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HomeMy WebLinkAboutFIR2024-00012 - FIR Inspections - 3/22/2024 Washington State Patrol Fire Protection Bureau G24035 f Office of the State Fire Marshal C DNSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE 0S u ber: SNTS-782 L ;:.Licensee D ,ta Operational --- West Coas -Fire�(works WASHINGTON .,.'�RoJesa, A R06orks Utah, LLC 29320 47th eve ue East ati ason Graham, WA 98338 O erate r: License License Number: WSPFL- 28 tand Ope to y: Steve Clark Phone Number: (253) 229- 247 Date of Issue-Marc , 20 Date piration:January 31, 2025 Consumer Fireworks Retailer Licenses issue a er Aay are LY 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 location/stand for retail sales to the public of state legal consumer fireworks purchased only from a licensed fireworks wholesaler. 3000-420-041(10118) SURRENDER THIS PORTION OF THE LICENSE TO THE FIREWORKS WHOLESALER -----------------------—-----------------------—--------------------------__��—--------------------------------------------------------------------- �,"`*rTON''' Washington State Patrol Fire Protection Bureau G24035 Office of the State Fire Marshal CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE 'E•,R,„AL,o��`� El 1:1 St d er: SN-15782 Licensee Data - West Coast Fireworks WASHINGTORbAlAAstRell-WricoT" FFreworks Utah, LLC 29320 47th Avenue East C my of up e io TMason Graham, WA 98338 ted r:Li see, License Number: WSPFL-0288 and Oper ed y:St ve Clark Phone Number: (253) 229- , 47 Date of Issue:March 20 Date xplration:January 31, 2025 Consumer Fireworks Retailer 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 location/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 3000-420-041(10118) Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal G24035 CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE �fr4RJ„ACS OE�Vb ❑ t d N er: SN-15782 Licensee Data Eap ti6ri'dil"Da � 0� West Coast Fireworks WASHINGTO !vWholesa er orks Utah, LLC 29320 47th Avenue East C ,nty of Operation: Mason Graham, WA 98338 '***Operated C Li ;- License Number: WSPFL-0 88 and Operated By: Steve Clark Phone Number: (253) 229-1 47 Date of Issue:March • _2_02 Date of Expiration:January 31, 2025 Consumer Fireworks Retailer 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 location/stand for retail sales to the public of state legal consumer fireworks purchased only from a licensed fireworks wholesaler. 3000420-041(10118) THIS PORTION OF THE LICENSE MUST BE POSTED AT THE STAND AT ALL TIMES m. - j, I� • �7 U W 2<Jo'ixz n Parking i, E WY- O i' i _ j F � . U 4 �y M n a ,• c� c �<Lw ���� Glo✓�, -rl� Zs3- Z79- 17,47 Z y 3z o Z174 A671 ® DATE(MM/DD/YYYY) AC"R o CERTIFICATE OF LIABILITY INSURANCE 5/29/2024 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). PRODUCER CONTACT Acrisure, LLC dba Britton Gallagher NAME:PHONE FAX 3737 Park East Dr.STE 204 A N •216-658-7100 ac No):216-658-7101 E-MAIL Beachwood OH 44122 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Everest Indemnity Insurance Co. 10851 INSURED INSURER B: Winco Fireworks Utah LLC 710 Amidan Drive INSURERC: Ogden UT 84404 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:682109264 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. 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIDD A GENERAL LIABILITY S18ML02067-231 12/31/2023 12/31/2024 EACH OCCURRENCE $1.000,000 I DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE � OCCUR MED EXP An one person) $ PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED Per dent)DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION WC STATU- O R AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) **For premise liability—this certificate reflects coverage for the dates and location noted below only.** **For product liability—this certificate reflects coverage for product purchased from the above referenced named insured only** Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Dates of Coverage for 4th of July Season: 06/28/24 through 07/04/24 Dates of Coverage for Christmas/New Year Season: 12/27/24 through 12/31/24 Location: 210 NE State Route 300 Belfair,WA 98528 See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Mason County P.O. Box 279 AUTHORIZED REPRESENTATIVE Shelton WA 98584 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: A�O ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Acrisure,LLC dba Britton Gallagher Winco Fireworks Utah LLC 710 Amidan Drive POLICY NUMBER Ogden UT 84404 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Operator:West Coast Fireworks Landowner: Steven Hoyt;Jannae Hoyt Additional Insured: Mason County,North Mason Fire Rescue Authority and their agents;West Coast Fireworks ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD