HomeMy WebLinkAboutCLE202000083 Application 2020-06-03APPRMD
by the County
gty
Zoning Clearance Applicationt�`51_ a t4 McIntire Rd,
File
�6AeAetiew4lq-UA��902
Phone 434.296.6832
FOR OFFICE USE ONLY Clearance Number' WW - 01B3
Fee Amount. $ 54 Date Paid: # 5l1t`20-20 By:
Receipt #: �Cs"(Zp�32 a Check #: M By: J P
Applicant - Fill out the entire page below
And return to Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Name:
Keystone Novelties Distributors, LLC
E-Mail Address:
permits@keystonenovelties.com
Mailing Address:
201 Seymour St., Lancaster, PA 17603
Phone #:
717-394-1078
Tax Map and Parcel
number and/or Address
of the Business:
061 MO-00-12-001 CO
Zoning:
Staff will fill out if unknown
Parcel Owner:
Federal Realty Investment Trust
Owner's Address:
Charlottesville, VA 22901
Check any that apply:
l�X] New Business Change of Use [_] Change of Ownership Change of Name
Business Name:
Keystone Novelties Distributors, LLC /dba Keystone Fireworks
Description of Business:
Describe the business including use, number of employees, number of shifts, availability of parking, and any additional info.
6/23/2020 - 7/5/2020 Sales of fireworks via temporary tent location 9am-1 1 pmXXc)( b(%X)(XXXr)OMMX7,/Xg)(,N.
We have operated at this location previous (5) years, Business Lic# 901574
Previous Business on Site:
N/A
Floor Plan:
Please attach either an architectural drawing or a sketch of the proposed business indicating the location of uses, the
uses of rooms, the total square footage of the use, and any additional information.
Total Square Footage Used
for the Business:
20x40 Temporary Tent for Retail Sales: See plot map attached
Is the Parcel Zoned LI, HI, or PDIP?
Yes No If yes, fill out a Certified Engineer's Report (CER)
Will there be food preparation?
Yes ✓❑ No If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
❑ Public Private If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
Public Septic If on septic, provide Virginia Department of Health approval
Will you be putting up any new signage?
Yes No If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
u Yes ❑ No If yes, obtain appropriate building permit and list permit # below
Please list any applicable Building Permit #s:
Zoning Clearance review cannot begin until the application above is complete and all applicable forms and fees are submitted.
This Clearance will only be valid on the parcel for which it is approved. If you change, intensify, or move the use to a new
location, a new Zoning Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the
information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand
them, and that I ill abide by th rn'.
Signature �`� ?.'`"" PrintedXk"XyAXO�dRick Seery, Keystone Novelties Distributors, LLC
Date ;�'.@ 05/10/20
2
Zoning
Application
cis ace
.
AP>
Albemarle County
Community Development
401 McIntire Rd, North Wing
Charlottesville, VA 22902
� lIG2T1�`
Phone 434.296,5832
Applicant - If you are not the land owner, please fill out the entire page below confirming that you have either
informed or are going to inform the owner of your zoning clearance application.
CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN
PROVIDED TO THE LANDOWNER
I certify that I will provide (or have provided) notice of this clearance application,
Keystone Novelties Distributors, LLC
clearance number provided by Staff or business name
to Federal Realty Investment Trust the owner
Name of landowner on record
of Tax Map and Parcel Number 061 MO-00-12-001 CO by either delivering a
TMP number of property
copy of the application to them in person or by sending them a copy of the application by
mail. (Please check one of the following below)
❑ Hand delivering a copy of the application to the owner identified above on
Date
® Mailing a copy of the application to the owner identified above on
Date 05/11/2020 to the following address:
*Andy Seligman (301) 998-8114 Email: aseligman@federalrealty.com
*Signed lease also provided with this application
(Written notice to the owner and last known address on our record books will satisfy this
requirement. Please see staff for help determining this information if needed)
Signature of Applicant
Applicant Name Printed &1XXXgq�ick Seery, Keystone Novelties Distributors, LLC
Date 05/10/2020
13
For Albemarle County Staff Review Only
Proposed Use:
((�(v �cr
Permitted:
Yes ❑ No
Permitted by Section:
5 CNj4l i, l em&
Supplementary Regulations:
Applicable Special Use Permit (SP):
G
Applicable Rezonings (ZMA):
_.
