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20090245 Permit Pkg 120809City of Yelm Community Development Department Building Division Phone: (360) 458-8407 Fax: (360) 458-3144 Applicant: Name: CARLA HAMRICK Address: 5207 187TH ST E TACOMA WA 98446 Property Information: Site Address: 906 ALGIERS DR NE Assessor Parcel No.: 227330110204 Subdivision: Contractor Information: Name: CARLA HAMRICK Address: CARLA HAMRICK 5207 187TH ST E TACOMA WA 98446 License No. : WSPFL-01342 Permit No.: 20090245 Issue Date: 12/08/2009 (Work must be started within 180 days) Phone: 253-431-1671 Owner: Phone: Expires: 01 /31 /2010 Lot: N/A Project Information: Project: FIRE WORKS Description of Work: CLASS C FIREWORKS STAND FOR THE 2009 PERIOD OF DECEMBER 28, 2009 THRU DECEMBER 31, 2009. Sq. Ft. per floor. First ~ ~~ ~ ~ _ s Second Third James Bland Garage Rctail Manager Basement Direct Importer & Wholesaler Fees: fames@thunderfireworks.com 253-875-0700 Item Contrac 5207 187th St. E. 1-888-900-7799 Fees FIRE CARLA H Tacoma. WA 98446 FAX 253-875-0550 S 35.00 TDTAI FEES: S 35.00 Applicant's Affidavit: I certify that I have read and examined the information contained within the application and know the same to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of Yelm regul lions including those governing zoning and land subdivision, and in addition, all covenants, easement an restric ' s of record. If applying as a contractor, I further certify that I am curently registered n t t e o ash on. S' nature Date 1 b Firm OFFICIAL USE ONLY Sets of Prints: final Inspection: Date: APPLICATION FOR RETAIL FIREWORKS STAND PERMIT TO: Governing body of city, town, or county in which fireworks stand will be located. DATE of APPLICATION: 11/16/09 Applicant Name: Carla Hamrick Address, City, State: 5207 187th ST. E. Tacoma WA 98446 Sponsor (If other than applicant): Address, City. State: Same as above Same as above Location of proposed fireworks stand: lEnclose drawing of stand location] 906 Algyers Drive NE. Yelm WA 98597 (906 Yelm Ave East ) [n Stand With Thunder Fireworks FIREWORKS STAND PERMIT For The Fireworks Sales Year Of: 2009 (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 The City of Yelm as the local governing authority, the named person, firm or organization is hereby authorized to sell U.N. 0336 1.4G Consumer fireworks at the location designated herein between the following date and times: Sales For Jul~• 4`h Sales For December 3l'` From: Noon June 28th 2009 From: December 28th 2009 To: 11:00 PM July 4th 2009 To: December 31st. sponsor: Same as above NE. Yelm WA /s/ Title: ~tyw•.i~' C Agency: ~ V Date: ~ Permit Number: Licensee Name: Carla Hamrick License Number: 9780 WSPFL -UI3a2 Cit~~ of Yelm (3E~?) 458-84G' RErx: 00015030 1~lG81~009 lO:Er'~ ASS OFER: CO TERM : 001 kEF~: 3500 TR~l: 33.0000 BUILDING PERMITS ~00'~0245 ~~5.OOOk NA~4RI~(. caRLA '~, ALGIERS DR NE FIRE 35.0(~~R TENDERED: 3J•~ G~CK November 16, 2009 Attention Gary. City of Yelm PO Box 479 Yelm WA 98597 RE: FIREWORtiti PERMI"I' - 1.4G CONSUMER FIREWORKS Dear Gary, 62y~ Please f nd enclosed a packet submitted to you for the purpose of a Class "C" Fireworks stand for the 2009-selling period of December 28, 2009 thru December 31, 2009 . The information provided in this packet is for a fireworks stand located at: 906 Algiers Drive North west Yelm WA 98597 (906 Yelm Ave Easy Parcel # 12730110204 Please confirm receipt of this application by fax, mail, or email at your earliest convenience. Once accepted, please direct all permits and or other pertinent information to Thunder Fireworks. attention James Bland. If any more information is required please let me know. You can contact me via email, or phone at 253-875-0700 oriames!%dthundertircworks.com. Sincerely, James Bland "Thunder Fireworks QEC 0 7 Z~G9 5207 - ]87th Street E., Tacoma, V1'A 98446 Phone (253) 875-0700 • Fay (253) 875-0550 November 16, 2009 Attention Gary. City of Yelm PO Box 479 Yelm WA 98597 KF:: TE:~iPORAftY' USE UFSCRIPTION Dear Gary W'e are requesting temporary use of the parking lot at 906 Algiers Drive North West Yelm WA 98597. (906 Yelm Ave East. Parcel # 22730110204. We will be setting up a 32' X 10' trailer for the use of class C 1.4G Consumer Fireworks sales during December 28, 2009 until December 31, 2009. The fireworks tent will be open to the public starting December 28`h upon inspection. Operating hours from December 28`" to December 31st will be 9:00 am to 11:00 pm . There will be electrical usage, such as; cash registers, credit card machines, overhead lighting. All appliances will be plugged into an outside generator using approved extension cords. If you have any questions or need any more information please call me at 888-900-7799. Thank you for you time. Sincerely, /~ James Bland Thunder Fireworks 253-875-0700 james~thunderfireworks.com CITY OF YELM PO Box 479 Yelm WA 98597 (360) 458-3244 OFFICE (360) 458-4348 FAX www.ci.yelr~~.wa.us APPLICATION FOR BUSINESS LICENSE 535.00 . oats No. Upon receipt of the license application and $35.00 payment, the City of Yelm will conduct an inspection of the premises for building and fire code conformance. Upon approval from the Yelm Building Department of said premises, the City Clerk's Office will process the application and mail license to applicant at Application is hereby made for a Business License for the City of Yelm NEW BUSINESS ^ NAME CHANGE/MAILING ADDRESS CHANGE ONLY DATE November 23.2009 BUSINESS NAME Carla HBmrICk NATURE OF BUSINESS Retail sales of 1.4G consumer fireworks BUSINESS LOCATION ADDRESS 906 Yelm Ave East Parcel # 22730110204 MAILING ADDRESS 5207 'I 87th St. East Tacoma WA. 98446 ANTICIPATED OPENING DATE December 28th 2009 DAYS 8 HOURS OF OPERATION December 28th to December 31, 2009. 9:00 Am to 11:00 PM OWNER(S) Carla Hamrick Birthdate 512/80 Social Security No. 533-86-4334 Address 9702 356 st S. MCkenna WA 98558 City State Tip TELEPHONE 253-431-1671 253-312-6215 (Business) (Home/Emergency) CONTRACTOR'S REGISTRATION NO. NA (If applicable) THURSTON CO. HEALTH APPROVAL NO. NA /-/A STATE OF WASHINGTON MASTER BUSINE~S.~ICEN~ NO. (UBI) ~O Z ~ 3 76 yD November 23, 2009 CITY OF YELM BUSINESS LICENSE APPLICATION Eff S/D8 R'uhington State Patrol 9 7 8 Fire Protection Bureau O[lice Of The Statc Fire Marshal Fireworks Stand Licen s e Washington State Fireworks License License fs Non-Transferable and f ulid jot Only One Sl~m~i Licensee Information Carla Hamrick '7j1 ~' ~~~~~ 5207 187th Street East State Fire Marshal Signature Tacoma, WA 98446 License Number: WSPFL-01342 Dctach this wallet card and carry with you for verification of ccrtification. Stand Information Contact Person: James Bland Phone Number: (253) 431-1671 County: Thurston Date of Expiration Date of Issue Stand Number: SN-03875 January 31, 20 ] 0 February 19, 2009 Washington State Patrol 9 7 8 0 Fire Protection Bureau 'lice Of The State Fire Marshal r...... -.~~.... ..~~ir~r~+(i Stand Location: 90~~Y~'_S Aili,.` ~ y~/•rr 1,~/• f8.~7 ~ 90~ Yc%~, ~6~ ~~auon: ~ _ ~„ (Stand Location To Be Completed By Licensee) Stand Locaunrr u 3000-420-012 (R 9/OS) ~ Stat F e hints-~wre CITY OF YELM COMMERCIAL BUILDING PERMIT APPLICATION FORM Project Address:906 Yelm Ave East Parcel #: 22730110204 Zoning; Commercal Current USe ~~"~~err Storel Retail Proposed USe: Consumer Fireworks ^ New Construction ^ Re-Model / Re-Roof /Tenant Improvement ^ Plumbing O Mechanical O Fire PrevenUSuppress/Alarm ~ Other Project DescriptioNScope of Work: Retail sales of 1.4 G Consumer Fireworks Class C Project Value: NA Building Area (sq. ft) Parking Garage Nn 1" Floor32~Q rt. 2n° Floor 3r° Floorna Building Height na Are there any environmentally sensitive areas located on the parcel? n~ If yes, a completed environmental checklist must accompany permit application. Copy of City Mklgatlon documentation (TFCi. I hereby cen.Hy that the above information is correct and that ttw construction on, and the occupancy and the use of the above described property will be In accordance with the laws, rules and regulatlona of the State of Washington and tM Citypt\YNm. ' r ~` ' 11 /16/09 Applicant's Signature Date Owner I Contractor I Owner's Agent I Contractor's Agent /Tenant (Please circle one.) All permits are non-transferable and will expire if work authorized by such permit is not begun within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days IDS Yelm Auenue Wtaf (360) ISS-3835 PO Box 479 (360) JS8-314J FAX Yelm, WA 98597 wwu~.cl.vPlm.wa.ua X00 (Bf+~PS '~~\ tiny T4: ~ST QSM 8007.STiTT i~ ~u, r.vvo n1;U ~.~~ r.~ LJJOtJUJJU lutWUer rlr~wor>~s X002/005 FIREWORKS TENT LEASE AGP;EEMEN'~ THIS LEASE AGRE$MEN'1' C"I~ Agxocmcnt"), tueodc this 17th day of November 2009 btatween Yelm Plaza LLC. a Washington corporation, hereinaflet designated the "Land Owned' end T~iLTNDER FIREWORKS, hereimR.er desisnated the "Lassos.,, WtIN13SSES: Thad tfio said Land,Owner does by these p~eseCta lease to Loaseo the following:.-_ _.~._. -•:~---I:-PItE1vQ8ES: 906 Algicrn Drive North Waal, (966 Yeim Avo East) =,; --- - ~- -~.a~----~--- A,rpd~tg><m-nnsrked ~c1'+ibff'`~'~~ 2. TP.RM: December 28° 2009 to January 1° 2010 3. REN'T': 4. SECURITY AND DAMAGE DBIt'OSI');': Waivod. i.SU6LT3T: Lassos shall not assign this I:ease Agreem~e.nt or any part h~f widhout the prior written co~,saat of Land Owner. ti. LESSEE'S OBLIGATIONS: Canoes ahaD~ . (a) Assturto Hill liabllhy for arty and all claims, damages or of action arising during the term of th)a Latse AgPOcment caused by Lessee, 1t's agerrts, contzactors, sub-eo~ntractors, guesp and invitees, artd hold Lend Owner haru~loas them from. (b) I'rovldc Lard Owner wlth ovidc»co of liability Insurance affection for the Term in an amount of not less the two million dollars ($2,000,000.00) with a rider listing land Owner as a n additional icuur+ed. >:.asa will provide doowtrenUeetion to Land Owner showing the Insurance eaoveraae is active prior to fife com mduxrnent of arty use of tl~ „~ ._,^,.,~.,...~ Premises for tha term nfihe Leaae. - -°- --- - - ~ --- (c) Properly dispose of all nebbish, garbage and waste geuatabed by Lassos; its agonts, oorrtractora, sab~contraators, gucst4 and invitees, is a cleats and sanitary ntatmcr. (d) Nat t+~sorlct the flaw oftraffic (pedestrian /vehicular). (e) Comply with any and all laws, rules, regulations and rBquit~ents imposed upon it by arry governmental agency governing tine Lossee'6 ptoposcd use of the Prctnlscs and post airy required perfonnsmee hoods with the local government.. Any permits or licensee roquircd oaf the underaigood Lessroa shall b~ obtained by the Lessen prior Uo the oomcpdteement ai'tt-e Term of this agrnomccrt. CUU'~ 1B3T~ U\ flOf Tf;~ST Q3lS 800Zi8T~TT ~~iu~Lvuo ~~~, a,u~ r~ L~d01JUJJU 1llWtllel' Clf'dWOfKS ~ 003/00~ (f) Not imwtionilly or nogli~ntty detttvy, deface, damage, impair or Reniovo any part of the Prsmiies, nor to pers'tut nay of it's agonts, contractors, sub-contractors, guesu and invitooe or anther persons aCtUg under itt control to do so. (ga Suffer no lien to arise ar be fibs by any taxing airthotity of by arty contractor, sub-contractor, or supplier or labor or materials lased bo .Lessee oY any otl~r thied party o~+ tho Premises; and, in tho event amy --=--- --- such lien or claim of lien is filod, case tfie sar„e m be smisfied a~ - - - . ~__- discharged in full within thirty (3b~ days follonving fist filing tlser+eo~.= - -- 'f.` USFk ~- [.ioorieoe -w1ll nse the Premises Do coadl sales of approvod' 1.4(it" or cxlimm~n~y known as Class "C" and/or Cocisnme~r Fiieworlcd along with those activities attendant to that intendod tree. Lessee may place temporary striping or cvne3 and a gent es neoessaty and trod appropriate signagc acid wilt remove the same at the end of tho tam Lessee shall not use the Promises for any illegal purpose. Lessee ng~s to oontbrm to sII state, county and municipal Docks, statutes, ordmancer and regulations eonceming the use end occupation of the Pranises amd to obtain the prior receipt of approval of authc~iaee of compdent jurisdiction for its intended use of the Premises with copies thcroof b Lead Ownu. If the Lecsce is unable to procure titic isooessary fmtvroric permits boom the Stott of Washington and the C~ of Yalm to operats o fireworks tent as the above mentioned Premises ttlon this I.aaeo Amt shall bo mill and void. 8. ALTI,.RA7'IONS: ~sCe agroes not to make alterations to the Pr+ernlsec with rho prior written consent of the Trsad Owner 9.3URREMDBR At the eocpiraaton of said term of this Lease Agrecmeat will surrendrr the Premises to Land Owner in a condition equivalent to or better that when first mado available to Liornsee. !0. ACCESS: Lessor will have unlimited acuoss to tbo Prcmisea during the term of the - Y,euo at the entt~ce ! exit shown on the attachibd Exhibit A.. ~1 _ . - --- 1 I . TAXBS: - ---_ - -band Owner shall be solely responsible for any texas on the ral _ _- ,- ProD~Y• I.esaee shall be solely respoiltible for ~ tax,es vn its peracmal -_ - ~ - ~ - - property and/or the conduct of its activities. 12. COSTS, ATTOl2NlrY'$ F£l3S AND VSNi1E: ~ by reason of any default or breach on the part of tithe party in the porformanoe of aqy of the provisions of this ap~reemetrt, enforcematst of spy term of this Lase is sought, a-liether ar not legal action is iNtituted, the losing party a8roee to pay alt nsssonable costs and attoray's fees of the prevailing party in oonricvtion thc~vlth. 1n the evert any claim for pcrsotsal itVucy, dtath, pcopctty damage, or other alleged liability is asserted agniast Land Ownea, Lessee agrees to defend and hold Lend Owner harmless of zny suet ciaim, iacludirig sttoznay's foca and legal t00 88tS 'OK SU(' TC~ST Q3e~ 8002/BTiTT 1~i1~i~UU9 A~ 9. a FAQ 2538750550 Thunder Fire~orks X004/005 cosh. It is agreed that the venue of aoy legal aotioa brought snider the sexton ot'this agreetnertt shall be Pierce County, sate of Washington. 