agenda staff report342ed706-1ebb-4fde...1. submit one (1) site plan depicting use (minimum size...

CITY COUNCIL AGENDA STAFF REPORT

DATE: June 6, 2018

TO: Mayor and City Council

APPROVED BY: David B. Dale, City Manarr \ t '

' PREPARED BY: Diego Favila, Fire Ctiiief~"

SUBJECT: Approval of Pre-Quqlified Applicants for the 2018 Sale of Safe and Sane Fireworks

----------------------------------------------------------------------------------------------------------------------------------------------Recommendation:

Approve the following list of prequalified applicants for the sale of Safe and Sane Fireworks for 2018:

1. Ministerio In Accion Mas Que Vencendores 2. Christ Community Church of Imperial Valley

Background:

From March 1 through April 3, 2018 the city of Calexico accepted applications for permits to sell safe and sane fireworks. Permits are issued only to nonprofit organizations and such fireworks shall be sold only at outdoor sales stands. Upon approval by council the applicant will be notified by May 23 of the granting or r~jection of their application. This is all in accordance of Calexico Municipal Code Chapter 15.24.

Qualifying nonprofit organizations were required to have been organized and established in the city's corporate limits for a minimum of one year prior to filing an application. Eligible nonprofits also were required to have a principal and permanent meeting place in the city and a bona fide membership of at least 20 members. A majority of the members must have been residents of the City of Calexico. The nonprofit must conduct activities primarily for the benefit of the city and its residents, or must serve more city residents than non-city residents to be eligible to receive a permit. No nonprofit organizations would be granted more than one permit.

The above listed non-profit groups submitted all the required application forms and fees and have been prequalified by the Fire Chief and City Manager for your consideration. The City Council shall, in its sole discretion,

AGENDA ITEM

10

determine the nonprofit organizations to which permits will be granted in accordance with Chapter 15.24 of the Calexico Municipal Code. Such determination shall be made at a regular or special meeting of the City Council in accordance with procedures established by the City Council. Only nonprofit organizations prequalified by the City Manager pursuant to Section 15.24.080 shall be considered.

Fiscal Impact:

None.

Coordinated With:

None.

Attachment:

1. Application for Ministerio In Accion Mas Que Vencendores. 2. Application for Christ Community Church of Imperial Valley.

2

TO:

FROM:

CALEXICO FIRE DEPARTMENT INTEROFFICE MEMORANDUM

DAVID DALE, CITY

SUBJECT:

DIEGO FAVILA, FIRE CHIEF

FIREWORKS APPLICATION REVIEW

05/23/18 DATE:

After reviewing the two applications received during the 2018 open application period for sale of Safe and Sane fireworks, I would like to report the following organizations have submitted and completed the application process:

• MINISTERIO IN ACCION MAS QUE VENCENDORES

• CHRIST COMMUNITY CHURCH OF IMPERIAL VALLEY

It is after this review that both applicants have met all the qualifying criteria for this application period and should be considered for your approval. As per CMC 15.24 your office shall make the recommendation to council for final approval. After final approval I will notify the groups of their training date and location and conduct a formal review of the rules and regulations for the sale of fireworks. Feel free to contact me if you have any further questions.

2018 FIREWORK APPLICATION PACKET:

CHRIST COMMUNITY CHURCH

NOTICE OF CHANGE

STATE OF CALIFORNIA

OFFTCE OF THE STATE FIRE MARSHAL

l 131 S. STREET

SACARAMENTO, CA 958 l l

(916) 445-8373

RETAIL FIREWORKS LICENSE NUMBER Y000774

CHANGE FROM: CHRIST COMMUNITY CHURCH OF IMPERJAL VALLEY

2540 ROCKWOOD A VE. . -CALEXICO, CA

CHANGE TO: CHRIST COMMUNITY CHURCH OF lMPBRIAL VALLEY

341 E. FIRST STREET CALEXICO, CA

DATE: 03-27;.20J8

COMMENTS: LOCATION CHANGE COUNTY: IMPERIAL

CC: CALEXICO FIRE DEPARTMENT

AMERICAN PROMOTIONAL EVENTS, INC 555 N. GILBERT STREET, FULLERTON, CA 92633

PHONE{114) 73B-1002 FAX (714) 731l-3661 ~1m1.totfireworl<s.com

OFFICE OF THE STATE FIRE MARSHAL RET1\IL FIREWORKS LICENSE APPLICATION

(Print or Type)

Complete and return all copies to the office nt:3arest stand location with the required fee of $50.00. APPLICATIONS MUST BE RECEIVED PRIOR TO JUNE 15 OF THE CURRENT YEAR.

113·1 S Street Sacramento, CA 958'11

(916) 445~83'73

RETAIL FIREWORKS LICENSE

Licensee cuRIST COMMUNITY CHURCH OF IMPERIAL VALL .---~,_lL_~----~-~ .". -·· . "--··-··------ --·-· ·~-~--- ___________ _

City, State & Zip ___ Cl\.l~XlCO,.CA

County_. IMPERIAL

LOCAL CONT ACT PERSON

Name. . . STEVE BEN Nm·

Phone <_:mlb 7...3.8-_1902

-Notice-COPY OF THIS NOTICE MUST BE POSTED AT STAND

WITH A COPY OF THE LOCAL PERMIT

A vallde!ed license has been Issued lo this organization shown nbova for the sale of Safe and Sane fireworks at the location indicated, After a permit has been issued by tile authority having jurisdiction this license allows the sale of only classified

"Safe and Sane" fireworkt1 at tho approved location from NOON, JUNE 28 to NOON, ,JULY G, of tile year Indicated. NOTE: f'{otail liconsees llJO required to be at !east 21 years of ago, employees of fireworks stands rnusl be at least 1 a and fireworks may not be sold to anyone under ll1<1 age of 16.

FIRE AUTHORITY HAVING JURISDICTION

Fire Dept. l~ CALEXICO FIRE DEPARTMENT ~ Address 430 E. STH STREET City, State & Zip CALE~CO, (~-~Jr~]j!.:L_ __________ _

White·Ucensee " Yellow-Fire Aulllofity;e. Pink- SFM File

XXK2540 !i1'~l Ol>I' 12 128826

I \,

Index 5942 PCA 59420 Source Code 125700-06

OFFICE Of THE ST A TE FIRE MARSHAL RETAIL FIREWORKS LICENSE APPLICATION

(Printor Type) ,

Co~~lete and return allco~ies to th~ office neareststand location with th,e required t~b ~f $5ff00, APPLICATIONS MUST BE RECEIVED PRIORTO JUNE 1,5 OF THE CURR,ENT YEAR.

Stand Location

, ··,,. 1131 s ·street\« Sacramento, CA 95811

(916) 445-8373

RETAIL FIREWORKS LICENSE>

---------------------------~

County _____ 1_:ti1_1_?t_~l_~i_Al_l ____________________ _

LOCAL CONTACT PERSON

Phone_{__]) '~7'l&~tno2



A validated license has been issued to this organization shown above for the sale of Safe and Sane fireworks at the location indicated, After a permit has been issued by the authority having jurisdiction this license allows the sale of only classified

"Safe and Sane" fireworks at the approved location from NOON, JUNE 28 to NOON, JULY 6, of the year indicated. NOTE: Retail licensees are required to be

Name

Address City.State &Zip

Fire Dept.

at least 21 years of age, employees of fireworks stands must be at least 18 and fireworks may not be sold to anyone under the age of 16,

MAILING ADDRESS OF LICENSEE


Validation No:

Address City, State &Zip

Signature qf ApJlicant

~:;, /s· I '24''

Date

White-Licensee • Yellow-Fire Authority• Pink- SFM File

~ OSP 12128826

Community Development Department Planning Division

"Temporary Use Permit"

RE IVED

MAR 2 9 20IS \h.M

CITY OF CALEX.le'O ·~ P1'.ANNING DIVISION

Request must be submitted a MINIMUM of 15 days in advance of the event date.

REQUIRED ATTACHMENTS: 1. Submit one (1) site plan depicting use (minimum size 8Y2" x 11"). 2. Written proof of approval from property owner. 3. Copy of the City of Calexico Business License, if applicable. 4. Non-refundable application filing fee of $135.00. 5. Insurance coverage naming the City as additional insured ($1,000,000 minimum per occurrence).

Applicant Name: FRANK ZAZUETA Date Submitted: 3/26/2018 Applicant Address: 1021 KLOKE ROAD, CALEXICO, CA Phone Number: _7_6_0--4-5-5--0-7_9_9 __ _

Company Name: CHRIST COMMUNITY CHURCH Alt. Phone Number: Location of Event: Bus. Lie. Number: --------

DateofEvent: 6/28/18 to 7/4/18 TotalDays: 7 Time of Event: (12-10) 6/28 to (9-10) 6/29-7/4 Describe in detail the type of event (attach additional sheets if needed): Safe and Sane Fireworks which are approved by

the State Fire Marshal are to be sold as a fundraiser by volunteers of multiple non-profit organizations. A fireworks booth will be dropped off as early as June 16, product will be delivered on June 27, picked up on July 5 and the stand will be picked up on July 6.

d?t~ Applicant Signature

"5·-Zfi-/[5 Date

(For City Use Only)

Cit De artment Recommendation b De t. Head Administration 0Denied Fire D Denied Police / DA 0Denied Utiliti(fS Services DA 0Denied

DA 0Denied DA 0Denied DA 0Denied

Plartnin Division DA 0Denied En ineerin Division DA DDenied General Services DA D Denied Other: DA 0Denied

Conditions of Approval:

ALL TEMPORARY USE PERMIT MUST COMPLY WITH ZONING ORDINANCE, SECTION 17.11.120 "TEMPORARY USE REGULATIONS".

D Approved D Denied By: Director of Planning & Development Services Date

(Please read reverse side, Section 17.11.120 "Temporary Use Regulations")

Revised l l/2009

TNT FIREWORKS

SALES ASSOCIATE BENNETT CITY CALEXICO

LOCATION# TBD ORGANIZATION CHRIST COMMUNITY CHURCH-CALEXICO ----"------

SIZE 6 X 32

SET-UP 6/22

TYPE OPM BACK DOORS 1 ---

DOWN 7/6

A-FRAMES 1 --

LIGHTS OPM

ADDRESS 341 E. FIRST STREET (STAND SITS BEHIND IN EMPTY LOT)

INTERSECTION NWC FIRST ST AND HEBER ST

THOMAS GUIDE~ COUNTY IMP PAGE GRID

SPECIAL INSTRUCTIONS SET STAND AS SHOWN- STAND WILL SIT BEHIND THE CHURCH BUILDING IN EMPTY FENCED LOT FACING PARKING LOT.

~§@@~[ID ©]' ~ =-~ , __ , __ -·- c;:_.

~~~~~·· ...............•

FIREWORKS BOOTH Gtled Empty Lot

. : ~ • fli : l!! . .

CITY OF CALEXICO FIREWORKS STAND PERMIT APPLICATION

ATTACHMENT B

PROPERTY OWNER AND/OR LESSOR /LESSEE CONSENT

INSTRUCTIONS: This form must be completed by the Owner of Record and/or lessor of the property.

Permission is hereby granted to ___ T_N_T_F_IR_E_W_O_R_K_S_-_7_1_4_-7_3_8_-1_0_0_2 ___ and (Fireworks Wholesaler)

-------=C..:...H=-=-R=l=S-=-T__;:C:;_;O=...;M=M.:....;:U:;_:;N_.:;.;l;...:.T_.;;.Y ...... C;:;...;H;...:.U.=..;;....;R;...;;C..:...H.;__ ____ for the exclusive right to use the property (Non profit Organization Name)

located at 341 EAST FIRST STREET , Calexico, California, from 8:00 a.m. on June 25, 2018 __ ....;;._;;,...;;...=~'--"--"'-'-'-""-'--'-------

(Fireworks Stand Address)

through 12:00 Noon, July 6, 2018 for a temporary fireworks stand to sell safe and sane fireworks from 12:00

Noon, to 10:00 p.m. on June 28, 2018 and 9:00 a.m. to 10:00 p.m. on June 29 th through and including July 4,

2018.

It is understood that the retail fireworks operatic ns will be conducted in accordance with all City, County, and

State regulations.

Owner/Lessor Name: CHRIST COMUUNITY CHURCH

Address: 341 EAST FIRST STREET

City, State, and Zip Code: __;:C"""A"""'L=E=X-=l_.;;.C__;:O_,_, ...... C_A ___________ _

Telephone Number: ( 760 ) ...... 4 ...... 2_7-_2_7_9_5 __________ _

Signature: (Controlling Party)

Printed Name: FRANK ZAZUETA

Title I Principal: PASfR:O P/1-9'"7°R..

Dated this Z- 6 day of # /l 12~-/r I 2018.

CITV o~F'1©AL1EXICO 1:·aB641 '·.· ... •. B~INE~S·.~E~~€ ~s :· . · ... '·l~"'';r-~. >i.

E>OS~HEBER AV-ENUE . ·. · .• ·. :(7~:iG)~.7e;}i~i1'?0- . ISSUE E)A.TE . .___-,--___ 'DN:f.:..EIREW.ORKS . . . . . .. . -.

,•· HJ ~ --.;T~~l

---------·--~-·

BOSINESSN!AME'.' 555:iN-G1bBEl~·sw·1fl1J!kTuif.l~ON~•lJ@"926$ - ;;~ - w• '''..' ~~,'- ''-~ • ...,,. __ _

:susu>i~§AADRJ;S$:·.,,. ... -.-, -.. "'-.. ..,..;, ·""".•c:..,_.._.,...--.,,-~----,-=-=-....,,,____,.=~~--=""====-== 61573,-~ __ _

·AccouNir.:NOMBER: .:= .• ----···'-..:----.. ··'.h-

o iR~~n== ;;;;Ho-tS~ . 'D Fo.oo . .• ·--_I • . ... _ _i -TYF1$:0F Bt:J$1NE$S.

,,~-·~=~"' ::::.....,_,, __ ·~-=--~.--:~·::.~=:..:.. r-=1'' L...Ji O"FHE~ [] ~EN~~§YSC9NTRA~TQR

· IDeaemb:er 31 '2018 ' '" -.- . ' - =" .0 SERMIC;;SS

ExFilRA1llO>f•Dl\TE: ~

F1NAN~•E)~A1rndEN1" • ;J~i;~l~Jf];Pfitte' ¢kERK ", , . ,.. .... - . I

·~·- ·-', -; ,-~"'· .·- ' --· - '""' -.- __ ,, ·- ~ . -

ORJG!~.µ(C oltl6JNM-t.1c::e:NSE;.Mtisw~f3

·s.~ ,, ··. ,· .. ;;•·,••.:.· .. . . Q0'1NOifCO~ >iih,eii,\~;f~El.~i~~s:t.se.tf:t~l".I INA· \rtsm~,et:.A:~

ACORD@ CERTIFICATE OF LIABILITY INSURANCE 11/112018 I DA TI! (lolMIDDIYYVY)

~ 3/27/2018 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 cortlflcate holder Is an ADDITIONAL INSURED, the pollcy(los) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(sl.

PRODUCER Lockton Companies NXMS:CT ------·1r~Not: 3280 Peachtree Road NE, Suite #250 f . .'J~Nif_ ,,_.,.

Atlanta GA 30305 ~:n'll~, (404) 460-3600 88:

INSURERjS) AFFORDING COVERAGE NAIC#

-- INSURER A : Everest lndcmn!.ty Insurance Company 10851 --INSURED American Promotional Events, Inc. INSUReR B: M11Y1•m ( nrf™ity_CQJilPlIDy 26743 1359683 DBA TNT Fireworks, Inc. IHSUReRC:

SSS North Gilbert Avenue INSURER 0: Fullerton CA 92833 !N8URERE: 341 E. First St.

.. -INSURERF:

COVERAGES CERTIFICATE NUMBER: 15292935 REVISION NUMBER· xxxxxxx 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 ANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

!fl# me OF INSURAHCE ADDLSUBRI l~•ni~~ POLICY NUMBER ,:oLICY Ef'l'.·. ! 1~2Mi~ LIMITS

A )l COMMERCIAL oet!ERAL UABIU1Y iv NI Sl8GL00242·171 111112017 1111112018 LEACH OCCURRENCE s I 000 000 :=i Cl.AIMS-MACS [XJ OCCUR I r:-lSe~(~, $ 500.000 ....._

I ~

MEO EXP (Any one pmQn) $ 5 000

>--

I j l PERSONAL & ADV INJURY s I 000,000

GEN'L AGGREGATE LIMIT APPLIES PER: ! GENERAL AGGREGATE s 2 000000 Fl DPR~ (]]Loe PRODUCTS· COMP/OP AGG s 2 000.000 POLICY JECT

OTHER: I $

AUTOMOBILE UABllJTY NOT ArPLICABLE I r~~~l~NGt.e l1Ml1 $ xxxxxxx ....._ IWYAUTO i BODILY INJURY (Per~) $ xxxxxxx ,__ OWNED ~ SCHEDULED I AUTOS ONLY AUTOS I '

BODILY INJURY (Per nccidont) s xxxxxxx ....._ HIRED I NON-OWNED -fROPERTY DAMAGE

$ xxxxxxx ..._ AUTOS ONLY r AUTOSONLY I l'<lr nceid@n!l

I $ xxxxxxx B Jl UMBRELLA UAB j1lJ OCCUR y N l!XC6023470.t)S i 111112011 111/1/2018 EACH OCCURRENCE s 5 000000

excess UAB CLAIMS-MADE i _AGGREGATE s 5 000 000 DED I I RETENTION s

I I s xxxxxxx I WORKERS COMPENSATION I i NOT APPLICABLE I ! PER I I OlN• AHD EMPLO'l'ERS' LIABILITY YIN

NIAi

I . STATUTE I -. ER .... ANY PROPRISTORIPARTNER/EXECUTIVE D I

1 E.L. ~-ti~~q~!'.!lf s xx:xx.xxx. OFFICERi?>IEMllER EXCLUDED? I I (Mllndatoiy In NH)

I I E.L. DI.SEASE· EA ~MPlOYEE s xxxxx.x_~

~rs~= 'ifF1~ERATIONS oof()w E.L. DISEASE· POllCY LIMIT s xxxxxxx

DESCRIPTION Ol' OPERATIONS I LOCATIONS I VENICLES (ACORD 101, Addltlonlll Romllflul SChodulo, moy bo atlllchod If more OJl'ICO It roqulrod) Property located @ 341 E. First St., Calexico, Ca. Ccrtificntc holder is an additional insured on 1hc General Liability as required by wrincn con1rac1 subjccl to policy tcnns, conditions, and exclusions.

CERTIFICATE HOLDER 15292935 Christ Commun it¥ Church of Imperial Valley & the City of Calexico, tlS appointed & elected officials, employees, ~prcscntatives & volunteers when acting m their official capacities as such 608 Herber Ave. Calexico CA 92231

CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

ACORD 25 (2016/03) The ACORD name and logo are reglsterod marks of ACORD

CHRIST CHURCH - CALEXICO

PART Ill

APPLICATION FORMS

APPLICATION & ATTACHMENTS A- G

IN ADDITION TO THE APPLICATION & ATTACHMENTS A- G, THE APPLICANT SHALL SUPPLY COPIES OF THE FOLLOWING DOCUMENTS AS PART OF THEIR COMPLETED APPLICATION PACKAGE:

• APPLICANT SHALL SUPPLY THE FOLLOWING DOCUMENTS:

• PROOF OF 501(c)(3) OR 2370d DESIGNATION FOR NONPROFIT FEDERAL TAX EXEMPT STATUS

• PROOF OF STATE TAX EXEMPTION: SEC. 214 OF REVENUE AND TAXATION CODE

• CERTIFICATE OF LIABILITY INSURANCE

• TEMPORARY SELLER'S PERMIT- 2017

• STATE FIRE MARSHAL RETAIL FIREWORKS LICENSE-2017

• PROPER IDENTIFICATION AND SIGNATURE OF THE PERMIT APPLICANT

• PLAN FOR STAFFING THE STAND DURING THE PROPOSED DAYS AND HOURS OF OPERATION

• DETAILED STATEMENT OF EACH AND EVERY KIND OF FIREWORKS PROPOSED TO BE SOLD

Calexico Fire Department

APPLICATION FOR FIREWORKS STAND PERMIT

Complete and return the requred application documents no later than 12:00 p.m. Noon on April1, 2018, along with a check in the amount of $835.00 made payable to: City of Calexico. This amount is refundable if your application is not approved.

The fireworks distributor/wholesaler named in this application is required to file an application for a Temporary Use Permit (TUP) and pay the required fee simultaneous with filing your Fireworks Stand Permit application. The TUP fee shall be pai by a separate check made payable to: City of Calexico in the amount of $835.00

Please Print or Type

Individual in Organization Applying for this Permit:

Zazueta Title: __ P_a_s_to_r __________ _

Emergency Contact Number: ( 760 ) ----------

Information on Three 3 Princi al Officers of the Or anization: Name Title Address

Walter Pastor

Zazueta Pastor

Nunn Pastor

Bus. 590W.

Res.

Bus. 590

Res.

Bus. 590 orange

Res.

Ave.

El

Phone

Bus.

Res.

Bus.

Res.

Bus. Ca.

Res.

Fireworks Stand Permit Application Page 2 of 3

Status of Organization (Religious, Charitable, etc.): [Also attach copy of 501(c)(3) or 23701d designation)

RELIGEOUS (CHURCH)

Date organization came into existence: Length of continued existence: ___ year(s)

Purpose of Organization: RELIGEOUS ORGANIZATION

Intended use of funds realized from sale of fireworks: _C_H_U.;...;R...;.C.;;..H ___ N'""'E=E=D....;;S'------------

Proposed location of fireworks stand:

Proposed Dates and Hours of Operation of the fireworks stand:---'----"'""----"----'--

Number of Employees who will work at the fireworks stand _....;:8;.,_-1=2=-------------

(Attach copy of the plan for staffing the stand during the proposed days and hours of operation)

State Board of Equalization Seller's Permit#: --------- [Attach copy of Sellers Permit]

Current Certificate of Tax Exemption#: (Attach Sec. 214-Rev. & Tax Code]

Property Owner Information: [Also complete the attached Property Owner Consent form]

Name of Property Owner:--------------------------

Address of Property Owner:--------------------------

Partnership Information:

If you will be partnering with another eligible organization to sell fireworks at the above location, please

complete the following:

Organization Name: ___________ Address-------------~----

Contact Person: .. -· ... _______ . _,ephone # (

Fireworks Distributor/Wholesaler Information:

Company Name: TNT FIREWORKS Address 555 NORTH GILBERT ST., FULLERTON, CA 92833

Contact Person: STEVE BENNETT Telephone# (714) 738-1002

I declare under the penalty of perjury that the above information contained herein is, to the best of my knowledge and belief, true and correct. I further declare that I have read the Rules and Regulations, which concern the retail sale and storage of fireworks in the City of Calexico and will abide by the contents therein. Subject to the issuance of a license, I agree to provide full accounting of the use and distribution of funds realized from holding such a license.

Date


I For City Use Only - Attachments and Payments Received

$835.00 Fireworks Stand Permit Application Fee (Refundable if application denied) Date Paid: ____ _ $500.00 Temporary Use Permit Application Fee (From Distributor) Date Paid: ____ _

Attachment A - Plot Plan (Sketch) Staffing Plan for the stand Attachment B - Property Owner/Lessee Consent Attachment C - Agreement to Comply with the Calexico Fire Department Requirements Attachment D - Roster of Current Members Attachment E - Report of Disbursements of Net Proceeds from Sale of Fireworks Attachment F - Not Due Until September 1, 2018 N/A Attachment G - Temporary Use Permit Application (Filed by Distributor) Proof of 501(c)(3) or 23701d Nonprofit Designation for Federal Tax Exempt Status Proof of State Tax Exemption: Sec. 214-Revenue & Taxation Code Certificate of Insurance for $1,000,000 Liability Copy of Current Temporary Seller's Permit from State Board of Equalization Copy of California State Fire Marshal Retail Fireworks License

Rev. 2/2012

ATTACHMENT A

CITY OF CALEXICO PLOT PLAN (SKETCH) AND STAFF PLAN OF PROPOSED FIREWORKS STAND LOCATION

ursuant to the provisions of the Health and Safety Code, State of California, and the City of Calexico Municip C e:

I/We h eby make application for permit to sell as a retailer; "Safe and Sane Fireworks" as defined by the alifornia

State Hea and Safety Code, at: -------------------

The following P t Plan (Sketch)of the proposed selling location shows where the fireworks stan will be placed on the property, the I ation and distance of all adjacent building(s) on-site, streets, driveways, rking spaces, and property lines in rela · n to the fireworks stand. (If insufficient space to diagram location; a ch a separate page.)

The staffing plan should elude the name of the members or the spouses or adult ch· ren of such members of the nonprofit organization t sell or otherwise participate in the sale of fireworks at ch stand during the purposed day and hours of o ration per Calexico Municipal Code 15.24.

SEE SEE

SEE

I/We hereby c rtify that all fireworks now on hand are not "dangerous fireworks" as defined i he abovementioned ea/th and Safety Code and that any merchandise hereafter purchased and/or offe d for sale by me/us sh II be in strict compliance with the provisions of said Code and/or local laws or ordinanc pertai · g thereto.

l e understand that storage and sales of all fireworks shall be subject to such restrictions as may be d dvisable by the City of Calexico Fire Department.

AGREEMENT TO COMPLY With

Calexico Fire Department REQUIREMENTS FOR FIREWORKS STANDS

ATTACHMENT C Page 1 of 2

I, ____ z_a_z_u_e_ta _________________ , an authorized representative or officer of

