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HomeMy WebLinkAboutFIR2015-00035 Fireworks Stand - FIR Permit / Conditions - 6/24/2015 N MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line (360)427-7262 ror�° Phone: (360)427-9670, ext. 352 Mason County Bldg. III 426 W. Cedar St Shelton, WA 98584 FIRE PROTECTION PERMIT FIR2015-00035 APPLICANT: VIRGINIA BEECH RECEIVED: 6/24/2015 CONTRACTOR: LICENSE: EXP: ISSUED: SITE ADDRESS: 18341 E STATE ROUTE 3 ALLYN EXPIRES: PARCEL NUMBER: 122205072009 LEGAL DESCRIPTION: ALLYN BLK: 72 LOTS 9-10 & LOTS 5-8 & 10' VAC PTN SHERWOOD AVE &VAC ALLEY ADJ PROJECT DESCRIPTION: FIREWORKS STAND PERMIT GENERAL INFORMATION System Information Type of Use: STND Sprinkler Heads: Audible Switches: Pull Stations: Fire District: 5 Flow Switches: Visual Devices: Door Releases: Hood& Duct?: Pressure Switches:: Smoke Detectors: Duct Detectors: Dry Chemical?: Zones: Heat Detectors: Wet Chemical?: Sprinkler?: Standpipe?: SQUARE FOOTAGE FEES Monitoring Company: First Floor: Type Amount Due Amount Paid Monitoring Phone No.:() - Second Floor: Fireworks Stand Permit $100.00 $0.00 Auto Fire Alarm?: Third Floor;: Total: $100.00 $0.00 FIR2015-00035 Please refer to the following pages for conditions of this permit. Page 1 of 7 CASE NOTES FIR2015-00035 CONDITIONS FOR FIR2015-00035 FIR2015-00035 Please refer to the following pages for conditions of this permit. Page 2 of 7 1.) Sales: WAC 212-17-21505 Retailers of fireworks-General provisions. Fireworks may be sold from 12:00 noon to 11:00 PM on June 28 through 9:00 PM on July 5. Fireworks may not be sold between the hours of 11:00 PM and 9:00 AM from June 28 through July 3. Fireworks may not be sold from 12:00 midnight to July 4 through 9:00 AM on July 5. X Fireworks may be sold from 12:00 noon to 11:00 PM on each day from the 27th of December through the 31 st of December of each year. X Only Division 1 AG consumer fireworks, obtained from state-licensed wholesalers, not otherwise prohibited by chapter 70.77 RCW or local ordinance, and holiday related products incidental but related to these products, may be sold in retail fireworks stands. X Fireworks stand locations: WAC 212-17-21509 Retailers of fireworks-location. (1)Activities or uses subject to this rule shall not be limited in location except where such activities or uses are prohibited or controlled by local development regulation, traffic safety or road construction standards. (2) Temporary retail fireworks stands shall not be located more than 150 feet from a private way, fire department access road, public road, street or highway as measured by an approved route around the exterior of the stand. The minimum requirements for private way shall be determined by the local authority having jurisdiction, but shall not exceed the requirements of locally adopted street, road and access standards. (3)Any two retail fireworks stands shall be at least 100 feet apart or shall be separated by a road, street or highway not less than 30 feet in width. (4) Retail fireworks stands shall be located as required by table 212-17-21509 in this section and attached to the permit. The minimum required area surrounding the stand shall be marked or flagged, except that flagging and marking shall not block a sidewalk or pedestrian pathway. Flagging need not exceed twenty feet in any direction. (5) Retail fireworks stands shall not be located closer than 100 feet from any motor fuel dispensing station, retail propane dispensing station, flammable liquid storage, or combnustible liquid storage. Retail fireworks stands shall not be located closer than 300 feet from any bulk storage of flammable or combustible liquid or gas, including bulk plant dispensing areas. X Surrounding area arond fireworks stands: WAC212-17-21511 Retailers of fireworks-areas around the retail fireworks stand. (1) The minimum areas around the retail fireworks stand specified in WAC212-17-21509 shall be kept free of accumulation of dry grass, dry brush and combustible debris. No parking shall be permitted within this minimum area. (2) No motor vehicle or trailer my be parked within twenty feet of a retail fireworks stand except when delivering , loading or unloading fireworks. (3) Fireworks shall not be discharged within 100 feet of a retail fireworks stand. Signs reading "NO FIREWORKS DISCHARGE WITHIN 100 FEET' in letters at least 2 inches