Applicable Site Plans (SDP):
Parking:
If there is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some
parking requirements are determined by a ZMA or by an approved Code of Development.
Parking Formula:
&vo
Defined by:
❑Site Plan ❑ Zoning Ordinance ❑ CoD [-]Existing
Total Square Footage of the Use:
'Doc L t
Required number of parking spaces:
Associated Clearances:
7-617_ 1D�
Variances:
N �� a
Violations:
�--
Is a site inspection necessary?:
❑ Yes ❑ No
Site Inspection on (date):
To Confirm:
Notes:
Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
Apploval Information
Approved as proposed ❑ Approved with conditions ❑ Denied
❑ Backflow prevention device and/or current test data needed for this site. Contact ACSA, 434.977.4511 ext. 117
❑ No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance
with the existing site plan.
❑ This site complies with the site plan as of this date.
Conditions:
Additional Notes:
Building Official C/h��� Date
Zoning Offlclak Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126
Keystone Novelties Distributors, LLC
201 Seymour Street, Lancaster PA 17603
Ph. 717-390-0844 Fax: 717-290-7774
Info@keystonenovelties.com
May 10, 2020
County of Albemarle - Comminity Development
401 McIntire Road,
North Wing Attn: Zoning
Charlottesville, VA, 22902
Attn: Michael Dellinger
We are again in the process of planning for our annual Fourth of July tent sale. I have included in
this package everything that I believe is necessary for the purposes of applying for our permit and
below is and outline of our intended event & supporting documents provided.
Location/Hours & Documents:
• Location: 1510 Seminole Trail, 29th Place Shopping Center, Charlottesville, VA 22901
• Sale Dates: 06/23 through 07/05/2020
• Hours of Operation: 9am to 9pm Daily, 9am to 10:30pm on the 3rd & 41h.
• Application: Zoning Permit
• Letter of Permission: Signed Lease
• Plot Map Diagram showing tent location on the property
• Tent Layout showing tables and exits
• Copy of the tent fabric Flame Retardant Certificate
• Insurance Certificates: Liability & Workers Comp Insurance Certificates
• Fees: Check for $54 to pay for the permit
The tent will be put up a few days in advance and removed as soon as possible after July 5. We post
"No Smoking" & "Exit" signs at all egress points and have (2) fire extinguishers on hand at all times.
Should you have any questions or if anything has changed for this year, please feel free to can or
email me at 717-390-0844 or permits@keystonenovelties.com.
Respectfully, Y
lick Seery.
Director of Retail Operations
Keystone Novelties Dist. LLC
rseey@keystonenovelties.com
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KEYSTONE NOVELTIES DISTRIBUTORS LLC
201 SEYMOUR ST
LANCASTER PA 17603-5847
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FINANCE QEPARTMEN
REVENUE ADMINISTRATION
401 MCINTIRE ROAD, RM 133
CHARLOTTESVILLE, VA 22902-4579
T: (434) 296-5851 Option 3
F: (434) 243-7906
Business2020 Application
Renewak
FILE BY MARCH 2. 2020
Complete Section B
New businesses
10 % LATE FILING PENALTY IF NOT FILED
Complete all sections and return with payment
within 30 bays from the date business begins,
BY DUE GATE business is cioiedimGved out of
Closure date- ( t
Alberndrrfe County
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KEYSTONE NOVELTIES
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1510 SEMINOLE TRL
CHARLOTTESVILLE VA 22901-0000
201 SEYMOUR
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Check this box and sign thil form to certify Out business yuafiftec
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raquir¢ment waiver. 5" instruction on back.
