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HomeMy WebLinkAbout12-13177 CITY OF ZEPHYRHILLS 5335-8TH STREET (si3)�so-oo20 13177 FIRE WORKS PERMIT Permit Number: 13177 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: Date Issued: 6/14/2012 Name: ZEPHYR LLC Total Fees: 530.00 Address: 7162 READING RD#730 Amount Paid: 530.00 CINCINNATI. OH 45237-3845 Date Paid: 6/14/2012 Phone: Work Desc: TEMPORARY SALE FIREWORKS - JUNE 14TH - JULY 10TH 2O12 � ` - 5. TEMPORARY SALES 25.00 � (V� �- � ' �� ' � . 1 i 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,administradve 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 pertormed 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. . � 1 ✓°, CONTRACTOR SIGN E PERMIT OFFICER PERMIT XPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041 Zephyrhills Fire Rescue 6907 Dairy Road, Zephs-rhi115, PL 3��42 Fire Chicf L3us (81�) 78U-0041 Keith Williains Fa� (813) 780-0044 13 June 2012 . ._ _..__.__.___ ____. .__�__._____._�___..,� Plan Number 12-022 Project: Fireworks Sales Stand, Gala�cy Fireworks, 5953 Gall Blvd Number of Pages: Temporary Sales Request and 26 Pages of supporting documents Date received by this Office: 06-7-2012 This Officer has reviewed the plan for establishing a fireworks sales stand and storage of stock at 5953 Gall Blvd, Zephyrhills. Plans are approved as submitted with the following conditions: 1. No Smoking signs must be posted at each entrance, in display area and at storage locations. 2. The attached Temporary Sales and Tent Checklist requirements shall be followed. 3. A certified portable pressurized water fire extinguisher must be present in addition to required ABC extinguisher(s). 4. Generator power supply, fuel storage, interior lighting and power c;ords shall be located the required distance from tent/tent material and secured in a manner to prevent the possibility of ignition sources. 5. Collection of copies of sales affidavit sheets shall be done weekly by this Office. 6. Per requirements of checklist, Social Security number for Kristin P. Watson must be provided. Payment of permit fee indicates acceptance of the requirements of the Temporary Checklist, Tent Checklist and these review comments. Inspections Required: 1. Inspection by fire inspector after location set-up, merchandise stocking but prior to sales for compliance with checklist and above requirements, contact the above number to request or 813-714-6328 (cell). Review and approval of the submitted plans does not relieve the contractor from the responsibility of correcting any deficiencies noted during inspection. Respect lly submitted on 13 June 2012 by, � Keith A. Williams, EFO, CFO, CMO, MIFireE Fire Chief Fire Safety Inspector, #148104 2���91��2HILLS FIRE DEPARTMEIdT • 69Q7 Dairy Road, Zephyrhi{Is, FL 33542 Fire Chief Kel�h Williams Bus (813j780-0041 Fax {813)`l�n-0044 FIRE SERVICE USER FEES occupancy No.: /DD 3 Plan No.: "Z - �.- Contractor: �,o-f ,����,�/� ��n-� Business Name: 72 e wZ�� Bi11in�A�,dress: d � . Business Address: �� 3 �.�f�> ! ��u�� �-l��` � � 6� � Business Phone No : /1'1,�a',a � - a�o -ysYi B�Ilmg �h�ne Na: Business Fax No.: Billing Fax No.: Contact: /n�'-�� �a y Contact: PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE �Sile Plan N!C Annual N/C Sprinlder S50 1st Alarm N/C Multi-Family/Commercial .O6 sf 1 st Re-inspeCtion N/C Standpipes S50 2nd Atarm N/C (Minimum Charge 525.00 2nd Re-inspection a100 Fire Pump S50 3rd Alarm N/C �Plan Revisions DBL 3rd Re-it�spection a250 Hoods S50 4th Alarm a�pp 4th Re-Inspedion a50p Fire Alarm S50 Sth Alarm a150 SPRINKLER SYSTEMS (Business cbsed uMil LP� �p �h A�� S� 