high, with the principal stroke of not less than one half inch, on contrasting background„ shall be conspicuously posted on all four sides of the stand. (4) No smoking shall be allowed within the retail fireworks stand or within the minimum flagged off area. Signs reading "NO SMOKING WITHIN 20 FEET' in letters at least 2 inches high, with the principal stroke of not less than one half inch, on a contrasting background, shall be conspicuously posted on all four sides of the stand. X Electrical supply and usage: WAC 212-17-21513 Retailers of fireworks stand use and construction. (1) Fireworks may be sold from: (a)A permanent structure which meets provisions of WAC 212-17-21505(3). (b)Temporary, stable structures made of wood, metal, fiberglass or other material. Any temporary fireworks retail stand greater than 400 square feet FIR2015-00035 Please refer to the following pages for conditions of this permit. Page 3 of 7 shall meet the requirments of a permanent structure, except tents or canopies as defined in the International Fire code retail stand greater than 400 square feet shall meet the requirements of a permanent structure. (c)Tents , canopies, or structures utilizing temporary membrane material. All tents, canopies or temporary membrane materials structures shall be made from fire retardant material or treated with fire retardant as identified in the International Fire code. Any tent, canopy or temporary membrane material structure falling within the scope of the International Fire code shall comply with those requirements. When those requirements are in conflict with other provisions of these rules, the more restrictive provisions shall apply. (2) Battery powered equipment, electrical equipment cords which are used in conjunction with a retail fireworks stand or a temporary storage structure or location must be listed by a recognized laboratory and used in accordance with that listing. If electrical power is supplied by an extension cord, the size of the cord, the length of the cord and the amperage and the voltage supplied shall be in compliance with the requirements of the National Electrical code, current edition. The cord shall be protected as necessary from drive-over and other physical damage. No additional permits from a city or county or state official having jurisdiction shall be required for these temporary uses except as specified in subsection(5) of this section. (3)All heating units shall be listed by a recognized testing laboratory and shall be used in accordance with the listing. Heating sources shall have"tip over' and temperature overheat protection. All heating devices shall have sealed type elements( i.e, oil filled or water filled radiator type). Open flame heating devices are prohibited. (4) Generators which use combustible fuel and which are at least twenty feet from the retail fireworks stand or the temporary fireworks storage structure shall be allowed. Generator fuel shall be limited to not more than five gallons and stored at least twenty feet from all stands. (5) Compliance with the National Electrical code, current edition, shall be required for all new, permanent electrical installations, including temporary power drops, subject to possible fees. (6) Retail sales of fireworks and other products which are holiday related shall be from buildings used for no other purpose. X Storage associated with retail fireworks: WAC212-17-21517 Retailers of fireworks-Temporary fireworks storage associated with the retail fireworks stand operation. (1) Temporary fireworks storage is not permanent fireworks storage. Temporary fireworks is defined as storage associated with retail fireworks sales and may only be from June 13 through July 13 and from December 12 through January 10 of the following year. Permanent fireworks storage is associated with retail or wholesale fireworks activites when the period of time of storage is other than, or longer than that specified for temporary storage. Temporary fireworks storage shall be in accordance with this section. Permanent fireworks storage is subject to the Internaitonal Fire Code and the local ordinances. (2) Delivery of fireworks to a location, or storage of fireworks in a facility, not authorized by the license and permit is prohibited. If the approved storage location is outside the jurisdiction issuing the permit, the authority issuing the permit shall notify the appropriate authorities of the jurisdiction in which the storage is to be Icoated. (3)A temporary fireworks storage facitlity or a temporary fireworks storage location shall be authorized as a part of a license and permit if it meets the requirements specified herein. (4) No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. (5) Storage of fireworks authorized by a retail license and permit is legel only during the periods specified in this section. (6) Fireworks may be stored: (a) In a locked or secured retail fireworks stand;or (b) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than 20 feet from the retail fireworks stand during hours of retail sales;or (c) In a locked or secured truck, container, trailer, other vehicle or anything similar which is not less than 20 feet from an inhabited building where the term "inhabited building" is defined as in the International Fire Code; or (d) In a magazine which meets the minimum standards of a type 4 as prescribed by the International Fire code, and which is not less than 10 feet from an inhabited building where inhabited building" is defined as in the International Fire code: or (e) In a locked or secured metal or wooden garage, shed, barn or other accessory building, or anything similar which is not less than: 20 feet from an inhabited building for storage of fireworks for one or two retail stands; or 30 feet from an inhabited building for storage of fireworks for three or more stands. The term " inhabited building is defined as in the International Fire code. FIR2015-00035 Please refer to the following pages for conditions of this permit. Page 4 of 7 (7)The local authority having juisdiction may reduce the minimum separation required of this section provided that safety of life and property is not diminished. (8) No Cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. (9) Temporary fireworks storage structures may be inspected prior to use and other inspections may occur on other days as warranted. There shall be no additional charge for all such inspections. X 2.) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 3.) Valid Permit Must be on-site. X OWNER/ BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. Signature Date OWNER - REPRESENTATIVE - CONTRACTOR Print Name (Circle one to indicate) FIR2015-00035 Please refer to the following pages for conditions of this permit. Page 5 of 7 . ► of SHF<� � � O FIRE MARSHAL' S 0 �►` �SNIN OFFICE G� "Building A Stronger Community TOGETHER" DATE: 6/22/2015 PERMIT: FIR2015-00034 f ` PROJECT ADDRESS: Allyn Center 1.$� E SR 3, Allyn Wa PROJECT DESCRIPTION: Retail Sales Fireworks Stand PROJECT APPLICANT: Virginia Beech CONTRACTOR/ARCH: Virginia Beech A review has been conducted of your permit application; Comments are provided below: Retail fireworks stands shall be not more than 150 feet from a public road, fire department access road, street or public way. See the enclosed WAC information regarding "Minimum Clearances" for fireworks stands. Since this information was not completely provided as required in the application packet, it will be checked at the time of inspection, prior to issuing the permit. Failure to meet the minimum clearances may result in your permit not being issued. Michael D. Patti, Assistant Fire Chief City of Shelton Fire Marshal 122 W. Franklin St. Shelton, WA 98584 360-432-5170 mpattiCcmfe.orp SHELTON CITY FIRE STATION OFFICE: 122 WEST FRANKLIN SHELTON WASHINGTON 98584 MAIL STOP:POB1910,SHELTON, WASHINGTON 98524 OFFICE:360-432-5170 FAX:360-427-9438 6/22/2015 WAC 212-17-21509:Retailers of fireworks—Location. 7-40C.Ni�'W_ 0 WASHINGTON STATE LEGISLATURI� - t Legislature Home . ch l Help l Mobile WACs>Title 212>Chapter 212-17>Section 212-17-21509 Inside the Legislature ,r Find Your Legislator 212-17-21507 << 212-17-21509>> 212-17-21511 ,t Visiting the Legislature ,t Agendas,Schedules and Calendars WAC 212-17-21509 Agency filingsfilings affecting this section * Bill Information Retailers of fireworks—Location. * Laws and Agency Rules * Legislative Committees (1) Activities or uses subject to this rule shall not be limited in location except where such activities or ,t Legislative Agencies uses are prohibited or controlled by local development regulation,traffic safety or road construction ,t Legislative Information standards. Center (2) Temporary retail fireworks stands shall not be located more than one hundred fifty feet from a * E-mail Notifications private way,fire department access road, public road, street or highway as measured by an approved * Civic Education route around the exterior of the stand. The minimum requirements for a private way shall be determined * History of the State by the local authority having jurisdiction, but shall not exceed the requirements of locally adopted street, Legislature road and access standards. Outside the Legislature (3) Any two retail fireworks stands shall be at least one hundred feet apart or shall be separated by a road, street or highway not less than thirty feet in width. * Congress-the Other (4) Retail fireworks stands shall be located as required by Table 212-17-21509 in this section. the Washington Minimum required area surrounding the stand shall be marked or flagged,except that flagging and * TVW marking shall not block a sidewalk or pedestrian pathway. Flagging need not exceed twenty feet in any * Washington Courts direction. * OFM Fiscal Note Website Retail Fireworks Stands-Minimum Clearances pins Motor Motor Washington* Vehicle Vehicle O•Ilcll Stab Gay.nn•.nt YW Nib Traffic Traffic PUBLIC PRIVATE Buildings Combustibles Property Line Parking ROAD` WAY K OF,STAND,_pt 20 FT. 20 FT. 5 FT. 20,FT!,J 20 FT. 5 FT. SIDE OF STAR y 20 FT. 20 FT. 5 FT. 20 FT. 20 FT,-'. 5 FT. FRONT OF STAND 40 FT. 40 FT. 20 FT. 20 FT. 20 FT. 20 FT. 20 FT.** 20 FT.** NOTE: Clearance distances are not cumulative * Measured from the outer edge of the nearest traffic lane. If stand is equipped with 135 fusible links which will automatically dose all sales doors in case of fire,or is equipped with a wire- mesh screen with openings of not more than one inch which covers not less than 90%of all sales openings. (5) Retail fireworks stands shall not be located closer than one hundred feet from any motor vehicle dispensing station, retail propane dispensing station, flammable liquid storage, or combustible liquid storage. Retail fireworks stands shall not be located closer than three hundred feet from any bulk storage of flammable or combustible liquid or gas, including bulk plant dispensing areas. EXCEPTION: 1. Fuel for generators as allowed by WAC 212-17-21513(4). 2. Fuel within the tanks of motor vehicles. [Statutory Authority: Chapters 43.43 and 70.77 RCW.WSR 05-12-033, §212-17-21509,filed 5/24/05, effective 6/24/05. Statutory Authority: RCW 70.77.250 and chapters 70.77 and 43.43 RCW.WSR 98-04- 007, §212-17-21509,filed 1/23/98, effective 2/23/98.1 httpJ/app.leg.wa.govM/AC/default.aspx?cite=212-17-21509 1/1 -n Im 56 CONCRETE MECHANICAL MANUFACTURED HOME m Date a Footings /Setbacks Gag Piping By Ribbons = Cinterior Date By Interior-Date By Date By 00 Exterior Date By Exterior-Date B W CtI Point Load/Isolated Footings BGS SLAB INSULATION Date By Z Date By Data By FIRE DEPARTMENT —y Foundation Walls Floors Date By Date By Data By DECKS FRAMING walls Date By Date By Data By PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Type: Dale By Date By Date By D.W.v DRYWALL Type: Int.Brace Wall Date By m Date By Date By FINAL INSPECTION N y Water Line Fire Separation CD Date, By Date By Date By Cn O o Pass or Request Inspect. c Type of Insp. Fail Date Date 0 ne y Comments y O n O 3 a r: 0 3 N O S p! O 3 :r N CQ tD 0) O V .coU MASON COUNTY (360)427-9670 Shelton ext.352 DEPARTMENT OF COMMUNITY DEVELOPMENT (360)275-4467 Belfair ext. 352 BUILDING PLANNING• FIRE MARSHAL (360)482-5269 Elma ext. 352 3 " Mason County Bldg. 111, 426 West Cedar Street 54 PO Box 279, Shelton, WA 98584 www.co.mason.wa.us FIR20 Mason County Fireworks Permit Application Incomplete applications will not be accepted A permit for retail sales or public display of fireworks is required. A completed application with required documentation and fees shall be submitted for Fire Marshal review. A permit will be issued upon satisfactory site inspection by the Fire Marshal. Applicant Information: 3co0 551 8� 1 I n 0- Owner: VIRGINIA BEECH Mailing Address: 321 E. PICKERING City. SHELTON State: WA Zip: 98584 Phone#: 253-922-0800 Email: LicensingN®tntfireworks.com Sponsor Information: Name: VIRGINIA BEECH Address: 321 E. PICKERING City: SHELTON State: wA Zip: 98584 Phone#: 253-922-0800 Email:LicensingNOtntfireworks.com Washington State Fireworks License Information (Copy Required): License Number: 15-C2q O Date of Issuance 