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8atfl to 5pfn Monday to Friday (434) 2 6-5851 Opt, 3 AlbemarleCountyFinance@Albemarle.org
1, 1 CIF N'S E A G R E U %I L N'T
A Name, KeN sione Novelties fils--
tributors- LLC
B, Check if n Individual(s) El Sole [Iroprictor
OR
0 Partnership 0( - 'OrPoration N LLC
%'here lbrineti (state): Pennsylvania
C. I i-.jdc Name Keystone Vovellte, Di,lnbutors, I Lc
D, ,Address: 201 Se l ink,qu- Street
I -!Ijjc, "Ner, I'A 17603. Arm, jack- *,,hry
I clephrine: 610-868-5715
LICENSOR: F—F�d—eralRealtv Invesonvin'Fruit, a� w%rici or-,—w&nzed �agent
Cv Notice Address: c4o federal RealtN Investment -'rust, 1626East JcMrson Street- Rockville. MD
208524041. ,Attention: Legal Department
Payment Address Federal Realty Investment [rust, P,O. Box 8500-3426 Philadelphia, PA
191 M-34-26 (or such other address as Licensor may designate by written notice).
SHOPPING 111 29* Place -('-Shopping'
C, EN, I F W % - I L- I
Ifallec"Ne for in-linespace, Spa—ce No., NIA (PtemisLs)as sho%Naon ExiiThir V —,,tt--:hcd Oth-
erwise, area on bit A Ifitcensce atilize" a tent oil the 11romiWs, it Must
bt`:"ce.rt*with sand bagsibarrelsor %vaterbarrek loseejjrc the jell, LicenscelliftV not bore
nnothe pavement. .Any eontaiutertsi placed onsire as part ol`Licensecs setup must be ciratt
and firee ot'chipped andlor missing paint
a'
I t'Licensor is supplying a kiosk ar can. Can \o- VA
LICENSE PE- J ('o mencing June 18, 2020 and c(Pirmg .114 92 1 0 1 20, during which Licence shall operate dur-
mj
RIOD: ing Shopping Center bouts.
LICE SE FEU: K Any —Part-al license periods shall he prorated o-n-a daily ba-
sis calculated tuna +65-day %car.
R W CE �N f V. —f L. —intentionally Deleted.
LICENSL FEE:
ADDITIONAL M. Administrative Fee to reimburse Licensor the cost of preparing this LicenseAgreement.iim.
CHARGES: ullarleous with its execution hereon, I. ILCYISWC Strait pay to Licensor the arrijaurn ot*Scvejjjy-I ive
Dollars ($75 00) (the: "AtIministrative fee"), The parties agree that this document shall he con-
tingent upon Licensor's receipt of such kdounistrative Fee upon Licensee's execution of this
License Agreement
DE- N. Intentionally DC[CWdr
POSIT:
PERMITTED The Premises shall he used filir the sale at retail of fireworks and sparklers as permitted by the
USE: ffituiicipality,and t*(irnoother purpose In no cNent shall Licensee use the Premises for anyuse
for
or purpose that would violate any exclusive or restricted use, whether now or hereafter existing
tin
riat the Shopping Center, nor any taws, slalules.or&rs, ordinances, zoning, and other regulations
and ordinances of federal, state, county, municipal and other governmental authorities having
jurisdiction.
The terms and conditions appearing on the ADDENDUi , the —Iwotion —or—the Premises as shown on CNIIJBIT A and rile
RULES AND REGI'LATIONS $1-tached as EXIIIHITH (including the Merchant Manual Rules and Regulations, it,
applicable) land CONSTRUCTION ADDEND1, M (ifsny)j, all of which are attached hereto. have been reviewed and
approved by the parties and are, incorporated into and made a part of this I iceti.se Agreement (hercrrrjftef. the "Agree-
nient") by reference.
IN WFINES.S WHERFor, the Miles hereunto set their hands on April 27, 2020
LICENSOR:
FEDPRAL REAL`FY INVUSTMENI-TRUS'r, a3 KEYS10NI; NOVEL'I"IES DISJRIBUIORS.
owner or authorized agent I-I.-C, a Pennsylvania limited babflitti company
By: 13Y
Name: Name. ev4 - I --- 25t
'ritle: Vice President - Ancillary Revenue 7
rule:
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oo
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tent location
generator
EXHIBIT
DOMINION DRIVE
re as,
solo
4
Portable restroom location on level ground,
n
against brick wall behind space 4200
NOW (Lane Bry3no
BERKMAR DRIVE
29TH PLACE
u
EXHIR111, "
Rl LFS AND REGUL,%'l'I0_NS
Licensee expressly Covenants and agrees. at all times during the License Period, and at such other times as Licerisce occu-
pies tile Premises or any pan thereof. to co"IPIN, at its Own Cost and expense, with the following:
1. Any handling or freight for any purpose, or deliveries to or from the I'VeMiSM shall he made in a manner consistent
with good retail practice and only at such times, in such areas, and through such entrances and exits as are from time
to time designated for such purposes by Licensor Any truck or machine used for handling freight or making deliver-
ies in the Premises or in the Shopping Center shall have rubber wheels On]%.