8 0-25 Heads S50 violations corrected) N�ual Gas S50 raN co�uu�ce a150 26 plus Heads a100 SPRINKLER SYSTEMS Fuel Tanks- per mnk a$Q STANDPIPE SYSTEM Hydro Undergrounds ¢15 Sparklers 5100 �Per Riser a50 Hydrostatic Test s65 per.ys�, Firo Waks �Op FIRE PUMP Acce�ance Test S45 per�yaem Camp Fire s� �Per Pump �100 HydraM Flow s75 CoMroUed Bum a�o0 FIRE ALARM SYSTEM Hood/Duct up 8 0-25 Devices 350 FIRE ALARM SYSTEM Plac:e of Assembly ZSp n„n,,,i 26 plus Devices s100 System Acceptance S50 Fae ProtecGon $� SUPPRESSION SYSTEMS Recsll Acceptance a50 plammable qppl�� �p Mm�a� Wet S50 OTHER Waste Tire Storage S5p n,,,,wi �rY S50 Fire walusmoke Wan E15 Per wau Generator<K1A/ s�pp CO2 S50 LP Ges 325 per mnk Ge►le�ator>9p Kyy t sp Other s50 Natural Gas S25 �r s�� Bio-Hazard W�te s100 �,,,,wi ❑ KITCHEN EXHAUST ���J�� Fumigation Tenting S5p Hood/Ducts S50 TeM 1 10'a greater •-�6—p.rqmt Torch P�/Appliad f 5p OTHER Fire Pump 345 HaZ.Meterials s100 �„ai LP Installation per lank S50 Fire Suppfes6lon S3Q Fuel Tank Installation a50 System Acceptance (Per Tank) s5o 8 Exhaust Hood/puct S3p �Naturol Gas Insfallation a50 Re-inSp8Cti0n DBL (Per System) (other than annual) ❑SP�Y�h S50 �Inspection scheduled DBL 8 and cancelled less than � 24 hours Construction Insp. N/C L _/ Emergency Vehkte AG 550 pERMR TOTAL � c>aFALSE AI.ARM PLANS TOTAL �r� INSPECTIpN TOTAL� �� � TOTA��__ _ _) GRAND TOTAL r�� Comments: �j,��� a _�ate• ��.�.�.�.L �(�c� Ins�ctor. �i����X�ZC-�—� � Temporary �Sales Checklis� � � City of'I.ephyrhills ' S335 8"'Strcet 'Lephyrhilis,FI.33542 Phone:813-780-0020/['ax:813-780-0021 REQUIREM�NTS Detailed Plot Plan showing setup of location. Refer to Ord 1038-09, Sec 5 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 Arior 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 we:ather, then 2 sides must be in the up position. FIREWORK REQUIREMENTS—(In addition to the above) Proof of State License. �„�,,LJ �� �_ 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. `��t.,r(� <�5� if X• ���s zNt� 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 1 S`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 �, $ 50.00—Tent Fee(40.00/BD, 15.00*/FD)—('�$1�00 waived for Fireworks) �3� � $40.00—Electrical Fee(if applicable) � Property Owner:_���Y-� J/r �L C, Applicant: -'I (� �7►''e - lC S Phone Contact: �I - �/- o� S/ ' � _ a7Q..� s1 Address Site: �9 5� C a// 8�V�{ Date(s)of Sale: �� ��� �� a �-�- �,u �o+'� a��� Ordinance No. 1038-09 (for additional requirements) i � � i � ! , ! .,; � C� G 3 � -- � o ��� ��-�� I J �S I���i ..�:. ,:x. 'r£ i �' j� 4 , ` � - � P �: x. __ _ .. .�,'y'�„ � � _ � 3 -� � , `� 3 ..���r .� - �...�„� .�. � --- - - - .,.,�,, ,,,,,,,,,, ,,,,�� „�� .Nage 1 0��2 Search Again Show Map Generalized Building Schematic Frequently Asked Quest�ons Estimate Taxes Other Parcel Cards: 1 � 2 � 3 � 4 � 5 � 6 Other Agency Data: Tax Collector School Board Supervisor of Elections Data Current as Of:� Weekly Archive - Saturday, March 21, 2009 Parcei ID � 10-26-21-0020-00000-003� (Card: 001 of 006) Classification 16 - Shopping Center Community Mailing Address Property Value ZEPHYR LLC Ag Land 7162 READING RD #730 �� CINCINNATI, OH 452373845 Land �Zgg 04,9 Physical Address - See Ail 5 addresses (First Shown) Building $223 519 5845 GALL BLVD Extra Features $6,642 ZEPHYRHILLS, FL 33542-3457 Market Value $529,210 Legal Description (First 4 Lines) Assessed (Save Our Homes) �p PINE GROVE PB 2 PG 15 COM SW COR LOT 10 TH NO2DG 02' 12"W Taxable Value $529,230 313.00 FT FOR POB TH CONT NO2DG 02' 12"W 306.96 FT TH Land Detail (Card: 001 of 006) Line Use Description Zoning V��{� T ��� YPe Price Condition Value � 1600 SH�R G OOC2 12,000.00 SF $7.32 1.00 ��� $87,840 �� 1600 SHC,Q.r.R G OOC2 38,000.00 SF $2.87 1.G0 SHO ������ $109,060 � 1600 �R G OOC2 37,145.00 SF $2J5 1.00 �j�� $102,149 Additinn�l 1 .