___ c_H_R'--IS;;;....T ___ c"""'o"'""M'""'M...;..U"""'N_l_T_Y_C'"'""H_U_R_C_H_""""c_A_L_E_X_IC_O ___ , a nonprofit organization, agrees to comply with the following

requirements set forth herein:

(a) No person shall fire, discharge, set off, or use any firewaks of any kind within the City. No parent, guardian, or other person having the legal care and custody of any minor child s hall allow such child to violate the provisions of this section.

(b) Notwithstanding the above, "safe and sane fieworks" may be discharged during the hours of 12:00 p.m. noon to 10:00 p.m. on June 28, and from 9:00 a.m. to 10:00 p.m. on June 29 through and including July 4, by adults or by minors under the direct supervision of an adult.

(c) No person shall sell any fireworks in the City other than safe and sane freworks, except during the hours of 12:00 p.m. noon to 10:00 p.m. on June 28, and from 9:00 a.m. to 10:0()>.m. on June 29 through and includingJuly 4. No person shall sell fireworks within the City limits without having first obtained a permit from the City to do so, as provided in Chapter 15.24 of the Calexico Municipal Code, and then onlyupon the terms and condtions specified in the granting of such permit. No person less than 18 years of age may sell, purchase, possess, use, or discharge "safe and sane fireworks."

(d) No holder of a permit shall sell or distribute any type of fireworks which fall within the State Fire Marshal's definitioof a "flare" or "California candle."

(e) All applicants, at the time of application, must have in their possession a valid "Retailers' License" issued by the State Fire Marshal.

(f) After the permit application has been approved by the CityManager's Office, permits shall also be obtained from the City of Calexico Building Department or the installation of any electrical equipment required for such stands. For the purpose of this part, every premise or structure form which the fireworks are sold is hereby defined as a "fireworks stand."

(g) No fireworks stand shall be located within 25 feet of another building, within 2fuet of a generator, within five feet of a curb line, nor within 100 feet of any gasoline pump.

(h) All fireworks stands shall be pre-assembled metal stands only with no more than 256square feet. All fireworks stands will be pre-wired for interior and exterior lighting. All stands will have attached metal floors to enhance security and waterproofing.

(i) Every fireworks stand shall be equipped with signs bearing the wr:rls "No Smoking" in red lettering at least four inches in height. Such signs shall be visible to every person working in the stand and every customer while being served.

U) All electrical must be conduits. The breaker boxes will be GFI breakers. The manufacturer must have installed all wiring. Absolutely no wiring allowed at the stand site.

(k) Each stand must have at least two exits, approximat ely equal distance apart, and in no case shall the distance between exits exceed twenty-four (24) feet.

(I) There shall be no signs except for the signs that come with the pre-assembled stands.

(m) Each stand shall be provided with two (2), two-and-one-half (2 1/2) gallon water pressure type fire extinguishers, underwriter approved, IN GOOD WORKING ORDER, and easily accessible for use in case of fire.

(n)

(o)

(p)

(q)

(r)

(s)

(t)

(u)

(v)


All weeds and combustible material shall be cleared from the location of the stand to a distance of at least 25 feet.

Each stand must have an adult in attendance and in charge thereof while fireworks are stored therein. Each stand must have security personnel at least 21 years of age on site during non-operating hours. Sleeping or remaining in the stand after close of each business day is forbidden.

All unsold stock and accompanying litter shall be removed from the location by 5:00 p.m. on July 5.

No fireworks stand shall be erected more than three (3) ca!lndar days prior to the time on which fireworks may lawfully be sold. The fireworks stand shall be removed from the temporary location by 12:00 p.m. noon the@day of July and all accompanying litter shall be cleared from the location by said time and date.

For each day or portion thereof that a fireworks stand is eraed, maintained, or left standing contray to the provisions of these requirements, the permittee may be subject to an administrative citation.

The Chief of the Calexico Fire Department and/or his designated representative shall have the power to suspend or revoke the permit of any permittee who is operating afireworks stand in violation of any state law, local ordinance, or these permit requirements, or which, in his opinion, consti tutes or creates a condition contributing to the cause or spread of fire.

The decision of the Fire Chief or his designee to suspend Ile permit of any permittee shall be subject to review by the Administrative Hearing Officer, forthwith. In view oflbe limited sales period each year, for suspensions affecting such sale period, a hearing shall be held at the earliest possible the that the permittee, the Administrative Hearing Officer or his designee, and the Fi"e Chief or his representative can schedule a meeting for such review for suspensions after the sale period. The hearing shall be held within one month after the request for hearing, which request must be made within fifteen (15) days after noticeofthe suspension. The Administrative I-earing Officer or his designee is authorized to set aside the suspension, or to modify the suspension by limiting its effect to only one or more days, or by setting aside the forfeiture of priority status for future years. The decision of the Administrative Hearing Officer or his/her designee shall be final.

The Calexico Fire Department will conduct an operator safety seminar for those individuals staffing the fireworks stands. Once the stand s stocked with fireworks, a member of the organization who has attended the seminar must be present during the business hours.

The Calexico Fire Department shall inspect the stand prior to its opening to the public. Periodic inspections will be conducted to ensure the safe operation of the stand.

Date

Print Name

ATTACHMENT D


MliMf.il!RGHIP ROSTER -

INSTRUCTIONS: The applicant has a choice of using this form or supplying the information on a form of their choosing providing the members' complete name and mailing address is provided. If additional pages are needed to document the nonprofit organization's membership, please reproduce this form.

NAME 'OF MEMBER - MAILING AD_DRES_S _foe -roRNE/2-c> . qt:Jte;:,x.1 c.o ~, I

"'lZ--2-fJ'J

lf40f.2.('1N ,4 -ro~E=/2o C;,4 Le<-/ C 0 I Cp::/ ,

"12..Z..S/ ---

Al--fi4A ~ J4 /277N e-z:.. s-r. c:Ai.eX..tC O. CA

Cf2-23./ 1-feC-roe P-f!IH I f2-f:?Z. -

Cfit,,ex..i co C4J' qZ2--SI

!5144Nc.A ~/I-(' //2€-;z:__ r C-ftJ f-e.X..t C-0 I' C-'4' qz_z~,

E/C-f f2I Q?vE /14 ,::/ /2-7/,<../ €-Z-c:;?J l-G-X. t c...c; J Cf/, t::'/Z-2-$]

-

(U:/BG-12-{' p ri C/ t l--,::J :-r

e~ l.-eX-- f CC> I c;;_,CJ, qZZ3J

Vl/2-~N/A 6-oHBZ / CFILe)cfC-01 CJ!J, o/2.2.SJ

.-/oSf/ v.t:l ,t....opez...... ~ l--t3-X l GO .1 C;e:l , "7 22-SJ

-::f=-S A I rl S VALEJVZ-UE-/-A ~~)C_fC.CJ I c.-;4_,. C/22$/

N0/2.-!VfA Vflt-Dc:;Z- ....... ' - .. -- --

~ £-e7<:-I. CO I c..A r q 2-Z.3 I

q:1. f2-L-o s fi~KJl</De~ CAl-/3X-cce>, c.A, q2zs1

c.-yN....,,-µ11A [/'Fl~:! . c.AL.e',X. !CO _,Cfi,.

q22&1 p,qvtp M/A/-L-t4 C!G

C-t;J l--G'x:. I CO ·, c...,:t , q22 ~I


REPORT OF DISBURSEMENTS OF NET PROCEEDS FROM SALE OF FIREWORKS IN 2017

ATTACHMENT E

INSTRUCTIONS: This form must be filed on or before April 1, 2017, concurrent with filing the required application documents for a fireworks stand permit in 2017. Use the backside of this form to itemize the expenditures if additional space is needed.

Net Fund Balance from Fireworks Sales Reported to the City on 3-31-17 $ (2- 16/t.-f. 00

Net Proceeds from 2017 Fireworks Sales reported to the City on 9-1-17 (Line 4) $ 6, ~ -:;-s . o,-1

SUBTOTAL OF FUNDS AVAILABLE $ /!-{ 11-/6(,

*ITEMIZED EXPENDITURES: (Expenditures made between 9-1-17 filing date and 4-1-18)

Cf.f'l3-a./L Fote (,A.I( ;c1t?{';uoJUL<;

pv12c1-IA9€ <t>F Ct+Atl?-<1. ""'

F.O f2_ et-I vfU!-/-1 S i4 ,;.J C'"'l'VYI I?<(/

TOTAL EXPENDITURES:

NET FUND BALANCE:

$ I 2, 6 t i.f. t:?o

/,,7q_o~oo

$

$ -- ..

l 21 Gl'-f

b

*Must be completed in detail. Each line item expense must be listed. Failure to do so will result in rejection of this filing.

I certify that all expenditures of net proceeds from the sale of fireworks were expended solely for charitable purposes within the City of Calexico.

SUBJECT TO AUDIT

Signature Title

CHRIST COMMUNITY CHURCH - >-2B-/8 Organization Date


ATTACHMENT B



Permission is hereby granted to ____ T_N_T_F_l_R_E_W_O_R_K_S_-_7_1_4_-7_3_8_-_10_0_2 ___ and (Fireworks Wholesaler)

-------=C""""H""R-=1-=S-'-T_C"'""O~M;..;;.;M"'"'U::;_;N""""l'-"T-"Y_C~H-=U""""R"""C'""'"H-'------for the exclusive right to use the property (Non profit Organization Name)

located at ___ 3_4_1 _E_A_S_T_F_IR_S_T ___ S_T_R_E_E_T __ , Calexico, California, from 8:00 a.m. on June 25, 2018 (Fireworks Stand Address)

through 12:00 Noon, July 6, 2018 for a temporary fireworks stand to sell safe and sane fireworks from 12:00

Noon, to 10:00 p.m. on June 28, 2018 and 9:00 a.m. to 10:00 p.m. on June 29 th through and including July 4,

2018.

It is understood that the retail fireworks operatio ns will be conducted in accordance with all City, County, and

State regulations.

Owner/Lessor Name: CHRIST COMUUNITY CHURCH

Address: 341 EAST FIRST STREET .

City, State, and Zip Code: _C_A_L_E_X_l_C_O~,_C_A ___________ _

Telephone Number: ( 760 ) -'4=2-'-7-=-2=-=-7-=9-=-5 __________ _

Signature: (Controlling arty)

Printed Name: FRANK ZAZUETA

Title I Principal: -PAS-1-RQ. ,PA S7'ol'<

Dated this Z- ~ day of ~A /2-C!-tf '2018.

TNT FIREWORKS

CITY

A-FRAMES 1 --

LIGHTS ---LOT)

THOMAS GUIDE - COUNTY I PAGE GRID ---- ---- ---s PE C IAL INSTR U CTI 0 NS ==-:.-=..::....::....:..::...:::.....:::....:.--=..::....:.=-.::..::.c:...:__::::::....::....:..c...:::.=......:...::...:..=.:=-=-=-=--=-=::..:....::..:.:.=......::....::....:.=__

LOT.

--------.··················

l'lllfWO!l:KS BOOTH Gated Empty Lot

---'...-----·········

. : ~

: i . . .

INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201

Date: M/~F; (' .. ~J

CHRIST COMMUNITY CHURCH OF IMPERIAlJ VALLEY INC

C/O WALTER COLACE 428 S 5TH STREET EL CENTRO, CA 92243

Dear Applicant:

DEPARTMENT OF THE TREASUF

Fmnl rnr<:»r TrlPn~ification Number:

DLN:

Contact Person: RAY PILCHER

Contact Telephone Number: (877) 829-5500

Accounting Period Ending: DECEMBER

Form 990 Required: NO

Addendum Applies~ NO

ID# 95218

Based on information supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from federal income tax under section SOl(a) of the Internal Revenue Code as an organization described in section 50l(c) (3).

We have further determined that you are not a private foundation within the meaning of section 509(a) of the Code, because you are an organization described in sections 509 (a) (1) and 170 (b) (1) (A) (i).

If your sources of support, or your purposes, character, or method of operation change, please let us know so we can consider the effect of the change on your exempt status and foundation status. In the case of an amendment to your organizational document or bylaws, please send us a copy of the amended document or bylaws. Also, you should inform us of all changes in your name or address.

As of January 1, 1984, you are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more you pay to each of your employees during a calendar year. This does not apply, however, if you make or have made a timely election under section 312l(w) of the Code to be exempt from such tax. You are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA) .

Since you are not a private foundation, you are not subject to the excise taxes under Chapter 42 of the Code. However, if you are involved in an excess benefit transaction, that transaction might be subject to the excise taxes of, section 4958. Additionally, you are not automatically exempt from other federal excise taxes. If you have any questions about excise, employment, or other federal taxes, please contact your key district office.

Grantors and contributors may rely on this determination unless the Internal Reven.ue Service publishes notice to the contrary. However, if you lose your section 509(a) (1) status, a grantor or contributor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or material change on the

Letter 947 (DO/CG)

-2-

CHRIST COMMUNITY CHURCH OF IMPERIAL

part of the organization that resulted in your loss of such status, or if he c she acquired knowledge that the Internal Revenue Service had given notice that you would no longer be classified as a section 509(a) (1) organization.

Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of Code sections 2055, 2106, and 2522.

Contribution deductions are allowable to donors only to the extent that their contributions are gifts, with no consideration received. Ticket purchases and similar payments in conjunction with fundraising events may not necessarily qualify as deductible contributions, depending on the circumstances. See Revenue Ruling 67-246, published in Cumulative Bulletin 1967-2, on page 104, which sets forth guidelines regarding the deductibility, as chari table contributions, of payments made by taxpayers for admission to or other participation in fundraising activities for charity.

In the heading of this letter we have indicated whether you must file Form 990, Return of Organization Exempt From Income Tax. If Yes is indicated, you are required to file Form 990 only if your gross receipts each year are normally more than $25,000. However, if you receive a Form 990 package in the mail, please file the return even if you do not exceed the gross receipts test If you are not required to file, simply attach the label provided, check the box in the heading to indicate that your annual gross receipts are normally $25,000 or less, and sign the return.

If a return is required, it must be filed by the 15th day of the fifth month after the end of your annual accounting period. A penalty of $20 a day is charged when a return is filed late, uhless there is reasonable cause for the delay. However, the maximum penalty charged cannot exceed $10,000 or 5 percent of your gross receipts for the year, whichever is less. For . organizations with gross receipts exceeding $1,000,000 in any year, the penalt1 is $100 per day per return, unless there is reasonable cause for the delay. The maximum penalty for an organization with gross receipts exceeding $1,000,000 shall not exceed $50,000. This penalty may also be charged if a return is not complete, so be sure your return is complete before you file it.

The law requires you to make your annual return available for public inspection without charge for three years after the due date of the return. You are also required to make available for public inspection a copy of your exemption application, any supporting documents and this exemption letter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are made widely available, such as by posting them on the Internet (World Wide Web) . You may be liable for a penalty of $20 a day for each day you do not make these documents available for public inspection (up to a maximum of $10,000 in the case of an annual return).

Letter 947 (DO/CG)

~;::-,;;'"'::,~STATE OF CALIFORNIA '''"f.ii\. FRANCHISE TAX BOARD 'T'.'J~) t PO BOX 942857 ~~~~7:~;1 SACRAMENTO CA 94257-0540 ---~·

Entity Status Letter

Date: 3/29/2017

ESL ID:

According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID:

Entity Name: CHRIST COMMUNITY CHURCH OF IMPERIAL VALLEY, INC.

[{] 1. The entity is in good standing with the Franchise Tax Board.

D 2. The entity is not in good standing with the Franchise Tax Board.

[{] 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d.

D 4. We do not have current information about the entity.

The above information does not necessarily reflect: • The entity's status with any other agency of the State of California, or other government agency. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or the entity

did business in California at a time when it was not qualified or not registered to do business in California: o The status or voidability of any contracts made in California by the entity at a time when the entity was

suspended or forfeited (R& TC Sections 23304.1, 23304.5, 23305a, 23305.1 ). o For entities revived under R& TC Section 23305b, any time limitations on the revivor or limitation of the

functions that can be performed by the entity.

Internet and Telephone Assistance

Website: ftb.ca.gov Telephone: 800.852.5711 from within the United States

916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments

FTB 4263A WEB (NEW 02-2012)

DISPLAY CONSPICUOUSLY AT PLACE OF BUSINESS FOR WHICH ISSUED z894806a

SB CALIFORNIA STATE BOARD OF EQUALIZATION

TEMPORARY SELLER'S PERMIT

Valid 06/28/2018 through 07 /04/2018

ACCOUNT NUMBER

I SR FHA 103-236408 l

L

CHRIST COMMUNITY CHURCH - CALEXICO FRANK ZAZUETA 341 E lST ST CALEXICO, CA 92231-2731

J

NOTICE TO PERMITTEE: You are required to obey all Federal and State laws that regulate or control your business. This permit does not allow you to do otherwise.

IS HEREBY AUTHORIZED PURSUANT TO SALES AND USE TAX LAW TO ENGAGE IN THE BUSINESS OF SELLING TANGIBLE PERSONAL PROPERTY AT THE ABOVE LOCATION. THIS PERMIT IS VALID FOR THE PERIODS SHOWN AND IS NOT TRANSFERABLE.

For general tax questions, please call our Customer Service Center at 1-800-400-7115 (TTV:711). For information on your rights, contact the Taxpayers' Rights Advocate office at 1-888-324-2798 or 1-916-324-2798.

BOE-442-ST REV. 5 (11-14)

A MESSAGE TO OUR NEW PERMIT HOLDER

As a seller, you have rights and responsibilities under the Sales and Use Tax Law. In order to assist you in your endeavor and to better understand the law, we offer the following sources of help:

• Visiting our website at www.boe.ca.gov • Visiting a field office

• Attending a Basic Sales and Use Tax Law class offered at one of our field offices

• Sending your questions in writing to any one of our offices

• Calling our toll-free Customer Service Center at 1-800-400-7115 (TTY:711)

As a seller, you have the right to issue resale certificates for merchandise that you intend to resell. You also have the responsibility of not misusing resale certificates. While the sales tax is imposed upon the retailer,

• You have the rigl1t to seek reimbursement of the tax from your customer

• You are responsible for filing and paying your sales and use tax returns timely

• You have the right to be treated in a fair and equitable manner by the employees of the California State

Board of Equalization (BOE)

• You are responsible for following the regulations set forth by the BOE

As a seller, you are expected to maintain the normal books and records of a prudent businessperson. You are required to maintain these books and records for no less than four years, and make them available for inspection by a BOE representative when requested. You are also expected to notify us if you are buying, selling, adding a location, or discontinuing your business, adding or dropping a partner, officer, or member, or when you are moving any or all of your business locations. If it becomes necessary to surrender this permit, you should only do so by mailing it to a BOE office, or giving it to a BOE representative.

If you would like to know more about your rights as a taxpayer, or if you are unable to resolve an issue with the BOE, please contact the Taxpayers' Rights Advocate office for help by calling toll-free, 1-888-324-2798 or 1-916-324-2798. Their fax number is 1-916-323-3319.

Please post this permit at the address for which it was issued and at a location visible to your customers.

CALIFORNIA STATE BOARD OF EQUALIZATION

Sales and Use Tax Department

NOTICE OF CHANGE

STATE OF CALIFORNIA

OFFICE OF THE STATE FIRE MARSHAL

1131 S. STREET

SACARAMENTO, CA 95811

(916) 445-8373

RETAIL fIREWORKS LICENSE NUtvlBER Y000774

Cl-11\NGE FROM:CHRJSTCOMMUNITY CHURCH OF IMPERJAL V1\LLEY

2540 ROCKWOOD AVE. CALEX1CO, CA

CHANGE TO: CHRIST COlVfMUN!TY CHURCH OF IMPEIUJ\L VALLEY

341 E. FIRST STREET

CALEXICO, CJ\

DATE: 03-27-2018

COMMENTS: LOCATION CHANGE COUNTY: Hv1PERIAL

CC: CALEXlCO FIRE DEPARTMENT

AMERICAN PROMOTIONAL F..VEllTS, INC 555 M. GILBERT STREET, FIJC~ERTON, Cl\ n:ia:l3

PHONE (714) 738-1002 F/1X {714) 7Jfi.J661 \'NNJ.tnllirnwor}'_s_com

OFFICE OF THE STATE FIRE MARSHAL RETAIL FIREVVOR!{S LICENSE 1..\PPUCP..TION

(P11111 nr Tyr.<!)

Complete and return all copies to the office rn?arest stand loc<:1!ion 1Nith Ille required fee of $50.00. /:\PPLICATIONS MUST BE RECEIVED PF~IOR TO JUNE ·1.s OF THE CURRENT YEA!~.

Licensee

Stand lorntion

I 13 1 S Street Sacramento. CA 953·11

(\JIG) 445-8373

!:;:ETt\IL FIHEWORKS LICENSE

Cllf\IST COivl1VlUt'JJTY_t:_HURCH OF IMPERl/\I. VALL

2S•10 ROCl(WOOD AVE.

City, Slate & Zip Cf\LEXICO, ~;-\

County tMPEfllAl

LOCALCONl~CTPERSON

Na mo STEVE BENNETT

Phone ( ]il'}-738-1002

-Nolico-COPY Of THIS NOTICE MUST BE POSTED AT STAND

WITH J-\ COPY OF THE. LOCAL PERMIT

/\ valldalo!l liwnse li<w ~Jccn issued to !111,; cirga111rnl1on sl1own ilb(»Je 101 111,, ,~;1le oi Salo mHl Sane lirew01;<s al the location 111d1c,1tocL After 3 permit has b;,>Jn 1,;·,1wd by lhr: .:111thority having 1u11sdiction lhis license allm•.s the sale of only clas~1fied

'Sufi~ and Sa11'1· fireworP.s iii the approved locat1011 from NOON. JUNE 2!l l0 NOON, JULY G, of trH: •;onr 111d1catetl. NOIE: l~eta1l licenseos aru fL'l\lllf(!d lo 1,,; -:it least:? i yf:ars of nae. crnpioye1~s of l11t1works stands nHJ!tl be at :e.Jst ta and f!rcwo1h!1 may not bt' ~old 10 Jnyone umier llle J\}!J of I G


Name Tl\IT FIHEWORl<S ·------· 1\cJdies:; -555..l\LGll.""'Ef,_,..RJ.._· ____________ _ City.Stale ' 2. Zip I FUl.LERTON, CA 92833

l----~---

FIR[ 1\U rHORITY l·l;\VING JURISDIC1 IO~J ------1

!'11e IJepL C;\LE>'.ICO Flf\E DEP:\RTMENT ! -------~--------------- I

1\ddrnss tlJO E. STH STHEET ! C11y, Stato I I'. Zip _m_pqco, CA 92231 ____ ~_ ----- - ---'

ACOR De CERTIFICATE OF LIABILITY INSURANCE 11/1/2018 I DATI! (MlllDDIYYYY)

'---" 3/27/2018 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 pollcy(los) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condlUons of the policy, certain policies may require an endorsemenL A statement on this certificate does not confer rlahts to the certificate holder In llau of such endorsement(s).

PRODUCER Lockton Companies NAME:"'' -n~Nn" 3280 Peachtree Road NE, Suite #250 f,.H9N.L.,.,,,

Atlanta GA 30305 ~~=89• (404) 460-3600 INSURERj8) AFFORDING COVl!RAGE - NAIC#

-· INSURER A: Everest lndcmn!!Y Insurance Company 10851 INSURED American Promotional Events, Inc. INSURSR e: Mnx11m lntiemnily__C_QIDPru)~ 26743 1359683 OBA TNT Fireworks, Inc. IHSURERC:

SSS North Gilbert Avenue IHSURERD: Fullerton CA 92833 INSURERE: 341 E. First St.

.. -INSURERF:

COVERAGES CERTIFICATE NUMBER: 15292935 REVISION NUMBER: xxxxxxx 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.

~I: TYPE OF IHSURAHCS I~.!'.!- lllUBR '"""" POLICY NUMBER r:oucY,~?' ! r:2M%~ LIMITS

A Jl COMMERCIAi. O&HEAAL LIABILITY lv NI Sl8GL00242-17 I 111112017 1111112018 LEACH OCCURRENCE $ 1.000 000

CJ Cl.AlMS-MAOE [X] OCCUR I I I PRE'i.liSE~l~nce> $ 500 000 ,.._

I >---I MED EXP (Anv one P61SOnl $ 5 000

I L PERSONAL & ADV INJURY $ 1.000,000 I--

I GEN'l AGGREGATE LIMIT APPl.IES PER: ' GENERAL AGGREGATE s 2 000 000 Fl POLICY o ~rc?T w LOC ! PRODUCTS ·COMP/OP AGG s 2.000 000

OTHER: I ! s AUTOMOBILI! UABIUTY ! NOT 1\rPLICABLE I ~~~ll"NGl.e LIMIT s xxxxxxx i I-

AflY AUTO I BODILY INJURY (Pet peraon) s xxxxxxx ,.._ OWNED ~ SCHEDULED I AUTOS ONLY AUTOS I '

BODILY INJURY (Pet accidont) s xxxxxxx I-- HIREO I NON.OWNED 1ROPER~E $ xxxxxxx AUTOS ONLY r AUTOSOtlLY i PMQ!:91lftn!l - l s xxxxxxx

B Jl UMBRELLA LIAB HOCCUR y N EXC6023470.0S i 11/112017 I ll/1/2018 EACH OCCURRENCE s 5.000 000

excessUAB CLAIMS.MADE i AGGREGATE s 5 000 000 OED I I RETENTION$

I : s XVVYYXX WORICERS COMl'l!NSATION I i NOT APPLICABLE I ! s~~TVTE I I ~~H· AHO EMPLOYERS' UABIUTY o f

