agenda item 1 - calexico342ed706-1ebb-4fde...2019/06/05 · certificate of insurance for $1,000,000...

AGENDA ITEM

1

DATE:

TO:

APPROVED BY:

PREPARED BY:

I EN

May 23, 2019

Mayor and City Council

David B. Dale, City Manar,,1

\

Diego Favila, Fire Chie~

FF IL

E

SUBJECT: Pre-Qualified Applicants for the 2019 Sale of Safe and Sane Fireworks ----------------------------------------------------------------------------------------------------------------------------------------------Recommendation:

Approve the list of prequalified applicants for the sale of Safe and Sane Fireworks for 2019:

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

Background:

From March 1 through April 3, 2019 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 rejection 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 be11efit 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.

Discussion & Analysis:

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, determine the nonprofit organizations to which permits will be

AGENDA ITEM

I

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:

Applications.

2

GROUP MINISTERIO EN ACCION MAS QUE VENCENDORES

ADDRESS 1407 IMPERIAL AVENUE

10< Application

~ $835 app fee

~ Plot Plan (ATTCH A)

~ Property Permission (ATTCH B)

1~ Fire Dept Compliance (ATTCH C)

~ Roster of Membership (ATTCH D)

l'Y. Net Proceeds of previous year (ATTCH E) <:

D\ Proof of Non-profit- federal exemption

\!, Proof of Non-profit- state exemption

~Seller's permit

\i.._ SFM

vl_, Insurance

**DUE BY NOON ON

THURSDAY, MARCH 28

TURN PACKET IN TO THE

CITY MANAGER!!

Ill

I I F M

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- 2019

• STATE FIRE MARSHAL RETAIL FIREWORKS LICENSE-2019

• 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

~ r i I ri ' ·~

Calexico Fire Department

APPLICATION FOR FIREWORKS STAND PERMIT

Complete and return the requred application documents no ater than 12:00 p.m. Noon on April1, 2019, 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_l_O_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_IE_R_C_E_A_V_E_.~, _C_A_L_E_X_l_c_o~,_C_A_9_2_2_3_1 ______ _

Mailing Address:

City: CALEXICO Zip Code: 92231 Telephone#:

. Individual in Organization Applying for this Permit:

Title: CEO/PASTOR

Mailing Address:

City: CALEXICO Zip: 92231

Emergency Contact Number:

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

Bus. 711 PIERCE AVE., CALEXICO Bus.

SAUL GARCIA CEO/PASTOR Res.

CYNTHIA GARCIA SECRETARY

Bus.

MERCEDES PARTIDA TREASURER Res.

·"

Fireworks Stand Permit Application Page 2 of 3

Status of Organization (Religious, Charitable, etc.): [Also attach copy of 601 (c)(3} or 23701 d 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: -·-=c;.::..H,,_,U=R'"'C=H~N=E=E=D-=S _________ _

Proposed location of fireworks stand:

1407 IMPERIAL AVENUE, CALEXICO, CA

Proposed Dates and Hours of Operation of the fireworks stand: 6/28 (NOON-101PM), 6/29-7/4 (9AM-10PM)

Number of Employees who will work at the fireworks stand --=13'-.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: __ N_O_N_E ________ 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 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.

I also certify that our organization has a principal and permanent meeting place in the City of Calexico and have been est. IJflShed for at least one year prior to the filing of this application; and that we have a bona fide member. hip of at lea 25, the majority of whom are residents of Calexico.


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, 2019 Attachment G - Temporary Use Permit Application (Filed by Distributor) Proof of 501 (c)(3) or 23701 d 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

N/A

I I

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: alexico, California.

The following Plot Plan ( etch)of the proposed selling location shows where the fl 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 r. 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 H. a/th and Safety Code and that any merchandise hereafter purchased and/or ered for sale by me/us shall be in strict compliance with the provisions of said Code and/or local laws or ordi noes as pertainin thereto.

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

SALES ASSOCIATE BENNETT CITY CALEXICO

LOCATION# CLX1407 ORGANIZATION MINISTERIO EN ACCION

SIZE 6 X 32

SET-UP 6/22

TYPE OPM BACK DOORS 1 --- ----DOWN 7/6

ADDRESS 1407 IMPERIAL AVENUE (FOOD4LESS)

INTERSECTION NWC BIRCH/ HWY 111 (IMPERIAL}

THOMAS GUIDE - COUNTY IMP PAGE

A-FRAMES 2 ---

LIGHTS OPM

GRID '

SPECIAL INSTRUCTIONS FACE STAND TOWARDS RITE AID, SET STAND IN MIDDLE ~ OF PARKING AREA AS PICTURED. CLOSE TO THE ISLAND ~ .•. · THAT IS TOWARD HIGHWAY 111. i

. . •CITY PF·CA.kEXfCQ . Flf!E\llJoRKS. ·$T:ANp :f?~RMIJ"APPI;.R~ATiON

PROPERTY OWNER ANO/OR ·LESSOR /LESSEE CONSENr . . . .... . . ' . . . . . . : . . .. ' ; . . . :- . . . . . . . . .. ·'. . . .. ·:·.' ~ . . . . : . . . ; .

iocateci ~t ..... 14n.t llViPERl.ALAVE• .... ·. ,·Car.exlco,,california,;from s:oo a.rn. on June 25, ·201 ·. (Fire\Vflrk$·$tand.l\dtires.$) ·

thtol]gh 1~:QO .N()orii Jµly 6, 201 fQr a t~mPOfi:l1YfireWorki;i.st£Jnd to ~ell safe arid ~mneflreWotl\s fr~m 1.2;00

Noon: to 10:00 p.m. on June 28', 201 .an.~ ~:ool'a)ft't() 10:00 p.m. onJr.ine.29111 thr~ugh ~nd includtn9 July 41 201 .

It '1$ unctetsh:ie>~ that the re\allflreworks oper~ti6 n$'wflf'be ¢ond.ucte(f. in apgordanoe wtiK all City, C.ounty, arid stat€! r.~gu1atifins..

. 9wn~rll.¢ssor.Ni;mie: . ,BJRbH:cjbRR, GI(). ~H P,~OPS.RTIESiLLO A1-.Ufress: ,,· u: oove:Sit:·:stfrre 17s ...

·. ~ . ·• . .-. -.. -. ·. ·--· .·

$f(Jnature:

Pr.lnt~ct. Nerne: ~ ..... "* .. +-.. """· ~~~.,,___,.,,..--.-;.+---....-.,...;~..,....--,

Title I Prrricfpa1: PR • l).ERTY l\t1ANAGBR •' \

Dat~d this .. ·• ~ day of .jfMf..(.l htf/,· '2019.

AGREEMENT TO COMPLY With

Calexico Fire Department REQUIREMENTS FOR FIREWORKS ST ANDS

ATTACHMENT C Page 1 of 2

I, SAUL GARCIA , an authorized representative or officer of

MINBSTERBO EN ACCBON MAS QUE VENCEDORE§ 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 fiieworks" may be discharged during the hours of 12:00 p.m. noon to 1 O:OO p.m. on June 28, and from 9:00 a.m. to 1 O:OO 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 1 O:OO p.m. on June 28, and from 9:00 a.m. to 1 O:Otp.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 condlions 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 wo: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.