� T : Acres 2 00 Tax Area 30ZH „ FEMA Code,o��Commericai Code M3012AQ Building Information - Use 16 - Shopping Center Locai (Card: 001 of 006) Year Built 1969 Stories Exterior Wall 1 Concrete 81ock Stucco 1.0 Exterior Wall 2 None Roof Structur� Rigid Frame w/Bar 7oist Roof Cove� Interior Walf 1 Plywood Panel Built-Up Tar anci Gravel Interior Wall 2 Drywall Flooring 1 Cork or Vinyl Tile Floorin 2 Fuel 9 Carpet Electric Heat Forced Air- Duc:ted A/C Central Baths 2.0 Line Description S Feet q• Repl. Cost New 1 SPA � 1,100 � 2 �� SDA $106,814 3 � CAN 400 $45,696 300 $10,282 Extra Fpat���a� rr .� nni �„ � ---- - - � vv ��.yly, VU1 l./� U110� Line Description Year � 1�"— 1 � PAV ASP U��� l Value 1969 22,800 �— $4,617-1 Sales History Previous Owner HUESING JAMES R Year � Month Book/Page C��— � 2000 � 03 YPe Amount � 1987 4341/ 1041 QC �— $0 � 09 � 1'�1 ,' 1677 ��^���'- �� .�^T-' http^//appraiser.pascogov.com/search/parcel.aspx?sec=10&twn=26&rng=21&sbb=0020&b... 3/23/2009 � LEASE AGREEMENT This Lease Agreement is entered into as of the 10`h day of March , 20 11 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 Zephryhills FI 2.Occupancy:Lessor represents and warrants that it owns the Preinises,and Lessor hereby grants Lessee the exclusive riglit to occupy and use the Premises undisturbed during each Term(as heremafter defined),access thereto(including the right to cross surrounding property belonging to Lessor,if any),along with all other rights provided to a tenant under the]aws of the state of Florida. 3 Term:. The periods during which Lessee will be entitled to occupy the Premises("Terms")are as follows: Term 1 is from June 15th 2011 until July 7th.20ll Term 2 is from Dec. 15th 20]1 until January7'�2012,1"InitialLeasePeriod")2011- 2016. Thereafter occupancy will be determined by Lessee's election pursuant to Section 11 This Agreement shall continue in full force and effect until the Option Periods identified in Section 11 below expire; 4 Use:Lessee may use the Premises to sell seasonal products,including but not limited to fireworks and items incidental thereto.' 5 Rent:Lessee will pay Lessor the sum of $2 000 00 for Tenn 1 and$1,500.00 for term 2 which will be due and payable on the first day of ihe applicable Term. 6. Permits:Lessee agrees to acquire any and all permits required by governing authorities for Lessee's intended use ofthe Yremises. If the permits are not approved for any reason,tliis Agreement will be null and void,and all deposits will be refunded to Lessee. If,afrer any necessary permits have been issued to Lessee,Lessee is prevented from using the Premises for ihe intended purpose of selling fireworks during any part oi'a Term because ofan act of God,war,executive order,ordinance,change in law,or other reasun beyond Lessor's or Lessee's control,Lessce will be reli:;ved of its obligation to pay rent for that Tenn,and any rent paid for that Term will either be refunded to Lessee or applied to the next Term,as Lessor chooses. Lessor shall malce that choice and notify Lessee within ten days of being informed by Lessee that it lias been prevented from using the Premises. 7 lndemnification:Lessee shall indemnify and hold Lessor harmless from any and all actions and claims resulhng duectly and solely from Lessee's use of the Premises,including but not limited to claims by Lessee's licensees,or invitee,and trespassers. 