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200911 � March 13, 2009 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 one (1) license for fireworks in Blair for 2009. We have received both your Certificate of Insurance and Nebraska State Fireworks Permit License 42009-RP-226430-388. 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, l re ; n Z da � Wheeler City Clerk Enc — (2) Cashier's Checks - 48038/48036 Cc: Trinity Lutheran Church, 141 South 2e Street, Blair, NE 68008 0"0"" N 'T' ITY 218 South 16th Street - Blair, Nebraska 68008 - 402 -426 -4191 - Fax 402 -426 -4195 - E -mail cityofblair @ci,blair.ne.us 'rise of av f 1. 2. 3. 4. APP LICATION FIREWORK LICENSE Calendar Year for Application 2001 Name of Applicant T n; tv Luthern Youth Group Address of Applicant 141 South 20th Blair, NE 68008 Contact Person Kristen Grote Phone# 402 -426 -5649 Is applicant working through a vendor? Yes ® No ❑ 5. Name of vendor participating with applicant (if applicable) Ka-Boomer's Ent . Inc 6. Address of vendor _p, Rox .£fib er - oo NE 6 8 0 66 847 Highway 77 Wahoo, NE 6 Contact Person rich Ludvik Phone #402-443-4593 7. Is certificate of insurance held by applicant or vendor? . Vendor LN Applicant ❑ 8. If held*by vendor, does insurance name applicant and city as additional insurers? Yes No ❑ 9. . License fee - $5,000 (Attached) 10. Certificate of Insurance (Attached) 11. Sales Tax # 156719 81 (Name Of Holder) Ka- Bo omer's Enterprises, Ine.. I/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. 1lwe 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. - /,; - 0 7 Date _ Z-16 Date FOR CITY USE ONLY: r. Date Received Applicant awarded license: Yes Time Received No ❑ F i E ' # i- i} �i� F3 11 f7 u u l yeses 246 South i 4tH H Street eet Lincoln, NE 68508 -1804 s LIC ENSE L FIREWOR 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 2 — 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: 2/4/2009 TYPE OF LICENSE AND FEE: RETAILER LOCATION OF OUTLET FOR RETAIL SALE OF FIREWORKS: Stand# g -RP- 226430- 388 -RL -003 13TH AND BUTLER BLAIR $250 STORAGE LOCATION: 13TH AND BUTLER BLAIR DISTRIBUTOR(S) /JOBBER(S): KA- BOOMERS ENTERPRISES, INC. SALES TAX NUMBER: 15671981 COUNTY WASHINGTON WASHINGTON DATE ISSUED: 2/6/2009 � jfrr � STATE FIRE MARSHAL H KA- '• :• LICENSE NUMBER WAHOO NE 68066- 2009- ACORD LIABIITY INSURANCE ,, CERTIFICATE OF L UAI E fMMJVD1Yyyy) 12/15/2009 FOR THE POLICY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER PLATTE VALLEY INS CORP ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR R & Huston ALTER THE COVERAGE AFFORDED BY THE POLI BELOW. 509 W Koenig St RLQUIREI-MEW, I IE INSURANCE AFFOROLL) BY - 11-IE POLICIES DESCRIBED IIERFIN IS SUBJECT P 0 Box 12-28 M I. NF ftf�fl7 1 INSURERS AFFORDING COVERAGE NAIC # INSUR t) INSUREP.A; E-vanstan Insurance Conipanyf' Non Admi-tter Ka--Boomers Enterprises, Inc. 847 Hwy 77 WW, I I Ipcg \Nahoo, NE 68066 INSIJRPRC GENERAL UAHJUI X 1r SURER COVEKAILit-5 OF INSURANCf-'-Lisl'EDBELOVVHAVE BEEN ISSULD'i THE INSURED NAMED Ai3OV FOR THE POLICY PLRIOD INDICAILD, NOf THL POLICIES VLRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RLSPECT TO %NHICHTHIS CLRTIPICAI L MAY BL 18SULD OR ANY RLQUIREI-MEW, I IE INSURANCE AFFOROLL) BY - 11-IE POLICIES DESCRIBED IIERFIN IS SUBJECT TO ALL THE TERMS, LXCLUSIONS AND COND1110-NISOF SUO I MAY POLICILS. PLRTAIN,J AGGRLGATL LIMITS SHOAtN MAY HAVE BELN REDUCED BY PAID CLAIMS. POLICYEXPIKAII 1"'. MM!DIYYY), WW, I I Ipcg ; POLICY EFFECTWE tlp� TYPkDJqaV E P NUMBER PATE WMIDWY1 !Aqq J- LIMITS EACHOCCURRENCI 2,000,000 GENERAL UAHJUI X PRFPn s > $ 100,000 COMMERCIALGI.NFRAI. LIAHu-rry CLAIW'FMADE MF0 FXS'(AnV We POT301 6 Excluded A SP836232 4/15/09 O"rs & Contractom 4/15/1 PERSONAI & A0V 141,11 IR" 2,000,000 ... ... AGGREGATF S 2,000,000 PRODUCT 5; - CCV.APfOP AC4(4 1W -- -------- AUTOMOBILELIAHILITY C01-AHINFL) 81WA.f- LIK I ANYAkJTO -_4 ALL OWNEDAUVOS HODILYINJUfrf SCHF() RFOALROS (pet pefwri) HIRED AIY10G HODI-Y INJUR" NON-OMNEDAU'05, PROPERI Y UAMAGI- (4ARAGE LIABILITY j ANY AUTO 01 HE I H414 FAACC' AU100110' m � i C, EXCESS)UMBRELL.ALIAMIty CCURRE.W3. ( MADE AGGREGATE ------- - ---- ----- DF-fAJ`T JOTH- WORKERS COMPENSATION AND It IT 1 1 EMPLOYERS'LIABILITY i F L. EACH ACC IDP, NT -- - --- ---- F L-A FJAPI,CYW� It I71riF.