0) 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.

ATTACHMENT C Page2of2

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

(o) 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 ofage on site during non-operating hours. Sleeping or remaining in the stand after close of each business day is forbidden.

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

(q)

(r)

(s)

No fireworks stand shall be erected more than three (3) caandar 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 erood, 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.

(t) The decision of the Fire Chief or his designee to suspend be permit of any permittee shall be subject to review by the Administrative Hearing Officer, forthwith. In view oflfle 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 Fre 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 noticeof the 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.

(u) 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.

(v) 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 I

CITY OF CALEXICO FIREWORKS Sl'ANO Pt;RMIT APPLICATION

MEMBERSHIP ROSTER

ATTACHMENT D

ltjSTRUOTIONS: Tho applicant has a cholco of using lhls form or $uppl~ng lhe lnformalkm on a form of their choosing providing lho membors' complalo name and mailing address ls provldar!. If additional pages are needed lo document the nonprofit organization's membership, please reproduce this form.

' ri I ! I I I i I I i '

CITY OF CALEXICO FIREWORKS STAND PERMIT APPLICATION

REPORT OF DISBURSEMENTS OF NET PROCEEDS FROM SALE OF FIREWORKS IN 2018

ATTACHMENT E

INSTRUCTIONS: This form must be filed on or before April 1, 2019, concurrent with filing the required application documents for a fireworks stand permit in 2019. 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 3-31-19

Net Proceeds from 2018 Fireworks Sales reported to the City on 9-1-18 (Line 4)

SUBTOTAL OF FUNDS AVAILABLE $ _____ _

*ITEMIZED EXPENDITURES: (Expenditures made between 9-1-18 filing date and 4-1-19)

r (JenerzJ Chw r'1:li pen~ $ _'=l-'-+-1 ~O b~D _ \ m1y~~t0 . h·1~ h uhlH-iq 12 LI 0

... rtroodeQut chi J (ch lontb b {LJ\tf,)QYj:{S I.

AJ u Rur Wb::RPrn\·)

- NC tl fl(,} r,e;pu~l-YUroc¥o.~g., 4 t) tvdu)

TOTAL EXPENDITURES:

NET FUND BALANCE:

!{?' I I ]lp3

1 l.ooo

$

$ r&

*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.

Title

·12/cx1/ 1q Date

l

I ti

INTERNAIJ REVENOE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201

Date: FEB 0 5 2010

MINST!i;RIO EN ACCION MAS QUE VENCEDORES INC

c/o SAUL GARCIA 711 PIERCE AVE CALEXICO, CA 92231

Dear Applicant:

DEPARTMENT OF THE TREASURY

Contact J?e1;.son: NANCY L HEA,GNEY

Contact Telephone Number: (877) 829"5500

Accounting Period Ending: December 31

Public Charity status: 170 (b} (1) {A) (i)

, , Fornt 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 detern\ined 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 rega:L·ding 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 501(c) (3) Public Charities, for some helpful information about your responsibilities as an exempt organization.

Letter 947 (DO/CG)

[:

r i I' I'. f:

MINSTERIO EN ACCION MAS QUE

Enclosure: Publication 4221-PC

Robert Choi Director, Exempt Organizations Rulings and Agreements

Lette1: 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)

Index 5942 PCA 59420 S01uce 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 15 OF THE CURRENT YEAR,

1131 S Street Sacramento, CA 95811

(916) 445-8373

RETAIL FIREWORKS LICENSE

Ucensee.-----'M_l_N_!ST_E_R_O_E_N_A_C_C_IO_N_M_A_S_Q_c_U_E_V_E_l\!Cf_OO_R_E _______ _

Stand Location

1407 IMPERIAL AVE

City, State & Zip CALEXICO, CA

county IMPERIAL

LOCAL CONTACT PERSON STEVEBENNITT

Name ______ ~--~------------~---~

Phone_c__.]14-73fH002

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

WITH A COPY OF THE LOCAL PERMIT

A validated license has been Issued to this organization shown above for the sale of Safe and Sane fireworks at the location lndica(ed. After a permit has been Issued by the authority having jurisdilltlon this license allows the sale of only classifle<:I

'Safe and Sane' fireworks at the approve<:l locatlon from NOON, JUNE 28 to NOON, JULY 6, of the year indicated. NOTE: Retail llcensees are required to be atleast 21 years of age, employees of fireworks stands must be atleasl 18 and fireworks may not be sold to anyone under the age of 16.

Name

Address C!ty,State &Zip

MAILING ADDRESS OF LICENSEE

TNT FIREWORKS

555 N. GILBERT

fUl!ERTON, CA 92833

FIRE AUTHORITY HAVING JURISDICTION

Fire Dept. Calexico Fire Department

Address 430 E. 5th St City, State & Zip Calexlco, CA 92231

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

2590061 cLX1407

.· .. Date' 1

Signature of.Applicant

1)s-j1

!$) OSP 12128626

ACORD® CERTIFICATE OF LIABILITY INSURANCE 11/1/2019 I

DATE (MMIDD/YYYY)

~ 11/1/2018 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).

PRODUCER Lockton Companies CONTACT NAME:

3280 Peachtree Road NE, Suite #250 rA~gN90 Ext\• J 1,ifc Nol: Atlanta GA 30305 E-MAIL (404) 460-3600

ADDRESS:

INSURERISl AFFORDING COVERAGE NAIC#

INSURER A: Everest Indemnitv Insurance Comnanv 10851 INSURED

American Promotional Events, Inc. INSURER e : Maxum Indemnitv Comnanv 26743 1359665 OBA TNT Fireworks, Inc. INSURER c : Berkshire Hathaway H omestate Ins Co 20044

555 North Gilbert Avenue INSURERD: Fullerton CA 92833 INSURER E: CLX1407 INSURER F:

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 AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSR TYPE OF INSURANCE ADDL SUBR POLICYEFF POLICY EXP

LIMITS LTR lllSO lwun POLICY NUMBER IMM/00/YYYYl IMMIDD/YYYYl

A _x_ COMMERCIAL GENERAL UABIUTY y N SI8GL00242-18 l 11/1/2018 11/1/2019 EACH OCCURRENCE $ 1000000 0 CLAIMS-MADE [i] OCCUR

DAMAGE TO RENTED $ 500 000

>------ PREMISES IEa occurrence)

~ MED EXP (Any ona person) $ 5 000

>------PERSONAL & ADV INJURY $ 1000000

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000 000 Fl POLICY o ~r8-r ~ LOC PRODUCTS - COMP/OP AGG $ 2 000 000 OTHER: $

AUTOMOBILE LIABILITY NOT APPLICABLE )i;~~~~~~~l~INGLE LIMIT $ xxxxxxx -ANY AUTO BODILY INJURY (Per person) $ xxxxxxx

~ OWNED - SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ xxxxxxx

~ -HIRED NON-OWNED PROPERTY DAMAGE $ xxxxxxx AUTOS ONLY AUTOS ONLY IPer accldenll ~ -

$ xxxxxxx B x UMBRELLA LIAB ~OCCUR y N EXC6023470-06 11/1/2018 11/1/2019 EACH OCCURRENCE $ 5 000 000

EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5 000 000 OED I I RETENTION$ $ xxxxxxx

WORKERS COMPENSATION N x I ~!ffTUTE I JOTH-c AND EMPLOYERS' LIABILITY YIN UB-7J538573 11/1/2018 11/1/2019 _ ER

ANY PROPRIETOR/PARTNER/EXECUTIVE WJ N/A E.L. EACH ACCIDENT s I 000 000

OFFICER/MEMBER EXCLUDED? (Mandatoiy In NH) E.L. DISEASE - EA EMPLOYEE $ 1000000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT s I 000 000

DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (AGORO 101, Addlllonal Remarks Schedule, may be altached If more space ls required) Additional Insured: Property located at l407 Imperial Ave., Calexico, CA Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms, conditions, and exclusions.

