HomeMy WebLinkAboutCLE202200048 Approval - County 2022-05-11Albemarfe County
9 V Zoning Clearance Application 101 lftl�
ChaMl lla, VA 229M
f'hane 4U,2965W2
F O R OFFICE U S E ONLY Clearance NumberC(��W7.Z- - " S
Fee Amount: $ 61.36 Date Paid: 1(419,2 By:W18'MS ),p CtWA' pQ
Application fee:�$159 + Technology surcharge: $2.36 rI '3•'
Receipt* I 6 I a$ Check #: (a;�j 1 at $ By: C 2 t- aV —0
Applicant - Fill out the entire page below and return to:
Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
maw'
SEASOA150tttMAtiKE LLC DAN ~4jf-
E-MailAddress:
NSOFc"AXkZPAOL.
Mailing Address:
Oyb Topnl/tr aOrE ✓.4. ZOfor
Phone#:
o3 qz,?
Tax Map and Parcel
number and/or Address
of the Business:
O%g00-p0-00-OIrf��
Zoning:
staff will fill out if unknown
PLAAA*D DEUEwp �
$IIJOPr�b CENlE2
Parcel Owner:
P0A)XADSk I,*A -TRYST
owneesAddress:
1,721. iq"f)T ptUi• CNAeotSva�
Check any that apply:
New Business Change of use ❑ Change of ownership Change of Name
Business Name:
5E-ASONS OF CHAOS 1,L.0 keTAIL FIRd'"cfcS
Description of Business:
Describe the business including use, number of employees, number of shifts, availability of par", and arty additional Into.
Ttik akrAIL 15AL& OF VA. AOPAa*-D FIA6t4XkS W6 A 8 �X O ' 57-46EC-
3Atk5 OAXAi ve-C- FRO(VI a z - 1717 ZOZZ
Previous Business on Site:
wD �XP2�5S
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:
320 5Q FT.
Is the Parcel Zoned LI, Hl, or PDIP?
Yes ZNo 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?
lkrpubfic 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 fist permit * below
Will there be new construction or renovations?
Yes 5�'No If yes, obtain appropriate building permit and list permit a 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.
signatu6--- � � Printed /7R.yi�EL 6. S/ 7uD
Date 'y 0 7 22 2
,2�y I Y Albemarle County
Community Zoning Clearance Application m ment
401 NkIMire Rd NorthVA 2Wig
hRGIN, Ph. 434.2 M32
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,
C LE2022-48
clearance number provided by Staff or business name
to WXDw0D A?*-t -65 , 22'f t L1l"sr A1.w, the owner
Name of landowner on record
of Tax Map and Parcel Number O1goo -00-00 - 011 Dlo 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 `i 2 S ' ZZ to the following address:
ZZ� �yrirsr �v.�u cRge�ogr.//is�d� z29�3
(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 2J.rVY-kL G. Si�soa�A
Date y 0 7• z Z
3
For Albemarle County Staff Review Only
Proposed Use:
Temp. Event (Firework Sales)
Permitted:
[Yes ❑ No
Permitted by Section:
Admen. Practices
Supplementary Regulations:
Applicable Special Use Permit (SP):
SP2018-12 (pylon sign)
Applicable Rezonings (ZMA):
ZMA1983-2
Applicable Site Plans (SDP):
SDP1988-53
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:
Defined by:
[-]Site Plan ❑ Zoning ordinance ❑ Coo ❑Existing
Total Square Footage of the Use:
320 sgft (8'X4O')
Required number of parking spaces:
Associated Clearances:
CLE2021-66, 2019-99, 2018-113
Variances:
VA1991-51 (Sign)
Violations:
No violation/all abated
Is a site inspection necessary?:
❑ Yes VNo
Site Inspection on (date):
To Confirm:
Notes:
Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
Approval Information
Approved as proposed ❑ Approved with conditions ❑ Denied
❑ Backf low 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 No objection Date 04/25/2022
Zoning Official Date 5-11-22
Fire Marshall approval 5/10/22
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4
Ponderosa Land Trust
22414m Sheet NW, Cbarbttestille, VA 22903
Phone: (434) 9SM736 FAR (434) 293-2280
Faoait: TamsbiarB�lVoodardl'rooerties cam
PARIUNG AGREEMEI7
This Parking Agreement made this 1_ day of December 2020, is between Ponderosa Land Trust- hereinafter
referred to as `Lessor, with office located at 224 140 Street NW, Charlottesville, VA 22903 (434-971-8860), and
Dan Simone w, Seasons of Change_ LLC, jointly and severally, if more than one, hereinsffa referred to as
`Lessee' wknber 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 sball be for fire (5) year,. fora 3 duee week period beginning on January 1. 2021. until December 31.