8. Pixtures:All structures(including tents)shal]be placed on the Premises under Hie approvat of Lessor Any placement shall not interfere with Lessor's use of property surrounding the Premises. Any installation shall not damage any of ihe Lessor's improvements on the Premises. 9 Insurance:Lessee sliall provide Lessor with proof of liability insurance before the Term begins. Liability insurance shall be in an amount of not]ess than$],000,000 for each occurrence. 10 Maintenance:Lessee sl�all 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 notif7es Lessor 30 days in advance of a particular year during the Option Period that Lessee elects to not exercise its option fi�r 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 ofrefusal to match any and all offers to lease lhe Premises during that year Lessor shall notify Lessee in writing ofany such offer and the terms thereof,and provide Lessee thirty days to elect to exercise or waive tlie 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 withiii 2 miles of the Premises. 13 Cancellation: If tl�e Premises is sold,master leased on a long term basis other than for the sale of fireworks,or the la�v is changed to prohibit the sale of fireworks for all remaining Terms,this Agreement may be canceled by either party providing thirty days written nctice to the other party IN W[TNESS WI I�REOF,Lessor and Lessee have each caused this Agreement to be executed and to take effect as of the date first above writlen,as evidenced by the signatures of tlieir respective duly authorized representatives appearing below y Fireworks,Incorporated(Lessee) {_�,�Q2. �--�.—� (Lessor) i . �y: '' � Z�., � /� ��� Signature � By��/�� l U V�----- Signature Rickv Johnson,Vice-President ___`���� � , ���`� V'�/)��,� �,� Na c and 1'itic Name and Titic Date Signed� ^ ��� — `� � '�'� �� � Date Signed Before me,ihe undersigned Notary Pubiic,personally appeared j ,C </ c� �,!'G+ .� ,known to me to be the persnn wh� executed the foregoing Lease Agreement,and shellte acknewled�ed to and be ore me that she/he executed such instrument and agrees to fully comply the:e���itL. IN WITNESS HERCOP,i I�ave set m 1 nd s 1 this�day of ��L�C.�h_ �,p -._� �__ � �-t�'�---. � Notary Public,State of Florida PATRICK D.COOK ,aa%;1:PYe( �''= ��r��ssion DD 745420 My Commission Expires '*: *? , ;;��;�; xpire April 3,2012 �� '%:;pF�;°�• 8ondeC Thru Troy Fain Insurance 800•365-7019 aa��+�nuwi � ; �NC7TICE OF'DEEd RESTRtCTiOAlS: The undersigned undsrstands that this permit may be su��ject°to'"deed".�restrictions" �vhich m�y be more restricfive than County regulations. �"he undersigned assumes responsibilii.y"for�compliance=with any applicable deed restrictions. a UNUCE�tSED CONTRi4CT{?RS AND COIVTRACTOR RESP�tVSfBtLITiES: If the owner has hired:a°contractor or - contractors to undertake work, they may be required ta be (icensed in accordance with state and Eocal�regulations. If the contractor is not licensed as required by law, both the owner.and contractar may be cited far a misdemeanor violation under state lavu. If fhe awner or intended contrac#or are uncertain.as to what licensing�requirE�menfs may_apply far the intended work, they are ad+�ised to contact the Rasca County $uilding Inspection division—Licensing Section.at 7.27-847- 8049. Furthermore, 'rf the awner has hired a confractor or contractors, he is advised to have the contsactor(s} sign portions of the "contractar Block" afi this appfication for wt�ich�they wil( be responsibls. If you, as the ourner sign as the contractor, that may be an indicatian fhat he is not propar{y licensed and is not entitled to perrnitting privileges in Pasco CQUnty. CONSTFZUCTlON.LIEN L.AW(Chapter713, Fiarida