CERTIFICATE HOLDER

12229692 Ministero En Accion Mas Que Vencedore and the City of Calexico; its appointed & elected officiafs, employees, representatives & volunteers when acting in their official capacities as such 608 Heber Avenue 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.

All rights reserved.

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

DISPLAY CONSPICUOUSLY AT PLACE OF BUSINESS FOR WHICH ISSUED f234219t

ACCOUNT NUMBER

CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION

TEMPORARY SELLER'S PERMIT Valid June 23, 2019 through July 4, 2019

/ 212064000 • 00001

MINISTERIO EN ACCION MAS QUE VENCEDORES CYNTHIA GARCIA. 1407 IMPERIAL AVE W

LALEXICO CA 92231-4812 _J

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 TRANFERABLE.

Office of Control: El Centro Branch Office

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.

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 1·888-324-2798or1·916·324-2798.

CDTFA-442-ST REV. 7 (5-18)

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.cdtfa.ca.gov Visiting an office Attending a Basic Sales and Use Tax Law class offered at one of our offices Sending your questions In writing to any one of our offices Calling our toil-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 right to seek reimbursement of thEi 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 Department ofTax and Fee Administration (CDTFA) You are responsible for following the regulations set forth by the CDTFA

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 CDTFA 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 CDTFA office, or giving it to a CDTFA representative.

If you would like to know more about your rights as a taxpayer, or if you are unable to resolve an Issue with CDTFA, 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 Department of Tax and Fee Administration

Business Tax and Fee Division

I

I

Community Development Department P Iai111i11g Division

"Temporary Use Permit"

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

REQUIRED AITACHMENTS: 1. Submit one (1) site plan depieting use (minimum size 8V2'' 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: Applicant Address: 711 PIERCE STREET, CALEXICO, CA Phone Number: Company Name: MINISTERIO EN ACCION MAS QUE Alt. Phone Number: Location of Event: 1407 IMPERIAL AVE Bus. Lie. Number: ---,1,---5-0-27_6 _____ _

Date of Event: 6/28/19 to 7 /4/19 Total Days: 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 fund raiser 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

icked u o ul 6.

(For City Use Only)

City Department Recommendation b r Dept. Head Si!:mature: Administration 0Approved 0Denied

" Fire I /I Approved 0Denied :+ .. v _ _v;y_J&. Police 0Approved 0Denied Utilities Services 0Approved 0Denied Community Services 0Approved 0Denied Redevelopment Agency 0Approved 0Denied Risk Management 0Approved 0Denied Planning Division 0Approved 0Denied Engineering Division 0Approved 0Denied General Services 0Approved 0Denied Other: 0Approved 0Denied

Conditions of Approval:

ALL TEMPORARY USE PERMIT MUST COi\'lPLY 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.ll.120 "Temporary Use Regulations")

Revised 1112009


LOCATION# CLX1407 ORGANIZATION MINISTERIO EN ACCION

SIZE 6 X 32

SET -UP 6/2.2

TYPE OPM BACK DOORS 1 ----DOWN 7/6


INTERSECTION NWC BIRCH/ HWY 111 (IMPERIAL)


A-FRAMES 2 ---LIGHTS OPM

GRID

SPECIAL INSTRUCTIONS FACE STAND TOWARDS RITE AID, SET STAND IN MIDDLE OF PARKING AREA AS PICTURED. CLOSE TO THE ISLAND THAT IS TOWARD HIGHWAY 111.

' ' ' CITY PF ·CAt.J:xrco Fl~EWORKS STANb :PE'RMfT'APPLICATiON

- ·- .- . . - ' ' : .. ~ ·. '; ' . ' ·. ' . . . . "

Permission Is hereby granted· to __ _.,..-'T""'"'N..,...t-'-F~:f.....,R"-"6c;;..cw'"'"'o~R-""K-"-'S~"'· 7~1'--,4o._"' r""'-"3__.c.a-"--.1'--"o-'-o.,....,2---"-'---,-- and (ffreWpi:f<&. Wool1Jsaler) · ·

~-~~fV\""":1,_..·,......·,N_~ _SV_b_-_w_z.._·c_i~61""'_:_~i\J~· '-,A~c;.-,-l2Z~:D..,.,0_10_-.___, ___ for the exclus.lve ri.Qhf to use the property (t'Jori · . prorttOrganlia~lotrNi:inie) ·

. .. .

located.at ' 1407 lMR~RiAL AVE• ,, .. ,,,, ! CEil,eX1co,:Callf6mta~ :fr.oiil 8:00 a.m. on June 25; 201 · (Flrework~·$tandl\~c,1tess) ··

thrqu,gn 1~:00 N0oh1 July a, 201 fora tempori:1cy.fireworks st~nd'to $$11 s1!)fe Md s~ne fireworks from 12; oo

Noon; to10:0o' p.ni. on June 28'; 201 .~o~ $:0b•a.m.·to1o:oop.m: onJune2~ 1li tl\roogh and Including ~uly 41

201 .

It 1s undefotoqd !hat tne retail flr~wqrks oP.etatfo ns wflr'P:_~. c:mriC:luctei;f In 1;1pq~r<l~nae wilh <.111 blly, coi.mtY, an ct

slat€/ r$gu1ati1:>n~ .

. <;.>wn~r/L,essor Name:

.Aq~r¢ss:

city,.stat~, and:Zlp.Co4~

:•.•_; .. ·.

'2019.

ACORD® CERTIFICATE OF LIABILITY INSURANCE [ 1/1/2019 I

DATE (MM/DD/YYYY)

~ 11/1/2018 THIS CERTIFICATE IS ISSUED AS A MATIER 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, certain pollcles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Heu of such endorsement(s).