M. This lease is only applicable for the three week period on or about June 10 to July. 8° Therefore, nothing in
this lease precludes the Lessor from renting the premises to a thud pant. during this five czar period, outside of
the three wed applicable period
&they Party may terminate this agreement when one party gives to the other, 90-dali written notice of intent to
terminate.
Lessee agrees to pay Lester =per year for parking in the assigned spaces located at 160 PartonCent,
ent, _
Payment is due on the fast (V) day- of the sell¢¢ penod payable to Woodard Properties- Cash is not accepted for
payment. Fees marapply for credit card naauctions or any electronic payment.
In the eteat the Lessee is unable to operate the business den to Government or County restrictions or mandatory
shutdowns directly related in the COVD-19 pandemic Lessee will not be requited to pay the teat for the
restricted tsmeframe
This Parking Agreement will nof automancally renew, and sball terminate on December 31. 20_6.
2. Conditions:
a. Parking is o,,- valid for Lessee and specified spaces.
b. Use of the parking lot when mow ardor ice are present is strictly at the risk of Lessee.
c. Parkiat and use of the parting lot 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 ma- 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 road NSF Payments:
In the event that Lessees full payment is not received in the office of Lessor by S:OOPAI on the 5a day past the
due date Lessee agrees to pay a late fee of $5 per parking spas. Lessee also agrees to pay a $50.00 handling fee
for arr� check returned by the bank for any reason. Lessor reserves the right to require a cashiers check or tmcey
order for payment.
4. Sou -Payment
If ate• payment required to be made under this Parking Agreement is unpaid when due, and Lessee fails to make
such payment within fn'e (5) days after written entice is served on Lessee notifying Lessee of nor -payment and of
I..*, intention to terminate this Parting Antemennt if such nisment is not o nd within the Eve day netiod
— nit Page 1
https://woodardproperties.nal.echosign.com/public/viewAgr...F9UZsb4JyGwSRkligchxPxlWHrRbm2gt_owevw3U_xNyS4X& 12/3120, 9:14 PM
Page 3 of 6
Lessor may terminate this Parking Agreement and parking permit will immediately become invalid and any
%elite parked in the patting lot displaying such permit may be rowed without warning, at owner's risk and
expense.
S. Lessor's Remedies After Termination:
If this Parking Agreement is terminated due to a breach or default, Lessen shall have a claim for unpaid parking
fees, a termination fee equal to one mouth's parl®g fee and a separate claim for actual damages for the bench or
default and msonable anorney's fees as provided by law. Actual damages include collection costs of any kind
incurred by Lessen to collect amounts owed by Lessee and interest at 18%on the unpaid balance until pad in full.
In the even that Lessor fiks a warrant for collection of any uvpnd amount due under this Parl®g Agreement
Lessee agrees to pay a processing fee of 575.00, in addition to coup costs and legal fees.
6. Contact Person: Lessee hereby appoints Dau Simone as a primary Contact Person for this Parking
Agreement The Contact Person shall be responsible for commimicating mth all person(s) listed as Lnsee and or
Vehicle Owne�Operator as well as distribuumg ant- additional copies of this Parking Agreement. Contacr
Information is as follows.
Work Phone Number (703)927-2718
Email: seasomsofchauge2ranaotcom
7. Notices: All notices to be given with respect to this Paling agreement shall be in writing. Allnotices from
Lessor in Lessee should be sent in 40563 John Mosby F3ighway. Aldie. VA 20105 and all des from Lessee to
Lesser should be sent to Woodard Properties. in; 14m Sreec NR' Charlotterille. VA 22%3. Each notice shall
be sent by electronic mail, regular mail or hand delivered to the party to be notified at the address set froth hetem
or at such other address as either parry may from time to time designate in writing. Nothing contained herein
shall be construed to preclude personal service of any ounce 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
packers- Terms and policies are smbject to change with reasonable notice- Penalties for future to comply with
Ponderesa Land Tout regulations include revocative of parking span, towing, legal action or other means
Lessor deems necessary as enforce its parking policies.
