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Home My WebLink AboutFIR2010-00009 Final Fireworks - FIR Permit / Conditions - 6/28/2010 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 Mason County Bldg.3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670, ext. 352 Shelton,WA 98584 FIRE PROTECTION PERMIT FIR2010-00009 APPLICANT: NORTH MASON PEE WEEPS RECEIVED: 5/14/2010 CONTRACTOR: LICENSE: EXP: ISSUED: 6/17/2010 SITE ADDRESS: 23861 NE STATE ROUTE 3 BELFAIR EXPIRES: 12/17/2010 PARCEL NUMBER: 123294100090 LEGAL DESCRIPTION: �l'CL 1'OOF BL4#04-37 PTN TR 9 NE SE EX S 29/194 PROJECT DESCRIPTION: FIREWORKS STAND NERAL INFORMATION System Information Type of Use: STND Sprinkler Heads: Audible Switches: Pull Stations: Fire District: 2 Hood& Duct?: N Flow Switches: Visual Devices: Door Releases: Dry Chemical?: N Pressure Switches:: Smoke Detectors: Duct Detectors: Wet Chemical?: N Zones: Heat Detectors: Sprinkler?: N Standpipe?: N SQUARE FOOTAGE FEES Monitoring Company: First Floor: Type Amount Due Amount Paid Monitoring Phone No.:()- Second Floor: Fireworks Stand Permit $100.00 $100.00 Auto Fire Alarm?: Third Floor;: Total: $100.00 $100.00 FIR2010-00009 Please refer to the following pages for conditions of this permit 1 of 6 1.) O r/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 ` 2.) VaIjOyermit Must be n-site. X t FIR2010-00009 Please refer to the following pages for conditions of this permit 3 of 6 3.) Consumer fire works me be sold only on the following days and times. June 28th from 12 noon to 11 PM June 29th to July 5th from 9 AM to 11 PM Xu YZ6 h from 9 AM o 1 noon X: Onl ashington State Fire Marshal approved class C common fire works may be sold. A fire works stand shall not be located more than 150 feet from an approved access road. Shall be at least 100 feet from another fire works stand or separated by a road, street or highway at least 30 feet in width. Shall not be located any closer than allowed by the attached table to other structures or exposures or be located closer than 100 feet from any flammable liquid or gas dispensing device, or 300 feet from any flammable liquid or gas bulk sto ,rN e or di ispensing facility. The minimum areas around a fire works stand, as specified in the attached table, shall be kept free from dry grass, brush, or combustible debris. This are hall be rriarkeo and flagged. X p/1u-cl -- Moto ehicles or tra'ers. ay not be parked within 20 feet of the fire works stand except when delivering, loading or unloading fireworks. X r Fireworks shall not be discharged within 300 feet of any fireworks stand.A sign stating "No Fireworks discharge within 300 feet" in letters at least 2 inches high nd in contrasti g co or shall be posted conspicuously on all sides of the structure. X No smoking shall be allowed within the fireworks stand or flagged off area. Signs stating " No Smoking W itin 100 feet' in letters at least 2 inches high and in c 9-r4rasting colors sh I be posted conspicuosly on all sides of the structure. All battery powered equipment, electrical equipement and cords shall be UL listed and used in accordance with that listing. Extension cords shall be of an ind ial grade type and shall be protected from physical damage. X All heating devices shall be UL listed. Only heating devices with sealed type elements shall be used, i.e. oil filled or water filled radiator type. Open flame or% qn element he tjny devices are prohibited. Gepqrators shall b located a minimum of 20 feet from any fire works stand. Fuel storage is limited to 5 gallons. A minimum 24 inch wide isle shall be maintained inside the full length of the stand. Customers are not allowed inside the fireworks stand. There shall be a minimum of 2 exits at least 28 inches in width located at oppsite ends of the stand. ThXz exits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. Slee ' g inside a fireyvorkp stand is prohibited. X FIR2010-00009 Please refer to the following pages for conditions of this permit 4 of 6 r he location of the nearest phone shall be posted in the fireworks stand. All occupants of the stand shall be informed as to the location of this phone. The loc mergency ph ne number, 911, and the address of the fireworks stand shall be