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2008t • i � � eo !" i seot a April 4, 2008 Rich Ludvik Ka- Boomers Fireworks P.O. Box 86 Wahoo, NE 68066 RE: Firework License in Blair Dear Mr. Ludvik, The Trinity Lutheran Church has been awarded two (2) licenses for fireworks in Blair for 2008. We have received both your Certificate of Insurance and Nebraska State Fireworks Permit. Enclosed you will find a map indicating the location of the space that has been designated for your sales outlet at Vet's Field. Please remember that your tent will need to be sized accordingly to allow for setup of the tent along with storage of all trailers and trash containers to meet the minimum State Fire Marshal standards on setback requirements (Please see attached map for layout options and maximum tent size).You are also required to furnish trash service providing ample trash containers to handle your own trash accumulation. All trash related to firework business is required to be cleaned up daily. The City will provide one 110 volt, 15 amp outlet for each of the spaces. If you have any questions or need additional information, feel free to contact me. We look forward to working with you for a safe and profitable fireworks season. Sincerely, Brenda Wheeler City Clerk Enc Cc: Trinity Lutheran Church, 141 South 20 Street, Blair, NE 68008 EQURLNOUSINO 218 South 16th Street • Blair, Nebraska 68008 • 402 -426 -4191 • Fax 402 - 426 -4195 • E -mail cltyofblair @ci,blair,ne,us OViORTUNITY APPLICATION FIREWORKLICENSE 1. Calendar Year for Application 2008 2. Name of Applicant Trinity Luthern Youth Group 3. Address of Applicant 141 South 20th Blair, NE 68008 Contact Person Kristen Grote Phone # 402 -426 -5649 4. Is applicant working through a vendor? Yes M No ❑ 5. Name of vendor participating with applicant (if applicable) Ka-Boomer's Ent . Inc 6. Address of vendor pc) p R6 wa h oo , NE 68066 847 Highway 77 Wahoo, NE 6806 Contact Person Rich Ludvik , Phone # 402-443-4593 7. Is certificate of insurance held by applicant or vendor? Vendor ® Applicant ❑ 8. If held*by vendor, does insurance name applicant and city as additional insurers? Yes 13 No ❑ 9. License fee - $5,000 (Attached) 10. Certificate of Insurance (Attached) 11. Sales Tax # -15671981 (Name of Holder) Ka- Boomer's Enterprises, Ine. Uwe, the authorized representative of the above applicant and/or vendor, do hereby make application for a fireworks license to be issued by and through the City of Blair, Nebraska. Uwe further agree to abide by all regulations and ordinances of the City of Blair, Nebraska and State of Nebraska relative to this application and the sale and storage of fireworks in the City of Blair, Nebraska. NEBRASKA STATE FIRE MARSHAL 246 South 14th Street r Lincoln. NE 68508 -1804 LICENSE FOR SALE OF FIREWORKS Permissible fireworks may be sold at retail commencing 12:01 AM June 25 and ending 11:59 PM July 4 and must be purchased from a licensed distributor or jobber. A jobber may not sell retail. Invoice copies for all fireworks must be kept available for inspection and must show the license number of the distributor or jobber. Fireworks may not be sold outside the city limits of an incorporated town or village. Violations of State Fire Marshal regulations may result in immediate revocation of this license. LICENSE GOOD ONLY FOR JUNE 25 - JULY 4 OF YEAR LICENSE ISSUED This copy signed, dated and numbered by the STATE FIRE MARSHAL constitutes issuance of a LICENSE pursuant to the provisions of Nebraska Revised Statute 28 -1246 (1994 Supp.). Such license shall be displayed at licensee's place of business. DATE RECEIVED: 1/16/2008 TYPE OF LICENSE AND FEE: RETAILER $250 LOCATION OF OUTLET FOR RETAIL SALE OF FIREWORKS: Stand# 3 -0= 124435- 017 -RL -004 13TH AND BUTLER BLAIR STORAGE LOCATION: 13TH AND BUTLER BLAIR DISTRIBUTORS) /JOBBER(S): KA- BOOMERS ENTERPRISES, INC. SALES TAX NUMBER: 15671981 LICENSE HOLDER: KA- BOOMERS ENTERPRISES: INC. PO BOX 86 COUNTY WASHINGTON WASHINGTON DATE ISSUED: 1/24/2008 STATE FIRE MARSHAL LICENSE NUMBER WAHOO NE 68066- 2008-RP-1 24435-017 ALLIED SPECIALTY INSURANCE OF TEXAS 25 ME LOOP 418,p SUITE 6" SAN ANTONIO, TEXAS 7a2lfi 2.10-341-.1321 114**401 lif I '' 1 11 W I I zlid� .1 . WI *151t 0-1 A kl-�� MAKE & ADDRESS OF INSURED: Ka-Boomers ■ Enterprises, In. P.O. Bx 86 Wahoo RE 68066 City of Blair 218 South Kith Blair, NE 68008 Conpanyq: T.H.E. Insurance Company P01W Number: M5MT7137 LIABILITY LIMITS BI/PD: OCC $ 1,000,000 AGG $2,000,000 ADDITIONAL INSURED: City of Blair & Employee's Trinity Luthern Church STAND LOCATION.