S. Signage: Lessee is responsble for nguage at their expense and with Lessors final approsal-
This Parking Agreement is the only agreement regarding parking between the two parties. If approved by
Ponderosa Land Trust I agree to the moms outlined above:
Lessee: Seasons of Change, LLC
Br. AWL)
Primed NameDU Simone
Title: CEO
bgk3, 2020
Taneshia Washington, Authorized Agent of Lessor
Ialtlnla IIY_ Pap2
https://woodardproperties.nal."hosign.comipublic/viewAgr... F9UZsb4JyGwSRkligchxPx7WHrRbm291 owevw3U_xNyS4Xis 12/3120, 9:14 PM
Page 4 of 6
ACG7R0® CERTIFICATE OF LIABILITY INSURANCE
°"'2"'""'
v11/2011ao2z
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((es) must be endorsed. If SUBROGATION IS WANED, subject to
the terms and conditions of the policy, Certain policies may require an endorsement A statement on this certificate does not corder rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
M
Britton -Gallagher and Associates, Inc.
One Cleveland Center, Floor 30
1375 East 9th Street
M 216-BSai7100 FAX 21665�7tDt
Not
Eatu%or.
ADOR can
OSURMS)AFFORDING COVERAGE
MAN:a
Cleveland OH 44114
NSa®tA: Everest Indemnity Insurance Co.
10851
INSURED 181BB
Fireworks Over America of South Carolina, Inc.
916 Rosewood Drive
INSURER a:
INSURER
NSUr®lD.
Columba SC 29201
_
INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: 697473898 REV13ION 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. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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 SHONN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NXP
R
TYPEOFNSURANCE
POLICY N11�
POLICY EiF
MNDDIYPOLICY YT
L1MT5
A
GENERAL
X COMMERCIAL GENERAL LNBInY
CLAIMS -MADE FxI OCCUR
X 1125000eac1Lb
SNaa0655.211
12131202/
1On2022
EACH OCCURRENCE
$1000000
a Dean
S
MEOEIIP ale
$
PERSONAL S ADV NXnY
$1,000000
GENERAL AGGREGATE
$ z0on 000
GEM AGGREGATE
X POLICY
Lahr APPLIES PER.
PRO- X LOG
IECT
PRODUCTS -CONPADP AGG
$000000
$
AUTOODDI E LIABIIrY
ANY AUTO
ALL ONNED SCHEDULED
AUTOS AUTOS
HRED AUTOS NOWYNED AUTOSPPRO.W=AMAGE
COMBINED SINGLE LIMIT
BODILY NIURY(Pw- paam)
$
BODILY NANY(PrsoddaE)
$
$
S
IIBtH1A 1111B
ESCOS LIVE
OCCUR
CIAMSMADE
EACH OCCURRENCE
S
KiGREGATE
$
DELI I I RETENTION
$
wolffl Rs COYPFMSATpR
AND FIrPLOYERS LIABILITY YIN
ANY PROPRIETOfWARTNERIEXECUTIVE❑
OFFICERA EMBER EXCLUDED?
(1L.mrar in Ml)
I Yee, e Oder
DESCRRIPTIOIPTION OF OPERAIN)NS Celow
MIA
I Vic STATU- OTK
EL EACH ACCIDENT
$
EL DISEASE - EA EMPLOYEE
S
EL DISEASE -POLICY LMR
$
DESCRIPipN OF OPERATIONS I LOCA7x,MSI VLNICLES (Aeaeh A(IORU 1N, AAMieanM ReeRAe SNaeIMe, ide ePeee is apieIO
Additional Insured extension of Coverage is provKled by above referenced General Liability policy where required by written agreement.
Stand Owner, Property Owner and Others listed below are named additional insureds.
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: 611122 - W7122
rconolreYs Y 1 nro CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N
Seasons of Change
ACCORDANCE WITH THE POLICY PROVISIONS.