conspicuously posted inside the stand. X KT Th shall be a mi im m of 2 approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. �( Co g, open flarrle or any type of open flame equipment is prohibited in a fireworks stand. Fireworks stands shall be locked when unoccupied and not open for business if fireworks are storged in the stand during these times. Fireworks stand shall not be locked when occupied. Fireworks maybe removed or transferred to a temporary storage structure or location approved as part of the license an rmit. X( Fireworks may be stored in a locked and secured retail fireworks stand, truck, container or trailer that is at least 20 feet from the fireworks stand during business hours, or in a locked and secured metal or wooden garage, shed, barn or other accessary building that is at least 20 feet from the fireworks s t ayo. X At least one person 18 yrs of age or older shall be on duty in the fireworks stand when fireworks are being sold to the public. Such person shall be responsible for the supervision of the fireworks stand and its operation. No person under tha age of 16 shall be allowed to occupy the fireworks stand Z open to the p blic. l It is illegal to knowingly sell fireworks to persons under the age of 16.A sign stating "No Sales Of Fireworks to Persons Under the age of 16" in letters at least 2.inches high and in contrasting color shall be posted on the front of the stand.A photo ID is required and it is responsiblity of the seller to require pro of age. Driver's li ense or photo ID showing date of birth issued by a public or private school, state, federal or foreign government is acceptable. X This permit omes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended for a period of 180 days at any time afterwork is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of work is by means of a progress inspection. The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access t`op the above described property and structure for review and inspection. OWNER OR AGENT: �Q�p z �(c DATE: FI R2010-00009 Please refer to the following pages for conditions of this permit 5 of 6 -n 55 CONCRETE MECHANICAL MANUFACTURED HOME NJ Footings r Sethacks Date ay Ribbons � Gas Piping _ OInterior Date By Interior-Date By Data tip OC Exterior date By Exterior-Date Bx Set-up > Point.Load I Isolated Footings INSULATION Date By BG f SLAB INSULATION Z Date By Data By FIRE DEPARTMENT Foundation walls Floors Date By m Date By Data By DECKS �2 FRAMING Walls Date By m Date By Data By PROPANE TANKS m PLUMBING Vault Data By Date ley OTHER Groundwork .Attic Date By Data By Type: bats By D.w.V DRYWALL Type_ Int Brace Wall Date By 'n Date 83 -o y Data By 56 ui Water Line FireSvpQrallorr FINAL INSPECTION CD Date By Date By Date By C O Pass or Request Inspect. c Type of Insp. Fail Date Date Dane By Comments AIDCD fR O 8 7 Q. O 7 y O S N C" O h SITE DIAL"M Date Updated:. Location #: \N W Nl- -- �1/ 2 Y ib 11 (f Location Name: (P-ea-ew�-4 -- Ordinance Of: Site Address: 1 14 VI V '�) -`� — Structure Size: CITY �e I PCII.1 .11- STATE/ZIP A/ �� Structure Faces:— Parcel: Sho,w all setback from SSUCtUres, gas, fire lan-es,, pubiic and pimlate roads. DropeirN lines, tr-e tes and landrnarks CHA SUBMI CMANGES FOR APPROVAL PRIOT R TO PERFORMING WORK 'Ice, Nv v Notes 12 1) z c7 c/ DL)(2 � THESE PLANS MUST BE MASON COUNTY F)PE ?'/l JARS IAL ON THE JOB SITE DATES��Z 31'� FOR INSFt=CTION• if SUBJECT TO FIELD INSRFQTll�Nt ALL APPLICABL CODES SHALL APPLY. ERRORS p AND/OR OMISSIONS ON PLA.�,S ARE SOLE RE- SPONSIBILITY OF OV,,NER/C0b1TiZ,C:T0R. CORREC- TIONS REOUIRcD FRO-M FIELD h;RFE.T(,On SI:At.l. dBE AT 011ri :R/COi4T;l .,n'R? rY.�-... _ Tlif; ii51. 9 PROVAL CDOES t`c,•T Cda,":y? TO i.. �.