-ASE • POLICY Lif-AT SPECIAt PROVISI.Cmsbelow OTHER DESCRIP I ION OF OPERATIONS I LOCATIONS I VEHICLES /EXCLUSIONS ADDED HY ENDORSEMENT I SPECIAL PROVIISIONS Deductible: Coverage A (BI & PD); $6,000, Coverage B (Personal Injury & Advertising Injury); $5,000 Stand Location: 13th & BLrtler, Blair, NE Additionni Insured: City of Blair and all it employees, Trinity Lutheran Church SHOULD ANY OF THE A13OVE DESCRIBED POLICIES BE CANCELLED BEFORE ImE EXPIRAI ION City of Blair 218 South 161h DAXE THEREOF, THE ISSUING INSURER WILL ENDEAVOR L 'IQ_ 10 MAIL L�AYS VVNITTEN Blair, NE 68008- NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, SUI F�AK.tjREIO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON IHU INSURER, trS AGENTS OR REPRESENTATIVES. --- AUTHORIZED REPRESENTATIVE is nampd as additional inwrod Hull & Co., Inc. - Lincoln grlt�el%l [c) ArCIRD CORPORATION 1988 ACORD 25 (2001108) Ems 9 March 13, 2009 Jeff Tracy Phantom Fireworks 2840 S. 70 Street, Ste -7, PMB -149 Lincoln, Nebraska 68506 RE: Firework License in Blair Dear Mr. Tracy, The Blair Eagles Aerie #3215 has been awarded one (1) license for fireworks in Blair for 2009. We have received your Certificate of Insurance but will need to receive your Nebraska State Fireworks Permit License no later than June 15, 2009. 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 minim 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, i Lei" Brenda Wheeler City Clerk Enc Cc: Blair Eagles Aerie #3215, PO Box 242, Blair, NE 68008 01PO HOUSING OPPORTUNITY 218 South 16th Street - Blair, Nebraska 68008 - 402 -426 -4191 - Fax 402 -426 -4195 - E -mail cltyofblair @cLblair,ne,us 1'7ise of av 1. 2. 3. 4. 5. Calendar Year for Application 2009 Name of Applicant A 1 , t �`t Address of Applicant 7 L A Z CA t a u Contact Person Phone Is applicant working through a vendor? Yes ' No ❑ of vendor participating with applicant (if applicable) 6. Address of vendor 2- 9 4 i A -ZZff Contact Person Phone # (qcyz El 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 Y No El 9. License fee - $5,000 (Attached) 10. Certificate of Insurance (Attached) 11. Sales Tax # 01 -- 2 (Name of Holder) 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 fir r cs in the City of Blair, Nebraska. C�4 /t'� Applicant Date -- r-7 ... if a lica e) Date FOR CITY USE ONLY: Date Received Applicant awarded license: Yes Time Received 10 • E I DATE (MM /DD/YYYY) rM 2/17Z2009 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. POLICY EFFECTIVE DATE MM /DD/YY POLICY EXPIRATION DATE MM DD Y LIMITS INSURERS AFFORDING COVERAGE NAIC # INSURED B.J. ALAN COMPANY BIG BEAR FIREWORKS, INC., PHANTOM FIREWORKS, IN 555 MARTIN LUTHER KING JR BLVD INSURERA: Lexington Insurance Co 10/30/2008 INSURER B: Granite State Insurance Co. 23809 INSURERc:Libert Mutual Group/Boston 23043 INSURERD:Arch Speciality Ins Co 21199 YOUNGSTOWN OH 44502 INSURER E: DAMAGE TO RENTED PREMISES Ea occurence 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 LTR DD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM /DD/YY POLICY EXPIRATION DATE MM DD Y LIMITS A GENERAL LIABILITY 43925182 10/30/2008 10/30/2009 EACH OCCURRENCE $1,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurence $50,000 CLAIMS MADE Fx_1 OCCUR MED EXP (Any one person) $ PERSONAL &ADV INJURY $1 GENERALAGGREGATE $2 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP /OPAGG $2 POLICY jE X LOC B AUTOMOBILE X LIABILITY ANY AUTO CA6 2 6 514 6 6 10/3 0/2 008 10 / 3 0/2 0 09 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ OTHER THAN EAACC $ ANYAUTO $ AUTO ONLY: AGG D EXCESS /UMBRELLA LIABILITY UFP 0 0 3 0 3 6 0 10/3 0/2 0 08 10/3 0/2 0 09 EACH OCCURRENCE $9 X I OCCUR FI CLAIMS MADE AGGREGATE $9 $ DEDUCTIBLE $ RETENTION $ C'' WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC734S320207 10/30/2008 10/30/2009 LI X S 1 I OER ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $500 E.L. DISEASE - EA EMPLOYEE $500 OFFICER /MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS OCATION: Blair, NE 68008 / 1301 Butler St. / Vet's Field PROPERTY OWNER: City of Blair; 218 South 16th Street; Blair, NE 68008 DDITIONAL INSURED: Blair Eagles Aerie #3215 PO Box 242; Blair NE 68008 UNICIPALITY: Blair, NE 68008 Group Code: Lincoln, NE CERTIFICATE HOLDER CANCELLATION City of Blair 218 S. 16th Street Blair NE 68008 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 CITY Of I)tAIQ �� :fix �� �5 � t" - �r t• �r0 � �iI�V � IVY ri o f av March 13, 2009 Jim Stannard Bellino Fireworks, Inc. 501 Olson Drive Papillion, NE 68046 RE: Firework License in Blair Dear Mr. Stannard, Dana College Baseball has been awarded one (1) license for fireworks in Blair for 2009. We have received both your Certificate of Insurance and Nebraska State Fireworks Permit #2009-RP-229569-403. 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, ,94&A- Wheeler City Clerk Enc Cc: Ken Misfeldt, Dana College Baseball/Athletics, 2848 College Drive, Blair, NE 68008 OPPORTUNITY 218 South 16th Street - Blair, Nebraska 68008 - 402 -426 -4191 - Fax 402 - 426 -4195 - E -mail ci ty ofblair @cLblair,ne,us 1. Calendar Year for Application 2009 2. Name of Applicant C s 6 3. Address of Applicant C ;)z C"o Ls-.C� b C� "Kia-'(1 bS"oE)8 U Contact Person 6,1 Phone # 9L/q— 3-Xq,2,) q2(o--' 3 4. Is applicant working through a vendor? Yes 2 No ❑ 5. Name of vendor participating with applicant (if applicable) 6. Addressof -vendor 5�01 L ('9 ?'D �-1 co Contact Person -� ((n Phone# t-C®d —'1 9 1(p 7. Is certificate of insurance held by applicant or vendor? Vendor Applicant ❑ 8. If held by vendor, does insurance name applicant and cit as additional insurers? Yes No ❑ 9. License fee - $5,000 (Attached) 10. Certificate of Insurance (Attached) 11. Sales Tax # '&YA I I q . (Name of Holder) LWI no *elu O'Aks FWC 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 ftirther 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 Time Received Applicant awarded license: Yes No ❑ DATE (MMIDDIYYYY) CERTIFICATE F LIABILITY INS RANCE "" 211112009 PRODUCER Phone: 440 -248 -4711 Fax: 440- 248 -5406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Britton - Gallagher and Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6240 SOM Center Rd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Cleveland OH 44139 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Lexington Insurance Co Bellino Fireworks Inc INSURER B: 501 Olson Drive, St 210 Papillion NE 68046 INSURERC: INSURER D: INSURER E: W • _ 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 LTR DD`L N POLICY NUMBE POLICY EFFECTIVE DATE M D POLICY EXPIRATION DA E MM DD LIMITS A GENERAL LIABILITY 5379100 5/ 4/ 2 0 0 9 5/4/2010 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES Eaaccurence ) $50,000 CLAIMS MADE Fx_1 OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 KEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PE0 x LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (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 $ OCCUR FI CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- TbRY 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 / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Location: 1301 Butler St, (Vets Field) Blair Ne, C Prairie Park Add Lot4 -11 E. 92ft of Lot3 Blk4 Additional Insured: City Of Blair Ne. Dana College Baseball /Athletics Donald J. & Valerie R. Bellino tiCK I Ir14A I C 11ULUMK UANULLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER Bellino Fireworks Inc. WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE 501 Olson Drive Suite 210 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Papillion NE 68046 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/081 riACORD CORPORATION 1 9R 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. 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: ITPE OF LICENSE AND FEE- RETAILER LOCATION OF OUTLET FOR RETAIL SALE OF FIREWORKS: IIQ STORAGE LOCATION: VETS FIELD BL4|R 8341141 WASHINGTON WASHINGTON 2/17/2O0Q _ STATE FIRE MARSHAL LICENSE HOLDER: BELL|N[)FIREWORKS, INC. 501 (]LG[)KJ ORSTE 210 PAPILLION NE 68046- 2009-RP-229569-403