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HomeMy WebLinkAboutFIR2024-00036 Fireworks Stand - FIR Permit / Conditions - 10/22/2024 4r� Mason County M3@B Mason County - Division of Community Development 615 W. Alder St. ZA 71� Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov FIR2024-00036 FIREWORKS STAND APPLICATION & STANDARDS PROJECT DESCRIPTION: RETAIL SALES OF CONSUMER ISSUED: 10/22/2024 FIREWORKS SITE ADDRESS: 210 NE STATE ROUTE 300 BELFAIR EXPIRES: 04/20/2025 l PARCEL: 123294100060 I7`7 7DII APPLICANT: Bargelt, Brandy OWNER: HOYT JANNAE L&STEVEN A 29320 47th Ave E 1240 NE TEE LAKE RD Graham,WA 98338 TAHUYA, WA 98588 2532791247 FEES: Paid Due Retail Fireworks Stand Permit $100.00 $0.00 Fee Totals : $100.00 $0.00 REQUIRED INSPECTIONS Fireworks Inspection CONDITIONS (3) Fireworks shall not be discharged within one hundred feet of a retail fireworks stand. Signs reading "NO FIREWORKS DISCHARGE WITHIN 100 FEET" in letters at least two inches high, with a principal stroke of not less than one-half inch, on contrasting background, shall be conspicuously posted on all four sides of the stand. * Retailers of fireworks—Cleanup. (1)At the end of the legal selling period, all fireworks must remain in the retail fireworks stand, temporary storage location authorized by the retail permit or another location approved by the local authority having jurisdiction or his or her designee until returned to the suppliers from which they were obtained, or until transferred to an approved location. * (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. ........ ... .. ......_...... . Printed by:Amber Selby on:10/23/2024 11:51 AM Page 1 of 2 rI Mason County gII@ Mason County - Division of Community Development 615 W. Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov FIREWORKS STAND APPLICATION & STANDARDS FIR2024-00036 * WAC 212-17-21505 Retailers of fireworks—General provisions. Fireworks may be sold from 12:00 noon to 11:00 p.m. on June 28 through 9:00 p.m. on July 5. Fireworks may not be sold between the hours of 11:00 p.m. and 9:00 a.m.from June 28 through July 3. Fireworks may not be sold from 12:00 midnight on July 4 through 9:00 a.m.on July 5. * Fireworks may be sold from 12:00 noon to 11:00 p.m. on each day from the 27th of December through the 31st of December of each year. * (2) No motor vehicle or trailer may be parked within twenty feet of a retail fireworks stand except when delivering, loading or unloading fireworks. * Failure to comply at any time with the provisions of this rule or any other applicable regulation shall constitute a violation of chapter 70.77 RCW and may result in the temporary suspension or immediate revocation of the license or permit, closure of the fireworks sales or storage structure, the seizure and/or forfeiture of some or all of the fireworks, and other criminal penalties as specified by law. * (4)No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. * (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. * (8) No cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. * (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 two inches high, with principal stroke of not less than one-half inch, on a contrasting background, shall be conspicuously posted on all four sides of the stand. * (4) Failure of the licensee to comply with subsection (3)of this section shall constitute forfeiture of the clean-up bond and the licensee shall be liable for any clean-up costs incurred by the city or county which exceed the amount of the bond. hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state/local law regulating construction or the performance of construction. Issued By: Contractor or Authorized Agent: Date: Printed by:Amber Selby on:10/23/2024 11.51 AM Page 2 of 2 Inspection Card Mason County 615 W. Alder St. Bldg. 8, Shelton, WA 98584 (360) 427-9670 ext 352 JIM www.co.mason.wa.us PERMIT# FIR2024-00036 PROJECT ADDRESS 210 NE STATE ROUTE 300 BELFAIR, WA 98528 PARCEL# 123294100060 PROJECT DESCRIPTION RETAIL SALES OF CONSUMER FIREWORKS OWNER Bargelt, Brandy ADDRESS PHONE INSPECTION INSP DATE COMMENT FIREWORKS INSPECTION CONDITIONS * (2)No motor vehicle or trailer may be parked within twenty feet of a retail fireworks stand except when delivering,loading or unloading fireworks. (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. (3)Fireworks shall not be discharged within one hundred feet of a retail fireworks stand.Signs reading"NO FIREWORKS DISCHARGE WITHIN 100 FEET'in letters at least two inches high,with a principal stroke of not less than one-half inch,on contrasting background,shall be conspicuously posted on all four sides of the stand. (4)Failure of the licensee to comply with subsection(3)of this section shall constitute forfeiture of the * clean-up bond and the licensee shall be liable for any clean-up costs incurred by the city or county which exceed the amount of the bond. (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. * (4)No open flames nor any type of open flame equipment shall be allowed in any temporary fireworks storage structure. (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 two inches high,with principal stroke of not less than one-half inch,on a contrasting background,shall be conspicuously posted on all four sides of the stand. " (8)No cooking is permitted in a retail fireworks stand or in a temporary fireworks storage structure. Failure to comply at any time with the provisions of this rule or any other applicable regulation shall constitute a violation of chapter 70.77 RCW and may result in the temporary suspension or immediate revocation of the license or permit,closure of the fireworks sales or storage structure,the seizure and/or forfeiture of some or all of the fireworks,and other criminal penalties as specified by law. * Fireworks may be sold from 12:00 noon to 11:00 p.m.on each day from the 27th of December through the 31st of December of each year. { s` Inspection Card �' Mason County 615 W. Alder St. Bldg. 8, Shelton, WA 98584 (360) 427-9670 ext 352 ` www.co.mason.wa.us Retailers of fireworks—Cleanup. (1)At the end of the legal selling period,all fireworks must remain in the retail fireworks stand,temporary * storage location authorized by the retail permit or another location approved by the local authority having jurisdiction or his or her designee until returned to the suppliers from which they were obtained,or until transferred to an approved location. WAC 21 2-1 7-21 50 5 Retailers of fireworks—General provisions. * Fireworks may be sold from 12:00 noon to 11:00 p.m.on June 28 through 9:00 p.m.on July 5. Fireworks may not be sold between the hours of 11:00 p.m.and 9:00 a.m.from June 28 through July 3.Fireworks may not be sold from 12:00 midnight on July 4 through 9:00 a.m.on July 5. I A� 5/29/2 CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) /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 NAME: Acrisure, LLC dba Britton Gallagher PHONE FAX 3737 Park East Dr.STE 204 N Ext: 216-658-7100 (A/C, A/c No):216-658-7101 Beachwood OH 44122 ADDRIESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: Everest Indemnity Insurance Co. 10851 INSURED INSURER B: Winco Fireworks Utah LLC 710 Amidan Drive INSURER C: Ogden UT 84404 INSURER D: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM POLICY EFF POLICY EXP LTR /DD/YYYY MM D /Y DYYY LIMITS A GENERAL LIABILITY S18ML02067-231 12/31/2023 12/31/2024 EACH OCCURRENCE $1.000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT 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 PROPERTY DAMAGE $ P acci HIRED AUTOS AUTOS er d ent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N LIM ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA (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/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#: ACC)R ID0 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 JNAIC 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 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t r - a - " u „ F -w. .fin 4� _ .. � � •.$ > �, ��� - Y_� S � VW y 300 ftiP 4 �w v.+ �a y ' 7N- v e o ell 1 mro: W r. 'r 300 , p l n v Randy Collins From: Brandy Bargelt <wcfireworks@icioud.com> Sent: Thursday, October 17, 2024 11:27 AM To: Randy Collins Subject: Re: Firework Stand Permit Condition ff Caution: External Email Warning!This email has originated from outside of the Mason County Network. Do not click links or open attachments unless you recognize the sender, are expecting the email, and know the content is safe. If a link sends you to a website where you are asked to validate using your Account and Password, DO NOT DO SO! Instead, report the incident. Hi Randy, I just submitted the application. Underthe sponsor section I listed two names; Kameron Riser&Steve Clark and listed their numbers in the phone number section. Kameron Riser 253.470.2111 Steve Clark-253.444.7011 Thank you so much! Brandy Bargelt Seven One Seven Ind.LLC West Coast Fireworks 253.279.1247 wcfireworks@icloud.com www.westcoast-fireworks.com On Oct 15, 2024, at 3:22 PM, Randy Collins <RCollins@masoncountywa.gov>wrote: Hi Brandy, One thing I forgot to share in my last response. When you turn on your permit application, even though there is not a line for it, please include the name of the individuals who will be running the stand as well as their contact info so I can share that with the local first responders. Thanks Randy From: Randy Collins Sent:Wednesday,October 2, 2024 12:48:41 PM To: Brandy Bargelt Subject: RE: Firework Stand Permit Condition 1 Hi Brandy, I do not believe we have established a deadline for New Year's stands so to be consistent, I would use the same timeframe we use for July 4. I can usually turn the permit around within a few days. Randy From: Brandy Bargelt<wcfireworks@icloud.com> Sent:Wednesday, October 2, 2024 11:47 AM To: Randy Collins<RCollins@masoncountywa.gov> Subject: Re: Firework Stand Permit Condition Caution: External Email Warning!This email has originated from outside of the Mason County Network. Do not click links or open attachments unless you recognize the sender, are expecting the email, and know the content is safe. If a link sends you to a website where you are asked to validate using your Account and Password, DO NOT DO SO! Instead, report the incident. Hi Randy, Can you tell me the deadline for New Years fireworks sales permit applications? I only see the date for the 4th of July season. Thankyou! Brandy Bargelt Seven One Seven Ind.LLC West Coast Fireworks 2S3.279.1247 wcfireworks(&icloud.com www.westcoast-fireworks.com On Jun 18, 2024, at 2:58 PM, Randy Collins <RCollins(abmasoncountywa.gov>wrote: Much appreciated.See you next Friday at 9 AM From: Brandy Bargelt<wcfireworks@icloud.com> Sent:Tuesday,June 18, 2024 1:41 PM To: Randy Collins<RCollins@masoncountywa.gov> Subject: Re: Firework Stand Permit Condition Caution: External Email Warning!This email has originated from outside of the Mason County PR Network. Do not click links or open attachments unless you recognize the sender, are expecting the 2 FIREWORKS TENT LEASE AGREEMENT THIS LEASE AGREEMENT("Lease Agreement"), made this day of 2024 between Steve& Jannae Hoyt, hereinafter designated the "Land Owner" and a Seven One Seven Ind. LLC, DBA West Coast Fireworks a Washington limited liability corporation, here in after designated the "Lessee." WITNESSES: That the said Land Owner does by these presents lease to Lessee the following: 1. PREMISES: 310 NE State Route 300; Belfair, WA 98528 2. TERM: December 18,2025 —January 6, 2026 3. RENT: 4. SECURITY AND DAMAGE DEPOSIT: Waived 5.SUBLET: Lessee shall not assign this Lease Agreement or any part hereof without the prior written consent of Land Owner. 