-F i':" . T. 7 RIGHRIGHTC• Vf L!. ._..,i''! !' C ? J MASON COUNTY FIRE MARSHAL IIflII Mason County Bldg.III 426 W Cedar St PO BOX 186 Shelton,WA 98584 (360)427-9670 Ext.273 CODE ENFORCEMENT FIRE INSPECTIONS FIRE INVESTIGATION PUBLIC EDUCATION STANDARDS FOR THE OPERATION OF RETAIL FIREWORKS STANDS Sales Consumer fire works may be sold only on the following days and times. • June 28th from 12 noon to 11PM • June 29th—July 5th from 9AM to 11PM • July 6th from 9AM to 12 noon • December 271h—31st from 12 noon to 11PM Approved Fireworks Only Washington State Fire Marshal approved Class C common fireworks may be sold. Fireworks Stand Location • A fireworks stand shall not be located more than 150' from an approved access road, • Shall beat least 100' from-another fireworks stand or separated by a road, street or highway at least 30' in width, • Shall not be located any closer than allowed by the table below to other structures or exposures, • Or be located closer than 100' from any flammable liquid or gas dispensing device, or 300' from any flammable liquid or gas bulk storage or dispensing facility. Retail Fireworks Stands—Minimum Clearances Buildings Combustibles Property Line Parking Motor Vehicle Motor Vehicle Traffic, Traffic, Public Road Private Way Back of Stand 20' 20' 5' 20' 20' 5' Side of Stand 20' 20' 5 20' 20' 5' Front of Stand 20' 20' 20' 20' 20' 20' r Surrounding Area around Fireworks Stands • The minimum areas around fireworks stands, as specified above, shall be kept free from dry grass, brush or combustible debris. This area shall be marked and flagged. • Motor vehicles or trailers may not be parked within 20' of the fireworks stand except when delivering, loading or unloading fireworks. • Fireworks shall not be discharged within 300' of any fireworks stand. A sign stating No Fireworks Discharge Within 300' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. • No smoking shall be allowed within the fireworks stand or flagged off area. Signs stating No Smoking Within 100' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. Electrical Supply & Usage • All battery powered equipment, electrical equipment and cords shall,be UL listed and used in accordance with that listing. Extension cords shall be of an industrial grade type and shall be protected from physical damage. All heating devices shall be UL listed. Only heating devices with sealed-type elements shall be used, i.e. oil filled or water-filled radiator type. Open flame or open element heating devices are prohibited. • Generators shall be located a minimum of 20' from any fireworks stand. Fuel storage is limited to 5 gallons. Fireworks Stand Operations • A minimum 24"wide isle shall be maintained inside the full.length of the stand. • Customers are not allowed inside the fireworks stand. • There shall be a minimum of 2 exits at least 28"in width located at opposite ends of the stand. These exits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. • Sleeping inside a fireworks stand is prohibited. • The location of the nearest phone shall be posted in the fireworks stand. All occupants of the'stand shall be informed as to the location of this phone. • The local emergency phone number, 911, and the address of the fireworks stand shall be conspicuously posted inside the stand. • There shall be a minimum of 2 (two) approved 2 1/2 gallon pressurized water fire extinguishers • located adjacent to each exit door. • Cooking, open flame or any type of open flame equipment is prohibited in a fireworks stand. • Fireworks stands shall be locked when unoccupied and not open for business if fireworks are stored in the stand during these times. Fireworks stands shall not be locked when occupied. Fireworks may be removed or transferred to a temporary storage y p ystructure or location approved as part of the license and permit. • Fireworks may be stored in a locked and secured retail fireworks stand, truck, container, or trailer that is at least 20' from the fireworks stand during business hours, or in a locked or secured metal or wooden garage, shed, barn or other accessory building that is a least 20' from the fireworks stand. • At least one person 18yrs of age or older shall be on duty in the fireworks stand when fireworks are being sold to the publie. Such person shall be responsible for the supervision of the fireworks stand and its operation. No person under the age of 16 shall be allowed to occupy the fireworks stand when it is open to the public. • It is illegal to knowingly sell fireworks to persons under the age of 16. A sign stating "No Sale Of Fireworks to Persons Under the Age Of 16"in letters at least 2"high and in contrasting color shall be posted on the front of the stand. A photo ID is required and it is the responsibility of the seller to require proof of age. Driver's License or Photo ID showing a date of birth issued by a public or private school, state, federal or foreign government is acceptable. 