- Vet's Field 13th & Butler Blair, NE 68008 1*1M, Bodily In ury & Property Aamage $ 1,000,000 $1,000,000 Products- 1,000,000 Policy P;riod: rrom; 02101108 To. 02101109 if Coverage shown herein applies only to those items scheduled on or endorsed to the policy. This certificate is not valid unless an original signature appears below. (Copies Not Valid). Coverace under the policy is conditioned upon full c ompliance by all insureds I with all applicable National Fire Protection Association (NFPA) codes and standards In effect at the time the stand is open. February 7, 2008 -&-1 �AUTHUHIZED kiXONATURE '4� A 9 I If-r% tkMr"^l A I 'r'%1 lKint IM A klr%f IKV% APPLICATION FIREWORKLICENSE 1. Calendar Year for Application 2008 2. Name of Applicant Trinity Luthern Youth Group 3. Address of Applicant 141 South 20th Blair, NE 68008 Contact Person _Kristen Grote Phone# 402 - 426 -5649 4. Is applicant working through a vendor? Yes ® No El 5. Name of vendor participating with applicant (if applicable) Ka-Boomer ' s Ent. Inc 6. Address of vendor po Bc)x 86 Wa h op NE 68066 847 Highway 77 Wahoo, NE 680 Contact Person _Ri_ch Ludvik Phone # 402-443-4593 7. Is certificate of insurance held by applicant or vendor? Vendor ® Applicant 8. If held'by vendor, does insurance name applicant and city as additional insurers? Yes FN No ❑ 9. License fee - $5,000 (Attached) 10. Certificate of Insurance (Attached) 11. Sales Tax # - 15 6 71 981 (Name of Holder) Ka- Boomer's Enterprises, In6. Uwe, the authorized representative of the above applicant and/or vendor, do hereby make application for a fireworks license to be issued by and through. the City of Blair, Nebraska. Uwe further agree to abide by all regulations and ordinances of the City of Blair, Nebraska and State of Nebraska relative to this application and the sale and storage of fireworks in the City of Blair, Nebraska. NEBRASKA STATE FIRE MARSHAL 246 South 14th Street Lincoln, NE 68508 -1804 LICENSE FOR SALE OF FIREWORKS Permissible fireworks may be sold at retail commencing 12:01 AM June 25 and ending 11:59 PM July 4 and must be purchased from a licensed distributor or jobber. A jobber may not sell retail. Invoice copies for all fireworks must be kept available for inspection and must show the license number of the distributor or jobber. Fireworks may not be sold outside the city limits of an incorporated town or village. Violations of State Fire Marshal regulations may result in immediate revocation of this license. LICENSE GOOD ONLY FOR JUNE 25 - JULY 4 OF YEAR LICENSE ISSUED This copy signed, dated and numbered by the STATE FIRE MARSHAL constitutes issuance of a LICENSE pursuant to the provisions of Nebraska Revised Statute 28 -1246 (1994 Supp.). Such license shall be displayed at licensee's place of business. DATE RECEIVED: 1/16/2008 TYPE OF LICENSE AND FEE: . RETAILER LOCATION OF OUTLET FOR RETAIL SALE OF FIREWORKS: Stand# 3 -RP= 124435- 017 -RL -004 13TH AND BUTLER BLAIR $250 STORAGE LOCATION: 13TH AND BUTLER BLAIR DISTRIBUTORS) /JOBBER(S): KA- BOOMERS ENTERPRISES, INC. SALES TAX NUMBER: 15671981 COUNTY WASHINGTON WASHINGTON DATE ISSUED: 1/24/2008 STATE FIRE MARSHAL LICENSE HOLDER: KA- BOOMERS ENTERPRISES; INC_ PO BOX 86 WAHOO NE 68066- 24435-017 r i ( IF 11MAS ;t,' s a 3 . i , 210-3741-JL323L Certificate Number.