3280 Peachtree Road NE, Suite #250 PHONE I r..e~ No\: IMC ~o Evl\• Atlanta GA 30305 E·MAIL ( 404) 460-3600 ADDRESS: --

INSURER(S\ AFFORDING COVERAGE NAIC#

INSURER A: Everest Indemnitv Insurance Company 10851 INSURED

American Promotional Events, Inc, 1NsURER a : Maxum Indemnitv Comnanv 26743 1359665

DEA TNT Fireworks, Inc. INSURER c: Berkshire Hathawav Homestate Ins Co 20044 555 North Gilbert Avenue INSURER D: Fullerton CA 92833 INSURER E: CLXl407 INSURER F:


INSR TYPE OF INSURANCE ADDL SUBR

1POLICY EFF ,~~Mi~ LTR •~so WVD POLICY NUMBER MMIDDNYYYl LIMITS

A x COMMERCIAL GENERAL LIABILITY y N Sl8GL00242- I 8 l 11/1/2018 11/1/2019 EACH OCCURRENCE $ 1 000 000 ~ ::::J CLAIMS-MADE W OCCUR

U/WJl\Gt TO HENTED PREMISES IEa occurrence) $ 500 000

MED EXP (Any one person) $ 5 000 -PERSONAL & ADV INJURY $ 1000000 -

GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2 000 000 =i POLICY D ~~g,:: ~ LOC PRODUCTS - COMP/OP AGG $ 2 000 000

OTHER: $

AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT $ xxxxxxx IEa accldenl\ -

ANY AUTO BODILY INJURY (Per person) $ xxxxxxx -OWNED - SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accldenl} $ xxxxxxx - -HIRED NON-OWNED PROPERTY DAMAGE

- AUTOS ONLY - AUTOS ONLY IPer accldenl\ $ xxxxxxx $ xxxxxxx

B _x_ UMBRELLA LIAS ~OCCUR y N EXC6023470-06 I 1/1/2018 11/1/2019 EACH OCCURRENCE $ 5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5.000 000

DED I I RETENTION$ $ xxxxxxx WORKERS COMPENSATION N I PER I I OTH-c AND EMPLOYERS' LIABILITY UB-7J538573 11/1/2018 111112019 X STATUTE ER

YIN ANY PROPRIETOR/PARTNER/EXECUTIVE [ill N/A E.l. EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH} E.L. DISEASE - EA EMPLOYEE $ 1.000 000 Ir yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1000000

DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addlllonal Remarks Schedule, may be allached II more space ls required) Additional Insured: Property located at 1407 Imperial Ave., Calexico, CA Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms, conditions, and exclusions,

CERTIFICATE HOLDER CANCELLATION

12229692 Ministero En Accion Mas Que Vencedore and SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE the Ci?s of Calexico; its appointed & elected THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN officia s, employees, r&;resentatives & volunteers ACCORDANCE WITH THE POLICY PROVISIONS. when actin~in their o 10ial capacities as such 608 Heber venue Calexico CA 92231

I

ACORD 25 (2016/03)

. . :2) / . ; ' AOTI<OO"~ "~"~"""" • JI;' / h2 zi[,,.i (W· fi~~ :/(.

© 1988·2~RD CORPOR1\TION. All •ght• '"'""'· 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

CLX1407/515/Jl9/924 2/6/2019 Permitting Fees***

REORDEn 905. U,s. PATEUT 110. 5531'.l2SO, 6575503, 5S411S'.I, 571J5353, 1i984-364, 6[}300t

Check No. 20118305

Check Date - 2/7/2019

Stub 1 of 1

135.00 135.00

135,00 135.00

GROUP CHRIST COMMUNITY CHURCH

ADDRESS 2540 ROCKWOOD AVE

_fl_ Application

~ $835 app fee ----'----

_\>(+-. _Plot Plan (ATTCH A)

----W.._. __ Property Permission (ATTCH B)

-~-1---Fire Dept Compliance (ATTCH C)

~ Roster of Membership (ATTCH D) ---

-~-'--_Net Proceeds of previous year (ATTCH E)

0( Proof of Non-profit- federal exemption

C:{ Proof of Non-profit- state exemption

\:J Seller's permit

Jk__sFM l~ +Insurance ~

**DUE BY NOON ON THURSDAY, MARCH 28

TURN PACKET IN TO THE

CITY MANAGER!!

MAR 2 8 2019

~

Ir

.

I

CHRIST COMMUNITY CHURCH - CALEXICO

Ill

PLI I

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- 2019

• STATE FIRE MARSHAL RETAIL FIREWORKS LICENSE-2019

• 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, 2019, 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 requiredfee 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: CHRIST COMMUNITY CHURCH - CALEXICO "3 £4, \ .£. F U2-~ 'T S'l •

Principal and Permanent Meeting Address: · 1021 l~la-kc Rel. Calexico, Ca. 92243

Mailing Address: 590 W. Orange Ave. El Centro, Ca. 92243

City: _E_l_C_e_n_tr_o,_C_a_._ Zip Code: _ 9_2_2_43 ___ Telephone#: (760 337-9400

Individual in Organization Applying for this Permit:

Name:_F_r_a_n_k_Z_a_zu_e_t_a _________ _ Title: __ P_a_s_t_or _________ _

Mailing Address: __ 5_9_0_W_. o_ra_n_g_e_A_v_e_. ---------------------

City: El Centro, Ca. Zip: _9_2_24_3_ Telephone# ( 760 ) ___ 42_7_-_27_9_5 _________ _

Emergency Contact Number: ( 760) __ 4_5_5-_0_7_99 ____ _

Information on Three (3 Principal Officers of the Organization:

Name Title Address Phone

Walter Colace Senior Pastor Bus. Bus. 760-337-9400 590 W. Orange Ave. El Centro, Ca.

Res. Res.

Frank Zazueta Pastor Bus. Bus. 760-337-9400

590 W. Orange Ave. El Centro, Ca. Res. Res.

Chris Nunn Pastor Bus. Bus. 760-337-9400

590 W. orange Ave. El Centro, Ca. Res. Res.

I

i ,-'


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:

2_c;qo !2,oucwo..::J~ .If'\ v'-L_

Proposed Dates and Hours of Operation of the fireworks stand: 6/28 (NOON), 6/29-7/4 (9AM-10PM)

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: __ w_·-_f\_i..;_v_\t\_f'.\_,_~_,-____________________ _

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

Contact Person: STEVE BENNETI

Address 555 NORTH 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 also certify that our organization has a principal and permanent meeting place in the City of Calexico and have been established for at least one year prior to the filing of this application; and that we have a bona fide membership of at least 25, the majority of whom are residents of Calexico.

signatUi0'61~~ 5 - Z-tl (;;.{.

9


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, 2019 N/A Attachment G - Temporary Use Permit Application (Filed by Distributor) Proof of 501 (c)(3) or 23701 d 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 Co e:

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

State Hea and Safety Code, at: Calexico, Calif rnia.

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 ATTACHED

SEE ATTACHED SEE A TT ACHED

SEE ATTACHED

//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 shr. I be in strict compliance with the provisions of said Code and/or local laws or ordinanc as pertain· g thereto.

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

, -,

TNT FIREWORKS SALES ASSOCIATE BENNETT CITY CALEXICO

LOCATION# XXX2540 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 2540 ROCKWOOD AVE. (WALMART)

INTERSECTION NWC ROCKWOOD/ HWY 111 AND COLE RD.