'k Mason County % . Fireworks Permit Application PO BOX 186 Permit# FIR DD I() - ('0('6� 426 W Cedar St Shelton WA 98584 Receipt # (360)427-9670 ext 273 CK # Date Received — WWM6512 A Permit for the 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 Name: Brett Bergdahl Mailing Address: 291 E Mountain View Dr City: Allyn State: WA Zip: 98524 Contact Number (3 6 0 ) 710-2121 Sponsor Information Name: NORTH MASON PEE WEES Mailing Address: 291 E Mountain View Dr City: Allyn State: WA Zip: 98524 Contact Number (360 ) 710-2121 Washington State Fireworks License Information (Copy Required) License No.: Date of WSPFL-00506 Issue: 04/08/2010 ❑ Pyrotechnic Operator License x❑ Fireworks Stand License Bond or Certificate of Insurance (Copy of Certificate/Bond Required) Provider: SEE ATTACHED Insured: Certified Holder: Location of stand/display Address: RIED REALTY 23861 NE HWY 3 BELFAIR, WA Directions to Site: Parcel Number: - - Legal Description: Legal Property Owner: * Please see the reverse side to complete your application The following erfluent information MUST be provided on the site diagram below Locations and Setback distances from the back, sides and front of retail sales stands or desi sated display areas to: a Fire Hydrants • Property Lines • Buildings s Parking • Combustibles e -Public Roads and Right of Ways • Fire Lanes • Private Roads and Right of Ways • Trees/Brush ® Landmarks • Utilities and Gas • Mortar separation distance • Designated landing' area 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 Brett Bergdahl 'Date FOR OFFICIAL USE ONLY BELOW THIS LINE Accepted By: Date: MASON COUNTY FIRE MARSHAL QZD3II Mason County Bldg.111 426 W Cedar St PO BOX 186 Shelton,WA 98584 (360)427-9670 Ext.273 CODE ENFORCEMENT FIRE INSPECTIONS FIRE INVESTIGATION PUBLIC EDUCATION STANDARDS FOR THE OPERATION OF RETAIL FIREWORKS STANDS Sales Consumer fire works may be sold only on the following days and times. • June 28th from 12 noon to 11PM • June 29th—July 51h from 9AM to 11PM • July 6th from 9AM to 12 noon • December 27th—31" from 12 noon to 11 PM Approved Fireworks Only Washington State Fire Marshal approved Class C common fireworks may be sold. Fireworks Stand Location • A fireworks stand shall not be located more than 150' from an approved access road, • Shall beat least 100' from another fireworks stand or separated by a.road, street or highway at least 30' in width, • Shall not be located any closer than allowed by the table below to other structures or exposures, • Or be located closer than 100' from any flammable liquid or gas dispensing device, or 300' from any flammable liquid or gas bulk storage or dispensing facility. Retail Fireworks Stands—Minimum Clearances Buildings Combustibles Property Line Parking Motor Vehicle Motor Vehicle Traffic, Traffic, Public Road Private Way Back of Stand 20' 20' 5' 20' 20' 5' Side of Stand 20' 20' 5' 20' 20' 5' Front of Stand 20' 20' 20' 20' 20' 20' 1 Surrounding Area around Fireworks Stands • The minimum areas around fireworks stands, as specified above, shall be kept free from dry grass, brush or combustible debris. This area shall be marked and flagged. • Motor vehicles or trailers may not be parked within 20' of the fireworks stand except when delivering, loading or unloading fireworks. • Fireworks shall not be discharged within 300' of any fireworks stand. A sign stating No Fireworks Discharge Within 300' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. • No smoking shall be allowed within the fireworks stand or flagged off area. Signs stating No Smoking Within 100' in letters at least 2"high and in contrasting color shall be posted conspicuously on all sides of the structure. Electrical Supply & Usalze • All battery powered equipment, electrical equipment and cords shall:be UL listed and used in accordance with that listing. Extension cords shall be of an industrial grade type and shall be protected from physical damage. • All heating devices shall be UL listed. Only heating devices with sealed-type elements shall be