- 0@e54 This certificate neither affirmatively nor neg tivelyamende extends or alters the covers a afforded by the policyties described hereon and.i.s issued as a matter of inormation and confers no right upon the holder. The olic (ies) identified below by a olicy number is in. force on the date of certfi.cae issuance. Insurance is aforded only with respect to these coverages for which a specific limit of liability has been entered and is subject to all terms of the policy having reference thereto, nothing herein contained shall modify any provision of said policy. In the event of cancellation of the policy, the Company issuing said policy will make all reasonable effort to send Notice of Cancellation to the Certificate Holder at the address shown herein, but the Co many any assumes no responsibilities for any mistake or failure to give such notice. Any insurance grade a. part of the policy includes as a pperson insured with. respect to an'occurrence taking place at a Fireworks Stand site: {i} the Fair or exhibition associationp sponsoring organization or committee (2) the owner or lessee thereof C3Y a munici a.l.ity granting the Named Insured permission to a operate a(n) Fireworks Stand, ut only as res cts bodily injury or-property damage caused by or contributed to by the negligence of the amed Insured while acting in the course and scope of their employment. RARE & ADDRESS OF INSURED Ha- Boomers Enterprises, Inc. P.O. Box 8€, Wahoo HE 68066 ADDITIONAL. INSURED City of Blair & Employee's Trinity Luthern Ch_ureb ► f - City of Eclair 218 South 16th Blair, NE 68008 1! Coupany: T.H.E. Insurance Company Policy Dumber: M5MT7137 LIABILITY LIMITS BI lPB s QCC $ 1,000,000 AGG $ 2,000,000 Products: $ 1,000,000 Policy Period: From 01 To 02101/09 STAND LOCATION: (reds Field 13th & Butler Blair, NE 68008 i2tA" 61 b Bodily In ury & Property 88mage $ 1.000,000 Bodily Injury &' Property Damage $ 1,000,000 - COMBINED SINGLE LIMIT Covers a shown herein applies only to those items scheduled on air endorsed to the polio This cert1heate is not valid unless original stgnature appears hie o w (Copies Not Valid). Cov+era a under the policy is conditioned upon full compliance by all insureds with ell a plicable National Fire Protection Association (HF codes and standards n effect at the time the stand is open. February 7, 2€103 A a i tP°S! nT1t°ftt h i Tit tk r%i fig A& lt% ® IKI^ " _ April 10, 2008 Rick Dooly Bellino Fireworks, Inc. RE: Tent Size You are hereby authorized to place a 60 x 60 tent on the 75 x 100 lot for your sales outlet in Blair. Please be advised that we are authorizing you to place a 60 x 60 tent on this site but it is your responsibility to assure that your tent can meet the requirements of the State Fire Marshal and assume all liability for those restrictions in reference to your tent placement. As a reminder, all storage and trash containers also need to be placed on this lot in compliance with the Fire Marshal regulations. If you have any additional questions, feel free to contact me. Thank you. Sincerely, Brenda Wheeler City of Blair OPPOPTUNITY 218 South 16th Street ® Blair, Nebraska 68008 ' 402 -426 -4191 • Fax 402 - 426 -4195 ' E -mail ciiyofblair @ci,blair.ne.us V 0 on Fil 9 �iise of April 4, 2008 Jim Stanward Bellino Fireworks, Inc. 501 Olson Drive Papillion, NE 68046 RE: Firework License in Blair Dear Mr. Stanward, Dana College Baseball has been awarded one (1) license for fireworks in Blair for 2008. We have received both your Certificate of Insurance and Nebraska State Fireworks Permit. Enclosed you will find a map indicating the location of the 75' x 100' space that has been designated for your sales outlet at Vet's Field. Please remember that your tent will need to be sized accordingly to allow for setup of the tent along with storage of all trailers and trash containers to meet the minimum State Fire Marshal standards on setback requirements (Please see attached map for layout options and maximum tent size).You are also required to furnish trash service providing ample trash containers to handle your own trash accumulation. All trash related to firework business is required to be cleaned up daily. The City will provide one 110 volt, 15 amp outlet for each of the spaces. If you have any questions or need additional information, feel free to contact me. We look forward to working with you for a safe and profitable fireworks season. Sincerely, ,&X4 Brenda Wheeler City Clerk Enc Cc: Ken Misfeldt, Dana College Baseball/Athletics, 2848 College Drive, Blair, NE 68008 EOURLNOUSIN0 OPPOflTUNiTY 218 South 16th Street • Blair, Nebraska 68008 • 402 -426 -4191 • Fax 402 - 426 -4195 ® E -mail cityofblalr @cl.blalr.ne.us i:. V V A ,, N. 1. Calendar Year for Application 2008 Contact Person kc- 1�.', �� ��- Phone # �1 C� 1 4. Is applicant working through a vendor? Yes No F 5. Name of vendor participating with applicant (if applicable) 6. Address of vendor Contact Person ®cam rJ 1&3 Phone # 7. Is certificate of insurance held by applicant or vendor? Vendor Applicant ❑ €l. If held by vendor, does insurance name applicant and city as additional insurers? Yes Q- No ❑ 9. License fee - $5,000 (Attached) 10. Certificate of Insurance (Attached) 11. Sales Tax # �j - 7 o S? (Name of Holder -C; 1 /we, the authorized representative of the above applicant and/or vendor, do hereby make application for a fireworks license to be issued by and through the City of Blair, Nebraska. Uwe further agree to abide by all regulations and ordinances of the City of Blair, Nebraska and State of Nebraska relative to this application and the sale and storage of fireworks in the City of Blair, Nebraska. FOR CITY USE ONLY: Date Received 3/ 3 / 09 Time Received , I , - Date — /0 C� Date Applicant awarded license: Yes No ❑ As NEBRASKA STATE FIRE �, 24 S 1 Street Linc 68508-180 �a LICENSE FOR SALE OF FIREWORK Permissible fireworks may be sold at retail commencing 12:01 AM June 25 and ending 11:59 PM July 4 and must be purchased from a licensed distributor or jobber. Ajobber may not sell retail. Invoice copies for all fireworks must be kept available for inspection and must show the license number of the distributor or jobber. Fireworks may not be sold outside the city limits of an incorporated town or village. Violations of State Fire Marshal regulations may result in immediate revocation of this license. °�, � fit) ��� �•' , �. �,. This copy signed, dated and numbered by the STATE FIRE MARSHAL constitutes issuance of a LICENSE pursuant to the provisions of Nebraska Revised Statute 28 -1246 (1994 Supp.). Such license shall be displayed at licensee's place of business. DATE RECEIVED: 1/23/2008 TYPE OF AND RETAILER $25 Stand# 3 -RP- 125291- 038 -RL -001 VETS FIELD BLAIR STORAGE L O CATIO N: F I E LD VETS BLAIR DISTRIBUTOR(S)/JOBBER(S): BELLINO FIREWORKS INC 1: • :: COUNTY WASHINGTON WASHINGTON DATE ISSUED: 1/24/2008 �z el/lx STATE FIRE MARSHAL LICENSE MOLDER: BELLINO FIREWORKS INC 501 OLSON DRIVE SUITE 210 PAPILLION NE 68046- 2008-RP-1 25291-038 C L' I L' Tv I N CERTIFICAT DATE (MM/DD/YYYY) TM r i ' 2/29/2008 PRODUCER Phone: 440 -248 -4711 Fax: 440- 248 -5406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Britton- Gallagher and Associates, Inc. 6240 SOM Center Rd. Cleveland OH 44139 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POUCYEFFECTIVE D TE D POLICY EXPIRATION DATE DD LIMITS INSURERS AFFORDING COVERAGE NAIC # INSURED Bellino Fireworks Inc 501 Olson Drive, St 210 INSURERA: Lexington Insurance Co 5/ 4/ 2 0 0 8 INSURER B: EACH OCCURRENCE INSURERC: Papillion NE 68046 INSURER D: INSURER E: DAMAGES RENTED PREMISES Ea occurence $50,000 COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR DD'L INSR TYPE OF INSURANCE POLICY NUMBER POUCYEFFECTIVE D TE D POLICY EXPIRATION DATE DD LIMITS A GENERAL LIABILITY 6690263 5/ 4/ 2 0 0 8 5/4/2009 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGES RENTED PREMISES Ea occurence $50,000 CLAIMS MADE a OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $2,000,000 POLICY M J ROT X I LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC $ ANYAUTO $ AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR FI CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- TORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Location: Vets Field Blair,NE Additional Insured: City of Blair Dana College Baseball / Athletics GtK I IFIt:A I t MULUtK GANGELLATIUN Bellino Fireworks Inc 501 Olson Drive Papillion NE 68046 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) © ACORD CORPORATION 1988