THOMAS GUIDE - COUNTY IMP PAGE GRID

SPECIAL INSTRUCTIONS SET STAND AS SHOWN, IN CENTER OF PARKING SPOTS, NEAR DRIVEWAY. FACE STAND TOWARDS THE REST OF THE WALMART PARKING LOT.


A TI A CHM ENT B

PROPERTY OWNER AND/OR LESSOR /LESSEE CONSENT

INSTRUCTIONS: Thi!!i form must be compleled 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;:::..,.." .,,_71,,_4 ... -7:..;3~8;...-1,:,,;;0:;.=0.=2 ___ and (Flrewort<s Wholesaler)

--------_,..-,,-..,.,...,,......,.,.--~--- for the exclusive right to use the property (Non profit Organization Name)

'2 <; C\._o

!coated at __ • ..:::2t50'-"=::;..;R:..::.O=C~KW"'""'""O'""O:;..;:;D""'A"""V.;:,.;E=--'' Calexico, California, from 8:00 a.m. on June 25, 2019 (Flreworka Stand Address)

through 12;00 Noon, July 6, 2019 for a temporary fireworks stand to sell safe and sane fireworks from 12:00

Noon, to 10:00 p.m. on June 28, 2019 and 9:00 a.m. to 10:00 p.m. on June 29 lh through anrJ Including July 4,

2019.

It Is understood that the retail fireworks operatlo ns wlll be conducted In accordance with all City, County, and

State regulations.

Owner/Lessor Name: Walmartlhc

Address: 702 SW 8th Street

City, State, and Zip Code: Bentonville. AR 72716

Telephone Number: ( 479 ) 273-4298

Signature: ,~4f.:f...k~ ;Jfe'onrr01t1rlf PiriY>

Printed Name: ---1/(i.l>..y:::q..J->1 e~1h~11......,(m'""-'-"a""""a=-----r1t1e I Principal: 't-1\ Q..D °'B tr :U:

Dated this \ '1~ day of 'Jin IAO.r ~ , 2019.

I,

AGREEMENT TO COMPLY With

Calexico Fire Department REQUIREMENTS FOR FIREWORKS ST ANDS


__ F_ra_n_l<_Z_a_z_u_e_ta _________________ , an authorized representative or officer of

_...;;;C...;..H;.;...R.;.;...I S::;...T'--'-C-=O-'-'M"'"'"M'""""U"""N'"'""l;..;.T_;_Y-'C""'H-'-U"-'R-'-C"""H'-'----=C-'-A=L=EX:....:.;;_;:I c:....:o;__ __ , a non profit organization, agrees to com ply with the following

requirements set forth herein:

(a)

(b)

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.

Notwithstanding the above, "safe and sane fiieworks" 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 1 O:OO 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 1 O:ocp.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 2reet 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 wo: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.

0) 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.

I'

f I ' ~I·

r


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

(o) 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 ofage on site during non-operating hours. Sleeping or remaining in the stand after close of each business day is forbidden.

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

(q) No fireworks stand shall be erected more than three (3) cmlndar 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.

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

(s) 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.

(t) The decision of the Fire Chief or his designee to suspend l:le permit of any permittee shall be subject to review by the Administrative Hearing Officer, forthwith. In view ofllie 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 Fre 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.

(u) The Calexico Fire Department will conduct an operator safety seminar for those individuals staffing the fireworks stands. Once the stand 8 stocked with fireworks, a member of the organization who has attended the seminar must be present during the business hours.

(v) 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.

4·~ Sigh~td~ ~~edRepresentative 5~ Z-8·-/9

Qgt~

CITY OF CALEXICO FIREWOFtKS STAND PERMIT APPLICATION

MliM&l&R$HIP ROSTSR

ATTACHMENT D

INSTRUCTIONS: The applicant has a choice of using this form or supplylng 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


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 2019. 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 3-31-18 $. ______ _

Net Proceeds from 2018 Fireworks Sales reported to the City on 9-1-18 (Line 4)

SUBTOTAL OF FUNDS AVAILABLE $ _____ _

*ITEMIZED EXPENDITURES: (Expenditures made between 9-1-18 filing date and 4-1-19)

TOTAL EXPENDITURES:

NET FUND BALANCE:

$

$

*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

srhfil6~ Title

Date

,:·I.NTERNAL REVENUE SERVI CE P. o. BOX 2508 CINCINNATI, OH 45201

Date: MAR

CHRIST COMMUNITY CHURCH OF IMPERIAL VALLEY INC

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

Dear Applicant:

DEPARTMENT OF THE TREASUF

Number:

Number:

Accounting Period Ending; DECEMBER

Form 990 Required: NO

Addendum Applies: NO

ID# 9 5218

Based on information supplied, and assuming your operations will be as stated in your ppplication for recognition of exemption, we have determined you are exempt from federal income tax under section 501(a) of the Internal Revenue Code as an organization described in section SOl(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 (;;i.) (1) ;;tnd 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 e~empt 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 a,pply, however, if you make or have made a timely election under section 3121(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 Revenue Service publishes notice to the contrary. However, if you lose your sect~on ~09(~} (1) status, _a g~antor or contr~butor 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 t.he 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 t.ax 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 c~nsideration rGceived. 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 Cumulat.ive Bulletin 19 67-2, 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 penalt) is $100 per day per return, unless there is reasonable cause for the delay. The maximum penalty for an organization with gross receigts 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 ctue date of the return. You are also :tequired to make available for public inspection a copy of your exemption application, any supporting documents ~nd 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 Wic;le 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) I I I I

l r.

. STATE OF CALIFORNIA ,;.; FRANCHISE TAX BOARD

PO BOX 942857 SACRAMENTO CA 94257-0540

Entity Status Letter

Date: 3/29/2017

ESL ID: I

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

Entity ID: 2036245

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

IZJ 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.

IZJ 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 reviver or limitation of the

functions that can be performed by the entity.

Internet and Telephone Assistance

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

916.845.6500 from outside the United States TTYffDD: 800.822.6268 for persons with hearing or speech impairments

FTB 4263A WEB (NEW02-2012)

! t' ,, " r r-,, r ~ ~

NOTICE OF CHANGE

STATE OF CALIFORNIA

OFFICE OF THE STATE rm.E MARSHAL

2251 1-IAR V ARD ST

SACRAMENTO, CA 95815

(916) 445-8373

RETAIL FIREWORKS LICENSE NUMBER Z000249

CHANGE FROM: CHRIST COMMUNITY CHURCH or IMPERIAL VALL,

SWC HEBHR & SECOND ST. CALEXICO, CA

CHi\NGE TO: CHRISTCOlv1MUNITY CHURCH OF IMPERIAL VALL 2540 ROCKWOOD AVE. CALEXICO, CA

DAT8: . 03-26"20 I 9

COMMENTS: LOCATION CHANGE COUNTY : IMPERIAL

CC: CALEXICO FIRE DEPARTMENT

AMERICAN PROMOTIONAL EVENTS, INC,· Wl::ST 665 N. GILBERT $1f\EET, FULLERTON, CA 02033

PKONE (714) 73a,1002 rAX (114) 73MOtl1 VHNl.tntnreworks.CQm

OFFICE OF THE ST ATE FIRE MARSHAL RETAIL FIREWORKS LICENSE APPLICATION

(PrJnt or 'fypc)

Index 5942 PCA 59420 Somce Code l 25700-06

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 15 OF THE CURRENT YEAR.

·1131 S Street Sacramento, CA 95811

(916) 445-8373

RETAIL FIREWORKS LICENSE

Licensee_~~~C,?MMUNITY CHURCH OF IMfgR.l~~-\{_~~~~~~---~-~~--~· ·--··-

~~~~on ___ ~~J~~~~8ER & SEC6N&&f- 2~!}QJiQ~J.5WOQ_P_6VE. City, state & Zip CALEXIC01 CA

County~-~~-~ IM_PE_R_IA_L ______ ---~------·· ------··-···-··· LOCAL CONTACT PERSON

STE:VE BENNm Name __ ~

-Notice-COPYOF THIS NOTICE MUST EE POSTED AT STAND

Wl'fH A COPY OF THE LOCAL PERMIT .

A vall(:lated license has been !~sued to this organization shown above for the s\)le of safe and Sane fireworks at the locallon indicated, Aller a permit has been Issued by the authority having jurisdictfon lhls license allows the sale _of only classified

"Safe .and S<1ile'' fireworks at the approved location fr{)m NOON, JUNE 28 to NOON,JUL Y 6, of the year Indicated. NOTE: Retail licensees are required to be at lea.st 21 years of a9e. employees of fireworks stands must bo at least 18 and fireworks may not be sold to anyone under the age of 16. · · ,

1 ;~~?:i\'\,~iX;;:~·J,''r;·cccf~- ".;~~·,;

MAILING ADDRESS OF LICENSEE

Name l~TNT FIREWORKS Address SSS N, GILBERT

~i~PSltile _!ULLERTON, CA92833

FIRE AUTHORITY HAVING JURl$DICTION

Fire Dopt Ca exlco Fire Departmeht

Address 430 E. 5th St sfgnattire o AfjJj ~ -

City, Slate & Zip Calexico, CA 92231

White;Ucensee • Yellow-Fire Authority• Pink· SFM File

ClXOOOt

ACORD® CERTIFICATE OF LIABILITY INSURANCE 1111/2019 I

DATE (MM/DDIYYYY)

L..----· 11/1/2018 THIS CERTIFICATE IS ISSUED AS A MATIER 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement{s).


3280 Peachtree Road NE, Suite #250 wgN~o Exll· I r..e~ Nol: Atlanta GA 30305 E·MAIL (404) 460-3600

ADDRESS:

INSURER(S) AFFORDING covrnAGE NAJCll

INSURER A: Everest Indemnitv Insurance Comoanv 10851 INSURED

American Promotional Events, Inc. 1NsURERB :Maxum Indemnitv Com:ianv 26743 1359683 DBA TNT Fireworks, Inc. INSURERC:

555 North Gilbert Avenue INSURER D: Fullerton CA 92833 INSURERE: XXX2540 INSURER F:

COVERAGES CERTIFICATE NUMBER· 14584622 REVISION NUMBER: xxxx:xxx THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE ln>m wvo POLICY NUMBER IMMIDD/YYYYl IMMIDDivvYYl

A x COMMERCIAL GENERAL LIABILITY y N SI8GL00242- I 8 I 11/1/2018 11/1/2019 EACH OCCURRENCE $ 1.000 000 - D CLAIMS-MADE [i] OCCUR DAMAGE TO RENTED PREMISES IEa occurrence\ $ 500 000

MED EXP (Any one person) $ 5 000 -PERSONAL & ADV INJURY $ 1000000 -

GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2 000 000 =i DPRO- [Kl LOG PRODUCTS - COMP/OP AGG $ 2 000 000 POLICY JECT

OTHER: $

. AUTOMOBILE LIABILITY NOT APPLICABLE YE~~~~~~1flNGLE LIMIT $ x:xxxxxx -ANY AUTO BODILY INJURY (Per person) $ xxxx:xxx

- OWNED - SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ x:xxxxxx

~ -HIRED NON-OWNED PROPERTY DAMAGE $ x:xxx:xxx AUTOS ONLY AUTOS ONLY IPar accldenll - -$ xxxx:xxx

B x.. UMBRELLA LIAB Fi OCCUR y N EXC6023470-06 1111/2018 ll/l/2019 EACH OCCURRENCE $ 5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5 000 000

OED I I RETENTION$ $ x:xxxxxx WORKERS COMPENSATION NOT APPLICABLE I ~f~TUTE I I OTH-ER AND EMPLOYERS' LIABILITY YIN -ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A -E.L. EACH ACCIDENT_ $ xxxx:xxx -----OFFICER/MEMBER EXCLUDED? (Mandatory In NH) -E.L. DISEASE- EA EMPLOYEE $ xxxxxxx ff yes, describe under

E.L. DISEASE - POLICY LIMIT $ :xx:xx:xxx DESCRIPTION OF OPERATIONS below

DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be al!ached If more space ls required) Additional Insured: Property located at 2450 Rockwood Ave, Calexico, CA, (XXX2540) Ceitificate holder is an additional insured on the General Liability as required by written contract subject to policy tenns, conditions, and exclusions,

CERTIFICATE HOLDER

14584622 Christ Community Church oflmperial Valley and the City of Calexico; its appointed & elected officials, employees, representatives & volunteers when acting in their offical capacities as snch 608 Herber Ave. Calexico CA 92231

ACORD 25 (2016/03)

CANCELLATION


DISPLAY CONSPICUOUSLY AT PLACE OF BUSINESS FOR WHICH ISSUED x980602g

CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION

TEMPORARY SELLER'S PERMIT

ACCOUNT NUMBER

J 254007040 - 00001

CHRIST COMMUNITY CHURCH FRANK ZAZUETA 2540 ROCKWOOD AVE

LALEXICO CA 92231-4406

Valid June 23, 2019 through July 4, 2019

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 TRANFERABLE.

Office of Control: El Centro Branch Office

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

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 1·888·324·2798or1-916·324·2798.

CDTFA-442-ST REV. 7 (5--18)

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.cdlfa.ca.gov Visiting an office Attending a Basic Sales and Use Tax Law class offered at one of our offices Sending your questions In writing to any one of our offices Calling our toll-free Customer Service Center at 1-800-400-7115 (TIY: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 right 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 Department of Tax and Fee Administration (CDTFA) You are responsible for following the regulations set forth by the CDTFA

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 CDTFA 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 CDTFA office, or giving it to a CDTFA representative.

If you would like to know more about your rights as a taxpayer, or If you are unable to resolve an issue with CDTFA, 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 Department ofTax and Fee Administration

Business Tax and Fee Division

Community Development Department l~rE.: [ ·" ~. --;--\7 _~:~ f ~.:1 Planning Division L-~ I

"Temporary Use Permit" . ' 11 :A:,C0'~,~~'.r' 1

1 Request must be subnutteda MINIMUM of15 days m advance of the eve t date'. L'! l!!JJ\NG D!VI~: 10 ,,; ~-~-~·--~--~~-~·~~ T; -· ~ ·---- - ~-~~- •

REQUIRED ATTACHMENTS: 1. Submit one (1) site plan depicting use (minimum size BY.z" 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 additionali.nsured ($1,000,000 minimum per occurrence).

Applicant Name: STEVE BENNETT Applicant Address: PO BOX 2437, FULLERTON, CA 92837-9900 Company Name: TNT FIREWORKS ("WHOLESALER") Location of Event: 2540 ROCKWOOD & 1407 IMPERIAL AVE.

Date of Event: 6/28/19 to 7 /4/19 Total Days: 7 Time of Event: (12-10) 6/28 to (9-10) 6/29-7/4

Date Submitted: 3/24/2019 Phone Number: -7-,1-4--7-3-8--1.,---0_0_2 __ _

Alt. Phone Number: 626-607-4868 (CELL) 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, and the stand will bepicked up on July 6.

tJifSJE Applicant Signature

(For City Use Only)

City Department Recommendation b J Dept. Head Signature: Administration 0Approved 0Denied .'l

Fire [2l' Approved 0Denied ==b. v .\/, 'QJI. Pohce 0Approved 0Denied Utilities Services 0Approved 0Denied Community Services 0Approved 0Denied Redevelopment Agency 0Approved 0Denied Risk Management 0Approved 0Denied Planning Division 0Approved 0Denied Engineering Division 0Approved 0Denied General Services 0Approved 0Denied Other: 0Approved 0Denied

Conditions of Approval:

ALL TEMPORARY USE ,PERMIT MUST COiWPLY 'VITH ZONING ORDINANCE, SECTION 17.11.120 "TEi\'IPORARY 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 1112009

... .. CITYOF·CAl..EXfCO . Flf{S\llJ~RKS $TAf\ip Pl:RMIJ'A~PPl,.ICATiON

PROPERTY OWNER ANP/ORl.ESSOR /LESSEE CONSENT .. ··· .. , . '·:·· .· . ·... . . ·.. . r. . · .. · .. ::,- .. ·. ·. .:.

Pem1ission is hereby' granted to --,-_,_...~T_N-.-T"'--F .... J--,R'-'E"-'W+O'-'-·R...,.K=S'-. ";---'· 7;_,_-10-'4"-'.~ 7---·3 ....... a-"-' .. 1---0-'02,...,.: · --"-"--,-__,.. and (flre\;JS>if<s.Wtiolei}ater)

--,--~~N\~:-\,.._.-,..,,·N~-~$\'-\\:::-____ fr_&_·c_·J~G""'. '""'!V~....,A~C~0~3J..,.,o__,,_r0_-____ . for the excilu::ilve r!Qht to µse the property (Nori·· . proOfbrfiJEihlzatron Name)· · ··

located cit _.,..,~~1~4~o}~· ·"'"IM,.... •. l?~.i::~R~lA""",_~L~.A~V~f.-~ .. "7-.. ~· ·~'·=··· • Cat_~Xl~o"Oalif6mta,-froJi1 8:00 a.m. on June 25, 201 · · (Flrew.ork$·Stahd Adctre$$) ·

thro[Jgh 1,?:po Noohi J~ly El; 201 for a .temp!JrarY firework$ sttJnd to sell safe i;ind sane fir(:).wotks from 12i00

Noon; tP 10;00 p.rii. on June 28, 201 an~ ~:Ob a.rri.'td 10.:00 p.m. onJune.291ii through and lncludtng July 41

201 .

It is unciat~ti:i.~d ~hat the re\all flrew0rks oper~tjq ns ·wfli'!J_e.6onducte1;ilri ~pqordance with ~II Gtiy, qounty, and

stat~ rt=igblaUcitis.

Qwner/l,essor Name: Address: City, Stat€)1 ~lid :Zf p Cd ct~ Telephone .,Num.~er: . . . . .--.~·

BIQnature:

... - •' ..

t 2019,


LOCATION# CLX:1407 ORGANIZATION MINISTERIO EN ACCION

SIZE 6 X 32

SET-UP 6/22

TYPE OPM BACK DOORS 1 ----DOWN 7/6


INTERSECTION NWC BIRCH/ HWY 111 (IMPERIAL)



GRID

SPECIAL INSTRUCTIONS FACE STAND TOWARDS RITE AID, SET STAND IN MIDDLE OF PARKING AREA AS PICTURED. CLOSE TO THE ISLAND THAT IS TOWARD HIGHWAY 111.


DATE (MM/DD/YYYY)

~· 11/1/2018 THIS CERTIFICATE IS ISSUED AS A MATIER 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.



3280 Peachtree Road NE, Suite #250 PHONE I r..e~ Nol: ,,.,,.. ~0 c .. H.

Atlanta GA 30305 E·MAIL ( 404) 460-3600 ADDRESS:

INSURERISl AFFORDING COVERAGE NAIC#

1NsuRER A: Everest Indemnity Insurance Company 10851 INSURED American Promotional Events, Inc. 1NsURER B: Maxum Indemnitv Comnanv 26743 1359665 DBA TNT Fireworks, Inc. INSURER c : Berkshire Hathawav Homestate Ins Co 20044

555 North Gilbert Avenue INSURER D; Fullerton CA 92833 INSURER E; CLX1407 INSURER F:


INSR TYPE: OF INSURANCE ADDL SUBR 1M~\lgM~ 1l1~Jg~ LIMITS LTR '"'•n iun1n POLICY NUMBER

A x COMMERCIAL GENERAL LIABILITY y N Sl8GL00242-181 11/1/2018 11/1/2019 EACH OCCURRENCE $ l,000 000 - D CLAIMS-MADE [i] OCCUR DAMAGE TO RENTED PREMISES IEa occurrence\ $ 500 000 MED EXP (Any ona person) $ 5 000 -PERSONAL & ADV INJURY $ 1000000 -

GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000 000 =i DPRO· [XI Loe PRODUCTS ·COMP/OP AGG $ 2 000 000 POLICY JECT

OTHER: $

AUTOMOBILE LIABILITY NOT APPLICABLE &~"!~~~j.~1~1NGLE LIMIT $ xxxxxxx -ANY AUTO BODILY INJURY (Per person) $ xxxxxxx - OWNED - SCHEDULED BODILY INJURY (Per accldenl) $ xxxxxxx - AUTOS ONLY f--- AUTOS HIRED NON-OWNED F:C.9~~~J.;i;,fiAMAGE $ xxxxxxx AUTOS ONLY AUTOS ONLY - ~

$ xxxxxxx B .X_ UMBRELLA LIAB f4 OCCUR y N EXC6023470-06 11/1/2018 11/1/2019 EACH OCCURRENCE $ 5 000 000

EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5 000 000 DED I I RETENTION$ $ xxxxxxx

WORKERS COMPENSATION N ~_I ~~~TE I I OTH-c AND EMPLOYERS' LIABILITY UB-7J538573 11/1/2018 11/1/2019 ER Y/N

ANY PROPRIETORIPARTNERIEXECUTIVE [BJ NIA E.L. EACH ACCIDENT $ 1000000

OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE- EA EMPLOYEE $ 1000000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE· POLICY LIMIT $ 1000000

DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Addlllonal Remarks Schedule, may be attached If more space Is required) Additional Insured: Property located at 1407 Imperial Ave., Calexico, CA Certificate holder is an additional insured on the General Liability as required by written contract subject to policy tenns, conditions, and exclusions.

CERTIFICATE HOLDER

12229692 Ministero En Accion Mas Que Vencedore and the City of Calexico; its appointed & elected officiafs; employees, representatives & volunteers when acting in their official capacities as such 608 Heber Avenue Calexico CA 92231

CANCELLATION



I

I


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 TNT FIREWORKS " 714a738-1002 and (Fireworks Wholesaler)

G~ \21 SI Lo tYI vVI "' rv1-'\' 7 CA'~ v\ <:~ tA'-1. for the exclusive right to use the property (Non profit Organization Nama)

2__';"L\ D

located at ~ROCKWOOD AVE . Calexico, California, rrom 8:00 a.m. on June 25, 2019 (Fireworna Stand Addreas)

through 12:00 Noon, July 6, 2019 for a temporary fireworks stand to sell safe and sane fireworks from 12:00

Noon, to 10:00 p.m. on June 28, 2019 and 9:00 a.m. to 10:00 p.m. on June 29 lh through and including July 4,

2019.

It Is understood that the retail fireworks operatlo ns will be conducted In accordance with all City, County, and

State regulations.

Owner/Lessor Name: Walmart Inc

Address: 702 SW 8th Street

City, State, and Zip Code: Bentonyllle. AR 72716

Telephone Number: ( 479 ) 2734298

Signature: ,~L_~ ?fSontroll1rliPirtY)

Printed Name: __.K ....... H__.....l t...___.Tu .......... 11 ..... Cm_Ct ...... O __ _ Title / Principal: \\/\ 0..0 l6 § e,r :0:

Dated this \ '1~ day of 'Jin IAOf ~ , 2019.

TNT FIREWORKS SALES ASSOCIATE BENNETT CITY CALEXICO

LOCATION# XXX2540 ORGANIZATION CHRIST COMMUNITY CHURCH-CALEXICO

SIZE 6 X 32

SET-UP 6/22

TYPE OPM BACK DOORS 1 -~~ -~--

DOWN 7/6


ADDRESS 2540 ROCKWOOD AVE. (WALMART)

INTERSECTION NWC ROCKWOOD/ HWY 111 AND COLE RD.

THOMAS GUIDE - COUNTY IMP PAGE GRID

SPECIAL INSTRUCTIONS SET STAND AS SHOWN, IN CENTER OF PARKING SPOTS, NEAR DRIVEWAY. FACE STAND TOWARDS THE REST OF THE WALMART PARKING LOT.


DATE (MM/DD/YYYY)

~ 11/1/2018 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.


PRODUCER Lockton Companies· CONTACT NAME:

3280 Peachtree Road NE, Suite #250 PHONE Ir~~ Nol: IMC Mo Exn: Atlanta GA 30305 E-MAIL ( 404) 460-3600 ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Everest Indemnity Insurance Comoanv 10851

INSURED American Promotional Events, Inc. INSURER B : Maxum Indemnitv Comnanv 26743

1359683 DBA TNT Fireworks, Inc. INSURERC: 555 North Gilbert Avenue INSURER D: Fullerton CA 92833 INSURERE: XXX2540 INSURER F:

COVERAGES CERTIFICATE NUMBER: 14584622 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.

INSR TYPE OF INSURANCE ADDL SUBR ,~ahlgWhi POLICY EXP LTR ....... ""'" POLICY NUMBER IMM/DDiYYYYl LIMITS

A x_ COMMERCIAL GENERAL LIABILITY y N SJSGL00242-l 81 11/1/2018 11/1/2019 EACH OCCURRENCE $ 1000000 D CLAIMS-MADE [i] OCCUR

DAMAGE TO RENTE:D $ 500 000 - PREMISES /Ea occurrence\

~ MED EXP (Any one person) s 5 000

~ PERSONAL & ADV INJURY $ 1000000

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000 000 ~ POLICY D ~:g-r CK] LOG PRODUCTS ·COMP/OP AGG $ 2 000 000

OTHER: $

AUTOMOBILE: LIABILITY NOT APPLICABLE &~~~~~~~l~INGLE LIMIT $ xxxxxxx -ANY AUTO BODILY INJURY (Per person) $ xxxxxxx

~ OWNED ~SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accldenl) $ xxxxxxx

~ ~

HIRE:D NON-OWNED rp~~~~c~[.';,~AMAGE $ xxxxxxx AUTOS ONLY ~

AUTOS ONLY f--

$ xxxxxxx B L UMBRELLA LIAB ~OCCUR y N EXC6023470-06 11/1/2018 11/1/2019 EACH OCCURRENCE $ 5 000 000

EXCESS llAB CLAIMS-MADE AGGREGATE $ 5 000 000 OED I I RETE:NTION $ $ xxxxxxx

WORKERS COMPENSATION NOT APPLICABLE I ~lf~TUTE I I OTH-AND EMPLOYERS' LIABILITY ER

YIN ANY PROPRIETORIPARTNERIE:XECUTIVE D NIA

E.L. EACH ACCIDENT $ xxxxxxx OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE- EA EMPLOYEE $ xxxxxxx If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ xxxxxxx

DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addlllonal Remarks Schedule, may be attached If more space ls required) Additional Insured: Property located at 2450 Rockwood Ave, Calexico, CA. (XXX2540) Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms, conditions, and exclusions.

I

CERTIFICATE HOLDER

14584622 Christ Community Church oflmperial Valley and the City of Calexico; its appointed & elected officials, employees, representatives & volunteers when acting in their offical capacities as such

CANCELLATION


608 Herber Ave. I ' CA 92231 AUTHORIZED REPRESENT~I.\l(E • . ,,:7/ /" .. ,

1--~C-a-ex~1c-o~~~~~~~~~~~~~~~..__~~~-,•;5_t.J{(;'~.~~·~··_._·~-(~~~~--1 ® 1988-2~~0 CORPORATION. All rights reserved.


GL Cost Center: 51101

AMERICAN PROMOTIONAL EVENTS - WEST

dba TNT Fireworks PO BOX 1318 4511 Helton Drive Industrial Park Florence, AL 35630

m~li'!'f.~~ 11mel!ili!l!"'i.tli"irj1"'ii"W-!!ll •14-M•ll@•M.~

20190206 2/6/2019 TEMPORARY PERMIT

REORDER 1105 •U.S. PATE/IT JIO, 553El2!l0, 6575506, 5(N11S31 5765353, 59114364, 6030(

Check No. 20118445

Check Date - 2/7/2019

;;·

Stub 1 of

135.00

135.00

1

135,00

135.00

agenda item 1 - calexico342ed706-1ebb-4fde...2019/06/05 · certificate of insurance for $1,000,000...

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