AJN PROPRIETOR/PARTNER/EXl!CUTIVE NIAi

I E.L. EACH ACCIDENT s XXXX)QQC_ OFFICEIWEMBER EXClUOED? I I ----------(Mandatoiy in NH) ! I E.l. DISEASE· EA EMPlOYEE $ xxxxx.xx ~rs~= ~ERATIONS bolow !

I ··---·

: E.l. DISEASE· POI.ICY LIMIT s xxxxxxx

DESCRIPTION OF OPERATIONS I LOCATIONS I VEKICLl!S (ACORD IOI, Addltlonol RQmllfQ SChodulo, moy bo allAchod If more &paCO i. roqultod) Propcny located @ 341 E. First St., Calexico, Ca. Ccnificatc holder is an additional insured on 1hc General Liability as required by written con1ract subjcc1 to policy terms, conditions, and cl\clusions.

CERTIFICATE HOLDER 15292935 Christ Commun it¥ Church of Imperial Valley & the City of Calexico, its appointed & elected officials, employees, ~prcscntatives & volunteers when acting m their official capacities as such 608 HeroerAve. Calexico CA 92231

CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

GL Cost Center: 51101

AMERICAN PROMOTIONAL EVENTS WEST dba TNT Fireworks PO BOX 1318 4511 Helton Drive Industrial Park Florence, AL 35630

INV©l©EN@. . --~~- - -

REORDER 905 • U.S. PATENT NO. 5539290, 5575508, 5641183, 5785353, 5984364, 6030000

Check No. 20104098

Check Date - 02/01/18

Stub 1 of 1

XXX2211/515/J18/799 01/31/18 Permitting Fees*** 835.00 835.00

iroTHe ORDER OF


CITY OF CALEXICO 608 HEBER AVENUE CALEXICO CA 92231

835.00

WELLS FARGO BANK, NA ~

412

VENDOR

835.00

CHECK NO. 20104098

DATE AMOUNT

2242867 02/01/18 $*******835.00

************************************

2018 FIREWORK APPLICATION PACKET:

Ministerio En Accion Mas Que Vencendores

NOTICE OF CHANGE

STATE OF CALlFORNfA

OFFlCE OF THE STATE F[RE MARSHAL

113 l S. STREET

SACARAMENTO, CA 95811

(916) 445-8373

RETAJL FIREWORKS LICENSE NUMBER Y000338

CHANGE FROM:lvITNISTERO EN ACCION MAS QUE VENCEDORE

211 W. BIRCH ST. CALEXICO, CA

CHANGE ro: MINISTER9 EN ACCION MAS QUE VENCEDORE

1407 IMPERAL A VENU~ CAI,EXICO, CA

COMMENTS: LOCA 'rION CHANGE COUNTY : IMPERIAL

.~~-~-----.-.~-·---

CC: CALEXICO FIRE DEPARTMENT • ,"<~.

AMF-RICAN PROMOTIONAL EVENTS, INC 55S N. GILBERT STREET, FULLERTON. CA92833

PHONE (714) 730-1002 FAX (714) 738-3661 www.totll1ewmks.c0rn

~·~ .. ~~-~·-·-.~~·~·-·--.-··-.·~

dcx 5942 CA 59420 ourcc Code l 25700-06 ·-~_,_.__,..__~_

OFFICE OF FIRE MARSHAL RETAIL FIREWORKS LICENSE APPLICATION

(Print or Type)

Complete and return all copies to the office nearest stand location with the required fee of $50.00. APPLICATIONS MUST SE RECEIVED PRIOR TO JUNE 15 OF THE CURRENT YEAR.

1 ·131 S Street Sacramento, CA 958'1 '1

(916) 445-8373


Licensee MINlSTE.RO Ef':l_~l\CCl().f\l MAS QUE VE_NCE~OflE

Stand Location

211 W. BIRCH STREET

City, State & Zip q~.~El<ICQ,_f_A _

IMPERIAL County.


Mame. STEVE BENNEH

-Notice-COPY OF THIS N01'1CE MUST BE POSTED AT STAND


A valldated license has been Issued to this organizatron shown above for the sale of Safe and Sane fireworks at the foc,atlon indicated. After a permit has been Issued by tho authority having jurisdiction this license allows the sare of only classified

"Safe and Sane'' fireworks at the approved location from NOON, ,JUNE 28 io NOON, .JULY 6, of the year lndlc:ited. NOTE: Retail licensees are required to be at l<!ast 21 years of ar;e. emp!oyues of fimworks stands must be, "'' Je11st 18 and fireworks may not be so!d to anyono under tho ago of 16,


Name TNT FIREWORKS

Address ' ssi; !~. GIU3EBT City.Stale & Zip FULLERTON, CA 92833


Fire DepL CALEXICO FIRE DEPARTMENT


430 E. STH STREET

CA 922.31

Signature ~f 0f_Applic1:1nt

I I 1f ~~- --~ Date

White-Licensee • Yellow-Fire Authority .. Pink- SFM File

2596061 t.;'E~ osr 12 12nn20

Index 5942 PCA 59420 Source Code 125700-06

OFFICE OF THE STATE FIRE MARSHAL RETAIL FIREWORKS LICENSE APPLICATION

(Print or Type)

Complete and return all copies to the office nearest stand location with the required fee of $50.00. APPLICATIONS MUST BE RECEIVED PRIOR TO JUNE 1.5 OF THE CURRENT YEAR.

Stand

1131 s·street Sacramento, CA 95811

(916) 445-8373


Location. ___________________________ _




A validated license has been issued to this organization shown above for the sale of Safe and Sane fireworks at the location indicated. After a permit has been issued by the authority having jurisdiction this license allows the sale of only classified

"Safe and Sane" fireworks at the approved location from NOON, JUNE 28 to NOON, JULY 6, of the year indicated. NOTE: Retail licensees are required to be at least 21 years of age, employees of fireworks stands must be at least 18 and fireworks may not be sold to anyone under the age of 16.


Validation No: Name TNT

~----~~~----~~~------~----~~

Address i:;i;r:, It! rm ~Inn City.State &Zip

Fire Dept.


FIRE AUTHORITY HAVING JURISDICTION ··signature of Applicant

Signature of Applicant

I / ,, l;JCJ/')J

Date '

White-Licensee • Yellow-Fire Authority• Pink- SFM File

~ OSP 12128826

GROUP MINISTERIO EN ACCION MAS QUE VENCENDORES

LOC # CLX1407

ADDRESS 1407 IMPERIAL AVENUE

X TUP application (NS&t':£ ~a.a)

'\X, Plot Plan

~ Property Permission

\X Copy of business license

~ $135 check

--~~Insurance

Community Development Department Planning Division

"Temporary Use Permit"

Request must be submitted a MINIMUM of 15 days in advance of the event date.

REQUIRED ATTACHMENTS: 1. Submit one (1) site plan depicting use (minimum size SW x 11''). 2. Written proof of approval from property owner. 3. Copy of the City of Calexico Business License, if applicable. 4. Non-refundable application filing fee of $135.00. 5. Insurance coverage naming the City as additional insured ($1,000,000 minimum per occurrence).

Applicant Name: SAUL GARCIA Date Submitted: 3/24/2018 ~~~~~~~~-

Applicant Address: Company Name: location of Event:

711 PIERCE STREET, CALEXICO, CA MINISTERIO EN ACCION MAS QUE 1407 IMPERIAL AVE

Date of Event: 6/28/18 to 7 /4/18 Total Days: 7 Time of Event: (12-10) 6/28 to (9-10) 6/29-7/4

Phone Number: 760-562-2190 Alt. Phone Number:

Bus. Uc. Number: 150276 ~~~~~~~~-

Describe in detail the type of event (attach additional sheets if needed): Safe and Sane Fireworks which are approved by the State Fire Marshal are to be sold as a fundraiser by volunteers of multiple non-profit organizations. A fireworks booth will be dropped off as early as June 16, product will be delivered on June 27, picked up on July 5 and the stand will be

icke Jul 6.

~

City Department Recommendation b v Dept. Head Si~ 'nat4re: Administration oe,.pproved D Denied

~\ Fire IV'! Approved 0Denied Police 0Approved 0Denied Utilities Services 0Approved 0Denied Community Services 0Approved 0Denied Redevelopment Agency 0Approved D Denied Risk Management 0Approved 0Denied Planning Division 0Approved D Denied Engineering Division 0Approved 0Denied General Services 0Approved 0Denied Other: 0Approved 0Denied

Conditions of Approval:

ALL TEMPORARY USE PERMIT MUST COMPLY WITH ZONING ORDINANCE, SECTION 17.11.120 "TEMPORARY USE REGULATIONS".

D Approved D Denied By: Director of Planning & Development Services Date

(Please read reverse side, Section 17.11.120 "Temporary Use Regulations")

Revised 11/2009

SIZE 6 TYPE BACK DOORS 1 A-FRAMES 2 ---- --- --- --

SET-UP DOWN LIGHTS -------

ADDRESS 1 E (FOOD4LESS)

INTERSECTION NWC BIRCH/ HWY 111 (IMPERIAL)

THOMAS GUIDE - COUNTY P PAGE GRID

-- ----------------------------------------,


ATTACHMENT B



·Permission is hereby granted to ____ T_N __ T_F_IR_E_W_O_R_K_S_-_7_1_4_-7_3_8_-1_0_0_2 ___ and {Fireworks Wholesaler)

M-x.~G-<ao 13..J Acei...> M.As Qw& VGNt:.C'l'.)utb?or the exclusive right to use the property (Non profit Organization Name)

located at ___ 1_4_0_7_1_M_P_E_R_IA_L_A_V_E_. ___ , Calexico, California, from 8:00 a.m. on June 25, 201 (Fireworks Stand Address)

through 12:00 Noon, July 6, 201& for a temporary fireworks stand to sell safe and sane fireworks from 12:00

Noon, to 10:00 p.m. on June 28, 2018 and 9:00 a.m. to 10:00 p.m. on June 29th through and including July 4,

2018.

It is understood that the retail fireworks operatic ns will be conducted in accordance with all City, County, and

State regulations.

Dated this I 2018.

. .......,,._.... ...... ,...,,·

,c;iTtr:m··''~©AL.EltJ:C()· · · -stiar·NEss upEINliJ£ 2/2012618

. ~08).H~i5:iAv(NUE .· .... · . \• ·• · -·. c?ao> 7s1::i-zJ'20_: . rssu£ aAT£~~"'""-'-----= FlRmBw.GRI<;S . ... . .. -. .. . .

Bl:JSJNESs!NA:ME:": . _:::-- .· - . .. -· .. 1 .• .... ·- .... .•... .•.. .

·· · · · 55&1N-Glf:-.SB!{;J?ST Ji.OkEEQtillON' X21N•92626 · :Bµs1~E$§~Oll~$: • ) '-·~ ·::~;·=. ., , 1 -~··· ~: . <· , ··· .. ·•. -.- . ···· ··· ........... .

61573:;~......... i . .AccouN:J;1N[JMSER: .... ;F~--"'··~ .• ·~~~::: ...... ...1.·. "' ......... ······•· .. ; .............. .. -- 'l )"~, ~~. ·';\

i j. ·. ~./' ....•..

Typc::QF :ses1111ESs QI 11~~A~d-1 w w~6i 1i~i.6:~1 ~1

'i'D F'ooo

. · .. ··. Q ~~K~t~~tj.;~.,~ 'ffJ·~§~ G ~$ ce1-CfiI~TIQl'!f!};)~-re: . '. · - ·· -

;F'1NAN(:g41P~?AR.iME:NT! d ··•· ,>< Jfft11i:C&c:(·~k ··~)J'.·lfJ1J#.·?: .·· ------.. ·--- -Cil,ERI<

ACORD@ CERTIFICATE OF LIABILITY INSURANCE 11/1/2018 I DATE (MMIDDIYYYY)

~ 3/27/2018 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 pollcy(les) must havo ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the tenns and condlllons 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 ondorsement(s).

PRODUCER Lockton Companies liXlU~'" ----·~ 3280 Peachtree Road NE, Suite #250 fAH~N.,E,. m-"· rrAlc IAIC Nol:

Atlnnta GA 30JOS ~~~DDo (404) 460-3600

,_ INSURl!Rll!I AFFORDING COVERAGE NAIC#

1NSURERA: Everest Indemnity Insurance Com11anL 10851 INSURED

American Promotional Events, Inc. msuRER a, Max.Jtrn Indemnity Compuny 26743 1359665 DBA TNT Fireworks, Inc. 1Nsu11ER c: Berkshire Hathaway Homcstate Ins Co 20044

SSS North Gilbert Avenue INSUllEllD: Fullerton CA 92833 ---· ---~--

INSURERE: CLXl407 IHSURERF:

-

COVERAGES CERTIFICATE NUMBER: 12229692 REVISION NUMBER: xxxxxxx 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 ANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

I~ l~,liCTSifll~f- -- ,.':BM&~ 1 ,:orrcv exp --

TYPI! OF INSURAHCe lou•~I-- POLICY NUMBER ur.trrs

A .x. COMMERCIAL GENERAL LIABILITY Iv N I Sl8GL00242· 171 111112017 111112018 EACH OCCURRENCE s I 000000 I lt>"mA~o""Amt:o s 500.000 D CLAIMS-MADE [i] OCCUR

I I PREMISES !Ea """"'""rcol --I MED E)(P t~ ens peraon) s 5 000 - I I

I PERSONAL & ADV INJURY $ 1.000 000 - I GEN'!. AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2.000 000 1 POLICY om~ w LOC

I i $ 2 000 000 : I PRODUCTS· COMP/OP AGG

I OTHER: i i $

AUTOl\IOBILS LIABILITY NOT APPLICABLE ~~SINGLE LIMIT $ xxxxxxx - !!!lL__ --ANY AUTO BODILY INJURY (Per peroon) $ xxxxxxx - OWNED .....- SCHEDULED BOOIL Y INJURY (Per accldenl) s xxxxxxx - AUTOS ONLY - AUTOS

-PROPERTY DAMAGE HIRED NON-OWNED ' $ xxxxxxx AUTOS ONLY AUTOS ONLY ~occid~I - - s xxxxxxx I

B ~ UMBRELLA UAB ~OCCUR ! Y NI EXC6023470..()5 : 11/1/2017 111112018 EACH OCCURRENCE $ 5.000 000 l!XCESSUAB CLAJMS.W.OE I i AGGREGATE s 5.000 000 OED I I RETENTION s I ! $ xxxxxxx

c WORKERS COMPENSATION N ! AMWC818062 (AOS) 111112017 I 111112018 \ x 1 s¥~TUTEL ! ~~ ... AHO l!All'LOVERS' UASIUTY YIN ! --AH'i PROPRIETOR/PARTNER/EXECUTIVE llil NIA E.L. EACH ACCIDENT s I ,0_00,000 OFFlCEM.IEMBER EXCLUDED? -- -(Mandatoty In NH) E.l. DISEASE· EA EMPlOYEE s 1.000,000 g~rCR~~~ i'll't:PERATIONS below E.l. DISEASE• POLICY LIMIT s 1 nnn ooo

I

I I I i

Ol!BCRIP'TION OP OPERATIONS I LOCATIONS I VElllCLSS (ACORO 101, AddlUoMI Rtmarb Schodulo, may bo oltllchod If moro spaco Is roqulrod) TlllS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR TillS HOLDER. APPLICABLE TO TllE CARRIERS LI St ED AND me POLICY TERl\l(S) REfERENCED. Additional In.sured: Property loClltcd at 1407 lmpcriol Ave .. Calexico, CA Ccniflcntc holder is on additional insured on lhc General Liability as required by written con1111ct subject to policy lcrms, conditions, and exclusions.

CERTIFICATE HOLDER CANCELLATION

12229692 Ministero En Accion Mns Que Vencedore and the City of Calexico; its appointed & elected ofliciors, employees, ~prcsentatives & volunteers when acting in their officinl capacities os such 608 Heber Avenue