1~eb. 9, 20- kS ❑ Pyrotechnic Operator License ® Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required): Provider: SEE ATTACHED Insured: Certified Holder: Location of Stand/Display: Site Address: ALLYN CENTER Directions to Site: Parcel Number: (twelve digit number) I aA;O - - Legal Property Owner **Please see reverse side to complete your application** The following pertinent information MUST be provided on the site diagram below Location and Setback distances from the back, sides and front of retail sales stands or designated display areas to: Fire Hydrants Property Lines Mortar separation distance Combustibles Parking Designated landing area Fire Lanes Public Roads and Right of Ways Trees/Brush Private Roads and Right of Ways Utilities Landmarks SEE ATTACHED DIAGRAM Applicants Affidavit I certify that the information provided herein is accurate and that compliance with all County, State and Federal laws pertaining to the sales or discharge of fireworks shall be maintained. Signed VIRGINIA BEECH Date 02/12/2015 I I FIRE PROTECTION BUREAU FIREWORKS LICENSING PROGRAM PO Box 42600 Olympia WA 98504-2600 �4• .+ (360)596-3914 FAX: (360)596-3934 a APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWM6502 TO Governing body of city,town,or county in which DATE OF FEBRUARY 12, 2015 fireworks stand will be located. I APPLICATION Applicant Name Address,City,State VIRGINIA BEECH 2120 MILWAUKEE WAY.TACOMA,WA.98421 Sponsor(If other than applicant) Address,City,State VIRGINIA BEECH 2120 MILWAUKEE WAY,TACOMA,WA 98421 Lora i n of proposed fireworks stand(Enclose drawing of stand location] 21 E STATE RT 3, ALLYN, WA ALLYN CENTER Manner and place of storage prior,during,and after sales dates ON SITE WITH SECURITY State-Licensed Fireworks Supplier AMERICAN PROMOTIONAL EVENTS NW 2120 MILWAUKEE WAY,TACOMA,WA.98421 -------- --- -------------------- --- --------------- ------ --------- --- FIR-CWOD17x-r%,-S"E STAND PERMIT For the Fireworks Sales Year of: 2015 (Must be conspicuously displayed at all times while the stand is open to the public) By virtue of having been granted a license by the State of Washington and this permit from MASON COUNTY as the local governing authority,the named person,firm or organization is hereby authorized t sell U.N. 0336 1 AG Consumer fireworks at the location designated herein between the o 'ng date and time Sales July 4`h Sales for Decem er 31s` From: From: -'�wf�e� e To: v� 1 d` eon To: p n v r �l� zg1Q'E TE RT 3, ALLYN, WA S t (� 5`Ga D�Q 6 �. °J VIRGINIA B CH 0oPew ° 6 ranting Permit Signature of A plicant Titt6 ��'��° Agency to Permit Number Licensee Name VIRGINIA BEECH License Number 3000-42"13(R 3109) / , ® DATE(MMIODN M) A��o CERTIFICATE OF LIABILITY INSURANCE 11r1,2015 2/12/2015 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). CONTACT PRODUCER Lock-ton Companies NAME, 3280 Peachtree Road NE,Suite 9250 PHONE I FAX AC Na: Atlanta GA 30305 E-MAIL (404)460-3600 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Everest Indemnitv Insurance Company 10851 INSURED American Promotional Events,Inc. INSURER B: 1359629 DBA TNT Fireworks,Inc. INSURER C: P.O.BOX 1318 INSURER D: 4511 Helton Drive INSURER E Florence AL 35630 INSURER F COVERAGES CERTIFICATE NUMBER: 12219619 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. INSR TYPE OF INSURANCE AD SUER POLICY EFF POLICY EXP LTR IN WV POLICY NUMBER MM1DD/YYYY MMfOD/YYl'Y LIMITS A X COMMERCIAL GENERAL LIABILITY N N SI8GL00242-141 I1/1/2014 11!112015 EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE oOCCUR PREMISES(Ea occurrence) s 500.000 MED EXP An one person) s 000 PERSONAL E ADV INJURY S 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2 000 000 POLICY ❑ PRO-JECTJ'7X LOC PRODUCTS-COMPIOP AGG S 2,000,000 I OTHER: S COMBINED AUTOMOBILE LIABILITY NOT APPLICABLE (Ea accident) S XXXXXXX ANY ALIT O BODILY INJURY(Per person) S XXXXXXX ALLOWNED SCHEDULED BODILY INJURY PeraccldenB S XXXXXXX AUTOS AUTOS NON-OWNIED PROPERTY DAMAGE S XXXXXXX HIRED AUTOS AUTOS s XXXXXXX UMBRELLA LIAR !OCCUR NOT APPLICABLE EACH OCCURRENCE S XXXXXXX I EXCESS LIAR CLAIMS-MADE AGGREGATE S XXXXXXX CED RETENTIONS SXXXXXX WORKERS COMPENSATION NOT APPLICABLE STATUTE ER AND EMPLOYERS'LIABILITY YiN ANY PROF RI ETORfPAR7N ERJEXECU TIVE ❑ E.L.EACH ACCIDENT S XXXXXXX OFFICERMt=_MBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S XXXXXXX If yyes un.describe der DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S XXXXXXX DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES fACORD 101,Additional Remarks Schedule,may be attached If more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTL-D AND THE POLICY TERM(S)REFERENCED Allyn Center located at 18321 Hwy 3 in Allyn,Wa(Loc.WWM6502) 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 12219619 Mason County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ma Virginia Beech THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 186 Shelton WA 98584 AUTHORIZED REPRESENT VE O 1988-201, A�D CORPORATION- All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r 1 kk �.oc l'�c�: 1 irLy��i In SUc� �2te DFaWn: (� Ordinacc©0f: Store/Center/Lot: aty&State: Parcei €1a: Stand Faces The DIrectlon Of: Stand Size: c `Sri t.a J y r s � � zk 5 r of .� M. c *� max,:;-°r°yT�TcG.#E ra } l � YF r U J t.'g'`. AN d NMI r.`=• r 9N.�,, 'rrrJY NM r;!�y<�, �y�i � r r�l�,fit.�.�,.�,- �,�r,, ``� � ,3 i• r �j ®,r�`L' `��.. xJ3-#2x pJ � rfi � 1 IMF �`Y ® DATE(MMIDDIYYYY) AC"R0 CERTIFICATE OF LIABILITY INSURANCE Ilrvzols 2i12i2015 �.— 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). CACT PRODUCER Lockton Companies NAME: 3280 Peachtree Road NF,Suite#250 PHONE FAX No C o E t Atlanta GA 30305 E-MAIL (404)460-3600 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Everest Indemnity Insurance Company 10851 INSURED American Promotional Events,Inc. INSURER B: 1359629 DBA TNT Fireworks,Inc. INSURER C: P.O.Box 1318 INSURER D: 4311 Helton Drive INSURER E Florence AL 35630 INSURER F COVERAGES CERTIFICATE NUMBER: 12219619 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 SHCWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR I POLICY EFF POLICY EXP L7R TYPE OF INSURANCE IN D WVD POLICYNUMBER MMIDDlYYYY MMlDDfYYYY LIMITS COMMERCIAL GENERAL LIABILITY N N 2 2 EACH OCCURRENCE A X SI8GL00_d_141 i t%U_O1 3 l ll l i_O15 DAMAGE TO RENTED CLAIMS-MADE �1CCCUR PREMISES(Ea occurrence) S 500,000 MED EXP(Anv oneperson) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000.000 POLICY PRO - JECT aX LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY NOT APPLICABLE (Ea accident) S XXXXXXX ANY AUTO BODILY INJURY(Per person) S XXXXXXX ALL OWNED SCHEDULED BODILY INJURY Peraccldent S XXXXXXX AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S XXXXXXX HIREDAUTOS AUTOS rPgraccidAnn s XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE- EACH OCCURRENCE S XXXXXXX EXCESS LIAR HCLAIMS-MADE AGGREGATE $ XXXXXXX I DED I I RETENTIONS $ xxxxxxx WORKERS COMPENSATION NOT APPLICABLE —Tp " AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORJPARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT S XXXXXXX OFFICERWEMBER EXCLUC N I A (Mandatory in NH) E.L.DISEASE.EA EMPLOYEE S XXXXXXX If yes,describe under 0 SCRIPTIONOF OPERATIONS cebw E.L.DISEASE.POLICY LIMIT S XXXXXXX DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached If more space Is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TER.NI(S)REFERENCED Allyn Center located at 18321 Hwy 3 in Allyn,Wa(Loc.WWM6502) 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 12219619 Mason Count)' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ivla M Virginia Beech THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 186 Shelton WA 98584 AUTHORIZED REPRESENTATIVE_ f ?// � r _ ©I gm201 AC RD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ------------------------------------- Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal 5.0290 CONSUMER FIREWORKS RETAIL SALES STAND LICENSE yRR3HAt'Sct Stand Number: SN-09366 Licensee Data Operational Data American Promotional Events, Inc. Wholesaler: TNT Fireworks 2120 Milwaukee Way County of Operation: Mason Tacoma, WA 98421 Operates For:Virginia Beech License Number: WSPFL-02766 Stand Operated By:Virginia Beech Phone Number: (253) 922-0800 Date of Issue:February 9, 2015 Date of Expiration:January 31, 2016 Consumer Fireworks Retail Sales Stand Licenses issued after May are ONLY valid for New Years Sales This license is NOT valid without a permit from a local fire code official/authority having jurisdiction. This license allows for operation of a single tocation/stand for retail sales to the public of state legal consumer fireworks purchased only from a licensed fireworks wholesaler. THIS LICENSE PORTION ACCOMPANIES YOUR LOCAL PERMIT APPLICATION