used, i.e. oil filled or water-filled radiator type. Open flame or open element heating.devices are prohibited. • Generators shall be located a minimum of 20' from any fireworks stand. Fuel storage is limited to S gallons. Fireworks Stand Operations • A minimum 24"wide isle shall be maintained inside the full length of the stand. • Customers are not allowed inside the fireworks stand. • There shall be a minimum of 2 exits at least 28"in width located at opposite ends of the stand. These exits shall remain unlocked and unobstructed during hours of operation or when stand is occupied. • Sleeping inside a fireworks stand is prohibited. • The location of the nearest phone shall be posted in the fireworks stand. All occupants of the stand shall be informed as to the location of this phone. • The local emergency phone number, 911, and the address of the fireworks stand shall be conspicuously posted inside the stand. i } • There shall be a minimum of 2 (two) approved 2 1/2 gallon pressurized water fire extinguishers located adjacent to each exit door. • Cooking, open flame or any type of open flame equipment is prohibited in a fireworks stand. • Fireworks stands shall be locked when unoccupied and not open for business if fireworks are stored in the stand during these times. Fireworks stands shall not be locked when occupied. Fireworks may be removed or transferred to a temporary storage structure or location approved as part of the license and permit. • Fireworks may be stored in a locked and secured retail fireworks stand, truck, container, or trailer that is at least 20' from the fireworks stand during business hours, or in a locked or secured metal or wooden garage, shed,barn or other accessory building that is a least 20' from the fireworks stand. • At least one person 18yrs of age or older shall be on duty in the fireworks stand when fireworks are being sold to the public. Such person shall be responsible for the supervision of the fireworks stand and its operation. No person under the age of 16 shall be allowed to occupy the fireworks stand when it is open to the public. • It is illegal to knowingly sell fireworks to persons under the age of 16. A sign stating "No Sale Of Fireworks to Persons Under the Age Of 16"in letters at least 2"high and in contrasting color shall be posted on the front of the stand. A photo ID is required and it is the responsibility of the seller to require proof of age. Driver's License or Photo ID showing a date of birth issued by a public or private school, state, federal or foreign government is acceptable. April 9, 2010 REF: WWM6512 ***URGENT*** Brett Bergdahl 291 E Mountain View Dr Allyn, WA 98524 Dear Brett Bergdahl, Enclosed are your City/County permit application, State permit, and insurance. You are required to file with your local authorities as soon as possible. You must have the. following items: ® Permit Fee $100.00, (NEEDED) ® Washington State Fireworks License ® Insurance ® Stand Diagram ® Local Application (finish filling out) • Deadline for filing is June 18th Or earlier, LICENSING IS ON A FIRST COME BASIS! Late filing will cause non-issuance of your permit. Should you have any questions or concerns, please feel free to contact me at (253) 922-0800. Thank you for your time and attention to this matter. Have a great season! Sincerely, Brenda Merritt Licensing & Permits Enclosure(s) `J AMERICAN PROMOTIONAL EVENTS,INC. 2120 MILWAUKEE WAY•TACOMA,WA 98421 TACOMA(253)922-0800•SEATTLE(253)838-1099 FAX(253)830-2930 www.tntfireworks.com APPLICATION FOR RETAIL FIREWORKS STAND PERMIT WWM6512 TO: Governing body of city, town, or county in which DATE OF JAN. 02, 2010 fireworks stand will be located. APPLICATION: Applicant Name: Address, City,State: NORTH MASON PEE WEES 2120 MILWAUKEE WAY, TACOMA„WA 98421 Sponsor (If other than applicant): Address, City,State: BRETT BERGDAHL 2120 MILWAUKEE WAY, TACOMA„ WA 98421 Location of proposed fireworks stand: [Enclose drawing of stand location] 23861 NE HWY 3 BELFAIR, WA RIED REALTY 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FIREWORKS STAND PERMIT For The Fireworks Sales Year Of: 2010 (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 the local governing authority, the named person, firm or organization is hereby authorized to sell U.N. 0336 1 AG Consumer fireworks at the location designated herein between the following date and times: Sales For July 4th Sales For December 31st From: From: To: To: Sponsor: NORTH MASON PEE WEES Location: RIED REALTY 23861 NE HWY 3 BELFAIR. WA /s/ /s/ FOR BRETT BERGDAHL Signature of Official Granting Permit Signature of Applicant Title: Agency: Date: Permit Number: Licensee Name: NORTH MASON PEE WEES License Number: 3000-420-013(Rev.2/05) SITE DIAGRAM Date Updated: y 12 b Location #: W W L Location Name: ;UO( Ordinance Of: MA�OVj �(T1�1i1 Site Address: Vvy 3 Structure Size: �1 • CITY , STATE/ZIP ! Structure Faces: Parcel: Show alp setback from structures, GuS Hre lanes, pUblic and pKwate roads r,)roperty kites bees a 1d lc7f?C "c31*,5 I i Lz S�G1Yt� I . E Notes Washington State Patrol \p� �kk Co�12- 11354 Fire Protection Bureau yv",r + Office OfThe State Fire Marshal T. Fireworks -Stand License Washington State Fireworks License License is Non-Transferable and Vallidd for Only OneStand ►J Licensee Information North Mason Pee Wees 2120 Milwaukee Way State Fire Marshal Signature Tacoma, WA 98421 License Number: WSPFL-00506 Detach this wallet card and carry with you for verification of certification. Stand Information - ------ Contact Person: Brett Bergdahl Washington State Patrol Fire Protection Bureau 11354 Phone Number: (360) 710-2121 Office Of The State Fire Marshal County: Mason Date of Expiration Date of Issue ANNUAL FIREWORKS STAND LICENSE Licensee: North Mason Pee Wees Stand Number: SN-05055 January 31, 2011 April 8, 2010 _ Contact Person: Brett Bergdahl -. 'License Number: WSPFL-0.066. Stand Number: SIV 05055; , [.Valid For One Stand] Date of Expiration: January 3 F 20 i 1 Stand Location: Location: [Stand L cat on=:To_BeCompleted By Licensee] [Stand Location To Be Completed By Licensee] 3000-420-012 (R 9/05) State Fire Marshal Signature Licensee Signature CERTIFICATE OF INSURANCE } ISSUE DATE ACORD,,, 05/03/2010 ' PRODUCER This certificate is issued as a matter of information only and confers no rights MCGRIFF,SEIBELS 8 WILLIAMS,INC. upon the Certificate Holder. This Certificate does not amend,extend or after the P.O.Box 10265 coverage afforded by the policies below. Birmingham,AL 35202 800-476-2211 COMPANIES AFFORDING COVERAGE ComApany Columbia Casualty Company INSURED Company American Promotional Events,Inc. B dba TNT Fireworks P.O.Box 1318 Company Florence,AL 35631 C Company D Company E This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding any requirement,term or condition of 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,conditions and exclusions of such policies. Limits shown may have been reduced by paid claims. CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY LT EXPIRATION A GENERAL LIABILITY 4015727097 11/01/2009 EACH OCCURRENCE $ 1,000,000 N Commercial General Liability 11/01/2010 FIRE DAMAGE $ 200,000 ❑Claims Made N occurrence MEDICAL EXPENSE $ EXCLUDED ❑Owners'and Contractors'Protection ❑ PERS.AND ADVERTISING INJURY $ 1,000,000 ❑ GENERAL AGGREGATE $ 2,000,000 General Aggregate Limit applies per: PRODUCTS AND COMP.OPER.AGG. $ 2,000,000 ❑policy ❑Project ®Location AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ❑Any Automobile BODILY INJURY Perperson) $ ❑All Owned Automobiles ❑Scheduled Automobiles BODILY INJURY Per accident $ ❑Hired Automobiles PROPERTY DAMAGE Per accident $ ❑Non-owned Automobiles COMPREHENSIVE ❑ COLLISION WORKERS'COMPENSATION WC Statutory Limit her FT- AND EMPLOYERS'LIABILITY EL EACH ACCIDENT $ EL DISEASE Each em to ee $ EL DISEASE(Policy Limn $ EXCESS LIABILITY EACH OCCURRENCE $ ❑occurrence ❑claims Made AGGREGATE Is Re:Reid Realty at 23861 NE Hwy 3 in Belfair,WA(WWM6512) The Certificate Holders are named as Additional Insureds with respect to General Liability as required by written contract subject to policy terms,conditions,and exclusions. CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Cady Family LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF Reid Realty ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Mason Pee Wees Mason County Authorized Representative PO Box 186 426 W Cedar ' Shelton,WA 98584 !Page 1 of 1 Certificate to# LX7BHWLM