SHOULD ANV OF THE ABOVE DESCRJBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

Calexico CA 92231

ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD

'• '



INV©l©E NQ.

REORDER 905 • U.S. PATENT NO. 5538290, 5575508, 5641183, 5785353, 59643611, 6030000

Check No. 20104533


Stub 1 of 1


(. I

IPAY

iTOTHE

ORDER OF 1 •

I

135.00 135.00

VENDOR DATE AMOUNT

2242868 02/08/18 $*******135.00

ONE HUNDRED THIRTY FIVE AND 00/ 100***,~\~fi't,;i;''f;fl~ ti'f1:** ******* ** **** ** ** * ** *************** ·::::: ::·:::··:·::::·

CALEXICO FIRE DEPARTMENT .ATTN: CHEIF PETE MERCADO 430 E. 5TH STREET CALEXICO CA 92231

REQUIRES 2 SIGNATURES

. <ij/~f:h,1,0: ~ ' -,)(/-,f/!:_l (_;_. 0 .£1 6' ! 0 1'- r( u._, I

--------------------------------~---

GROUP MINISTERIO EN ACCION MAS QUE VENCENDORES

** E N

LOC # CLX1407

ADDRESS 1407 IMPERIAL AVENUE ITV MAN E !!

I\ $835 app fee

)\ Plot Plan (ATTCH A)

?\ Property Permission (ATTCH B)

X Fire Dept Compliance (ATTCH C)

___ Roster of Membership (ATTCH D) (f\)Q;b--n> ~~""TS)

_ ___.;.._Net Proceeds of previous year (ATTCH E) ~t>C "11> Cl:>M\>l.Sffi)

__ A~_ Proof of Non-profit- federal exemption

_ _,j.....,.,,,___Proof of Non-profit- state exemption

~ Seller's permit ---

SFM

Insurance

PART Ill

APPLICATION FORMS

APPLICATION & ATTACHMENTS A-G

IN ADDITION TO THE APPLICATION & ATTACHMENTS A- G, THE APPLICANT SHALL SUPPLY COPIES OF THE FOLLOWING DOCUMENTS AS PART OF THEIR COMPLETED APPLICATION PACKAGE:

• APPLICANT SHALL SUPPLY THE FOLLOWING DOCUMENTS:

• PROOF OF 501(c)(3) OR 2370d DESIGNATION FOR NONPROFIT FEDERAL TAX EXEMPT STATUS

• PROOF OF STATE TAX EXEMPTION: SEC. 214 OF REVENUE AND TAXATION CODE

• CERTIFICATE OF LIABILITY INSURANCE

• TEMPORARY SELLER'S PERMIT- 2018

• STATE FIRE MARSHAL RETAIL FIREWORKS LICENSE-2018

• PROPER IDENTIFICATION AND SIGNATURE OF THE PERMIT APPLICANT

• PLAN FOR STAFFING THE STAND DURING THE PROPOSED DAYS AND HOURS OF OPERATION

• DETAILED STATEMENT OF EACH AND EVERY KIND OF FIREWORKS PROPOSED TO BE SOLD

Calexico Fire Department

APPLICATION FOR FIREWORKS STAND PERMIT

Complete and return the requred application documents no later than 12:00 p.m. Noon on April1, 2018, along with a check in the amount of $835.00 made payable to: City of Calexico. This amount is refundable if your application is not approved.

The fireworks distributor/wholesaler named in this application is required to file an application for a Temporary Use Permit (TUP) and pay the required fee simultaneous with filing your Fireworks Stand Permit application. The TUP fee shall be pai by a separate check made payable to: City of Calexico in the amount of $835.00

Please Print or Type

Name of Organization: __ M_IN_IS_T_E_R_l_O_E_N_A_C_C_IO_N_M_A_S_Q_U_E_V_E_N_C_E_D_O_R_E_S __________ _

Principal and Permanent Meeting Address: ___ 7_1_1_P_E_E_R_C_E_A_V_E--'.,'-C_A_L_E_X_IC_O_,:;...C_A_9_2_2_3_1 ______ _

Mailing Address: 241 HERNANDEZ ST

City: CALEXICO Zip Code: 92231 Telephone#:

Individual in Organization Applying for this Permit:

Name: SAUL GARCIA Title: CEO/PASTOR

Mailing Address: 241 HERNANDEZ ST

City: CALEXICO Zip: 92231 Telephone# ( 760 ) _5_6_2_a2_1_9_0 __________ _

Emergency Contact Number: ( 760 ) _5_6_2_~8_2_2_5 _____ _

Information on Three 3 Princi al Officers of the Or anization: Name Title Address Phone

SAUL GARCIA Res. 241 HERNANDEZ 90

CEO/PASTOR CA LEX.

cK.wc1011. #17 Bus.

CYNTHIA GARCIA SECRETARY CA 92231

ReS.241 HERNANDEZ CALEX.

Bus.

MERCEDES PARTIDA TREASURER ReS.1159 PARKYNS


Status of Organization (Religious, Charitable, etc.): [Also attach copy of 501(c)(3) or 23701d designation] RELIGIOUS

Date organization came into existence: 1-8-2009 Length of continued existence: _7 __ year(s)

Purpose of Organization: RELIGIOUS ORGANIZATION

Intended use of funds realized from sale of fireworks: CHURCH NEEDS -="'-'-"=-=-=-=-=....:...:..===='----------~

Proposed location of fireworks stand:

1407 IMPERIAL AVENUE, CALEXICO, CA

Proposed Dates and Hours of Operation of the fireworks stand: ----'=.::::....J.=:..=.::...::........::...::..:....:..:..:.u...:::..:.=:::.....:...:......:....>..:::..:=

Number of Employees who will work at the fireworks stand __...8_-_1_2 ____________ _

(Attach copy of the plan for staffing the stand during the proposed days and hours of operation)

State Board of Equalization Seller's Permit#: --------- [Attach copy of Sellers Permit]

Current Certificate of Tax Exemption#: [Attach Sec. 214-Rev. & Tax Code]

Property Owner Information: [Also complete the attached Property Owner Consent form]

Name of Property Owner: _B;;;;...._;&;.__;_H;;._;;,,C...;.O..;..R __ P_. ____________________ _

Address of Property Owner: 1451 DOVE STREET, SUITE 175, NEWPORT BEACH, CA 92660

Partnership Information:

If you will be partnering with another eligible organization to sell fireworks at the above location, please

complete the following:

Organization Name: NONE Address _________________ _

Contact Person: _________ Telephone# (

Fireworks Distributor/Wholesaler Information:

Company Name: TNT FIREWORKS

Contact Person: STEVE BENNETT

Address 555 N. GILBERT ST., FULLERTON, CA 92833

Telephone # (714) 738-1002

I declare under the penalty of perjury that the above information contained herein is, to the best of my knowledge and belief, true and correct. I further declare that I have read the Rules and Regulations, which concern the retail sale and storage offireworks in the City of Calexico and will abide by the contents therein. Subject to the issuance of a license, I agree to provide full accounting of the use and distribution of funds realized from holding such a license.


I For City Use Only - Attachments and Payments Received

$835.00 Fireworks Stand Permit Application Fee (Refundable if application denied) Date Paid: ____ _ $500.00 Temporary Use Permit Application Fee (From Distributor) Date Paid: ____ _

Attachment A - Plot Plan (Sketch) Staffing Plan for the stand Attachment B - Property Owner/Lessee Consent Attachment C - Agreement to Comply with the Calexico Fire Department Requirements Attachment D - Roster of Current Members Attachment E - Report of Disbursements of Net Proceeds from Sale of Fireworks Attachment F - Not Due Until September 1, 2018 NIA Attachment G - Temporary Use Permit Application (Filed by Distributor) Proof of 501(c)(3) or 23701d Nonprofit Designation for Federal Tax Exempt Status Proof of State Tax Exemption: Sec. 214-Revenue & Taxation Code Certificate of Insurance for $1,000,000 Liability Copy of Current Temporary Seller's Permit from State Board of Equalization Copy of California State Fire Marshal Retail Fireworks License

Rev. 2/2012

ATTACHMENT A

CITY OF CALEXICO LOT PLAN (SKETCH) AND STAFF PLAN OF PROPOSED FIREWORKS STAND LOCATI

Pursuant to e provisions of the Health and Safety Code, State of California, and the City of C exico Municipal Code:

I/We hereby make pplication for permit to sell as a retailer; "Safe and Sane Fireworks" as efined by the California

State Health and Sa ty Code, at: -------------------r

The following Plot Plan ( etch)of the proposed selling location shows where the fi works stand will be placed on the property, the location a distance of all adjacent building(s) on-site, streets riveways, parking spaces, and property lines in relation to th fireworks stand. (If insufficient space to diagra location; attach a separate page.)

The staffing plan should include e name of the members or the spouses r adult children of such members of the nonprofit organization to sell o therwise participate in the sale of fir, works at such stand during the purposed day and hours of operatio er Calexico Municipal Code 15 4.

SEE ATTACHED SITE PLAN SEE ATTACHED SITE PLAN

SEE ATTACHED SITE PLAN

//We hereby c ify that all fireworks now on hand are not "dangerous fireworks" as defin mentioned a/th and Safety Code and that any merchandise hereafter purchased and/or ffered for sale by me/us sha be in strict compliance with the provisions of said Code and/or local laws or ordi nces as pertainin thereto.

I/We nderstand that storage and sales of all fireworks shall be subject to such restrictions as ma ad sable by the City of Calexico Fire Department.

AGREEMENT TO COMPLY With

Calexico Fire Department REQUIREMENTS FOR FIREWORKS STANDS

ATTACHMENT C Page 1of2

I, SAUL GARCIA , an authorized representative or officer of

MINISTERIO EN ACCION MAS QUE VENCIEDORE§ a nonprofit organization, agrees to comply with the following

requirements set forth herein:

(a) No person shall fire, discharge, set off, or use any firewaks of any kind within the City. No parent, guardian, or other person having the legal care and custody of any minor child s hall allow such child to violate the provisions of this section.

(b) Notwithstanding the above, "safe and sane fieworks" may be discharged during the hours of 12:00 p.m. noon to 10:00 p.m. on June 28, and from 9:00 a.m. to 10:00 p.m. on June 29 through and including July 4, by adults or by minors under the direct supervision of an adult.

(c) No person shall sell any fireworks in the City other than safe and sane freworks, except during the hours of 12:00 p.m. noon to 10:00 p.m. on June 28, and from 9:00 a.m. to 10:0()>.m. on June 29 through and includingJuly 4. No person shall sell fireworks within the City limits without having first obtained a permit from the City to do so, as provided in Chapter 15.24 of the Calexico Municipal Code, and then onlyupon the terms and condtions specified in the granting of such permit. No person less than 18 years of age may sell, purchase, possess, use, or discharge "safe and sane fireworks."

(d) No holder of a permit shall sell or distribute any type of fireworks which fall within the State Fire Marshal's definitioof a "flare" or "California candle."

(e) All applicants, at the time of application, must have in their possession a valid "Retailers' License" issued bytheState Fire Marshal.

(f) After the permit application has been approved by the CityManager's Office, permits shall also be obtained from the City of Calexico Building Department or the installation of any electrical equipment required for such stands. For the purpose of this part, every premise or structure form which the fireworks are sold is hereby defined as a "fireworks stand."

(g) No fireworks stand shall be located within 25 feet of another building, within 2feet of a generator, within five feet of a curb line, nor within 100 feet of any gasoline pump.

(h) All fireworks stands shall be pre-assembled metal stands only with no more than 256square feet. All fireworks stands will be pre-wired for interior and exterior lighting. All stands will have attached metal floors to enhance security and waterproofing.

(i) Every fireworks stand shall be equipped with signs bearing the wa:ls "No Smoking" in red lettering at least four inches in height. Such signs shall be visible to every person working in the stand and every customer while being served.

G) All electrical must be conduits. The breaker boxes will be GFI breakers. The manufacturer must have installed all wiring. Absolutely no wiring allowed at the stand site.

(k) Each stand must have at least two exits, approximat ely equal distance apart, and in no case shall the distance between exits exceed twenty-four (24) feet.

(I) There shall be no signs except for the signs that come with the pre-assembled stands.

(m) Each stand shall be provided with two (2), two-and-one-half (2 1/2) gallon water pressure type fire extinguishers, underwriter approved, IN GOOD WORKING ORDER, and easily accessible for use in case of fire.

(

(n)

(o)

(p)

(q)

(r)

(s)

(t)

(u)

(v)


All weeds and combustible material shall be cleared from the location of the stand to a distance of at least 25 feet.

Each stand must have an adult in attendance and in charge thereof while fireworks are stored therein. Each stand must have security personnel at least 21 years of age on site during non-operating hours. Sleeping or remaining in the stand after close of each business day is forbidden.

All unsold stock and accompanying litter shall be removed from the location by 5:00 p.m. on July 5.

