Texas Department of Insurance
State Fire Marshal’s Office Mail Code 112-FM
333 Guadalupe • P. O. Box 149221, Austin, Texas 78714-9221
512-305-7900 • 512-305-7922 fax • www.tdi.state.tx.us
	
RENEWAL APPLICATION
FIREWORKS LICENSE

1	License Number	Expiration Date	Renewal Fee	*Late Fee	Fireworks Safety & Education Fee	Total Fee	

*Please note that LATE FEES will be required for renewal applications that are not postmarked on or before the expiration date.
Please refer to page 2 for the fee schedule.

2	Name & Mailing Address of Firm:	3	Location Address of Firm:	

	4	Location County:		

PLEASE MAKE SURE ADDRESSES SHOWN ABOVE ARE CORRECT. An additional $20 is required for address changes.
All or some of these documents (as required for your firm) are currently on file.  If the document is expired or will expire at the time of renewal, a new one will need to be submitted before this renewal can be processed.	
Assumed Name Certificate (Expires every 10 years or sooner)	Letter of Good Standing (Expires every year)	
	
COMPLETE ANSWERS MUST BE GIVEN TO ALL QUESTIONS.  ANY FRAUDULENT REPRESENTATIONS ON THIS RENEWAL APPLICATION MAY BE CAUSE FOR DENIAL, SUSPENSION, OR REVOCATION OF THE CERTIFICATE OF REGISTRATION.
		YES	NO			YES	NO	
5	Has there been a change of owners or officers of your firm in the last two years? If “YES”, list current owners or officers on a separate sheet.			6	The firm regularly generates less than $6 million in annual gross receipts.			
								
7	The firm regularly has fewer than 20 employees.			8	The firm is independently owned and operated. (i.e. not a subsidiary or subject to control by another entity or not publicly traded)			
9	The firm regularly has fewer than 100 employees.							
9	Does your firm store fireworks in the state of Texas?  If “YES”, please list below all locations where 1.3G or 1.4G are stored.  Use additional sheet if necessary.			
INDICATE CLASSIFICATION CODE 1.4G OR 1.3G	LOCATION
(If no street address, please describe exact location)	ESTIMATED MAX. WEIGHT
DURING THE YEAR	ARE THERE
500 OR MORE CASES?	
	Street Address	City	Gross Weight	*Net Weight		

						
*Net Weight is the weight of all pyrotechnic and explosive compositions and fuse only.	
8	In applying for a renewal of a fireworks license or permit, I certify that I am familiar with and will comply with Chapter 2154 of the Texas Occupations Code and the Fireworks Rules.  I hereby authorize the Texas State Fire Marshal or his representative to enter, examine and inspect any premises, building, room or establishment used by my firm while engaged in the business to determine compliance with the provisions of Chapter 2154 and the Fireworks Rules.	
		
	Signature 			
	Printed Name		Title		Date			
						
Application must be signed by the individual applicant or, for a firm, by the sole proprietor, by each partner of a partnership, or by an officer of a corporation or association.
all fees are non-refundable, except for overpayments resulting from mistakes of law or fact.
NOTICE ABOUT CERTAIN INFORMATION LAWS AND PRACTICES
With few exceptions, you are entitled to be informed about the information that the Texas Department of Insurance (TDI) collects about you.  Under sections 552.021 and 552.023 of the Texas Government Code, you have a right to review or receive copies of information about yourself, including private information.  However, TDI may withhold information for reasons other than to protect your right to privacy.  Under section 559.004 of the Texas Government Code, you are entitled to request that TDI correct information that TDI has about you that is incorrect.  For more information about the procedure and costs for obtaining information from TDI or about the procedure for correcting information kept by TDI, please contact the Agency Counsel Section of TDI’s Legal & Compliance Division at (512) 475-1757 or visit the Corrections Procedure section of TDI’s web page at www.tdi.state.tx.us.

TEXAS DEPARTMENT OF INSURANCE

STATE FIRE MARSHAL'S OFFICE

Certificate of Registration Renewal Checklist

To renew a certificate of registration issued by the State Fire Marshal's Office, a complete renewal application is required.  

A renewal application is considered complete only if:  the firm has an appropriately licensed employee on staff, the appropriate fee and a completed renewal application are submitted,
AND
all required documents (as required for your firm) listed on the front page.

Late fees will be charged if a renewal application and renewal fee are not postmarked by the expiration date of the certificate of registration.  Late fees will also be due if a renewal application is not complete before the expiration of the certificate or within the 30-day notice period.

TYPE OF LICENSE	RENEWAL FEE	FIREWORKS SAFETY & EDUCATION FEE	LATE FEE	
FWM
Fireworks
Manufacturer License	
$1000.00 (each year)	
$250.00	DAY 1-90	DAY 91 – 2 YRS	
			
$500.00	
$1000.00	
FWD
Fireworks
Distributor License	
$1500.00 (each year)	
$250.00	
$750.00	
$1500.00	
FWJ
Fireworks
Jobber License	
$1000.00 (each year)	
$250.00	
$500.00	
$1000.00	

					
An additional $20.00 revision fee is required for address changes.	

Check or money order for the renewal fee should be made payable to the TEXAS DEPARTMENT OF INSURANCE and mailed with this complete application and current valid documents to:

State Fire Marshal's Office
Mail Code 9999
P. O. Box 149221
Austin, TX  78714-9221

If you have any questions, please contact us at (512) 305-7930 or by writing to the above address:

Texas Secretary of State:	Texas Comptroller of Public Accounts:
(512) 463-5578	1-800-252-1386	
	http://ecpa.cpa.state.tx.us/coa/Index.html