Statutes,_as amended): If valuation of wark is$2;500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Gonstrucfion Lien Law—Homeawner's Protectian Guide" prepared�by the Fiorida Department of Agriculture and Consumer Affairs. Ifi the appficant is someone other than the"owner", I certify that I have obtained a copy of the above described document and pramise in goad faith to deliver it to the"owner" prior to commencement. - CONTRACTOR'S/GIWNER'S AFFtDAViT: I certify that al( the information in this appfication is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land • development. �ipplicatian is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or�installation has commenced priar to issuance of a permit and that afl work wil( be performed to meet standards of aA laws regulating construction, County and City codes, zoning regulations, and land development regulatians in the jurisdiction. I also certify that 1 under5tand that the regulations of other government agencies may apply to the intended work, and fhat it is my responsibilit±l to identify what acfions f must take to be in compfiance. lf[ am the AGENT Ft3R THE OWNER, I pramise in good faith ta infarm the owner of the permiring conditians sef forth in ihis a�davit prior to commencing canstruction. E unders#and that a separata permit may be required for electrical work, plumt�ing, signs, wel4s, pooks, air conditioning, gas; or Qther instalEations not specifically included in the application. A permit issued shaH be canstrued to be a ficense to proceed with the work and not as authority to violate, cancel, aifer, or set aside any provisions ofi;the technical codes, nar shall issuance of a permi#prevent the Building Official from thereaftes requiring a carrection of esrprs in plans, construction or violations of any codes. Every permit issued shall become invalid un3ess the work authosizad by such permit is commencsd within six months of permif issuanee, or if work authorized by the permit is suspended ar bandaned for a period of six {6) months after fhe fime the work is cc�mmencad. An extension may be requested, in writi g, from the Building OfFcial for a psriod not to exceed ninety (90) days and wi11 demonstrate justifiable cause for the extension. If work ceases fior ninety(90)consecufive days,the job is considered abandoned. WARNiNG TO OWNER; YUUR FAILURE TD RECORQ A NOTiCE OF C�MMENCEMENT MAY RESULT iN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, Ct�NSULT WITH YOUR LENDER�R AN AlTORFJEY BEFORE RECORDING YOUR NOTIGE OF Ct3MMENCEMENT. FLORIDA JURAT(F 117.03) OWNER�R AGENT ,L.�!Y- _ CONTRACTOR `J� '��� Su nbe and swo to( i e )pefore me this Sub c}�e and swo r a rmed)be re e this g� � Z- by �C < </ � 4.-.!o— J /�z L by C� � o -.� Who is/are perso��llv kno,wn�to me or has/have produced Who islare pers�nally known t me or has/have produced �s idenfifiCation. as identification. Nota Public /' �.' � �Y _ - / Notary Public Commission N .,••'ti�"•,�•,•,, PATRICK D,COOK ' ,,;.�,,, ,�,i..� ,.. � Cammission No n c. • .•; '' Ir �+,,, F: Comm�se�on UU i4�i20 Name af EVota ; nte�Dndea�rFqll�lf InwronceA�o�3es��ois Name of Notary , ti �n i;,W,��p,�ga7o�g I I rage 1 ot 1 `• .T: �.,�t"°,,��t^°�.. ;��. y*,r;'a,'�;n,, ,�,,,r;;.� $' ip' �a.� '?": � '� 'Ymi�i'P.'Z-..,�,l.l�='^.r,.• � � ' t; .;''I��,# f;y'x�yq�d,�,;;, f-y. � '��„L`.e4'i. � s-t:rrt6H,��'y+nw' �oi . '�'� � '1�.4��,�,`,��,".. �,�'� ��'Saf�,.§4� ,,,. 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C +:,�r e t�., Z_" �'�CZl� QA vc,; �; :243:5'" :s:,;y • ��i� XI"� ^:� Rj,- ��., ,Na �•'rd%'�'': i�i�;�'..g t ,r «� j+3�� ' "r � 4'1., "I... �� .4^Y,', *� ���i�tf� b � �' :,Ei, ;�:,,;,;'. .','��? ._:3'�I�.._ . E'{" '�' ,� .