No fireworks stand shall be erected more than three (3) cailndar days prior to the time on which fireworks may lawfully be sold. The fireworks stand shall be removed from the temporary location by 12:00 p.m. noon the~ day of July and all accompanying litter shall be cleared from the location by said time and date.

For each day or portion thereof that a fireworks stand is eremd, maintained, or left standing contray to the provisions of these requirements, the permittee may be subject to an administrative citation.

The Chief of the Calexico Fire Department and/or his designated representative shall have the power to suspend or revoke the permit of any permittee who is operating afireworks stand in violation of any state law, local ordinance, or these permit requirements, or which, in his opinion, consti tutes or creates a condition contributing to the cause or spread of fire.

The decision of the Fire Chief or his designee to suspend lle permit of any permittee shall be subject to review by the Administrative Hearing Officer, forthwith. In view oflbe limited sales period each year, for suspensions affecting such sale period, a hearing shall be held at the earliest possible the that the permittee, the Administrative Hearing Officer or his designee, and the Fi'e Chief or his representative can schedule a meeting for such review for suspensions after the sale period. The hearing shall be held within one month after the request for hearing, which request must be made within fifteen (15) days after noticeofthe suspension. The Administrative rearing Officer or his designee is authorized to set aside the suspension, or to modify the suspension by limiting its effect to only one or more days, or by setting aside the forfeiture of priority status for future years. The decision of the Administrative Hearing Officer or his/her designee shall be final.

The Calexico Fire Department will conduct an operator safety seminar for those individuals staffing the fireworks stands. Once the stand is stocked with fireworks, a member of the organization who has attended the seminar must be present during the business hours.

Signature of Aut ori Date

S.w--Print Name


MEMBERSHIP ROSTER

ATTACHMENT D

INSTRUCTIONS: The applicant has a choice of using this form or supplying the information on a form of their choosing providing the members' complete name and mailing address is provided. If additional pages are needed to document the nonprofit organization's membership, please reproduce this form.

t.

,_' r __.._..,,,_.,.,,_....._,,_ ___ u


REPORT OF DISBURSEMENTS OF NET PROCEEDS FROM SALE OF FIREWORKS IN 2017

ATTACHMENT E

INSTRUCTIONS: This form must be filed on or before April 1, 2018, concurrent with filing the required application documents for a fireworks stand permit in 2015. Use the backside of this form to itemize the expenditures if additional space is needed.

Net Fund Balance from Fireworks Sales Reported to the City on 3-31-17

Net Proceeds from 2017 Fireworks Sales reported to the City on 9-1-18 (Line 4)

SUBTOTAL OF FUNDS AVAILABLE $ _'*lt ...... 1 ..... a"'"'"~', _L+-) ..... r_1 _

*ITEMIZED EXPENDITURES: (Expenditures made between 9-1-17 filing date and 4-1-18)

TOTAL EXPENDITURES:

NET FUND BALANCE:

$ ______ _

$

$

{p ! Et L/D

*Must be completed in detail. Each line item expense must be listed. Failure to do so will result in rejection of this filing.

Dat6 '


ATTACHMENT B



·Permission is hereby granted to ___ ...:...T.:..:N-"-T-'-F-'-IR~E-'-W'-O;;..;R~Kc.:::.S_--'7--'i--'4--'-7--'3:.;:8'--i-'--O::...c0:.;:2:;__ __ and (Fireworks Wholesaler)

M'l:.~s-uo £=...J A~r..J AfAs Que V6Nt:.E1)utb(or the exclusive right to use the property (Non profit Organization Name)

located at ___ 1_4_0_7_1_M_P_E_R_IA_L_A_V_E_. ___ , Calexico, California, from 8:00 a.m. on June 25, 201 (Fireworks Stand Address)

through 12:00 Noon, July 6, 201& for a temporary fireworks stand to sell safe and sane fireworks from 12:00

Noon, to 10:00 p.m. on June 28, 2018 and 9:00 a.m. to 10:00 p.m. on June 29th through and including July 4,

2018.

It is understood that the retail fireworks operations will be conducted in accordance with all City, County, and

State regulations.

Owner/Lessor Name:

Signature:

Dated this I 2018.

INSPECTION DATE: TNT FIREWORKS

SALES ASSOCIATE CITY ------ ----------LOCATION#-=.=::...::...::...;...;:;....:.__ ORGANIZATION

-------------

SIZE 6 TYPE BACK DOORS A-FRAMES 2 --- --

SET-UP DOWN LIGHTS -------ADDRESS 1 (FOOD4LESS)

INTERSECTION NWC BIRCH/ HWY 111 (IMPERIAL)

THOMAS GUIDE - COUNTY I P PAGE GRID ---- ---s PE CIAL INSTRUCTIONS ....:......:...=-=---=::....;:__:_:_=-=-=--=-=-=-.::..:....::.::=-=-.:...::.;:_;_;~~'-=-'--=--::....:....=-==--~~"-==-

INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201

Date: FEB () 5 2010

MINSTERIO EN ACCION MAS QUE VENCEDORES INC

C/O SAUL GARCIA 711 PIERCE AVE CALEXICO, CA 92231

Dear Applicant:

DEPARTMENT OF THE TREASUP.Y

Employer Identification Number:

DLN:

Contact Person: NANCY L HEAGNEY

Contact Telephone Number: (877) 829-5500

Accounting Period Ending: December 31

Public Charity Status: 170(b) (1) (A) (i)

Form 990 Required: No

Effective Date of Exemption: January 8, 2009

Contribution Deductibility: Yes

Addendum Applies: No

ID# 31306

We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 50l(c) (3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records.

Organizations exempt under section 50l(c) (3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter.

Please see enclosed Publication 4221-PC, Compliance Guide for 50l(c) (3) Public Charities, for some helpful information about your responsibilities as an exempt organization.

Letter 947 (DO/CG)

-2-

MINSTERIO EN ACCION MAS QUE

Enclosure: Publication 4221-PC

Robert Choi Director, Exempt Organizations Rulings and Agreements

Letter 947 (DO/CG}

Entity Status Letter

Date: 3/24/2015

ESL ID:

According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID:

Entity Name: MINISTERIO EN ACCION MAS QUE VENCEDORES

~ 1. The entity is in good standing with the Franchise Tax Board.

D 2. The entity is not in good standing with the Franchise Tax Board.

~ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d.

D 4. We do not have current information about the entity.

The above information does not necessarily reflect: • The entity's status with any other agency of the State of California, or other government agency. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or the entity

did business in California at a time when it was not qualified or not registered to do business in California: o The status or voidability of any contracts made in California by the entity at a time when the entity was

suspended or forfeited (R& TC Sections 23304.1, 23304.5, 23305a, 23305.1 ). o For entities revived under R&TC Section 23305b, any time limitations on the revivor or limitation of the

functions that can be performed by the entity.

Internet and Telephone Assistance

Website: ftb.ca.gov Telephone: 800.852.5711 from within the United States

916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments

FTB 4263A WEB (NEW 02-2012)

DISPLAY CONSPICUOUSLY AT PLACE OF BUSINESS FOR WHICH ISSUED u388357s

SB CALIFORNIA STATE BOARD OF EQUALIZATION

TEMPORARY SELLER'S PERMIT

Valid 06/28/2018 through 07 /04/2018

ACCOUNT NUMBER

I SR FHA 103-236395 l

L

MINISTERIO EN ACCION MAS QUE VENCEDORES CYNTHIA GARCIA 1407 IMPERIAL AVE W CALEXICO, CA 92231-4812

J

NOTICE TO PERMITTEE: You are required to obey all Federal and State laws that regulate or control your business. This permit does not allow you to do otherwise.

IS HEREBY AUTHORIZED PURSUANT TO SALES AND USE TAX LAW TO ENGAGE IN THE BUSINESS OF SELLING TANGIBLE PERSONAL PROPERTY AT THE ABOVE LOCATION. THIS PERMIT IS VALID FOR THE PERIODS SHOWN AND IS NOT TRANSFERABLE.

For general tax questions, please call our Customer Service Center at 1-800-400-7115 (TTY:711). For information on your rights, contact the Taxpayers' Rights Advocate office at 1-888-324-2798 or 1-916-324-2798.

BOE-442-ST REV. 5 (11-14)

A MESSAGE TO OUR NEW PERMIT HOLDER

As a seller, you have rights and responsibilities under the Sales and Use Tax Law. In order to assist you in your endeavor and to better understand the law, we offer the following sources of help:

• Visiting our website at www.boe.ca.gov • Visiting a field office

• Attending a Basic Sales and Use Tax Law class offered at one of our field offices

• Sending your questions in writing to any one of our offices

• Calling our toll-free Customer Service Center at 1-800-400-7115 (TTY:711)

As a seller, you have the right to issue resale certificates for merchandise that you intend to resell. You also have the responsibility of not misusing resale certificates. While the sales tax is imposed upon the retailer,

• You l1ave the rigl1t to seek reimbursement of the tax from your customer

• You are responsible for filing and paying your sales and use tax returns timely

• You have the right to be treated in a fair and equitable manner by the employees of the California State

Board of Equalization (BOE}

• You are responsible for following the regulations set forth by the BOE

As a seller, you are expected to maintain the normal books and records of a prudent businessperson. You are required to maintain these books and records for no less than four years, and make them available for inspection by a BOE representative when requested. You are also expected to notify us if you are buying, selling, adding a location, or discontinuing your business, adding or dropping a partner, officer, or member, or when you are moving any or all of your business locations. If it becomes necessary to surrender this permit, you should only do so by mailing it to a BOE office, or giving it to a BOE representative.

If you would like to know more about your rights as a taxpayer, or if you are unable to resolve an issue with the BOE, please contact the Taxpayers' Rights Advocate office for help by calling toll-free, 1-888-324-2798 or 1-916-324-2798. Their fax number is 1-916-323-3319.

Please post this permit at the address for which it was issued and at a location visible to your customers.

CALIFORNIA STATE BOARD OF EQUALIZATION

Sales and Use Tax Department

NOTTCE OF CHANGE

STATE OF CAL!FORNf;\

OffICE OF TllE STATE FIRE iv!/\RSll;\L

1131 S. STREET

SACAR1\MENTO, CA 9:i81 l

(916) 1li!5-8373

RE'l'AIL J=iJREWOHJ(S LICENSE

1': UivlBER YU00338

CHANGE FROM:Jvl!NlSTERO EN 1\CCION iv1i\~) QUE VENCEDORE

211 W. BIRCH ST .

. CALEXICO, CA

'1' MINISTERO EN ACCION MAS QUE VENCEDORE CHANGE .O: 1407 li'v!I'ERAL AVENUE CALEXICO, CA

DATE: 03-27-2018

COMMENTS: LOCATION CHANGE ·~--

COUNTY : !MPEIUAL ___ _

CC: CALEXICO FIRE DEPARTMENT

AMERICAN PROMOTION/\!. f:VE:MTS. INC 555 M. GIUlF.flT STREET, FUU.ErnoN. C1\ n2:J13

Pl·IOME (7~4) 730-100:? F/1X (714) '/30·3GG1 \'NN1,tntfirowo1ks.com

OFFICE OF THE STATE FIRE MARSHAL RETAIL FIREWORKS LICENSE AP PUCA TION

(Print or Type)

Index 5942 PC;\ 59420 Source Code l 25700-06

Complete and return all copies to tile office nearest stand location witll t11e required fee of $50.00. APPLICATIONS MUST BE RECEIVED PRIOR TO .JUNE 15 OF THE CURRENT YEAR.

·1131 S Street Sacramento, CA 958·11

(9'16) '145~8373


Licensee MINISTERO EN ACCIOfll MAS O.UE VENCEOOR_t:

Stand Location

211 W. BIRCH STREET

City, State & Zip CALEXICO, CA

County ___ _ IMPERIAL


STEVE BENNm Name ________ _

Phone_ t__Zl!A-738-1002



A validated license has been issued to this organization shown above for the sale of Sare and Sane fireworks al llm location 111dicated. After a permit has been issued hy the authority having 1urisdiclior1 this license allows the sale oi only classified

·safe and Sane· fireworks at the approved location from NOON, .JUNE 28 to NOON, JULY 6, of the year Indicated. NOTE: Retail licensHes are required to be al ICJasl 21 years of age, employees of fireworks stands must be ;:it least 18 and riieworks rnay not be sold lo anyone under the at1e of 1G.


Nanie TNT FIREWORKS

Mdross SSS M. GILBERT Cily,State & Zip FULLERTON, CA 92833


Fire Dept. CALEXICO FIRE DEPARTMEl\IT I ·~-.

