FM REVIEW •
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Fire Marshal Division
P.O. Box 370
Lillington, NC 27546
910493-7580
Application for Plan Review
Application NI 8 - a V.
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Date Received: Received By:
Name nfProject: TFireworks Temp Tend Sale
Physical Address of Project: - I E65 13u({c to t4 Ke Ptd.t)
Bill ✓av�3'G7� NC a7JJ�
Plans Submitted By: Billy BlaCk l,On
Protect Phone: (919)_215.2107
Contact Person/Address: Billy Blackmon
PO Box 97 Hope Mills, NC 28348
•
Contact Phone: (919 }215 .2107 ( -
Contractor's Name/Info: TNT F reworks
11 it 11
Contractors Phone: (919-215-2107 )-
• Plans that are submitted will be reviewed as quickly as possible with an
average time of review between 7-10 working days.
• Status checks may be conducted on plan reviews by visiting the website
httn://hteweb.harnett.ore/Click2GovBP/Index.isa or by calling the Harnett
County Central Permitting Office(910493-4759), or the Harnett County
Fire Marshal's Office(910-893-7580).
• Approved plans must be picked up from the Central Permitting Office and
all fees paid before any required inspections can be conducted.
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1
AC O® CERTIFICATE OF LIABILITY INSURANCE DATE(1 01 "
n/1/2018 5/31/2018
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 en ADDITIONAL INSURED,the pollcy(ies)must have ADDITIONAL INSURED provisions or 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).
P CONTACT
PRODUCER -
LOckton Companies NAME:
3280 Peachtree Road NE,Suite#250 PHONE FAX
NC No:
Atlanta GA 30305 -MAIL
(404)460-3600 ADDRESS.
INSURER(S)AFFORDING COVERAGE _ MICA
INSURERA:Everest Indemnity Insurance Company _ 10851
INSURED American Promotional Events,Inc. INSURER B:
1359629 DBA TNT Fireworks,Inc. INSURER C: - _
-
PD.Box 1318 INSURER o:
4511 Helton Drive INSURER E:
Florence AL 35630
INSURER F:
COVERAGES CERTIFICATE NUMBER: 15418778 REVISION NUMBER: XXXXXXX
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.
--:AOOL SVGA -_. POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE IINSD WVD POLICY NUMBER IMMTDIYYYYI IMMNDMYYI LIMAS
A XCOMMERCAL GENERAL LABILITY y N $IAGL00242-1)1 11/1/2017 11/1/281$ EACH OCCURRENCE 1,000,000
___
CLAIMS-MADE X OCCUR DAMAGE TO
Iraoccurrence) 500,000
MED EXP(Any one person) 5,000
PERSONAL&ADV INJURY 1,000,000
GEN1 AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE 2,000,000
POLICY JPRO-ECTT XI LOC PRODUCTS-COMP/OP ACG 2,000,000
OTHER
AUTOMCOILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT
(Es amdenj XXXXXXX
ANY AUTO BODILY INJURY(Per Polson) XXXXXXX
OWNED — SCHEDULED BODILY INJURY(Pel accident/ XXXXXXX
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE XXXXXXX
AUTOS ONLY _ AUTOS ONLY (Por accident)
XXXXXXX
UMBRELLA LAB _ OCCUR NOT APPLICABLE EACH OCCURRENCE XXXXXXX
EXCESS LAS CLAIMS-MADE AGGREGATE XXXXXXX
DED RETENTION$ XXXXXXX
WORKERS COMPENSATION NOT APPLICABLE STATUTE ERH
AND EMPLOYERS'LABILMT
ANY PROPRIETORNARTYEPJEXECUTIIE Y(" EL.EACH ACCIDENT XXXXXXX
(Mandatoory In NH)EXCLUDED' n x1A P'
E.L.DISEASE•EA EMPLOYEE XXXXXXX _
I1 a describe under
DESCRIPTION OF OPERATIONS bbelowEL.DISEASE-PouLIMIT lett XXXXXXX
1
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule.may be attached If marl space N required)
ADDITIONAL INSURED:FNCI280;Vacant Lot--Clayton Towne Center 12809 US Hwy 70 West Clayton,NC 27520;Donald and Catherine Pendley-Customer;
Certificate holder is an additional insured on the General Liability as required by written contract subject to policy terms,conditions,and exclusions.
CERTIFICATE HOLDER CANCELLATION
15418778
Piedmont Companies SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Box THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
POPO
1732 ACCORDANCE WITH THE POLICY PROVISIONS.
7 28093
AUTHORIZED REPRESE/NTT"4BBVF
91988-20 AC RD CORPO TION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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