�' „ � � ,� 1� http://maps.pascogov.com/mapdata/4522123544159 jpg 5/16/2011 �`C°� CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DD/YYYY) 4/2/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THF CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE �4FFORDED 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 and Associates, IIIC. PHONE FAx 6240 SOM Center Rd ac No eXt:44 -24 -4711 nic No�:44.Q-24�- 406 E-MAIL Cleveland OH 44139 ADDRESS. INSURER(S)AFFORDING COVERAGE NAIC# __ _____,_ _____ _ wsuReR,a:Lexington Insurance�2___— _ ! __ INSURED wsuaeRe.Axis Surplus Ins Com�an� _____ Galaxy Fireworks Inc. �NSUReRC:New Hampshire Insurance Cg. 3841 204 E. Martin Luther King Blvd INSURERD Tampa FL 33603 — - -- - I WSURER E. INSURER F. COVERAGES CERTIFICATE NUMBER:506061824 REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED,480VE 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 7ypE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LTR INSR WVD POLICYNU BER MM/DDlYYYY MMIDDIYYYY LIMITS A GENERALLIABILI7v 64200908-02 ` /10/2012 /10/2013 Z EACHOCCURRENCE , $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED � � �� PREMISES E=a occurrence 550,000 I CLAIMS-MADE � OCCUR � MED EXP(Any one person) $ -- -- i PERSONAL F.ADV INJURY I $1,000,000 � GENERAL AGGREGATE ' $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER� PRODUCTS COMP/0P AGG $2,000,000 � POLICY PR� X LOC 5 C AUTOMOBILE LIABILITY CA0661444302 /10/2012 /10/2013 `' Eaaccident 51,000,000 ' X ANY AUTO BODILY INJURY(Per person) S I ' ALL OWNED SCHEDULED BODILY INJURY Per accident $ 'i AUTOS AUTOS ( � I X HIREDAUTOS X NON-OWNED PROPERTYDAMAGE $ , AUTOS I Peracadent� 5 B UMBRELLA LIAB X OCCUR EAU753159 6/10/2012 0/10/2013 EACH OCCURRENCE $4,000,000 I X EXCESS LIAB CLAIMS-MADE � � i AGGREGATE: � $4,000,000 -�__ i DED RETENTION$ g WORKERS COMPENSATION WC STATU- ' OTH- 'i AND EMPLOYERS'LIABILITY Y I N T RY LIMITS ER ANY PROPRIETORlPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED� ❑ N!A E L EACH ACCIDENT $ ,(Mandatory in NH) E.L DISEASE:-EA EMPLOYEE 5 � If yes,describe under �, , DESCRIPTION OF OPERATIONS below � E.L DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Stand Location. 5943-5953 Gall Blvd Zephyrhills, FI 3542. Additional Insured: City of Zephyrhills, Pasco County Board of County Commissioners, Mark Ayer, and all their agents, representatives and 'I subsidiaries. CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Zephyrhills, Pasco County Board of County ACCORDANCE WITH THE POLICY PROVISIONS. Commissioners. Mark Ayer 7162 Reading Rd. Suite 730 AUTHORIZED REPRESENTATIVE Cincinnati OH 45237 �es�*�R�' O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010l05) The ACORD name and logo are registered marks of ACORD - -- - Jeff Atwater Casia Sinco CHIEF FINANCIAL OFFICER BUREAU CHIEF Julius Halas DIVISION DIRECTOR Keith McCarthy ,����. SAFETY PROGRAM NIANAGER FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Gaines Street -Tallahassee,Florida 32399-0342 Te1.850-413-3644 Fa�c.850-410-2467 Galaxy Fireworks 204 E Martin Luther King Blvd Tampa FL 33603 ��il���ll��ll��ll�����ll� CERTIFICATE OF REGISTRATION RETAILER THIS CERTFIES THAT: Galaxy Fireworks 5953 Gall Blvd Zephyrhills FL 33542 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 33542 Pasco Issue Date: 02/O1/2012 TYpe� 07 Class: 64 County: Pasco License/Permit Number: 186104-0008-2010 Expiration Date: O1/31/2013 � . 1� Chief Financial Officer �� , �rii�r�FINANCIAL OFFICER Casia Sinco Julius Halas BUREAU CHIEF DIVISION DIRECTOR Keith McCarthy �'►��,�� SAFETY pROGRAM MANAGER FLORIDA DEPARTMENT OF FTNANCIAL SERVICES DIVISION OF STATE FIRE MAR,�HqL 200 East Gaines Street -Tallahassee,Florida 32399-0342 7e1.850-413-3644 Fax.850-410-2467 Galaxy Fireworks Inc. 204 E Martin Luther King Boulevard Tampa FL 33603 ��II���II��Ii��ll�����ll� ---T--�.-_.,�_ -------__._ CERTIFICATE OF RE ,SIG TR� IpT N I�TT� --°-- WHOLESALER OF SPARKI,ERS THIS CERTFIES 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 reta.iler. selling sparklers to a Issue Date: 02/O1/2012 Type' 07 Class: 62 County; Hillsborough License/Permit Number: 725840-0001-2006 Expiration Date: Ol/31/2013 / �'� ����� Chief Financial Officer 10!1612000 22;22 8139324048 T�t�PA TEtJT" �S PAGE @2 rr k •FI . �� � �#t .�„�;'�'. � r tb O � � � � � .� �- ? t� b f�` . m v� o mm � �„ ? � tD � n � � .y '�: �+ � �. � O � 3 � � �; �-3j• a, � •• � t-��n' � � _ -i � � � �' � � �; � �• �� �� a � _ °, � � �' � ,,� � � � rnm � � � o = N � � � �'�� � �, o � "+� � � o '� � a ci o m d m o � � �`� o � �' �' � w: �, � � � � 3 3 '�: c� +.' � �. � '-� � � fl� � � '�''' � �' � ``-�ti f � � � � O � � � N � � � � � � �. rn � � � � �u � � z � � .Ni�,. n: �' `�¢ � � � -,� s° a . • � � � � � � � � � o, � ,� � � & �� � .. . � r- m � .,,, � n c� m s� 3 � .� � t� � a� 3 �. 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Inv. # SAFE/SANE ASSORTMENTS -- 000000000105 Big Bang Item Number 000000000102 Bi pi 4/1 GLX-106 � 9 pper 5/1 GLX-103 000000000103 Comet Collection 000000000111 Cosmic Cluster �$�� GLX-104 000000000107 Cosmic Countdown $�� GLX-118 000000000116 Final Countdown 4�� GLX-113 000000000106 Just for Kids 6�� GLX-124 000000000101 Little Dipper 24�� GLX-112 000000000108 Ninja �$�� GLX-102 000000000109 Party Time 6�� GLX-114 805253004733 Siuler 5�� GLX-115 000000000100 Star Gazor 6�� WC 805253004740 Thriller 24�� GLX-100 000000000113 Warp Speed 6�� WC Inv. # �2�� GLX-121 FOUNTAINS Item Number 754471202011 7th Heaven 705834221330 Ancient Myth 6�� FOA Ftn. 705834020223 April Showers 18�� �'22-133 705108305018 Ass't. 8" Ftn. (Winda) 36/1 Y02-022 705834220630 Astro Jam �2�3 P3050 676551000877 Awe-Some �$�� Y22-063 705834020360 Backyard Fountain 4�� GPH3079 754471202110 Barrel of Fun 20�4 Y02-036 705108305308 Beautiful Minds 12�� FOA 805253113633 Behemoth �2�� P3053 705108301010 Blaze and Blade 9�� WC Ftn. 676551000815 Blue Ice (100 gr ftn.) �2��2 P3010 705108310005 Blue Sunday 24�� GPH3073 000000000211 Boom and Buzz 2�� P3100 705108304103 Brilliant Shower Ftn. 40/1 Y02-021 705834220722 Bulk Cones #3 Conic 48�� P3042 761507118062 Bulk Cones #5 USA Spring Blossom �$�4 Y22-082-G 676551037590 Burn Baby Burn 96�� P3051 000000000202 Butterfly & Flowers 16/1 GCF086 000000000210 California Candle 48�6 �833 754471200215 California Dreamin' 36/6 T6018 754471200611 California Sunrise 24�� FOA Ftn. 754471200017 Call of the Wild 36/1 FOA Ftn. 705834640087 Chains of M ste Fountain 36/1 FOA Ftn. 000000001523 Climbin Panda 4�� Y64-008 24/6 K1149 000000000205 Conic #3 000000015226 Crowd Thinner 60/12 T1515 676551050216 Cuckoos 6�� GL-PS0001 705834640070 Dazzling Dyno 24�6 GL- 0852 �05834440654 Dracula Fountain 4�� Y64-007 705108304509 Dream Flower '12�4 Y22-069 693019040107 Dream World 48�� P3045 000000000226 Dreamer 24�� wB4010 754471201410 Electric Rainbow 36/4 P3006 705834221262 Elfs Whisper �2�� FOA Ftn. 6932352140018 Enchanted Garden �2�� Y22-126 680149019707 Endless Applause 24�� GG-4002 705834640025 Fantasy Dance 4�� LBF 12 680149008886 Fantasy Land 4�� Y64-002 754471201113 Far Out 4�� LBF 6 705108310401 Fire Fighter Fountain �2�� FOA Ftn. 000000000231 Fire Invioable 6�� P3104 705834221170 Firetongue Fountain �2�3 P4002 676551000921 Flamenco (100 gr) 24�� Y22-117 705834640063 Floro Glo �$�� GPH3084 80525311420 Fool's Gold 6�� Y64-006 80525311302 Frisky Starburst 24�� WC Fountain 705108302703 Gadzooks 48�� �NC Fountain 676551033851 Gardenia 12�6 P3027 80525301210 Girl Power 32�� GCF056 - 676551001027 G�itr 30/1 WC Fountain 754471202219 Grand Illusion 6�� GPH3094 676551051459 Ha 6�� FOA Ftn. ppy Festival 18/4 0925 676551071136 Happy Silvery Flowers 754471201212 Havana Heat 24�4 0847-6 754471202714 Hearts A-Fire �$�� FOA2012 705834220609 Heat Wave 4�� FOA Ftn. 705108302109 Heavy Rhinoceros 40/1 Y22-060 000000000302 HN-60 Asst. Fountain �2�� P3021 000000000303 HN-89 Asst. Fountain 36/4 HN-60 000000000304 HN-90 Asst. Fountain �$�4 HN-89 000000000224 Holl 18�4 HN-90 ywood Park 24/1 P3013 676551001669 Hot Roll 676551036289 Jazz (100 gr ftn) 16/1 GPH3149 754471201311 Just Another Stinkin Fountain �2�� GCF081 687985424719 Jumboshell Fountain 24�� FOA 000000000305 Killer Bees 4�� BP4247 80525311421 Lava Lamp 24�4 GL-W499A 680149008800 London Tower Bridge 6�� WC Fountain 10/1 SF33 ,687985450817 Love Oh Fire 4/1 ' 80525311427 M�M B500 � 676551000914 Magic Illumination 32�� WC Fountain 754471199816 Malibu Madness �2�� GPH3083 676551001010 Mi Amor 36/1 FOA1998 705834220616 Mummy's Wrath 4�� GPH3093 680149023001 Mushroom Cloud 40/1 Y22-061 754471202912 Mystic Rain $�� SF130 80525311370 National Treasure Ftn $�� FOA 705834221132 Naughty Croc 6�� WC Fountain 705834640049 Nocturnal Vision �$�4 Y22-113 805253113459 One Big Fountain 6�� Y64-004 705834221507 Oriental Magic 4�� wC Ftn. 705108304400 Palm Party Ass't. Ftn. $�� Y22-150 805253113824 Perfect Silence 4�3 P3044 74471201915 Pertect Storm 96�� WC Ftn. 705834020414 Precious Stones 6�� FOA Ftn. 80525311423 Psychedelic �$�4 Y02-041 754471201519 Quiet Riot 4�� �NC Ftn. 705834220913 Rainbow Fountain 6�� FOA Ftn. 000000000238 Rock Music 16/6 Y22-091 705108310104 Rolling Stone 36/1 P3024 676551031215 Rosy Cheeks 4�� P3101 676551000938 Rumba �8�� GCF050 687985426218 Scary Stuff 6�� GPH3085 676551037583 Screaming Monkey 6�� BP4262 705834220678 Shell Fountain �2�� GCF085 676551051435 Silvery Flowers-9" 24�� o22Y 67 805253130326 Six Alarm �$�4 0847-9 754471202813 Solar Storm �2�� WC Fountain 705834640018 Space Bastion 6�� FOA 342529920019 Space Lamp 4�� Y64-002 000000000360 Stage Party 24�4 W42� 754471199717 Star Dust Ftn. 2�� P3041 17544712019 Stars Over America 24�� FOA Ftn. 705108303809 Sunny Princess 24�� FOA Ftn. 687985425211 Super Fountain 36/1 P3038 676551071167 Tigers Roaring 6�� BP4252 705834221156 Tropical Fish 20�4 T1006 687985426713 Up in Smoke 36/1 Y22-115 805253113817 Visions 16/1 BP4267 705834220753 Whistling Color Cuckoo 48�� WC Ftn. 000000000204 Whistling Dixie (Phx Tail 48�� T1117 705108304608 Wonderland � 48�6 T1016A 36/1 P3046 805253113794 Worlds Strongest Fountain Inv. # �8�� ' WC Fountain , � SPINNERS & WHEELS Item Number 676551051442 Ground Bloom Flower Gorilla 000000000513 Spinning Wheel ( � 20�12 GL-09018 000000000514 Tri-Rotating Wheel �2�6 � 0544 Inv. # 24��2 ' T7500 NOVELTIES Item Number 000000000500 Aladdins Lamp 676551033479 Black Snake 48�3 �N468 612141811317 Black Snake (Legend) 15/48 GM801 000000000502 Booby Traps �5�4� GM801 000000000519 Crackling Balls 10/144 T8501 000000000503 Friendship Pagoda 16/12/6 0205A 680149000001 Fuse 144/1 W613A 0000000001522 Glow Worm 450/1 FU30-1 705834320231 Ha 15/48 GM811 ppy Lamp 72/1 Y32-023 000000000512 Hen Laying Egg(Cock Crowing..) 24/24 612196020115 Hydra Breeding W701 000000000526 Oriental Dragon 24��2 LN6020 705108900121 Pa po 48�4 P7003 �Y pper (6pk) 12/24 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