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HomeMy WebLinkAboutCLE202200048 Application 2022-04-14 ________., ,,,,,,,,, ..s. ,..,‘ ,,,, • •, Albemarle County 9Zoning Clearance Application Community Development �' 401 MclnGre Rd,North Wing Charlottesville,VA 22902 r1RCIN� Phone 434.296-5832 FOR OFFICE USE ONLY Clearance Number( ZWZ . _L(g Fee Amount: $61.36 Date Paid:(.,,l Ig l as By: ea tS Application fee:$59+Technology Surcharge:$2.36 Receipt#: i A 5 i a$ Check#: I ), 1 a$ By: SvD Applicant- Fill out the entire page below and return to: Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902 Name: 56ASCNSOFCMAN6L,LLC/DAM) 6IMONE E-Mail Address: S ONSOFCHA 4,Z 0AOL.CAN Mailing Address: L/oyb3faany/fl1uhood, �t�4�C, ✓�. 201os" Phone#: (703) 427 -Z718 Tax Map and Parcel Zoning: pm,t4416 D DEc o/ fr number and/or Address Staff will fill out if unknown of the Business: "j�0 0 'OD -00 - O 17 CP 5140pp1'.06 Ctiu Parcel Owner: Po,uDeos,t hAytib 1 .'ST Owner's Address: 22 4- pi/HST,N.4,t1. CNAeU?1dl k Check any that apply: New Business Change of Use Change of Ownership I I Change of Name Business Name: 5 EASC)NS OF CFff AZE J I.,LC_ 12eTA I L- FIK�Watic.S Description of Business: Describe the business including use,number of employees,number of shifts,availability of parking,and any additional info. 1-14E R.ET'AIL. 43.4Lk. OF VA. APp X b FtA CS , 15W6 A 8'X4/0' 3re6_L 3AtkS CoAl+"nf112 . FROM f/23 - I7I7 , Z.oZz Previous Business on Site: DIED EXp2ES 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: 3 z 0 562 FT. Is the Parcel Zoned LI, HI, or PDIP? Yes I ro If yes,fill out a Certified Engineer's Report(CER) Will there be food preparation? Yes I 'I "o If yes,provide Virginia Department of Health approval Is the Parcel on public water or private well? 11/public I I Private If on private well,provide Virginia Department of Health approval Is the Parcel on public sewer or septic? ['Public I I Septic If on septic,provide Virginia Department of Health approval Will you be putting up any new signage? I I Yes I to io If yes,obtain appropriate sign permit and list permit#below Will there be new construction or renovations? 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 will abide by them. Signatur m-d. Verirs Printed 04A)/EL. cg'. 5/.'1i 2) Date 'y e 7 22 2 �,tit Bf�. � � Charlottesville,V C Albemarle County �� Community Development Zoning Clearance Application J ® 401MclniveRdNorihwing �,�, A 22902 r i Phone 434296.5832 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, clearance number provided by Staff or business name to Ltlootw D poc)i s, 22i( iil rns-r,N.w. the owner Name of landowner on record of Tax Map and Parcel Number O'l goo -00 00 - O I r1 Dee 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 9' 2S•2 Z. to the following address: 2 y //rirsr. N.A.) cloebogait, tf. z 2 903 (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 !��►r� 5,‘ ' Applicant Name Printed 7>.9vvIL G. S/41 4. Date y07•zz 3 Ponderosa Land Trust 22414m Street NW,Charlottesville,VA 22903 Phone:(434)989-6736 FAX:(434)293-2280 Email: Tanashia!MWoodardPrcperties.cons PARKING AGREEMENT This Parking Agreement,made this 16' day of December.2020.is between Ponderosa Land Trust,hereinafter referred to as`Lessor,'with office located at 224 I4a Street NW,Charlottesville,VA 22903(434-971-8860),and Dan Simone w Seasons of Change. LLC,jointly and severally, if more than one,hereinafter referred to as "Lessee,"whether singular or plural. Woodard Properties is the Agent for Lessor. Lessor and Lessee hereby agree to the following additional terms and conditions: 1.Property,Term,Parking Payments and Renewal The term shall be for five(5)Years,for a(3)three week period beginning on January 1.2021,until December 31, 2026.This lease is only applicable for the three week period on or about June 10 to July 8t°.Therefore,nothing in this lease precludes the Lessor from renting the premises to a third party,during this five year period,outside of the three week applicable period. Either party may terminate this agreement when one party gives to the other,90-days written notice of intent