~~~~~~~~ I Signature of Applicant Address City, Stole &Zip

430 E. STH STREET

CALEXICO, CA 92231 _,4_~12---0<Jtc

While-Licensee <> Y1)1iow-Firo Aulhorityo Pink- SFM f'ile

259GOGl

ACORD® CERTIFICATE OF LIABILITY INSURANCE 111112018 I DATE (MMIDD/YVYY)

~ 3/27/2018 THIS CERTIFICATE IS ISSUED AS A MA1TER 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 ADDmONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of tho policy, cenaln policies may require an endorsement. A statement on this certificate does not confer rlAhts to tho certificate holder In lieu of such ondorsement(s).

PRODUCER Lockton Companies i;inik!"' ·-3280 Peachtree Road NE, Suite #250 r.K,9NJ. a_ ... TrAlc iAIC Nol: Atlanta GA 3030S ~~~QQ• (404) 460-3600

>---- INSURER!!!! AFFOROINO COVERAGE HAICll

1HSURl!RA: Everest lndemnit:Y Insurance Com11anv 10851 INSURE!> American Promotional Evcnis, Inc. msuRSR a: Mrurnmlndemnity Comnnnv 26743 1359665 DBA TNT Fireworks, Inc. IHSURl!J!. c: Ber~shire Hathawa)'. Homestate Ins Co 20044

SSS North Gilbert Avenue IHSURERD: Fullerton CA 92833 --·----

IHSURERE: CLXl407 -

INSURERF:

COVERAGES CERTIFICATE NUMBER: 12229692 REVISION NUMBER: xxxxxxx 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 ISSUEO 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.

1r:: TYPE OF INSURAHCE 1::.qo.H~r- POLICY NUMBER --POLICY BFFTi>oCTcv l!XP

"·1M LIMITS

A .x. COMMERCIAL GENERAL UASILl'IY Iv N I Sl80L00242-171 11/112017 111112018 EACH OCCURRENCE s I 000000 D CLAIMS-MADE Ci] OCCUR I

I riliWACIETO'"RmEo s 500.000 PREMISES·-r---

I ·-

f--I MED EXP (Any cne penion) $ 5 000

I I

I ;

PERSONAL & ADV INJURY s I 000 000 ,__ I GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE s 2 000 000

~· POllCY o ~r8T ~ LOC I t

$ 2.000 000 : I PRODUCTS· COMP/OP AGG

n OlltER: i i $

AUTOMOBILS LIABILITY NOT APPLICABLE ~~SINGLE LIMIT $ xxxxxxx f-- '1!l!L-

ANY AUTO BODILY INJURY (Per peroon) s xxxxxxx ,__ OWNED - SCHEDULED BOOIL Y INJURY (Per accidanl) s xxxxxxx

f-- AUTOS ONLY - AUTOS HIRED HON-OWNED ~riRO~TY DAMAGE $ xxxxxxx ,__ AUTOS ONLY - AUTOS ONLY Por · !l!!ll

I s xxxxxxx B lX. UMBReUAUAB ~OCCUR ! Y N EXC6023470.0S : 11/112017 11/1/2018 EACH OCCURRENCE s 5 000 000

excess UAB CLAIMS.MADEi i AGGREGATE $ 5 000 000 OED I I RETENTIONS I $ xxxxxxx

c WORKERS COMPl!NSATION N. AMWC818062 (AOS) 111112017 I 111112018 IX I ;¥;TUTEL .l ERn• AND ll!MPLOYERS' UASIUTY YIN ! --All'< PROPRIETORIPARTNER/EXECUTIVE lli1 N/A

: E.L. EACH ACCIDENT s I ,0_00,000 OFFICER/MEMBER EXClUOEO? -- -·

(Mandatory In NH} _ E.L. DISEASE· EA EMPLOYEE $ J,(l00,!)00 grssc:= ~~PERATIONS below E.L. DISEASE· POLICY LIMIT s 1000 000

I

i I i

DESCRIPTION OP OPERATIONS f LOCATIOHB I VElllCU!S (ACORD 101, Addlllo1141 Rtmalf<e Bdlodulo, moy bo oltllchod II moro 1poc:o Is roqulrod) TlllSCERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR 11115 llOLDER,APPLICABLE n>TllE CARRIERS LISTEDANOTIIE POLICY TERM(S) REFERENCED. Additional lruiurcd: Property located at 1407 lmpcriol Ave., Calexico, CA Ccniflcatc holder is an oddilional insured on lhc General Liability as required by written contract subjc<:t to policy lcrms, conditions, nnd exclusions.

CERTIFICATE HOLDER CANCELLATION 12229692 Ministero En Accion Mns Que Vencedore and the City of Calexico; its appointed & elected ofliciars, employees, ~rcsentatives & volunteers when acting m their officio I capacities ns such 608 Heber Avenue

SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISfONS.

Calexico CA 92231

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD



REORDER 905 • U.S. PATENT rm. 5538290, 5575508, 5641183, 5785353, 5984364, 6030000

Check No. 20104099


Stub 1 of 1


:.TOTHE ORDER Of


835.00

WELLS FARGO BANK, NA 56-382

412

835.00

CHECK NO. 20104099

DATE AMOUNT VENDOR

2242867 02/01/18 $*******835.00

EIGHT HUNDRED THIRTY FIVE AND 00/10011'~"1,:{#t*'~:*;~ ************************************

CITY OF CALEXICO 608 HEBER AVENUE

'' (___~JI· -· -.. '- l'-;i It

~tJ / / I/ I Co"" ... - }

CALEXICO CA 92231

, Mv L--. -- l?/'- ,,< ,,,. _ _,

'-----------------·--··-----------------------------------------~J----

agenda staff report342ed706-1ebb-4fde...1. submit one (1) site plan depicting use (minimum size...

Documents