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24 YELM NYE PERMIT APPWashington State Patrol Fire Protection Bureau G24036 Office of the State Fire Marshal CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE s1r1~~N=1578~ )n lle!atrona~ta WASHINGTQNltffJfe~1El'?AlROborks Utah, LLC Licensee Data West Coast Fireworks 29320 47th Avenue East f.ounfy orop -~~tifn: Tnurs on Graham, WA 98338 Q eratea\ '~r: Lie.en~ License Number: WSPFL- 1 , 2887 Phone Number: (253) 229-247 Date of lssue:Marc ~::::::::::1111....-Date , ~jon: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. 3000-420-041 (10/18) SURRENDER THIS PORTION OF THE LICENSE TO THE FIREWORKS WHOLESALER ------------·---------------________________ , ______ _ Washington State Patrol Fire Protection Bureau G24036 Office of the State Fire Marshal CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE _ ostB~~e_r_: Licensee Data wr ASH IN Gl.l~ f~-\: ?~p~~~a~1onaf rea~A I DnL West Coast Fireworks M. .:m:c~ ; \..J \-~-,,~Wholesaler~\l'Ji'filcd>~~ rks Utah, LLC 29320 47th Avenue East n cgu~tyJ ciPe~9r:Thurston Graham, WA 98338 Operated 1ar:Licensee Phone Number: (253) 229-247 u Date of lssue:Marc~~~-20 ,. -_ate..,o Ex iratLon: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. 3000-420-041 (10/18) THIS LICENSE PORTION ACCOMPANIES YOUR LOCAL PERMIT APPLICATION ------------- Washington State Patrol Fire Protection Bureau G24036 Office of the State Fire Marshal CONSUMER FIREWORKS RETAIL SALES (CFRS} FACILITY LICENSE Dt1tjtrr:~N-157~•:: "•~ Licensee Da~ ~~rur1 Da1bA . n West Coast Fireworks WASHINGTQ~~ ~Wnt'\esfierWw,JcffwJ!0rks Utah, LLC 29320 47th Avenue East n C ,!tk,ty of Opei'af o : Thurston ~raham, WA 98338 I 'eJ;lei: ted : Lifrense Phone Number: (253) 229-1t7 Date of lssue:Marc~ ~--....-Oat of:"'Ex Ltatio : 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. 3ooo42o-041 (10118) THIS PORTION OF THE LICENSE MUST BE POSTED AT THE STAND AT ALL TIMES THIS FORM IS INTENDED FOR USE BY LOCAL AUTHORITIES HAVING JURISDICTION (AHJ) IN THE EVENT THEY DO NOT HAVE A PERMIT FORM SPECIFIC FOR RETAIL FIREWORKS SALES AT A CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY. IT IS NOT MEANT TO BE REQUIRED IN ADDITION TO OR IN LIEU OF ANY LOCAL PERMITTING FORM AND/OR PROCESS THAT MAY EXIST WITH THE LOCAL AHJ. Directions: Provided the local jurisdiction has no permit form of their own, complete this permit application and submit it with the local AHJ portion of your Retail Fireworks Stand License to the jurisdiction in which you wish to run your CFRS facility. WASHINGTON STATE FIREWORKS RETAIL SALES PERMIT APPLICATION Applicant Information D New/First Time Applicant Previous Permit Holder Name of Group, Organization, or Person (Last, First, Middle Initial, and Date of Birth) Issued the Fireworks Retailer License e of Birth flt/ t, City, CZ-SS)Z. ~, · \2-lt'f-w~ ZIP Code) CN~, (_IJ\N'... ( ---->---~--------Phone Number E-Mail Lo ca I Business Number (if required) CFRS Facility Information D Stand Tent Other: _____ Size: z_D~\ -(.,00 ~1r Square Feet/Dimensions ) rty Owner Phone Number &Z--3--30 I\ OZDC/ Parcel Number for Stand Location Fireworks Supplier Information List all of the licensed fireworks wholesalers who will be supplying this stand product lU,~ $~ Storage Information On Site D Off Site: .....,,...----------------------- Storage Address (Complete Including Street, City, State, and ZIP Code) ~Sales Structure D Detached Building D Truck/Trailer D Other: ____________ _ CHECKLIST FOR SUBMISSION Check with the local AHJ for all applicable submission dates and deadlines: D Application/Permit Fee D Insurance Certificate ($1,000,000) D Clean-Up Bond Fee (if applicable) D Valid Washington State Fireworks Retailer License D Property Owners Written Permission D Detailed Site Plan D Interior Plan (required for tents and "other'' facilities) I hereby certify the information in this application is true and correct. I am aware of and agree to comply with all relevant provisions of law, rule, and an ordinance of the state of Washington and the city/county permitting this CFRS Facility. ----- ---=------1......-~.=.........:!lo£....~~~~~...,,£..----b (~X~~:J.~~~pf 1~iJslG!¥i FIRE CODE AUTHORITY HAVJNG JURISDICTION DENIED Permit Number f Approved By Date of Approval ' i::; SEE BACK QF THIS"FORM FOR ANY RESTRICTIONS, CONDITIONS, OR NOTATIONS ON THIS PERMIT ' . . . Signature of Permitting Official Printed Name and Title Date of Signature THE FIREWORKS RETAILER LICENSE HOLDER (LICENSEE) SHALL RETAIN THIS PERMIT WITH THE ASSOCIATED FIREWORKS RETAILER LICENSE AND MAKE THEM BOTH AVAILABLE FOR INSPECTION AT ANY TIME THE STAND IS IN OPERATION 3000-420-013 (R 11/16) CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS WC STATU-TORY LIMITS OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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 WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Acrisure,LLC dba Britton Gallagher &Associates One Cleveland Center,Floor 30 1375 East 9th Street Cleveland OH 44114 216-658-7100 216-658-7101 Everest Indemnity Insurance Co.10851 Winco Fireworks Utah LLC 710 Amidan Drive Ogden UT 84404 1196859194 A X 1,000,000 500,000 X 1,000,000 2,000,000 2,000,000 SI8ML02067-231 12/31/2023 12/31/2024 X 2/1/2024 **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:906 Algeirs Drive Yelm,WA 98595 See Attached... City of Yelm P.O.Box 479 Yelm WA 98595 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: 1 1 Acrisure,LLC dba Britton Gallagher &Associates Winco Fireworks Utah LLC 710 Amidan Drive Ogden UT 84404 25 CERTIFICATE OF LIABILITY INSURANCE Operator:Lucky Dog Fireworks;West Coast Fireworks Landowner:Yelm Plaza LLC Additional Insured:City of Yelm and all its employees;West Coast Fireworks ENTER/EXIT 8'Fire Extinguisher Certificate ofItame gaga: 2 Rotztance AZTEC TENTS Invoice Number: 0222585-IN Date Manufactured 2665 COLUMBIA ST Customer P.O.: 2942 6/19/2017 TORRANCE, CA 90503 Customer Number: ABC92B7 (800) 228-3687 This Is to certify that the materials described below have been flame retardant treated (or are Inherently flame retardant), CORT Party Rentals Cort Accounts Payable Bodc Svcl0/520/01 P.O. Box 23567 New Orleans, LA 70183-3567 Certification is hereby made that the articles described below hereof are made frow a-flame-retardantfabric or -material registered -and approved-bythe • - - California State Fire Marshal for such use, The fabric has been tested and passes NFPA 701 Large Scale. See chart to right for trade name of --r1. o ery -- teen r.M10 F.Y. h . (77, GM' , Il, I., M 73' r.11791' 4— Fa9IlCS p r. 1 qj tqa r neje f-'J� ,/U,or OAF Gea Myj 16VI 29pa r.")01, VAr - 11i F-593 Q E�4Yf:}Yry Erpc - mysuw Umt - r-1 CAI, rMan WecOMInt 502 P,944,U1- Ferran arcoanuemt 152 .stEAE, $Twvs(e040 aryl, I t. Vnar F.5'0.91 f�, Tecn, nec9 ctn valcn F, 5W mynt wamefipan F146Oi (n VJ+ItOpe t —11511n tad F.j0r.9} iir vcntapt _, P,,.o LJi -t 21M In V".W 1 F 1121J9 1, Wt5,j! VAna 11r9 }'ite On fnVantapg 1Veolen)CoaStOnC f-0l9.Oi Vc.t++aa7. il`JltTllO,/j�PI5t5 A•:J9.9i flame-resistant fabric or material used and additionally referenced on the label of the fabric panel. THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING t' David Bradley General Manager- Manufacturing ��w a `� Name of Applicator or Production Superintendent Title of Applicator or Produulon Superintendent ' ,L !1 p :k f SlriLy qys k!? r i �At +� �} / r'^ 1� � 1} nAfi '�. ajt "i /', � ',ar � t.��} / t�...� Ar >y r1 1 i.1�+ 11 A A 4 fit. z3•, 4 atit',�t fb� �� eF�r?n Ih, t i.° i 1'',' ITEM CODE ITEM DESCRIPTION UNIT ORDERED PRODUCED Z221 DV20CM1002 # 20x10 Mid DV JT/JT Lite Top UW EACH 10 10 wl Double Valance SN4P Blockout White- i. # No Ratchet Tensioners Z221 DV20CM1035 # 20xl0 Mid DV JT/JT Lite Top CLR EACH 4 4 w/ Double Valance w/ SN4P Blockout White Trim # No Ratchet Tensioners # OLD TRIM DETAILS Z221 DV20CM2035 # 20x20 Mid DV Jumbotrac Top CLR EACH 4 4 w/ Double Valance w/ SN4P Blockout White Trim # No Ratchet Tensioners # OLD TRIM DETAILS ?221DV30CM2002 # 30x20 Mid DV Jumbotrac Top UW EACH 6 6 w/ Double Valance SN4P Blockout White- # No Ratchet Tensioners ?221 DV40CM2002 # 40x20 Mid DV Jumbotrac Top UW EACH 10 10 w/ Double Valance SN4P Blockout White- # No Ratchet Tensioners FIREWORKS TENT LEASE AGREEMENT THIS LEASE AGREEMENT ("Lease Agreement"), made this X day of 2024, between Yelm Plaza LLC, hereinafter designated the "Land Owner" and Seven One Seven Ind. LLC, a Washington limited liability corporation, hereinafter designated the "Lessee." WITNESSES: That the said Land Owner does by these presents lease to Lessee the following: 1. PREMISES: 906 Algiers Drive North West, (906 Yelm Ave East) As per the diagram marked Exhibit "A". 2. TERM: December 16, 2024 to January 6, 2025 3. RENT: Seven hundred fifty dollars ($750.00) due on June 15th of the corresponding year. If a fireworks ban is implemented or failure to obtain permit or license, which restricts Lessee from obtaining necessary permits, the rent will refunded in full to Lessee. Seven One Seven Ind. LLC reserves the first right of refusal should terms and conditions as set forth above change prior to January 1 of the renewal year. 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 7. USE: 8. ALTERATIONS: 9. SURRENDER: 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 it's 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 files by any taxing authority or by any contractor, sub-contractor, or supplier or labor or materials used be 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. Licensee will use the Premises to conduct retail sales of approved "I .4G" 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 thereof to Land Owner. If the Lessee is unable to procure the necessary firework permits from the State of Washington, Thurston County or the City of Yelm to operate a fireworks tent on the above mentioned Premises then this Lease Agreement shall be null and void. Licensee accepts the Premises in its present conditions, "AS IS, WHERE IS, and with ALL FAULTS." Lessee agrees not to make alterations to the Premises without the prior written consent of the Land Owner. At the expiration of said term of this Lease Agreement Lessee will surrender the Premises to Land Owner in a condition equivalent to or better that when first made available to Licensee. Reasonable wear and tear acceptable. 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 he 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 LEASE AGREEMENT - PAGE 2 the prevailing party in connection therewith. In the event any claim for personal injury, death, property damage, or other alleged liability is asserted against Land Owner arising from Lessee use of Premises during the Term of this Agreement. 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 Pierce 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: Yelm Plaza LLC 18230 East Valley Hwy Suite 108 Kent WA 98032 (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 P0 Box 5394 Spanaway, WA 98387 Phone: 253.279.1247 14. EXECUTION: This instrument 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. LESSEE: By: LEASE AGREEMENT - PAGE 3 906 Yelm Ave. Yelm, WA 98597 20’ x 30’ tent 2 0 ’ x 3 0 ’ D o o r 2 0 ’ P E R I M E T E R