Dan Simone
AUTHORIZED REn1ESE1TATNE
40463 John Mosby Hwy.
Aldie VA 20105
-
® 198$-207 V AL:V T(u T.V rtrvrv. n..,.. ..•• . •e
ACORD 25 (20IW06) The ACORD name and logo are registered marks of ACORD
wopmeD L OCA1 BAN
FW&MVelts (W-IN
Initiaisq _ Page 3
�i-c�-�cwa r.a. c-� u> >ChOUI`1�l J'IbbbC4CC1
F,ecA-rr Vit-W
I'll F I IZ E WO RKS
SaxbS
WrNl�N
S WINDOW
� WWAo,J
3�tl�s
w,NDpkJ
SAcrS
WWf�V
qo.#
THIS 1S A 2 "X qD-" siI~EL. SGA -CwJrAr.vje-4Z
uWIi H WILL--M L6Eb FO&,-ME tAL6-OF CCAS5,�Cn
VA. AtOMeoveb Ff2Ewo�xs . 'i H s IS 7NE 5 /vX 5E4.iF
COAAAWED �E5 WIT J5Elb ►N -�2fV IOiiS Yf S
L TFt I s 1-oe�+r� on.r,
-5iDE VICfa/
zzgf�',
PLAS111 C,
Ail+J CAAMPP ;
� Do�25 SEc�eE�A w/
LCXV,V6 MEC14NOSM
FIREWORKS
40.
_r -
4 Lr x 8,-,<,t'1CY"
cen�r6t 'Ct p
Re men th'.
$
3:
&usbn
Pa ow uwg Np SeN liter
hu" nwnlers wdt 3.* nm txk am seam
acavnear,em ccowxo ct LM = cwm
CMVW* ww=ea -1wrr4y ru vcwrtm
M$cm
To mwl jT Rr Z ff*tt S= YX/
16= a& txg t-tyararns
6-4 Pnmea
C'unVow mWncw we= b roc of -
to=rn w etr m c=wn w of Mn YvaW ad
O In m Co. e c�RF e�ce va
Ext Pane
A 2 mn h* M-90 Mall Comp. pa'a wM
%w= =nG=A1 o7wQ gay -amdm
m3m
Dwh
AS Deew =M bUCdOn uw+a o rats owo-ore
tram 2 mm #W rule beet arwmt
cc VWk wih A bgW aam hiQW CMV"
vAh lko Jrn wA 4rpw m end 2 wm%o ban
.;pof Q= (= Kcoreepas a rr.AVV
eaMdra p�cprlrm }YjPr Ceatwrc
SO For" .
t6mmar2mMeick idmdp. : wih
val = 1dvi'MSVWIC*s=n
a "w*dar*xcu%vwehc!wto
peeowam
tkror Fcrww
12 mm wick mom Pew p.orm wl(n PWM
�+aran�v�w-r+�a '
>IcCeA+er taia nsriwowl�.vwlcea bt:41cp
•rW wa.1 corn hew mot pmaa k.41 t=,%
Pro ehxw
x 8' x 8'6'
Pro c1pW
.a ,'+';8`-rr 0'e
Wn4fftlans
n 6m
nanr-
OrnwrMlam
q
fpb*--
scva
.ID' C
tMnfm
C=Maus
£UNfJ7
3• C
2478 r:m
-:rcln -
.% w .
...= 4
t5�rfo ha[�.r
L• e"
2D91 rmr
�hw,$t
e".b'-'.''.•�.y,"'tm..
rrcafa prr.-
:a un'
t�.0 art+
': rJ6 CxcaY -
«`a a. tr
::dbb: rr ra
..
.?XTm
ti(es% wiv
47117 hs
< =q-
lrvwtrn rr _
�n�
`.-.•� :Y7:
.Tcu AWJ
ba =M)i.r 090696EM WET TT02;/TE/90
S
RTAA
lit f l i 1 l l 1 7'r f 1 l-i .3 3 t t i i i i i l j 3 1 a I 1 1 1
BASE
1
x
3
4
_ 1TiN
f4MR die, UXT
'�4k nStifslpLY
PAT AS%.IIf4,r
REAR ASSEMBLY
uw msaua t
PR
1
1
I
t
RAiPRlA1
— ~.
--
RJWA
ARE I,
stlR
pIR
K
spear
s
r
srn-u
Imp
'
—. a•�,_ 1
r
FRUNT
nacre saaom.lwm
nw:
uava
sxu lElr tau
nmeo.
saw &Iwnr-
MaE UfImR .:.
me* M
pia .
nR OFM womr..
]6MP... 64
SEE
sa..a w.