to terminate. Lessee agrees to pay Lessor per year for parking in the assigned spaces located at'60 Pantttj"Cerrie, Payment is due on the first(1f°)day of the splint"period,payable to Woodard Properties. Cash is not accepted for payment Fees may apply for credit card transactions or any electronic payment. In the event the Lessee is unable to operate the business due to Government or County restrictions or mandatory shutdowns directly related to the COVID-19 pandemic, Lessee will not be required to pay the rent for the restricted timeftame. This Parking Agreement will not automatically renew,and shall terminate on December 31.2026. 2.Conditions: a. Parking is only valid for Lessee and specified spaces. b. Use of the parking lot when snow author ice are present is strictly at the risk of Lessee. c. Parking and use of the parking tot is strictly at Lessee's own risk including,but not limited to, vehicle and personal safety and security. d Lessee shall be liable for any damages to Lessor's property caused by Lessee or by Lessee's vehicle. e. Lessor may change the configuration of the parking area as Lessor deems necessary. f. Lessee is responsible for the removal of signage and trash on the last day of the two week period. 3. Late Payments and NSF Payments: In the event that Lessee's full payment is not received in the office of Lessor by 5:00PM on the 5t►day past the due date.Lessee agrees to pay a late fee of S5 per parking space. Lessee also agrees to pay a S50.00 handling fee for any check returned by the bank for any reason_ Lessor reserves the right to require a cashier's check or money order for payment. 4. Non-Payment: If any payment required to be made under this Parking Agreement is unpaid when due,and Lessee fails to make such payment within five(5)days after written notice is served on Lessee notifying Lessee of non-payment and of Lessor's intention to terminate this Parking Agreement if such payment is not paid within the five day period Initials_14'. T7ti Page 1 hops://woodardproperties.na1.echosign.coo/publiciviewAgr...F9UZsb4JyGwSRkiigchxPx1WHrRbm29t_owevw3U_xNyS4X8, 12/3120, 9:14 PM Page 3 of 6 } Lessor may terminate this Parking Agreement and parking permit will immediately become invalid and and vehicle parked in the parking lot displaying such permit may be rowed without warning,at owner's risk and erfiense. 5. Lessor's Remedies After Termination: If this Parking Agreement is terminated due to a breach or default,Lessor shall have a claim for unpaid parking fees,a termination fee equal to one month's parking fee and a separate claim for actual damages for the breach or default and reasonable attorney's fees as provided by law. Actual damages include collection costs of any kind incurred by Lessor to collect amatmts owed by Lessee and interest at 18%on the unpaid balance until paid in fall. In the event that Lessor files a warrant for collection of any unpaid amount due under this Parking Agreement, Lessee agrees to pay a processing fee of S75.00,in addition to cant costs and legal fees. 6. Contact Person: Lessee hereby appoints Dan Simone as a primary Contact Person for this Parking Agreement The Contact Person shall be responsible for communicating with all person(s)listed as Lessee andlor Vehicle OwneriOperator as well as distributing any additional copies of this Parking Agreement. Contact Information is as follows: Work Phone Number:(703)927-271S Email:seasonsofchanne2skaol.com 7. Notices: All notices to be given with respect to this Parking Agreement shall be in writing. All notices from Lessor to Lessee should be sent to 40463 John Mosby Highway.Aldie,VA 20105 and all notices from Lessee to Lessor should be sent to Woodard Properties,22414`h Street.NW.Charlottesville.VA 22903. Each notice shall be sent by electronic mail,regular mail or hand delivered to the party to be notified at the address set forth herein or at such other address as either party may from time to time designate in writing. Nothing contained herein shall be construed to preclude personal service of any notice in the manner prescribed for personal service of a summons or other legal process. All policies,which are or may become in effect governing the operation of the parking facility,apply to all parkers_ Terms and policies are subject to change with reasonable notice_ Penalties for failure to comply with Ponderosa Land Trust regulations include revocation of parking spaces, towing, legal action or other means Lessor deems necessary to enforce its parking policies_ 8. Signage: Lessee is responsible for signage at their expense and with Lessor's final approval. This Parking Agreement is the only agreement regarding parking between the two parties. If approved by Ponderosa Land Trust,I agree to the terms outlined above: Lessee: Seasons of Change,LLC By: 03-4420 Printed Name:Dan Simone Title:CEO Date,2020 .1444. Lessor: 9gfe3, Tanashia Washington,Authorized Agent of Lessor Initials 1►4a' 21y Page 2 https://woodardproperties.natechosign.com/public/viewAgr...F9UZsb4JyGwSRkligchxPx1WHrRbm29t_owevw3U_xNyS4X& 12/3/20, 9:14 PM.. Pane 4 of 6 a Ace CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �.►% 2/11/2022 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 CONTACT NA Britton-Gallagher and Associates, Inc. PHONE FAX One Cleveland Center, Floor 30 In/c.No.Ea 216-658-7100 INC,No):216-658-7101 1375 East 9th Street AADDR�: infoabrittongallagher.COm Cleveland OH 44114 INSURER(s)AFFORDING COVERAGE NAIC INSURER A:Everest Indemnity Insurance Co. 10851 INSURED 18166 INSURER B: Fireworks Over America of South Carolina, Inc. INSURER c 916 Rosewood Drive Columbia SC 29201 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:697473898 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. MISR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE BIER WVD POLICY NUMBER Ir IDD/YYYY) (IrIDDJYYYY) LETS A GENERAL LABILITY SIBGLOOB55-211 12131/2021 10/112U[2 EACH OCCURRENCE $1,000,000 DAMAGE TO X COMMERCIAL GENERAL LIABILITY PREMISES( a°eminD ence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ X $2500 Deductible PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY F Tau n LOG S AUTOMOBILE LIABILn'Y COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED AUTOS AUTS (Per accident) $ S UYBREl1A I.IAB OCCUR EACH OCCURRENCE S _ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION WC STATU- OTH- AND E#IPLOYER LIABILITY Y/N TORY LIMITS ER S ANY PROPRIETOR/PARTNER/EXECUTNE N/A EL EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE S If yes,desaibe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I 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. Stand Owner,Property Owner and Others listed below are named additional insured's. Property Owner Ponderosa Land Trust,224 14th Street NW,Charlottesville,VA 22903 Stand Owner: Dan Simone DBA Seasons of Change Location: 260 Pantops Center,Charlottesville,VA 22903 Dates: 6/122-717/22 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Seasons of Change ACCORDANCE WITH THE POLICY PROVISIONS. Dan Simone 40463 John Mosby Hwy. AUTHORIZED REPRESENTATIVE Aldie VA 20105 / ®1988-2010 ACORD CORPORATION. ran ngnss reserved. 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CITY T.N. 71C-1' ?�, ,,. ..j.glp r Je.g.....r(�. il:..:.)-,... $1.y1:. .. q , LAVING R0. 47 T UWI 1EUnI.'9N IAUST ` ,•-,1{,i{'.•fj�ii{�+•�, . [, + ' AND JAGDIELINE S. RHyO�NWImCT I YY `• {f , +' '. T> t�l.'Sj::1y. [ .•..;lb CITY CITY B.O.273-5.15 PLAT ''Ls ....•tr i, •�r �:. f':+'•;..•••r'l:• ..* ' ALSO GEa LAESCOI)ID PLAT aT .. /� '(i . •1: ....-y• 'S' ROCFA'K. RAT G ASSOC INC. ,, .�r f ••••}';)1•P,.i i• �w . DAM/AUTAIST 7. 1995 - ,•�'.aa,' a ��•/`� •A• d,,/.. /P T,M. EyM- GJI-Z ' • J„ y '. i i;I',, ,�„p AE0 4ARi 1 'ICI�NYEpUpTONI uA NOTES: • ` • y •1, LF . e'a , D.a. ?217-iGl O.a. aG7-'J6 PLAT '` Sa • - 2. A[ffJRO1raT 7a TIE PHMA 11.DW S) AIfR M IIAP f . EFl•ECTITE-OATH FESNUMT 4,i Z09'J 1 P 710006 0VS DI NIS P'NO�RTT OORS�IM ZONIS .iFJB.IS ` i......4I' Qy , A (100 TSAR FLOD9 PUIT9, t • .@• IOIJf ,/ 4F , 3, ZrOP 04 7LA.lai.T TC AN T TOY a: TRIO •U.- LATO MIT ��y PHYSICAL SURVEY A7O aPRrn�n DDIWANT w.A. Jlo- a o.��ii�-,soap.' •PP- .BONER PO_C • vim-.�r ICALPARCE. ♦PPI.•POrRR G LSGNT 1'9LL 4. aYER1TsuG ecT T9 DE PDiAOVIM0. y�OFAM At hair •9M WATERPalen cNETERLIC ��t�•. TI1E PROPERTY OF RHO PROPERTIES. LLC A. AESONATICH FOR..9mo A0 RAILIOCKI p,f. Dotti15 G —...-o•s?aE' INC 4�•. LOCATED ON I),5. R0411E 29 6Ot D LA:1E) 0.B. ]9T,1731. • RZp'pI9TRI 0' ea,LINE E T9 iNE Cm OP o+ARL9>Ta1v1tLF ALBEMARLE CVUNTY, YIRp1N1A CELL mo-A • SCALE I' 50 'OATS JANUAAI 8. 2008 5 ro TITLE REPORT RIWIpaL, TN10 ntoPIATr IS CL'a.ECT T 3TDrtTB NCAOMT «EA*S*XTf. UTILITjl3 [aTES PAVENINT !T, VP on B,-!•U Ate` ,1 DISYLATID ai linsts7S69, (:: 0.'-•'.:1 Dlilo'I4rCON.-J1ETa MO IY Fs PRPP6rTTlaf. LLL r Y _1 ►ATENEN 7. TlE BEA7111165 uC D3TANCES SNOT•HEStai O.1•A[N))IE91a APE DOSE TAKE{FROM PLAT FeroSI IN tie ALDIMM. .,•' •J oEli0 Ms I/ia rLl �7 N. RAT y ffOC.. f.S.E 1T17-1a 11. �p CrTEET COCKILY CIA0.'IT L'OID1T r-t�S OffICB Is DIED BOOK JOT Ai -- OLLOTIEST VA reo03 SASE 55, — ISI S/110Se. 293'319I 13624 LEASE AGREEMENT This agreement of Land Lease is made this !day of Rt2Q/(. , 20 22 between Got CHEN ,(LESSOR) and EASOM)$ of et 4)bE JJ-C. ,(LESSEE)for the Property described as an area at the front of I I/5 -IRA IL ,more specifically Described on the attached site plan. LESSOR and LESSEE agree that for and in consideration of the sum of ( 4) Paid by check to the LESSOR at the signing of this document or prior to the commencement date of said Lease,LESSEE may land lease the site indicated on Exhibit A here to during the period of 411 ?HtV 7/IS aou . LESSEE agrees to obtain the necessary permits from Coviuri Of- A05EMgL Lk for the purpose of selling VA. h/A[L D Fitiwctr..5 during this period. LESSEE agrees to provide a certificate of insurance to the LESSOR providing coverage during the above dates,naming Gu; C rtEJ1 as additionally insured. LESSEE agrees to remove all stands,merchandise and refuse from the leased area by II S , 2oZZ. And shall restore the area to the same condition it was before the lease began. In addition,LESSEE agrees to hold G . CH EN and owners harmless of any and all accidents;etc. LESSEE will be responsible for all activities on leased premises related to their business operations. LESSOR: Gu: Crt6, SIGNED: C"--1../- WITNESS: Offit DATE: y O/•2 2 LESSEE: JE/So F Camiz ILL( SIG WITNESS: DATE: `/•o/•L.Z ® AcoRE) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/11/2022 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 CONTACT NAME: Britton-Gallagher and Associates, Inc. PHONE FAX Nor 216 658 7101 One Cleveland Center, Floor 30 1Evc.No.Extl:216 658 7100 A 1375 East 9th Street E-MAIL Do ESS: info@brittongallagher.com Cleveland OH 44114 INSURER(S)AFFORDING COVERAGE NAIL* INSURER A:Everest Indemnity Insurance Co. 10851 INSURED 18166 INSURER B: Fireworks Over America of South Carolina, Inc. 916 Rosewood Drive INSURER C: Columbia SC 29201 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:611643658 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 ADDLTYPE OF INSURANCE INSR SUER POLICY NUMBER M/DDPOUCY EFF POLICY EXP LTR INSR /YYYY) (MM /Y/DDYYY) UMITS WVD A GENERAL LIABILITY S18GL00655-211 12/31/2021 10/1/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ X $2500 Deductible PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- X LOC COMBINED SINGLE LIMIT $ AUTOMOBILE UABIUTY (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accdent) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS I IA CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'UABIUTY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT /M $ OFFICEREMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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. Stand Owner,Property Owner and Others listed below are named additional insured's. Property Owner: Gui Chen Stand Owner: Dan Simone DBA Seasons of Change Location: 1195 Seminole Trail,Charlottesville,VA 22901 Dates: 6/1/22-7/7/22 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Seasons of Change ACCORDANCE WITH THE POLICY PROVISIONS. Dan Simone 40463 John Mosby Hwy AUTHORIZED REPRESENTATIVE Aldie VA 20105 . - 7" J ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/06) The ACORD name and logo are registered marks of ACORD