I All garbage and other refitse shall be kept inside the Premises in the type 0*1'containcy specified by Licensor until col-
lected: All garbage shall be prepared for collection. and collected in the manner and at the times mid places specified
by Licensor. Licensee shall Use any smicc furnished or designawd by Licensor for the removal of garbage and other
refuse. If Licensor does not provide or designate such service. LiccnsAiuc shall be solely responsible for contracting for
the removal of garbage and other refuse from the Premises and shall pay promptly all charges theretbr.
3. Licensee shall not: (i) suffer, allow or permit any vibration, noise, odor or'flashing or bright light to emanate from the
Premises or from any I machine or other installation located therein, or othenvise suffer, allow or Permit the Same to
constitute a nuisialace to or jntcrfierc with the safety, comfort or convenience of Licensor or orally other occupant or
user ofthe Shopping Center; (U) display, paint, or place any handbills, bumper stickers or other advertising devices on
any vehicles) parked in the parking area(s) ofthe Shopping' Center, whether belonging to Licensee, its cruployce(s).
Or any other person(s)-, (in) solicit business or distribute any handbills or other advertising materials in the common
areas; (iv) conduct or pernut any activities in the Shopping'Centcr that might constitute a public or private nuisance:
(v) permit the parking ofary, vehicle,.; or ale placement ofany displays, trash receptacles or other items, so, as to inter-
fere with the use ofany drkway, the lane, corridor. walkway. parking area, mall or any Other common area; (vi) Use
or occupy the Premises or permit anything it) he done therein ic hich in any manner might cause injury or damage
therein or in or about the Shopping Centerr, or is ill me Of OCCUPY tile Prennw,s in any manner N%hich is unreasonably
annoying to other tenartMicensces in the
see", btlsiness. Shopping Center unless directly occasioned by the proper Conduct of I -icen-
4. Licensee shall secure and protect the Premises, and all property located within the Premises. Licensee acknowledges
and agrees that it, and not Licensor. is solely responsible for securing and protecting the Premises and all property,
located therein,
5 Licensee shall use the plumbing within the Premises and the Shopping ('enter only for the purpose for which it is de-
signed. Licensee shall be solely responsible for any braakagc, stoppage or damage resulting from its violation ofthis
provision, and shall pay any costs associated tlicreN'vith to Licensor upon demand as :additional Charges. I..icenscc
shall contract for and use termite and pest exti."imation services for the Premise,,, % , v ith such ctintractor, as Licensor
may from time to time designate, or with a reputable contractor of its choosing. suhlect to Licensors prior written
consent. Licensee shall participate in any window cleaning program that may he established by Licensor.
6. Licensee shall install and maintain at all times a display otmerchandise in the display windows (ofany) ofthe Prem-
ises and shall keep such display windows well lighted 'during, its hours of operation and at least one 11) hour thereat
ter. All articles, and tile arrangement, style, color and general appearance thereof, shall be in keeping with the charac-
ter and standards ofthe Shopping Center as reasonably determined by Licensor.
7. If License undertakes any construction activities %vtUch cause any work stoppage. picketing, labor disruption or dis-
pute, so as to interfere with the activities at the Shopping Center. licemstc shall, upon request from Licensor, iffirrickli-
atetv suspend any construction work being performed in the Premise, giving, rise to such labor problems. Licensee
shaft have no claim for damages orally nature against Licensor for such Suspension
9Licensee shall Use the Shopping Center name and logo and include Licensee's trade name and the address and identity
of Licensee's business, ill the Premises in all advertisements made, by Licensee in any manner and many medium
9, Licensee shall not conduct of permit to be conducted any auction, rjrc, "going Out ol'business" or similar type of sale
(Whether real or fictitious) from the Premises: provided, however that tilts provision shall not restrict the ab.IOIUIC free-
dom (as between Licensor and Licensee) oruccrisce to determine its Own selling Prices nor shall it preclude periodic,
seasonal, promotional or clearance sales held in the ordinary course oftiusiness
10 Licensee shall not place a load on any floor in the Premises or the Shopping Center which exceeds the load Which the
floor was designed to carty, or which may result in improper weight distribution on such floors.
11, Licensee shall riot install, operate or maloMill in tile Premises, or in any
other area ofthe Shopping Center, electrical
equipment which does riot bear the Underwriters Laboratories seat of approval, or which would overload the electrical
system or any part thereofbeyond its capacity for proper, efficient and suille operation
12, TO the extent required by Licensor or by any law, role, regulation, guideline or order, Licensee shall provide sound
barriers for all mechanical systems serving the Premises.
13, Licensee shall not store, display, sell, or distribute any alcoholic beverages (except as ilia), he altovved under the Per -
nutted Use), dangerous maierrils, flammable materials, explosivcs, Or weapons in the Premises, or conduct any illegal
or unsafe activities therein
14 Licensee "I not sell, distribute, display or offer for sale (i) any parophcrnalia common[% cmplo)ed in the Use or
ingestion of illicit drugs: or in) any X-rated, pornographic. lewd, or su_callcd'.ad1lIt'1 newspaper, book. magazine,
film, picture, video tape or video disk, Licensee shall not operate or permit to be operated in the Premises any auto-
matic teller machines, or any coin or token operated vending machine or similar device including telephones, lockers.
toilets, scales, amusement &,vim, and machines for the sale of beverages, toods, candy, cigarettes or other goods,
15, No radio Or television aerial or other device may ee be erected by Ltnwst: oil the roof oron any exterior wall ofthe
Premises, or the building in which the Prermses'is located, without t- icenisor's prior written consent. Any aciriW, or
other device installed without such written Consent shall be -,object to removal by Licensor. at Licensee"s sole risk and
expense, without notice
Exhibit 8 Page I
16. Licensee shall, upon five ki
1 (5) days riticn notice trim I. icensor, provide to Licensor a list of license numbers of all of
Licensee's and its employees' vehicles. If Licensee or its ctrip1t)yees fail to park their vehicles in designated parking
areas, or it'Licensee undertakes or permits the delivery of merchandise or other items except as bereirt provided, JA-
censor may, in addition to its other rights and remedies under [tic Agreement and/or at lain. charge Licensee and Li-
censee shall pay to Lwvnsor, on demand. S25.00 per day Per vehicle parking in an% area other than those designated
by Licensor and/or $25.00 per delivenr for deliveries undertaken or permitted by Licensee in the manner heremabove
prohibited,
17, Licensee shall compiv with all other reasonable rules and regulations From time to time established by Licensor or any
association formed in the Shopping Center which apply generally to all other stores (other than tenanivOicensces occu-
pying more than 15AX) square fiect),
Exhibit 9 page 2
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PAGE 01
CERTIFICATE
OF FLAME RETARDANCE
Reference Your ()I.je.r #'. ",art at
Ou� Order # 0011649'
I , t err ,
This is to certif tha . ' " Hulite A(-chiten% Lot
is flame retardant according CO the fOIJOWing specificatiori ard stlzmdairdF:
Cal iforrija Fire Varshall Registration �Tjflc j 9*,
RC8, Fabric n F12203
Nati,onal, Fi i o ot,cdon ,�.ssocjxjo-
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P,"') d U c t S 3 0 C P I i 0 111 n t e r n a 4 V, A., 710 p -S
we cc-,ti-fy tj�ls 1(jt r)i, Her,,!ujite Architcnt rent and sti-octural t',Ibri . 'c k i T1.
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parameters pLIblisbed Jo ottr'descripniyc producr litela',UTe, ard'techliczil bulletins.
/01 Wpe- FROG ANV POL(f MW5.
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30 Rober" Nin"Well
Quality Coritz-01 Manave,
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k'rcduc,.-.k Marketed by
HERCUL)TE PRODUCTS, INC,
P.O. BOX 786
Y OR K, PA '17 405
:1<1vc beer tcVed by -an In accordamm wicl,
th-
of the Health and Safety Code, -and mcccs the Anninur)) %Cuire'73e-:;s esi-Fi6lished-by is S-'!JTP.
Fire Marshfl for
'F-TIAME RETARDANT FABRIC
State Fire M t., rs Ila
2020 Beginning Inventory VA
Item
Units
Quantity
Item
Units
Quantity
#8 Gold Sparklers
48
1 cs
Morning Glory, 14"
360
1 cs
#10 Color Sparklers
288
1 cs
Mystic Sundae
8
1 cs
#20 Gold Sparklers
48
1 cs
Open Flower Happy Bird
72
1 cs
3D Glasses
75
75 pcs
Party Poppers
120
1 cs
Barn Burners
16
2 cs
Red Riot
36
1 cs
Big Dog
8
2 cs
Rising Storm
40
1 cs
Big Stinker
12
12 pcs
Silver Star
30
1 cs
Boss Hog
4
1 cs
Smoke Balls
180
1 cs
Chase the Ace / Desert Moon
96
2 cs
Snappers
300
1 cs
Crackling Balls
96
1 cs
Spaced Out
8
1 cs
Crackling Crystals
12
1 cs
Tie Dye Surprise
72
2 cs
Cuckoo
144
1 cs
Tomahawk Rocket Fountain
144
1 cs
Deck The Sky
12
1 cs
Turbo
30
1 cs
Dragon Slayer
60
1 cs
Waterfront Celebration
18
1 cs
Fight Like A Girl
6
1 cs
Wonder Twins
54/2
1 cs
Fire & Ice
8
2 cs
World of Wonders
8
2 cs
Flying Betsy/America the Beautiful
24
1 cs
Wrath of the Beast
6
1 cs
Freaky Tiki
8
1 cs
Glow Sticks
50
50 pcs
Lighthouse ( $100 Bonus item)
36
3 cs
Giant Punk
25
25 pcs
Anniversary Celebration ($zoo Bonus)
16
2 cs
Gotham City
8
1 cs
HN 90/Floral Assorted Fountains
144
2 cs
ASSORTMENTS
Jumbo Morning Glory
48
1 cs
Crowd Pleaser
36
3 cs
Killer Bees
48/2
1 cs
Heavyweight Champion
18
3 cs
Lightning Rod Candles
96
1 cs
High Voltage
9
3 cs
Lil' Big Shot
54/2
1 1 cs
Jackpot! (CT)
16
2 cs
Magic Color Burst
60
1 cs
Larger Than Life
4
2 cs
Magic Snakes, 4 pack
72
1 cs
Mega Monster
2
2 cs
Mammoth Smoke
100
1 cs
Wild Card
4
1 cs
Maximum Overload
12
1 cs
Mini Mystic Sundaes
18/4
1 cs
Extras
SIb Extinguisher
Trays
2 Pennants
8 Baskets (Bags on Top)
Banners
L & S sign holder
Received By:_ Tent #:
ACC>Ra CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
12/13/2019
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 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
Britton Gallagher
One Cleveland Center, Floor 30
1375 East 9th Street
Cleveland OH 44114
CONTACT
NAME
- - - - --
PHONE FAX
IA No Ext : 216-658-7100 AIc No : 216-658-7101
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A; Everest Indemnity Insurance Co.
10851
INSURED 8086
Keystone Novelties Distributors LLC
INSURER B : AXIS Surplus Ins Company
26620
201 Seymour Street
INSURER C
INSURER D:
Lancaster PA 17603
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER! cA11F4n57 RFVICIr1N MI IMRFR•
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.
ILTR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
M� DDY
MMIDD/YYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE i,� OCCUR
FP
Y
Y
S18ML00041-191
12/31/2019
12/31/2020
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 500,000
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
jECT POLICY PRO- X LOC
PRODUCTS - COMP/OP AGG
$ 2.000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
B
X
UMBRELLA LIAB X
EXCESS LIAB
OCCUR
CLAIMS -MADE
P-001-000241749-01
12/31/2019
12/31/2020
EACH OCCURRENCE
$ 4,000,000
AGGREGATE
$4,000,000
DED RETENTION$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatoryin NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
WC STATU- OTH-
T R I ER
-_
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement.
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.
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