Maa,
OaOKabOO
'WINwmil
iaw
22aa
ra
*11MOL'
r
Lal6 aw
raa
mm
IZW4 r
ra
tow
aiilaat
suoxs:
n•
.
llsaml.I
lxttu.
m
' a�allenloo'.;
�aluf,,
7w
COOK
_
CM Jul
.-
6IfAKCDOMG 3AWANP QRR XIM
e
..W mw 2w:moni-alImw
a=
ill
af_
,am&" u cawr
,ate t- MUM pmmwc
A! xol gas
.21
ioi'�rr�i
tortemllu
W
�•afwu�oo
aF
r-a HOli�B`.,
Q-0 HO11�36
�w mma
N ]OISIIW
r sa+
V—V .401.m3e :
SchZM
w
Law
MI y a �-
taN7U4i b-{'W ,,,•
AWN �7
OWA
goo
.......... ...........
ME
. . . . . . . . . . . . . . . . . . . . . . . . .
' it' 'i anno[rv[nm TNF wTalIppapOl1rLLSS�'ppa�tl[[a,a IM mu nu.
• •• Ile i \ MITI,
6 rtO�O�"AMNT pp 4 It MINIM ``
�M IT Is
I=1�L `.-G - vi tk W.TlrilaN
�•. IxW Xrr
Al WIX OR Cult
wr
,,��%%//s cc.� tlYRLTTpviLlC PIIL�T mHpgtllW
U d* ay t A{Yf` AYWE
a
r�ii 'a JV �` 3, �•yp�kt���, `�t61., h- \. ,a'r}r
r' "SvY.<' •li'..'
t y ��p
Y N• :l N' {!; yl,�. ' �aBww.I IiLLnil,II i Wi At
�`� rn T )4 �• .;; Lm �i � . � • r-Y\. rpiw� O Y. a.G" �9x -.W 5 sqb ls.i
'i.. T� .,i. �i °� ;w �,+T.N-•YiL7=tat U\(-2...: iY nvaltT�
�:- r : l:j•K`:'.o "'_L •��yay;, .paw§Kv, .Y r, 1,,..\ .,.
aX5Slt
• rqf��, ..� �v:.: iiX�tl.ltr it 11 �{' ��+
I/t,L,C'yq C�[n ��[T.x.lal:ml.T ! 11/p
uO I 0. A, , Y.„(' T tW'�M�'J':'It'',1 .a.. •. � JXfi18 sT60w.i� .�.tt�IL j11 ���• � �j t.: �. P. �
CCCottti-uwiaeuT /v I \ \(t •�I T� w.'iO.S'
61X-1L1-
"wf 1 4 1lY{N4li 1 nl ixTta Ttaw. LLL
'11�r at. Is\-sse
Wm- -
L "IXON3U TO III e[N. ILOW I�Napp1.11R Mi 4
a 1�W091 l DI II[MLIMI `rt nm wl ut .1 xmi
1. MYYf311 H6W.'t TO YI i TO vlglgl' i0.1C • \)_ WJ 'Ieai PWSIL•AL $UYVEY
.c `loabl cawwt w.►. J1 tat ao-bad. 'vt" � PARCEL c'.
w�i-wrn L4LS6lIT Ins /v1-J T!E PROPER OF WIC PROPERTIES. LLC
'J. IIWRIT a1L8.1 10 IK' /LL1p11MC y®iW 4 IIRT' q1- W10111IV �•
'Ft -.. LOCATED ON Li, S.
A ettfi{v,T[(n rw QIMIIMtt euwn o.s. aw•.ro a f'- flMlIE 29 MORTYBOIXIc LANE)
t.t. aa}sau. iff STRUT
ALEG'NARpE COUNTY. YIRCINIA
SCALE:!-- 50'4AF O DATE:JANOl.PT 0. 2008
Ott in[ MIT Ile Wwy)1//v1u.tB. iY0-OU.
t. NO IITIA Knorr FlaWLM. Im IX T' It 41/cl
14 Wf .\®1TIbuL t.01mTI, a p�{(�p� VTLIli4 mom'XJ41'Et V.IE6rv1 1W
.TO/IA CTS=Nmo! WT Ct[eT. Ml /ryWFllflct. u[
�^'� TMe'LS [OnA[If NO
• /.-W /.oOeLp C=K.1fO
a. TMe B ORT T'"M aai awl in aloTit Rne: Ea Jurtt a R4II e. W/ / $1AU,i.