6. LESSEE'S OBLIGATIONS: Lessee shall: (a) Assume full liability for any and all claims, damages or causes of action arising during the term of this Lease Agreement caused by Lessee, it's agents, contractors, sub-contractors,guests and invitees,and hold Land Owner harmless there from. (b) Provide Land Owner with evidence of liability insurance effective for the Term in an amount of not less the one million dollars ($1,000,000.00)with a rider listing Land Owner as an additional insured. Lessee will provide documentation to Land Owner showing the insurance coverage is active prior to the commencement of any use of the Premises for the term of the Lease. (c) Properly dispose of all rubbish, garbage and waste generated by Lessee, its agents, contractors, sub-contractors,guests and invitees,in a clean and sanitary manner. (d) Not restrict the flow of traffic(pedestrian/vehicular). (e) Comply with any and all laws,rules,regulations and requirements imposed upon it by any governmental agency governing the Lessee's proposed use of the Premises and post any required performance bonds with the local government.. Any permits or licenses required of the LEASE AGREEMENT—PAGE 1 undersigned Lessee shall be obtained by the Lessee prior to the commencement of the Term of this agreement. (f) Not intentionally or negligently destroy,deface, damage, impair or remove any part of the Premises, nor to permit any of its agents, contractors, sub-contractors,guests and invitees or other persons acting under its control to do so. (g) Suffer no lien to arise or be filed by any taxing authority or by any contractor, sub-contractor,or supplier or labor or materials used by Lessee or any other third party on the Premises; and, in the event any such lien or claim of lien is filed, cause the same to be satisfied or discharged in full within thirty (30)days following the filing thereof. 7. USE: Licensee will use the Premises to conduct retail sales of approved"I AG" or commonly known as Class "C"and/or Consumer Fireworks along with those activities attendant to that intended use. Lessee may place temporary striping or cones and a tent as necessary and erect appropriate signage and will remove the same at the end of the term. Lessee shall not use the Premises for any illegal purpose. Lessee agrees to conform to all state, county and municipal codes, statutes, ordinances and regulations concerning the use and occupation of the Premises and to obtain the prior receipt of approval of authorities of competent jurisdiction for its intended use of the Premises with copies there of to Land Owner. If the Lessee is unable to procure the necessary firework permits from the State of Washington,Mason County to operate a fireworks tent on the above mentioned Premises then this Lease Agreement shall be null and void. 8. ALTERATIONS: Lessee agrees not to make alterations to the Premises with the prior written consent of the Land Owner 9. SURRENDER: At the expiration of said term of this Lease Agreement will surrender the Premises to Land Owner in a condition equivalent to or better than when first made available to Licensee. 10. ACCESS: Lessee will have unlimited access to the Premises during the term of the Lease at the entrance/exit shown on the attached Exhibit A. 11. TAXES: Land Owner shall be solely responsible for any taxes on the real property. Lessee shall be solely responsible for any taxes on its personal property and/or the conduct of its activities. 12. COSTS,ATTORNEY'S FEES AND VENUE: If,by reason of any default or breach on the part of either party in the performance of any of the provisions of this agreement, enforcement of any term of this Lease is sought,whether or not legal action is instituted, the losing party agrees to pay all reasonable costs and attorney's fees of the prevailing party in connection therewith. In the event any claim for personal injury, death,property damage,or other alleged liability is LEASE AGREEMENT—PAGE 2 Name: Address: Phone: asserted against Land Owner,Lessee agrees to defend and hold Land Owner harmless of any such claim,including attorney's fees and legal costs. It is agreed that the venue of any legal action brought under the terms of this agreement shall be Mason County, State of Washington. 13. NOTICES: (a)Notices to Land Owner shall be delivered,personally or by certified mail,postage prepaid,addressed to Land Owner at: (b) Notices to Licensees shall be delivered,personally or by certified mail,postage prepaid, addressed to Licensees at: Seven One Seven Ind.LLC DBA West Coast Fireworks PO Box 5394 Spanaway,WA98387 14.EXECUTION: This instnunent is signed in multiple identical copies,any one of which will suffice for legal purposes as an original. IN SIGNING THIS INSTRUMENT EACH PARTY ACKNOWLEDGES AND REPRESENTS TO THE OTHER SIGNERS: (a) That the person signing has read the instrument in its entirety. (b) That the person signing this document has authority to do so and to bind his/her principal,understands that this instrument constitutes and important and binding legal contract,which fixes and determines certain legal and obligations of the persons signing it. (c) That no provision of this document can be changes by reference to any oral representations or agreements. IN WITNESS WHEREOF,the Lessee and Land Owner have each hereunto signed this instrument in duplicate the day and year first above written. LEASE AGREEMENT—PAGE 3 Land Own �>Zvlv Qel Sigl4tuWe Signa e Brandy Bargelt Steven Hoyt Printed Name Printed Name 10.16.2024 10-15-24 Date: Date: LEASE AGREEMENT—PAGE 4 Washington State Patrol Fire Protection Bureau G24035 1 Office of the State Fire Marshal l'ue NSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE ''f+,•ENAt��f� S = rid' umber: SN=15782 . .. _ 0 Licensee D eta nal Data- West Coas JFirerks 1NASHINGTO► olesaler Wik F,"ireworks Utah, LLC 29320 47th wP East Operati n Mason _. Graham, WA 98338 erate r: Licens License Number: WSPFL- 28 tand Opeate y: eve Clark Phone Number: (253) 229- 247 Date of Issue:Marc , 20 Date pica on:January 31, 2025 Consumer Fireworks a ailer Licenses issue after ay are 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(10/18) SURRENDER THIS PORTION OF THE LICENSE TO THE FIREWORKS WHOLESALER "t"GTONRr+� Washington State Patrol Fire Protection Bureau G24035 Office of the State Fire Marshal CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE St Ed REMAV+ [:1 tl, er: SN-15782 21 Licensee Data MA SHINGTQ .a. T d� West Coast Fireworks YY W !es a rks Utah, LLC 29320 47th Avenue East C my of Ope i :Mason Graham, WA 98338 ted r:License.,,. 7 License Number: WSPFL- 288 and Oper ed :Steve Clark � Phone Number:(253) 229-{u 47 Date of Issue:March 20 Date of Ex Iration: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(10/18) 43"k"`T°"''4,e Washington State Patrol Fire Protection Bureau Office of the State Fire Marshal G24035 Y. CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE '�f R'IREHAI'S OEM Stand N' mber SN-15782 C a Licensee Data ' -twfational 'La West Coast Fireworks 2 4 T 4v r co Fireworks Utah, LLC tea:, 29320 47th Avenue East C ty of Ope 'o Mason Graham, WA 98338Opeted : Litcp�t License Number: WSPFL- 288 and Oper ed St ve Clark Phone Number: (253) 229- 47 Date of Issue:March` 20 Date rati :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. 3000A20-041(10118) THIS PORTION OF THE LICENSE MUST BE POSTED AT THE STAND AT ALL TIMES l ® DATE(MM/DD/YYYY) ACORO 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 NAME: Acrisure, LLC dba Britton Gallagher PHONE 216 658 7100 FAX No):216 658 7101 3737 Park East Dr. STE 204 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 INSURER C: Ogden UT 84404 INSURER D: 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 TYPE OF INSURANCE ADDL SUER POLICPOLICY NUMBER MMIDDY EFF/YYYY MMIDDY EXP/YYYY LIMITS LTR A GENERAL LIABILITY S18ML02067-231 12/31/2023 12/31/2024 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE I-XI OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 1-1 POLICY PRO X LOC $ AUTOMOBILE LIABILITY COMBED SINGLE LIMIT Ea acciINdent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS $ NON-OWNED PeOra cidPE en DAMAGE HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- ER AND EMPLOYERS'LIABILITY /N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (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(2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ACC® 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 e u • w ' ) ! �� r1 300 ' t s ots 300l r, 1 , r. RVParldng r M a S`J , ' 1 •----------------------- ADD YOUR LOGO HERE ------------------------- RETAIL FIREWORKS STAND INSPECTION CHECKLIST Inspecting Agency: Phone Number: Inspector: Date: Contact Person: Phone Number: Property Name: Property Address: Structure Type Local Permit Number ❑ Fireworks Stand ❑ Fireworks Tent Retail Fireworks Stand WAC Requirements WAC WAC 212-17-21509 to 212-17-21519 Reference ADMINISTRATION ❑ A State Fire Marshal's License posted. 212-17-185(1) ❑ Local Permit posted. ❑ Proof of insurance coverage as specified in RCW 70.74. ❑ Written Authorization from the property owner which allows use of the site. ❑ A Site Plan of the proposed location of the fireworks stand shall be drawn to scale on 212-17-185(2) an 8 '/z x 11 diagram. This diagram shall show the size of the stand; distance from the stand to structures, buildings, fire hydrants, other stands, streets, and parking areas. ❑ Posted Signage: List of legal fireworks, No Smoking, and Photo ID Required. STRUCTURE ❑ Retail sales of fireworks and other products which are holiday related shall be from 212-17-213 buildings used for no other purpose; OR, ❑ A permanent structure which meets provisions of WAC 212-17-21505(3). ❑ Temporary, stable structures. ❑ Tents, canopies, or structures utilizing temporary membrane materials made from fire 212-17-21513 retardant or treated with fire retardant. ❑ Electrical service shall be installed in accordance to NEC & AHJ. STAND LOCATION ❑ Not more than 150 feet from a private way/public road, street, or highway. ❑ Fireworks stands shall be at least 100 feet apart or separated by a road, street, or highway not less than 50 feet. ❑ Meets Minimum Clearances. Retail Fireworks Stands - Minimum Clearances Buildings Combustibles Property Parking Road* Private Way 212-17-21509 BACK OF STAND 20 FT. 20 FT. 5 FT. 20 FT. 20 FT. 5 FT. SIDE OF STAND 20 FT. 20 FT. 5 FT. 20 FT. 20 FT. 5 FT. FRONT OF 40 FT. 40 FT. STAND 1 20 FT.** 20 FT.** 20 FT. 20 FT. 20 FT. 20 FT *Measured from the outer edge of the nearest traffic lane. **If stand is equipped with 135 fusible links which will automatically close all sales doors in case of fire. Exception: Fuel for generators, fuel within the tanks of vehicles. ------------------------ ADD YOUR LOGO Z HERE -------------------------- EXTERIOR WAC Reference ❑ Area around stand kept free of dry grass, dry brush, and combustible debris. ❑ No parking within 20 feet, except when delivering and unloading fireworks. ❑ Sell <100' from storage & dispensing of flammables. 212-17-21511 ❑ No fireworks may be discharged within 100 feet of a stand. ❑ NO SMOKING signs with at least 4" letters, posted. GENERATOR ❑ Generator at least 20' from stand. ❑ No high grass, weeds, trash near generator. 212-17- ❑ 6 BC extinguisher on site for generator. 21513(4) INTERIOR ❑ Clear aisle ways of at least 24 inches. ❑ Customers permitted inside only when greater than four hundred square feet. ❑ Temporary stands shall have two exits at least 28" in width. 212-17-21515 ❑ Two approved pressurized 2 '/z gallon water-type fire extinguishers. ❑ No open flames or flame equipment inside. STAND OPERATIONS ❑ Stand shall be secured when unoccupied if fireworks are kept in the stand. ❑ At least one person 18 years of age must be present at all times. Sellers shall require proof of age. ❑ No person under the age of 16 shall be allowed within a retail fireworks stand (other than customers). ❑ Fireworks not sold or offered to children less than 16 years of age. ❑ A sign reading "no sale of fireworks to person under the age of sixteen years." 212-17-21515 ❑ "PHOTO ID REQUIRED" in letters at least two inches high shall be posted. Sellers shall require proof of age ❑ No sleeping inside a retail fireworks stand or temporary fireworks storage facility. ❑ Location of the nearest telephone must be posted and workers aware of it. ❑ Local emergency phone number posted. ❑ No cooking is permitted in a retail fireworks stand or temporary storage structure. WAC 212-17-21517(8) CLEAN UP ❑ At the end of the selling period, all fireworks must remain in the retail stand or temporary storage authorized by the permit or AHJ (or designee) until returned to the 212-17-21519 supplier. ❑ Cities and counties may require a clean-up bond. Inspection by: Inspection Date: ❑ Stand Approved ❑ Stand Not Approved Re-inspection By: Re-inspection Date: ❑ Stand Approved After Re-inspection ❑ Stand Not Approved After Re-inspection Comments: 1 Washington Fireworks Stand Requirements 20 Feet ...........•............... .......... ............ ..............�.................. 1 � Back A 20 Feet AL..................... Side ,... Side .....................> so Feet Door Door Minimum of 28 inchest- Minimum of 28 inches wide at ends �=�Frcint wide at ends at/ends Parking within . 20 Feet of a Fireworks Stand 20 Feet .................................................... .y...................................................... A ............. ............A..............A........... A............. ............. 40 Feet for buildings and combustibles qt EXIT EXIT NO SMOKN! No Sale of Fireworks to No Fireworks Persons Under Age of No Fireworks Sixteen Ye1; ars Discharge Within Discharge Within PHOTO ID REQUIRED 100 Feet 100Fee1 Side Front Side Fire Extinguishers: Required Signage A minimum of two fire No Smoking:1 each side door extinguishers is required No Fireworks Exit:1 each side door Discharge Within No Discharge of Fireworks:1 each side 100 Feet Back Retail Fireworks Stands -Minimum Clearances Generator Motor Vehicle Motor Vehicle Buildings Combustibles (with less than 5 Property Line Parking Traffic Public Traffic Private Gallons of Fuel) Road(1) Road Back of Stand 20 Feet 20 Feet 20 Feet 5 Feet 20 Feet 20 Feet 5 Feet Side of Stand 20 Feet 20 Feet 20 Feet 5 Feet 20 Feet 20 Feet 5 Feet Front of Stand 40 Feet 40 Feet 20 Feet 20 Feet 20 Feet 1 20 Feet 1 20 Feet 20 Feet(2) 1 20 Feet(2) Note: Clearance distances are not cumulative. (1) Measured from the outer edge of the nearest traffic lane. (2) If stand is equipped with 135 fusible links which will automatically close 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. 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. Washington Fireworks Tent Requirements ' 20 Foot � '............. .......... ............ -A..............A...............A•`` �01 ♦♦ AL Back Tables Tables 1 AAAAL 20 FNt "•"""•••••• Side 4 Ft Minimum Aisles Clearance Side ••••••••••••••Di 20 Fast 1 Tables Tables � ' 1 � Front ® / No Parking within 20 Feet of a Fact 30 Feet ♦ Fireworks Tent `♦ ,`, ............................ �...................v.20Fist.........................,,� .......�„ Combustible vegitation and 4 I waste material shall be removed and kept clear AL inside and within a 30-foot — — — perimeter of the tent. 40 Feet for bulldings and combustibles �............... ........................................A..............i.............. YYYYYYYYY M n No Fireworks harge Within Discharge Wlthln EXITNo Sale of Fireworks to 77 100 Feel Persona Under Age of No Freworks Sixteen Years Discharge Within PHOTO ID REQUIRED 100 Feel Side Front Side In this illustration-the gray shade represents a section of tent that is 12 open. o Required Signage Fire Extinguishers: EXIT No Smoking: Each side door A minimum of two fire extinguishers xF,,kt'6�,� Exit:Each side door n c is required No Dischar a of Fireworks:Each side 8 Back Retail Fireworks Stands-Minimum Clearances Generator Motor Vehicle Motor Vehicle Buildings Combustibles (with less than 5 Property Line Parking Traffic Public Traffic Private Gallons of Fuel) Road(t) Road Back of Stand 20 Feet 20 Feet 20 Feet 5 Feet 20 Feet 20 Feet 5 Feet Side of Stand 20 Feet 20 Feet 20 Feet 5 Feet 20 Feet 20 Feet 5 Feet Front of Stand 40 Feet 1 40 Feet 1 20 Feet 1 20 Feet 20 Feet 20 Feet 20 Feet 20 Feet(2) 20 Feet(2) Note: Clearance distances are not cumulative. (1) Measured from the outer edge of the nearest traffic lane. (2) If stand is equipped with 135 fusible links which will automatically close 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. 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 closerthan three hundred feet from any bulk storage of flammable or combustible liquid or gas,including bulk plant dispensing areas.