13. NO'fIC~.S: (a) Notices to Land Owner shall bs delivered. personally or by oertifled mad, postage prepaid, addrossed m Land Owner at: Yelm Plaza LLC. 18230 Last Valley Hvey.5uite 10$ _ _ _ Kent WA 980C;2 _ . . (6TN to Licausees s6a11 be delivered, Personally of by cxttifuad _._. -. . ~ p~~ Pnp~d, eddnessed m LioQUeed ai: _ _.:~--~- - "~' - _ .. ,~ ... _ .. -~.~.r-'_'- - Thunder Fa+e~~`.. SZ07 187'` Street B. Tacoma, WA 98446 P:253.875.0700 F:253.875.OSS0 14. EXECLJ'ITtJN: This instrument i6 signed !n multiple identical copies, any one of whicti will suffice !loot legal pin~poscs as an ori~al. IN HIGNII~IG THIS INSTiJMEIVT EACH PARTY ACKNOWI.EDG-ES ANA >IiEP1tE•S~i!ITS TO TSE Ox'$ER SIGI+IERS: (s) That the ~r'aoe sag bas t+ead dte iratilnncnt in its eatirnty. (b) Thet the Pam ~~8 ~ document sus snthority to do so and to bind his/her principal, unddssands that this b~umeat canstihitee and irnpcxtsrrt end binding loge! oontreot, which fixes and dctertnlnoaf oettam sera! and obligations of thn mesons sigaltlg it. (c) That no pt+nvision of this documoat can ba changed by re8aatoe to arry oral mprceentatio!ns a agroements. IN ~VICI'1~IF,SS ~VI~REOF, the Leasx and Land Owner bsve each heaeunEo signed this instnuaent in duplicate the day sad year feat above written. LAND OWNER: r~ _ Ydm propertini - •"~"~~~"~undc7 y' ,~ ~ y~i,t~ ; ~. ~. ~ ~+'~ W. Bland Retail Manager. /~/ LEAS$ Af~~~EMRNT ~z~~_ ,+ _ ~:~ _ r~ ~~ '~=` ~~y M N ~ i '' ~ 711 p8 7 ' G `d ~ ~ ~{. Mtii ice: ~ ~ , w `d /y •.' r- • • ~ A ,~ r ~_ ~ ~. s .. ~- ~ -~ ~~ .___~_. i ~ 1 { ~' .. ~, _, ~ ! ~. - ,~ ~! '~ ~~ ,, :~~, 1'~~ ~~~ ;~ 1 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) „ 11 23 2009 PRODUCER phone: 440-248-4711 Fax: 440-248-5406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Britton-Gallagher and Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6240 SOM Center Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cleveland OH 44139 INSURERS AFFORDING COVERAGE NAIC # a+suRED INSURER A: j, on n r C _ Thunder Fireworks Inc. INSURER e: In n 9 5207 187th Street East INSURERC:Axi an Tacoma WA 98446 INSURER D'. J ~+• N c THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOA THE POLICY PERIOD INDICATED. NO'T'WITHSTANDING 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 T'rIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL ":.... TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HF,'1F: BEEN REDUCED BY PAID CLAIMS. INSR %U)l)' POLICY NUMBER POLICY EFFECTIVE I POLICY EXPIRATION ~~ TR A i GENERAL UABILfTY 4 3 9 2 5 4 5 3- 01 11 / 15 / 2 0 0 9 11 / 15 / 2 010 EACH OCCURRENCE s 0 }( CCMMERCIALGENERALL1A80.1TY ~ M a = OO - CLAIMSMADE ©OCCUR MEDEXP(Arryone rson i PERSONAL 8 ADV INJURY S Q O Q GENERAL AGGREGATE S O Q Q Q GENiAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG S 0 0 POLICY PRO• LOC B AIlT OYOBILE IJABIUTY CA 9 3 8 2 9 6 5 8 11 / 15 / 2 0 0 9 11 / 15 / 2 010 COMBINED SINGLE LIMIT ~ (~ soddent) c ~ ,~n ~ - , .- ANY AUTO _ ALL OWNED AUTOS BODILY INJURY SCHEOULEDAUTOS (Per person) HIRED AUTOS BODILY INJURY s NON-OWNED AUTOS (Porecddent) PROPERTY DAMAGE (PersoddenQ f W tAOEL1ABILRY AUTO ONLY-EA ACCIDENT i ANY AUTO OTHER THAN ~ ACC S AUTO ONLY' AGG : C EXCESSAIMBRELLAUABILITY EAU710 6 S 0 11 / 15 / 2 0 D 9 11 / 15 / 2 010 EACH OCCURRENCE i Q Q - 000UR ~ CLAIM9 MApE AGGREGATE S ~ , ~ ~ ~ , ~ / Q _ S DEDUCTIBLE i RETENTION i S C STATU- OTH- W i WORKERS COMPENSATION AND I EMPLOYERS' LUUlLLITY ANY PROPRIETORlPARTNER/EXECUTIVE El. EACH ACCIDENT S OFFICERr?AEMBER EXCLUOED7 E.L. DISEASE - EA EMPLOYEE _ -. _ .