(IYW6IP1Tpy� /�W !T 16VR0 IN n YITE 11l}IY Kl i Ic m4T'cuwr Ligp orFta'ln o® taa Aa At � . ��p
. 0�4 43W Y1 YdYI
LEASE AGREEMENT
This agreement of Land Lease is made this ! rday of ""ell— Z o
between Gu i CHb.y (LESSOR) and
3EAs aus aF cR^4bfr t 1,LG (LESSEE) for the
Property described as an area at the front of 11,M :59M wOLL T2A IL more
specifically Described on the attached site plan.
LESSOR and LESSEE agree that for and in consideration of the sum
Of
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
q1 7#eL) 7115'
LESSEE agrees to obtain the necessary permits fro�ouuN of A l 6CMAL Lk- for the m
purpose of selling ✓A. NA[Auj 1~1LEwd41S during this period.
LESSEE agrees to provide a certificate of insurance to the LESSOR providing coverage during
the above dates, naming C.Wj as additionally insured.
LESSEE agrees to remove all stands, merchandise and refuse from the leased area by
Ills 2ozZ
And shall restore the area to the same condition it was before the lease began.
In addition, LESSEE agrees to hold G;- COMAJ and owners harmless of
any and all accidents; etc. LESSEE will be responsible for all activities on leased premises
related to their business operations.
WITNESS: r(i✓ DATE: q -o/•L2
A`O/P.0 CERTIFICATE OF LIABILITY INSURANCE
DAT21M12022 Y)
vnno2z
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(iss) 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 endorsema s .
PRODUCER
CONTACT
NAIE:
Britton -Gallagher and Associates, Inc.
One Cleveland Center, Floor 30
1375 East 9th Street
PHONE 216-658-7100 : p1gg5�7101
ADORL inf tintio al her.com
wfURE s AFFORDING CMERAOE
xucf
Cleveland OH 44114
INSURER A: Everest Indemnity Insurance Co.
10851
INSURED 18106
INSURER B:
Fireworks Over America of South Carolina, Inc.
916 Rosewood Drive
INSURERC:
Columbia SC 29201
INSURER D:
INSURER E :
INSURER F :
CnVFRenEA CERTIFICATE NUMBER- A11FWV58 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. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MATH 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.
INa t
L
TYPE OF INSURANCE
ADDL
SU
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
A
OBIERILL UA911.TIY
SIBGL00555 11
12231l2021
1011121)22
EACH OCCURRENCE
$1000000
PRE ISES
$
X COM11 ERCIAL GENERAL LIABILITY
NED EXP one
$
CLAMS41ADE 7 OCCUR
PERSONAL a ADV INJURY
S 1000000
X 12500 DINJudblis
GENERAL AGGREGATE
$ ZODOJODO
GENL AGGREGATE
LIMIT APPLIES PER
PRODUCTS - COMPIOP AGO
SZODIXODD
$
X POLICYPRO-
X LOC
AUTOMOBILE llAORM
1NED
WisASINGLE LIMIT
ANY AUTO
BODILY INJURY(Pw person)
S
SODRY INJURY (Pon isss( NA)
S
ALL OWNED SCHEDULED
AUTOS AUTOS
NOWOMED
HIRED AUTO PAVrOS
PROPERTY DAMAGE
fliff
$
S
UMBRELLA UAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
f
OICESS LJAS
CLAIMS -MADE
DED I I RETENTION
$
WORKERS COMPENSATION
VA: STATU- OTf4
AND EMPLOYERS LIABILITY
ANY PROPRIETOR)PARTNER/EXECWIVE YIN
EL EACH ACCIDENT
f
E.L DISEASE - EA EMPLOYEE
S
OFFICERMEMBER EXCLUDED?
(Begatory in NN)
MIA
E.L DISEASE -POLICY BUT
f
I yse Eesabe'n0er
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Sch le, ff more space is "uiRE)
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 insureds.
Property Owner: Gui Chen
Stand Owner: Dan Simone DBA Seasons of Change
Location: 1195 Seminole Trail, Charlottesville, VA 22901
Dates: 6/1/22 -7f7n2
CANCEL L ATInN
VGR I Ir1Va� 1 G r1V GV G�
'
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
AUTHORIZED REPRESENTATNE
y
40463 John Mosby Hwy
Aldie VA 20105
U 1505.2010 ACORD CORPORATION. Bun. All ngnu reserved.
ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD