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2015„ ;> �`� t \�� J e ��se of a March 9, 2015 Rich Ludvik Ka- Boomers Enterprises, Inc. PO Box 86 Wahoo, NE 68066 RE: Firework License in Blair Dear Rich, The Washington County Long -Term Recovery Team has been awarded one (1) license for fireworks in Blair for 2015. Please submit a current Certificate of Insurance as well as your Nebraska State Fireworks Permit License by June 19, 2015. 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 no larger than 40 x 40 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. City Staff will have the area marked for setup. You are also required to furnish trash service providing a trash container no larger than six (6) yards to handle your own trash accumulation (see attached map for trash storage). 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 218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 o Fax 402 - 426 -4195 • E -mail cltyofblair@ci,blaicne,us CITY OF BLAIR APPLICATION FOR FIREWORK LICENSE Contact Person 'P- c L Lu y'i y- Phone # D . _ �'(-/ 3 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 P No ❑ 9. License fee - $5,000 (Attached) 10. Certificate of Insurance (Attached) 11. Sales Tax # l 71 �'` (Name of Holder) 0'b .S Uwe, the authorized representative of the above applicant and /or vendor, do hereby make application for a fireworks license to be issued by and through the City of Blair, Nebraska. Uwe further agree to abide by all regulations and ordinances of the City of Blair, Nebraska and State of Nebraska relative to this application and the sale and storage of fireworks in the City of Blair, Nebraska. -C Date Date FOR CITY USE ONLY: Date Received Time Received Applicant awarded license: Yes El No D ACC-PRO CERTIFICATE OF LIABILITY INSURANCE DATE PAIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND, ONF R,$ NO RIGHTS UPON THE CERTIFICATE H LDER. Tills CER TIFICATE DOSS NOT AFFIRMATIVELY O NEGATIVELY MEND,' TEN QR ALTER THE COVER AGE A 'Fi1RDF —D 0 Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSI,IRER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT* If the certificate holder Is an ADDITIONAL INSURED, the pollcy (ies) Mast Ise endorsed. It ai_I RIB A1I5 IS W MVIED, subject to the terms and conditions of the policy, certain policies may rmquire an endorsement. A statement o this certificate does not confer rights t o the certificate holder inlieu'ofsuchanderr emeh s i'BULUCE� ATE: Ryder Rosacker & Huston (MGD by Dull & Compa =Lx- he :..�;� t�c N. 0 09 W Koenig St n Grand Island NE 63802 _ 1NS8RE�AFFORDING COVERAGE N9AIC 0 INSURER A �SCQTT 1297 -ALE IN INSURED INSURER 8 - dba Ka- Boomers Areworriss INSU32ER3?: PIS Sox Its Wahoo NE 5S9t35 'IN�sUT�q INSURER F COVERAGE$ CERTIFICATE NET E R. 989332736 REVISION NUMBER* THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMET) ABOVE FOR THE PDI_ICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIRCMENL TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT At1ITH RESPECT TO VA18CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES bESCRISEDJ4EREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS CONDITIO OF SUCH POLICIE& LIMITS SHC)VtV MAY I" AVE BEEN REDUCED BY PAID CLAIMS. 3NISR' LT TYr'E Ian IPdSURANDE 31 8� 4AfUl i7DlIGYE€ P4?i 1GY 8 UMBER NR IDOT4 PoucYE?Cp MMIDI LIMITS GENERAL LIABILITY � rP$221We4 �f1512D'8� /'i,6il2016 EAGi'DCGURRENGE 51,�C3Q,Oa0 £xG @iNhERCIAL OE£aERAL L1ABI1 .tTY CLAIMS -NAAAE OCCUR � DAMAGE TO REN FED PNi3= 1rSIaES fza accunc>nc�` w9fl4,Qi1{1 MEDF -XP Aaywe raw) $5,000 P $1 ,500,00 0 ( I I ____ _ GrNERALAoGR 2.I1C80 JCI1l _ .... . .... ,. LL PRODUCTS - GnR Pf{�? AEG 52,0t10,t3f3t) GEML taGGl?EGATE LtMI AFPLIE s PE2 � m.._ _ _ s POLICY PR LCiC I, AVT0MQ01LE LIASILITY BODILY IN4URY(ParPeisga) � ANYAUTO AUTOS OWNED AUTOSSULEG 80DILY INJURY (Pereccident) a Pt;t�PL-R I f I�RivIAGE S NON -OWNED HiRFDAUT`rS AUTO � ^n I UM SR x OCCUR CX.S(7flfl2�aU5 ; ..115f249.�s � 19�l2Q'I6 E ACH OCCU RRENCE � Lz,5Qf3,QrJ't) X AGGRFGATC $3,�fl EXCESS LIAR CLAIMS -NAAr3E I DEC! RETENTION $ S WORKERS COMPENSAMN FWC STATi3 RUTH_ YJ Ilxil7 AND Eh4P1.oYtRS' LIABILITY ANY PR( 3PRIE.7012/frARTNEiRiEXECU11vE YIN t3(I�8C4f�;NA£NRDEREXGLUDEW N 1 . _ E L; EACH ACCIDE $ {N1{at#daiary fix NH) i EL. DISEASE- EA EMP1 O tE S if yyes, de5ct%e inner DESGR'PTJONOFC3I?ERATIONS � _ _.. E.L,DISLASE - POLIICYLIMIT $ i 3 I � _ Other Aggrpgate PI'nducts- GotM1OP Agrg DESUR3IP'nON'OF OPr:RATIONS I L OCA -OON $I VEiill ILeS {Attzrh -ACOAD IOI,,Addiefonaf 82rmarks Sched0ec ITmrore space is ruYd+ Trod) Blanket Additional insured applies; to the entities listed below per attached farm GLS -150s when required by written agreement. City of Blair Employees Stand Location, 13th & BUtler, Blair, NE ACORD 25 (2410105) The ACORD name and logo ark registared marks of ACORD Valerie Bellino Bellino Fireworks, Inc. 501 Olson Drive, Suite 210 Papillion, NE 68046 RE: Firework License in Blair Dear Valerie, The St. Francis Borgia Catholic Church has been awarded one (1) license for fireworks in Blair for 2015. Please submit a Nebraska State Fireworks Permit License by June 19, 2015. 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 no larger than 40 x 40 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. City Staff will have the area marked for setup. You are also required to furnish trash service providing a trash container no larger than six (6) yards to handle your own trash accumulation (see attached map for trash storage). All trash related to firework business is required to be cleaned up dail 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 Whee er City Clerk Cc: St. Francis Borgia Catholic Church, 2005 Davis Dr., Blair, NE 68008 218 South 16th Street < Blair, Nebraska 68008 ^ 402 - 426 -4191 • Fax 402 - 426 -4195 • E -mail cityofblair @ci.blair.ne,us CITY OF BLAIR APPLICATION FOR FIREWORK LICENSE 1. Calendar Year for Application 2015 2. Name of Applicant St. Francis Borgia Catholic Church 3. Address of Applicant 2005 David Drive Blair, NE 68008 Contact Person Fr. Mario Rapose Phone # ( 402) 426 -3823 4. Is applicant working through a vendor? Yes ® No ❑ 5. Name of vendor participating with applicant (if applicable) Bellino Fireworks, Inc. 6. Address of vendor 501 Olson Drive Suite 210 Papillion NE 68046 Contact Person Valerie Bellino Phone # ( 402) 935 -1916 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 ® No ❑ 9. License fee - $5,000 (Attached) 10. Certificate of Insurance (Attached) 11. Sales Tax # 8341141 (Name of Holder) Bellino Fireworks Inc. 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 D,6-7/2-6 Date - Date M FOR CITY USE ONLY: Date Received Applicant awarded license: Yes ❑ Time Received • - R 246 South 14th Street Lincoln, NE 68508-1804 L I C E 0 S E F 0 7-S4LE-0E-F1REWGRKe-v- Permissible fireworks may be sold at retail commencing 12:01 AM June 25 and ending 11:59 PM July 4 OR 12:01 December 29 and ending 11:59 PM December 31 and must be purchased from a licensed distributor orjobber. A 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 orl.* IL Violations of State Fire Marshal regulations may result in immediate revocation of this license. LICENSE GOOD ONLY FOR CALENDAR YEAR IN WHICH ISSUED "Nag '111 �g I - ,J I Ad/d/d/1111, NOUN,- This copy signed, dated and numbered by the STATE FIRE MARSHAL constitutes issuance of a LICENSE pu#' th i! Statute 28-1246 (1994 Supp.). Such license shall be displayed at licensees place of business. ///g M l,lg . - DATE RECEIVED: April 17, 2015 04:28 PM TYPE OF LICENSE AND FEE: Retail Permit (July) - $25.00 rMS/0000/l/.1 V lftph 11h, qb OMNI, COUNTY: Washington Tent in parking lot DISTRIBUTOR(S)/J Bellino/�, 15 11 85648 - 4) DATE ISSUED: April 17, 2015 03:08 PM STATE FIRE MARSHAL LICENSE NUMBER: 2015-RP-1 3928492-159-01 AM/ 1 //O/f Revised LICENSE HOLDER: Bellino Fireworks, Inc. ACOR ® C ERTIFICATE c 4w/ OF LIABILITY IN DATE /27 Y) 02/27/2015 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, ANDTHE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC. P.O. BOX 10265 CONTACT NAME: A/C N No Ext : 600 476 -2211 PAX No); E -MAIL ADDRESS: Birmingham, AL 35202 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :James River Casualty Company 13685 09/04/2015 INSURED Bellino Fireworks, (no INSURERS: INSURER C : 501 Olson Drive, Suite 210 Papillion, NE 68046 INSURER D INSURER E : D AG O PREMISES Ea occurrence $ 1,000,000 INSURER F : MED EXP (Any one person) $ EXCLUDED COVERAGES CERTIFICATE NUMBER:YTNCGNL9 REVISION NUMBER: 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 LTR TYPE OF INSURANCE DOL D S BR POLICYNUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 000576611 05/04/2014 09/04/2015 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE OCCUR D AG O PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ EXCLUDED PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 5,000,000 X POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Fa accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB H CLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED R ETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N STATUTE O ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Location: 1301 Butler St. (Vet's Field) Blair, NE City of Blair, NE St. Francis Borgia Catholic Church Bellino Fireworks, Inc. Donald J. and Valerie R. Bellino The Certificate holder and the above listed are Additional Insureds respects to General Liability policy as required by written contract. CERTIFICATE HOLDER 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. Bellino Fireworks, Inc. AUTHORIZED REPRESENTATIVE 501 Olson Drive Suite 210 A l i . Papillion, NE 68046 Page 1 of 1 ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD r 06 ise of � March 9, 2015 Eric Clauson Wild Willy's Fireworks, LLC 1710 S. Hwy 50 Springfield, NE 68059 RE: Firework License in Blair Dear Mr. Clauson, The Washington County Food Pantry has been awarded one (1) license for fireworks in Blair for 2015. Please submit a Nebraska State Fireworks Permit License by June 19, 2015. 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 no larger than 40 x 40 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. City Staff will have the area marked for setup. You are also required to furnish trash service providing a trash container no larger than six (6) yards to handle your own trash accumulation (see attached map for trash storage). 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 Cc: Washington County Food Pantry, 1737 Washington St., Blair, NE 68008 218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 -426 -4195 ^ E -mail cityofblair @d.blaicne,us CITY OF BLAIR APPLICATION FOR FIREWORK LICENSE 1. Calendar Year for Application 2015 2. Name of Applican ,� 401" ( .(,un 3. Address of Applicant 1 3 7 W a s l�; ✓�� S + . 13 c`� r , /tJ Contact Person 4c 4v Q '' ec, 6 Phone # 401 & 57 - ? 3 & y 4. Is applicant working through a vendor? Yes N' No ❑ 5. Name of vendor participating with applicant (if applicable) �IJ L, N v's f\ , p Gwr, sk /r_/'- 6. Address of vendor 1 S. Nw\j 50 e &eG 5 Contact Person J� L (- je s o w Phone # 401 -2.53- 2 c 2 5 7. Is certificate of insurance held by applicant or vendor? Vendor '�t Applicant ❑ 8. If held by vendor, does insurance name applicant and city as additional insurers? Yes �Z- No ❑ 9. License fee - $5,000 (Attached) 10. Certificate of Insurance (Attached) 11. Sales Tax 9 (Name of Holder) W . k� �,J , lv` 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. Date - 2 / 20/1 5 Date FOR CITY USE ONLY: Date Received Time Received Applicant awarded license: Yes ❑ No ❑ NEBRASKA STATE FIRE MARSHAL 246 South 14th Street, Lincoln, NE 68608-1804 LICENSE FOR SALE OF FIREWORKS Permissible fireWo*s May be sold at retail commencing 12,01 AM June 25 and ending 11:59 PM July 4 OR 12.'01 AM December 20 and ending I 1.59'PM December 31 and must be purchased from a licensed distributor or jobber; A job*�� may not sell retail. Invoice copies for all fireworks must be kept available for inspection and must $hQW the license number of the distributor or jobber. Fireworks May not be sold outside the city limits of an incorporated town oryfilege. Violations of Statefire Marshal regulations may: result in immediate revocation of this license, LICENSE GOOD ONLY OR CALENDAR YEAR IN WHICH issurm 4 q, This copy signed dated and numbere by the STATE S IRE MARSHAL constitutes issuance of aLICENsE p to the raska Revised 28-1248 re I04 supp.)-Sucblicenwshall be displayed at licenseWi plac of bus iness. DATE RECEIVED: June. 05, 2015 09AO AM TYPE OF LICENSE AND FEE; Retail Permit (4uly) - $25.00 LOCATION OF OUTLET FOR RETAIL SALE OF Fl" 1301 Butle '10 Blair Tent in parking lot STORAGE LOCATION: Wild W,!0 '" s F! 111,88936-6) DATE ISSUED' April 08, 2015 04:05 PM STATE FIRE MARSHAL LICENSE HOLDER: Washington Cou nty Food Pantry LICENSE NUMBER: 21015-RP- 13694376-120-01 4 COUNTYk Washington DATE ISSUED' April 08, 2015 04:05 PM STATE FIRE MARSHAL LICENSE HOLDER: Washington Cou nty Food Pantry LICENSE NUMBER: 21015-RP- 13694376-120-01 C,ERTITICATIK Off` INSURANCE No: S20201 We, certify that insurance is afforded' as stated below, This Certificate does notaiffirmatively'air negatively amend, extend of alter theepverage, afforded, by the insurance policy and the insurance itions afTorded is subject to all theterms, exclusions and conditions of the policy. INSURER NAMED INSURED POLICY TERM COVERAGE, Admiral Insurance Company POLICY NO, CA00000320925-1091 Wild Willy's Fireworks, LLC 17105 S. Hwy So Springfield, NE 68059, March 1, 201540 March 1, 2016; Both bays 12,01 AA. Standard Time Premises-Operations Liability, Occurrence Basis M. Claims Made Basis LIMIT OF LIABILITY $1, each Occurrence, $6,000,006 general ag gregate gregate The limit it of liability shall not be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS The sale bt, and related products at the insured location, during the period of operation. It is certified that, for the period otoperation stated below and when named below as such, this policy includes as Additional Insureds 11) the operator(s), sponsor(s . prorq otcr(s), organizer(s), ofthe Insured Premises used principally for the retail sale, of consumer fireworks'supplied by the Named Insureds and/or 2) the owner(s), man , ager(s), tenant(s), mortgagee(s) (Including other entities having simijarinterests), ofthe property on which the insured Premises is located and/or 3) the licciising authority issuing a permit or license for the op eration of the Insured Premises And/or 4) any entity for which the Named Insured is "aired, by written contract, to provide insurance such as is afforded by the terms ofthis Ii I po; Icy- NAMES) OF ADDITIONAL, INSURED(S) City of Blair X South 16ih Street Blair, Nebraska 68008 Voice (401) 426.4191 Joseph's Coat Thrift Store, & Washington Count Pond Pantry 1737 Washington SL Blair, NE 68008, ADDRESS OF INSURED PREMISES Veterans Memorial Ball Field ;lair, NE PERIOD OF OPERATION June 24", 201 — July 5 2015 It is certified that this policy requires a 30 day mutual notice ofcancellation between the insurer and the Named Insured, In the event of such cancellation we will endeavor to mail 10 days written notice to the Additional Insured(s), - whose name and address i I s shown hereon, b4t.failure to mail such notice shall impose no Oligatiorior liability of any. kind Upon the insurer and/or the undersigned. DRAYTON INSURANCE BROVERS, INC. February 20th �rERV-SI DATE OF ISSUE A�4.T V INC. 0 CENTER POINT ROAD, SUITE 301 BIRMINGHAM, AlASAMA 35215 PHONE: (205) 8 FAX-(20$) $$4-5999 CERTIFICATE Of TINSIVRANC I E NO. 515101 We certify that insurance is afforded as stated below. This Certificate does not affirmatively or negatively amend, extend it alter the coverage 411tirded by the insurance polipy.and the insurance afforded is, subject to 611 the term, exclusions and conditions of the policy. INSURER Admiral Insurance Company POLICY N©. CA00003209-25-1091 NAMED INSURED Wild Willy' s FireWorks, LLC 11 105 & Hwy 50, Springfield, NE 68059 POLICY TERM March 1, 201 to March 1, 2016; Both Days, 12:01 A.M. Standard Time COVERAGt Products Liability, including broAd'forin vendors liahillty4 Occurrence Basis Claims Map Basis LIMIT OF LIABILITY $5,000,000 each occurrence, $0,000,00(/ products aggregate The limit of liability shall not-be increased by the inclusion of more than one insured or additional insured. INSURED OPERATIONS The manufacture, sale or distribution of consumerfirewor" , (I.4G) and related products, It is certified that, if named below, this policy includes as Additional Insureds 1) the distributor or seller offhe Named Insured's products ar '2) the owner(s), inanager(s), tenant(s), mortgagec(s) (including other entities having similar interests), of the property from which the Named In products are distributed or sold and/or 3), the licensing authority issuing a permit of license for the distribution ofthe Named Insured's products 4) any entity for which the Named Insured is required, by written contract, to provide insurance such as.is. afforded "by the terms of thispolicy. NAME(S) OF ADDITIONAL INSURED(S) City of Blair 218 South 16 Street Blair, N0braska.68008 Voice (402) 426-4191 Joseph's Coat Thrift ,$torc4 Washington Courity Fond Pantry 1737 Washington St. Blair, NE 6$008 It is ccif at I cert th this policy requires a, 30 day mutual notice of cancellation between the Insurer and the Named Insured. In the event of such cancellation we will endeavor to mail 10 days written notice to the Addftio,nalInsu,red(s), whose name and address is shown hereon, but failure to mail such not!" shall impose no obligation of liability of any kind upon the I insurer and/of the undersigned, DRAYTON INSURANCE BROKERS, INC,, frebrmry 20 2015 , DATE OF ISSUE A., �,�TRINGXR, PRE$11)�E�N����