----- - -- ~- ~ S - -- If yes, deealbe under ~ SPECIALPROVISIONSbelow ~ I r:a °,r nSE.PnI ~r•.v LIP.q!7 --- --- 5 OTHER DESCRIPTION OFOPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSK)NS ADDED BY ENDORSEMENT / SPECIAL PROVISK>NS cation: Parking Lot of 906 Yelm Ave North Weat Yelm WA 98597 ddi[ionally Insured: City of Yelm and all it's employees, Yelm Plaza and -.._ _ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of Yelm WILL ENDEAVOR TO MAIL30 DAYS WRITTEN NOTICE TO THE PO BOX 479 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Yelm WA 98597 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSIIRER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZEDREPRESENTATTVE ~~~ ACORD 25 (2001108) p ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DWYYY`/1 ,~ 11 23 2009 PRODUCER Phone: 440-248-4711 Fax: 440-248-5406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Britton-Gallagher and Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6240 SOM Center Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cleveland OH 44139 INSURERS AFFORDING COVERAGE NAIC # wSUREO INSURERA xi n I uran Co _ Thunder Fireworks Inc. INSURER e: In n e 5207 187th Street East WA 98446 INSURER C. i 1 m an Tacoma INSURER D. - -- i INSURER E' I THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. OTWITHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ' D'~ POLICY NUMBER POLICY EFFECTIVE I POLICY EXPIRATION L9KTS A GENERAL uABILITY 4 3 9 2 5 4 5 3- O 1 11 / 15 / 2 0 0 9 11 / 15 / 2 010 EACH OCCURRENCE s 0 _Q 0 COMMERCIAL GENERAL LIABILITY PREMI Ea Ix:c E O C1AlMS MADE a OCCUR MED EXP (Arty ons person) S PERSONAL 8 ADV INJURY S O OQ GENERA_LAGGREGATE S OO _Q00 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS • COMP/pP AGG S O O 0 PRO- POLICY LOC $ AUT OMOBILELIABILRY CA93829658 11/15/2009 11/15/2010 COMBINEDSINGLELIMIT (Ea ectleent) b 1, 0 0 0, 0 0 0 g ANY AUTO ALL OWNED AUTOS BODILY INJURY b 9CHEDULEDAUTOS (Perpsnwn) }( HntEOAUTOS 80DILYINJURY S }{ NON-0WNED AUTOS ({~ socfdenl) PROPERTY DAMAGE P ld S ( er scc enf) SIIRAOE LUUlILRY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG f C ExcESaluweRELU LIA81Lm EAU710 6 5 0 11 / 15 / 2 0 0 9 11 / 15 / 2 010 EACH OCCURRENCE s 0 0 0 }{ OCCUR ~ CLAIMS MADE AGGREGATE S O S DEDUCTIBLE f RETENTION S ~ b tNOR1~Rb COMPENSATION ANO WC STATU- OTH- RYLIMITS EMPLOYERS' LIABILfTY ANY PROPRIETORlPARTNER/EXECIlTNE E.LEACMACCIDENT f OFFICERlMEMBER EXCLUDED? El. DISEASE - EA EMPLOYEE b _ n Aesutl»~nder SPECIAL PROVISIONS bsbw F~ o~sensE-aoricvuMlr s OTHER DESCRIPTION OF OPFJTATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENOORSEYENT I SPECIAL PROVISIONS ocation: Parking Lot of 906 Yelm Ave North West Yelm WA 98597 dditiorally ]nsureri: City ~~f YeLn ar.d all it's employees, Yelm Pla::a and .~11 it':. rr.~pl•r,~~-,:;. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED City Of Yelm BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL V L DAY WR E FO BOX 479 ENDEA OR TO MAI 30 S ITT N NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 5"_ Yelm WA 98597 SHALL IMPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPO"+ THE INSURER, ITS AGENTS OR REPRESHNTATIVES. AUTHORQEDRI-PRESENTATIVE ~1E~ ACORD 25 (2001/08) ©ACORD CORPORATION 1988