlC Emergency Vehicle Ao $50 INSPECTION TOTALc=J per lent $15 $45 $30 $50 $50 $50 $50 $30 DBL $50 GRAND TOTAL Date: ~ /3l! 0 'b Insij~ctor: '(u~ ~J./~ ~.t.M ~! {lkt- ~... 1A-DI' ';temporary 'Sales Checklist City of Zephyrhills -5335 8th Street .Zephyrhills, Fl. 33542 Phone: 813-780-0020 / Fax: 813~780-0021 "* 1~50 REQUIREMENTS ~Plot Plan showing s~tup of location. vi Notarized letter fromproperty owner stating their approval. A flame retardant certificate is required IF a tent is involved. Inspection is required once tent is erected and prior to opening for business. Approved certified fire extinguishers per NFP A 10. No SmQking signs must be placed outside entrances. IF there is a wire fence or chain link fencing must have at least 5 Ft setback from tent and at least 2 exits. IF tent has sides, the sides shall be in the up position unless there is inclement weather, then 2 sides must be in the up position. FIREWORK. REQUIREMENTS - (In addition to the above) V'- Proof of State License. .~.d~ c;;;;;L. Jd~t nfltMn~tn:~ :::::le. . 2 Copy of Drivers License and 6securi~f all personnel dealing with the sale of fireworks at the tent location. FEEs -L- / ~$ $ 30.00 - City Registration (If Regulated by DBPR- Fee is Waived) -f) $500.00 Fireworks fee - Fire fee ap- r Sales Fee for 15t two da s 1.00 - Temporary Sales Fee per day for each consecutive day thereafter, not to ~ exceed duration of30 consecutive days an4no more than one occurrence per calendar year per Ordinance #408. U ~ D IUfV ...' 11./ _ @ !{. (n $ 50.00 - Tent Fee (35.00/BD, 15.00*/FD) -(*$15.00 waived for Firewotks) . $ 35.00 - Electrical Fee (if applicable) Property Owner: Applicant: Phone Contact: Address Site: Date of Sale: ~~-e.. 2-D - :]'lA.J~ ~ 7.0D & ~(l r-I~ t..i ~w/'P/97 l'V ~//tl~ /p,'j'1/l1'1'-,1~fi~~ " Ordinance No. 408 dated 1/26/1987(foI additional requiremOIrts)~:~L~. &~r~ ,,1 ~ ~..... --....-......'...., - .__..~-_._---_.~._._- -.."- .- INI ...r 9.. . .V~ .~ ~~ ~<: ~O rr , I I I , I . I ., I '" . I . I \ I ) I I J M.I(ltllG .'.Utl/O .W.". ..'''0 EJ "",0 . I "aM' .----- DATE 5-/~ -O'~ ~ryJ.;; C~ 6 +rb GIVE PERMISSION TO: OWEN YOUNG & UNIVERSE NOVELTY & FIREWORKS COMPANY,lNC. POST OFFICE BOX 1862. RIVERVIEW. FLORlDA33S68 (813) 617~1874 TO SET UP AND OPERATE A TEMPORARY STAND ON MYPROPERTY LOCATED AT: ;q 35 6.,,4... ~Lvd Z ePh \(R U,45 LOT # BLOCK # SUBDMSION #- ~oi~ STATE OF FLORIDA COUNTY OF HILLSBOROUGH SWORN TO AND SUBSCRIBED BEFO~ ME THIS . OF ~ 20 ..e.~y d) IV 'I ~. ;<l;STJ<.. 1$ PERSONALL ~." ClCNO HAS PRODUCED .AS IDE A TIO~../ ~~~/ NOTARY.. P-- tIIiIfr NIle .....fI..... e. .. .......to._ 0. . .IID.... .......,...........,.... ST ATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA CERTIFICATE OF REGISTRATION SEASONAL RETAILER . THIS CERTIFIES THAT: UNIVERSE NOVELTY & FIREWORKS CO., INC. 5935 GALL BLVD ZEPHYRHILLS, FL 33599- liAS REGlSTERED TO THE PROVISIONS OF FLORIDA STATUTES TO ENGAGE IN THE BUSINESS OF SELLING SPARKLERS AT RETAIL, FROM JUNE 20 THROUGH JULY 5 AND DECEMBER 10 THROUGH JANUARY 2 AT THE FOLLOWING LOCATION LOCATION: 5935 Gall Blvd. Zephyrhills, FL 33599 PascoLT.'A- 02 Ol 2008 07 63 83999800062002 0165960001 200.00 Issue Dnle Type Class County License/Permit Number Application # Taxes & Fees ~~ Chief Fin.llltial Otlictr 01 31 2009 Expire Date 1Y',I"'.1!!lYf tY4 If" IVlIV. IVI'" IV"V'Iyt ,y. 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CD ~ G E .a i:i: CD ..&: to- ~ o (/) +J ~ Q) .0 o 0:: CD .... e e -I"l t-:l 'I .' 5 : J . .~l~--- I i llll~ If i,!1 (.. .! !!-r Ii I . . ! :,. . r--- J I g IS ....,. .....'.-' 1.. lO ... :0 ................~ '8 o I> () tr"l Cl f" :4- ~ %"' TJ."I;. .i'lo H- T3 1... ~,~ : !1l. ~ - ~ ~ ~~ ~~~ ~. ~.f"'1=,;. +- -i,:f' -.,." (l:> ~"-~ "*"" . I i L I ! 1f4 15 I. I qp !I I i l I N o >< ~ o t-14 ~ ~ o .... ~ CIJ ~ a t""'"+ -- '-'-'---"- ~ -'--. '---. --'- ~- ---.-- ~-- --" -~,_ M"._____ ___. __. .____ __ _ ~..___. :..... ~>',... ., " . . ..,.... /..... " -. .:<:.~', UNIVERSE NOVELTY & FIREWORKS CO., INC. P.O. BOX 1862 RIVERVfEW,FL. 33568 CITY OF ZEPHYRHILLS CONTRACTOR CERTIFICATE 5335 8TH ST. ZEPHYRHIlLS, FL 33542 ;"It/ c,; PERIOD COMMENQNG OCT. 1, 2007 TO SEPT. 30, 2008 r:;ish Expires: 1/31/2008 Type: NOC:SMALLAPPL REP~~~~."_._ i.t!/J.L."uu; Ph: (813}677-1874 Insurance: M7MF2991 Expires: 2/17/2008 BF'#7f:_fPiid:Jl 20.00 ~'Q4!~007 F'IF'RNT:V/1J3-~CKtU a5::;.~. ';'-~'_'2 L'Ct $:500~ un CONi" rF/: -Uii] VE F:}fiL --C';;;; Stlu(("CrN1:NA~ ,:: This registration expires each year on Sept. 30. License: 839998000620 Notes: .. ~ UftIYER8'E NOVELTY & FIREWORKS COMPAN~'NC. , ~~~, ~~.' ")."".. ~,".;l<i^"<! ~,,~1' {'"'' Narne__ Q~rrN.-~ '?; Address _.__________. 8820 U.S. Hwy. 301 . Riverview, FL 33569 Phone (813) 677-1874. Fax (813) 671-1790 E-mail: FireworksFlorida@aol.com /?~~ t Official Licensed NASCAR NFL. N8A. MLB. Fair. Festivals' Special Evenfs Wholesale. Retail' Direct Importers Date ~c'. I d I :kx17 --~._------- QUANTITY DESCRIPTION PRICE EACH AMOUNT ,'''bOVE! items received on consignment from UNIVERSE NOVELTY & FIREWORKS CO., INC. I understand payment or return of merchandise is to take place within 20 (jays from above date. (Signature) _ ~~ Q.Q CD ~ ~o J I 0 *~~. *.* -t ;;*~-;- *. ~" ~!fl~~~~W?J(~!i ' \.,WRSENOVELTY & FIREWORKS COMPAN~ INC. 'il .~ -'1ii1'-.,._' . . _ .,,..i~,'rLt- , i~i ; /1-. n '3 Narr:tE L.:] (f\J..n _ Aadr€ :~-_._-- --,-- 8820 U.S. Hwy. 301 . Riverview, FL 33569 Phone (813) 677-1874. Fax (813) 671-1790 E-mail: FireworksFlorida@aol.com ,~~l p~~~ Date 1'2 '-12--0, Orficial Licensed NASCAR NFL, NBA, M.LB Fair' Festivals' Special Events Wholesale' Retail. Direct Importers >1tJ~\NTITY DESCRIPTION ment from UNIV understand payment or return of merchandise is to take place within 20 r. ibove dale. (Signature) ~ ClQoo-----.J f-- * ~-~.>'\..:. *. * ";-*~"7~~~~ PRICE EACH AMOUNT UN1V'ERSE NOVELTY & FIREWORKSCO:MPANY, INC. . "q:::-~ 8820 U.S. Hwy. 301 . Riverview, FL 33569 ~,;,.~,,' '. . "n Phone (81~~) 6.17-1874' F~x (813) 671-1790 . .~gr,.., . E-mail: FlreworksFlonda@aol.com Name__-'-~~~ Address Official Licensed NASCAR NFL. NBA, M.L.B Fair' Festivals. Special Events Wholesale' Retail. Direct Importers Date _ r~ - tz..- 07 ..----.--..-.--.-.--.---- QUANTITY DESCRIPTION PRICE EACH AMOUNT i\bove items received on consignment from UNIVERSE NOVELTY & FIREWORKS CO., INC. I understand payment or r rn of merchandise is to take place within 20 I , days from above date. (Signature) I *.~. . *.* . R 8 ~** .*.. * '~'* u:N:iVSRSE NOVELTY & FIREWORKS COMPANY, INC. rr--.. 8820 U.S. Hwy. 301 . Riverview, FL 33569 "~-........- ~.,-.... "~I'" Phone (81~) 677-1874. F~x (813) 671-1790 " .".,~_ .', E-mail: FlreworksFlonda@aol.com ..,.I~. :"' -' 1~. J Name__-1~t-~3-Y~ Address Official licensed NASCAR NFL, NBA. M.LB Fair' Festivals' Special Events Wholesale' Retail' Direct Importers Date I ~ - J ';l-(j " QUANTITY DESCRIPTION PRICE EACH AMOUNT ~ ~{f n -\. r\ .--\-It Bnt\.! I :?q I q r' ~L~O C ~((?'U nri ~\OOIY\ 1=\~ld~,V L. () n ~~ Q,G'4-\in Pnr.k. }q,Q" Above items received on consignment from UNIVERSE NOVELTY & FIREWORKS CO, INC, I understand payment or retrr.;;erCh~ndise is to take place within 20 days from above date. (Signature) ,.Jh.Al> Q QCP+. ) * ""t.~_..>^>':' *. * ~ ;-*2:}.-:'~~~ ................. --.. '- OPERATOR LICENSE A450 122 385 007 co.IE.IfM AllEN .,....ST PIlUI,..-~ ......... Sa ...... ~ liIlTw- &A. -.*_ F _ - IfAZ D .. .....111 ... .- 01~-20:t(} ~,;,~ o...~ T22Z2Im ~ ~ OPERATOR UCENsE A 450 149 189 42S DOrtAtDEI:A!AROAIUN -lJli3fRtINTsr PAlo,.... ........1inII -_ $ora ...... ..I.i: T"", e..u 1>....... ....,.. !ill HAlO .. ......... ... -=:..'::~ -~--~ R153268 ~"l:L- I~ - ~S"Lfl 31'J--' lo- CL<i L .' Ma~ 13 2008 12:5?PM HP LASERJET FAX p.2 ~CORD.. CERTIFICATE OF LIABILITY INSURANCE I DAi(M~ 5 13 08 1'IIClDUCER. All~ed Spec~alty Insurance, Ine THIS CERT.ICA TE IS ISSUED AS A MATTER OF INFORIIA 110N 10451 Gulf Blvd. ONLY AND CONFERS NO RIGHTS UPON THE CERT1F1CATE Treasure Island, FL 33706 ~fLDER- TH18 CERTIFICATE DOES NOT AM~,e. EXTEND ~~ 800/237-3355 INSURERS AFFORDING COVERAGE NAIC' .....MD Universe Novelty & Fireworks IN8U1lEJ1 A~ T . H . E . Insurance Company Company, Inc. INSUR!R B: P.O. Box 1862 INSURER C: Riverview FL 33568 INSURER D: I'N!I~!;: THE Pa.lClES OF INSURANCE USTED BElOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE fOR THE POUCY PERIOD INClCATED. NOlWTHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF NN CONTRACT OR OntER DOCUMENTW\lH RESPECT1'O VlHCH lHlS CERTIfiCATE MAY BE ISSueD OR MAY PERTAIN. THE INSURANCE AFFORDED BY TlIE POliCIES DESCRIBED HEREIN 16 SUBJECT TO ALL 'THE TeRMS. EXCLUSIONS AND CONDITIONS OF SUCH aE8. AGGREGATE UMlTS SHCMtI MAY HAVE BEEN REDUCED BY PAID CLAIMS. INIIl 'I. -L PClUC't IFFIClM! POIJCY" UI'WtA 1ICIIII UIIn ~IML UAalU1T EACH oa::URIQ;NCE I 1,000,000 A X CCUMERClALGENERALLlASI.llY M8MF6580 02/17/08 02/17/09 ~.J...TO ReNTED I 50,000 I CLAlIol8 UAOI!! [K] OCCUR MEDElCPlM.__1 I PER~ &ADVINJURY 1 1,000,000 GENERAl. ~EGATE 1 2,000,000 nAGGREfl UMIT Al'Pnl'ER: PRODUCTS - =-IOP AOQ 1 PDUCY ':.,R,g: ~ ~OBLI! UMIU1Y COMBINED SI,.,OLE UMIT 1 NlY AUTO (I!a eccI_O - - ALL OVIMEO AUTOS IOOIL Y INJURY cPer~) 1 - scttEDULEIl AUTOS - I'IIREDAUTOS IOOIL Y INJURY (Per 8CCidenL) 1 - N~AlJTOS PROP!RTY DMIAQE , (.....~ ~UUI~ AUTO OM. Y . EA ACCID!NT S NfY AUTO OllER THAN EA ACC S AUTO ONLY: ...= s acau_UALlA8U1'I' EACH oc:cuRRE~CE S W OCCUR 0 ClAIMS MACE AGGREGATE S S q DEDUCTIBLE S ~I'NTItlN s I ......CO_M11ONMD I~!~~e I ,~:- _LOYPS' UAIILIn' I".L. EACI'I ACCIDENT S Mr PROf'RIETCRlPARTNEIIlElIECVTl\IE OFFICE_EMlER EXCLUDED? E.L allEASE. EA ENPLOYEE S ~,~~under E.L. DlSEAS!. POLICY LIMIT S 01M1R MICIlPnDN OF ~1IClIIIIL0CA1IOIIa/"""1CUI.'!llCLUllClNt MIIlID BY eNOOMeMlNT 11I'eQA~ PIUMIlONI EFFECTIVE FROM 6/l0/0S THROUGH 7/05/08 ( INCUDES SET UP AND TEAR DOWN DATES) ADDITIONAL INSURED: CITY OF ZEPHYRHILLS 5335 8TH ST, ZEPHYRHILLS, FL AS RESPECTS TO THE OPERATION OF THE NAMED INSURED ONLY. FIREWORKS STAND SITUATED AT 5935 GALL BLVD., ZEPHYRHILLS, FL 33542 IIIOULDAIIY OF 1ItI! AMWIIl8C_81 POLIC.. _ ~ &lFOM 1Il!'-11OIII 1M11E THIIl8DI'. 'nil! _1_ WILL IMlIAVOIt '10 MAL -1.Q... DAV.~!Jj IIO.-TO THe CBnI'lCA" NOLDIR. _m 10 nil LB"T. BUT I'ALIIM1O DO 10 IItALL ~I NO 08UGA'TlON OIl.~un Of NIY ICIIID.-.aN lIle..UMIt, ITI AGINlS OR 'W. ACORD 21 (2lHl1108) Ma~ 13 2008 12:57PM HP LASERJET FAX p. 1 .. ...... ...'.. .... .... . . ~,. $.,. . ALLIED .2fJ!1jLS <5/3- 76~ -002-1 TIP"',' CIL- 00 May 13, 2008 CITY OF ZEPHYRHILLS 5335 8TH ST ZEPHYRHILLS FL 33542 RE: Certificates of Insurance Dear Sir/Madam: Enclosed is an original and/or a duplicate Certificate of Insurance. Thank you for the opportunity to serve you. If you have any questions please feel free to contact me anytime. Sincerely, ~6~ Shelly Godde Account Representative Enclosure ALLIED SPECIALTY INSURANCE, INC. 10451 Gulf Boulevard, Treasure Island, Florida 33706. 727367-6900. 1 800 237.3355 · FAX 727 367-5695/1407 &5 N.E. Loop 410, Suite 600, San Antonio, Texas 78216. 210 341-1321 · 1 800 235-8774 · FAX 210 341-2050 4 CORD", CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY) 5/13/08 PRODUCER Allied Specialty Insurance, Inc THIS CERTIFICATE IS ISSUED AS A MAnER OF INFORMATION 10451 Gulf Blvd. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Treasure Island, FL 33706 HOLDER. THIS CERTIFICATE DOES NOT AME_N.P, EXTEND OR 41' In ..' n\AI 800/237-3355 INSURERS AFFORDING COVERAGE NAIC# INSURED Universe Novelty & Fireworks INSURER A: T. H. E. Insurance Company Company, Inc. INSURER B: P.O. Box 1862 INSURER C: Riverview FL 33568 INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTIIVITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT IIIIITH 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. AGGREGATE LIMITS SHO\MII MAY HAVE BEEN REDUCED BY PAID CLAIMS. I!'I~ ~'?'!: POLICY NUMBER POLICY EFFECllVE POUCY EXPIRA liON UMITS A ~ERAL UABIUlY X COMMERCIAL GENERAl LIABILITY I CLAIMS MADE 00 OCCUR M8MF6580 EACH OCCURRENCE 02/17 / 0 8 02 /17 / 0 9 ~t~~~c RENTED MED EXP (AllY one Il8reonl PERSONAL & AmI INJURY GENERAl AGGREGATE PRODUCTS-COMP~PAGG $ 1,000,000 $ 50,000 $ $ 1,000,000 $ 2,000,000 $ - f-- ~LAGGRE~ LIMIT APP~PER: I I POLICY I I ~~,P; I I LOC ~TOMOBILE UABIUTY _ ANY AUTO _ ALL OWNED AUTOS __ SCHEDULED AUTOS _ HIRED AUTOS _ NON-OWNED AUTOS - ~GE UABIUTY I ANY AUTO ~ESSlUMBREUA UABIUTY W OCCUR D CLAIMS MADE R DEDUCTIBLE RETENTION $ WORKERS COMPENSA liON AND , EMPLOYERS' UABILlTY ANY PROPRIETORlPARTNERlEXECUTIVE OFFICERlMEMBER EXCLUDED? ~~~::,~~lCI1be under OTHER -- .- --"""...,...,..~.....-. ,.-.--....,-, r-:;::.:::-:- -.> ~r7Uf?n\V7ri'- ~\i \ t _;"..1.-,._~;:~ ' \ I .' - : .', 'i \ (\ DESCRlPlION OF OPERAllONS I LOCA liONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS \ ~ i . EFFECTIVE FROM 6/10/08 THROUGH 7/05/08 (INCUDES SET q~~ DM.. ~~.~.DAT~S) ADDITIONAL INSURED: CITY OF ZEPHYRHILLS " ' . 5335 8TH ST, ZEPHYRHILLS, FL, 1 AS RESPECTS TO THE OPERATION OF THE NAMED INSURED ONJ,JY .-lt~ ___ .. FIREWORKS STAND SITUATED AT 5935 GALL BLVD., ZEPHYRHtL~S,FL l .,:~ CITY OF ZEPHYRHILLS 5335 8TH ST ZEPHYRHILLS FL 33542 SHOULD ANY DF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR 10 MAIL ...1Q... DAYS WRITTEN NOTICE 10 THE CERTIFICATE HOLDER NAMED 10 THE LEFT, BUT FAILURE TO DD SO SHALL ACORD 25 (2001/08) ALLIED CIL-OO May 13, 2008 CITY OF ZEPHYRHILLS 5335 8TH ST ZEPHYRHILLS FL 33542 RE: Certificates of Insurance Dear Sir/Madam: Enclosed is an original and/or a duplicate Certificate of Insurance. Thank you for the opportunity to serve you. If you have any questions please feel free to contact me anytime. Sincerely, ~6~ Shelly Godde Account Representative Enclosure ALLIED SPECIALTY INSURANCE, INC. 10451 Gulf Boulevard, Treasure Island, Florida 33706. 727 367-6900. 1 800237-3355' FAX 727 367-5695/1407 85 N.E. Loop 410, Suite 600, San Antonio, Texas 78216. 210 341-1321 . 1 800235-8774' FAX 210 341-2050