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HomeMy WebLinkAboutImage (2)�4 qxe yx� INRV `'��� STATt Or WASHINGTON Sole Proprietor KENNETH ALLEN KERSEY GOT FUSE FIREWORKS 35822 74TH AVE SOUTH ROY WA 98580 4; Issue Date: May 02, 2025 Unified Business ID #: 601717746 Business ID #: 001 Location: 0003 Expires: Apr 30, 2026 i :- UNEMPLOYMENT INSURANCE - ACTIVE TAX REGISTRATION - ACTIVE L`s, CITY/COUNTY ENDORSEMENTS: YELM GENERAL BUSINESS - NON-RESIDENT #10283 - ACTIVE REGISTERED TRADE NAMES: GOT FUSE FIREWORKS BUSINESS LICENSE Ihis document lists the registrations, endorsements, and licenses authorized for the business named above. By accepting this document, the licensee certifies tlx: information on the application was complete, true, and accurate to the best of his or her knowledge, and that business will be conducted in compliance with all applicable Washington state, county, and city regulations. UBI: 601717746 001 0003 KENNETH ALLEN KERSEY UNEMPLOYMENT INSURANCE - GOT FUSE FIREWORKS ACTIVE 35822 74TH AVE SOUTH TAX REGISTRATION - ACTIVE ROY WA 98580 YELM GENERAL BUSINESS - NON-RESIDENT #10283 - ACTIVE Uvecic�r, ih�pnrhnenl of Rem�nue Expires: Apr 30, 2026 Direr tac Ihryxutmenl of Revenue DATE (MMIDD/YYYY) 1 ACC)R " CERTIFICATE OF LIABILITY INSURANCE 4/23/2025 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 aendorsed. SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A stattement on thiss certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CONTACT PRODUCER NAME:_ _ Acrisure Great Lakes Partners Insurance Services PjHONE E1cU 216-658-7100 FAX .No):216-658-7101 223 West Grand River Ave #1 E-MAIL Howell MI 48843 ADDRESS: — - INSURER(S) AFFORDING COVERAGE NAIC M INSURED Jake's Fireworks Inc. 1500 E 27th Terr. Pittsburg KS 66762 COVERAGES INSURERA: : Arch Speci IS INSURER : LeXington 19437 INSURER E INSURER F NUMBER: CERTIFICATE NUMBER: 1317763539 REVISIONA. n AnnvG FnR THF Pnl ICY PERIOD THIS INDICATED. CERTIFICATE EXCLUSIONS IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT. MAY BE ISSUED OR MAY PERTAIN, AND CONDITIONS OF SUCH POLICIES. TYPE OF INSURANCE OF INSURANUL OL LIS I to I$twYV nrAV M 01-1 TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN REDUCED S BR POLICY NUMBER CONTRACT THE POLICIES BY POLICY EFF MM/DDIYYYY 2/15/2025 OR OTHER DOCUMENT DESCRIBED PAID CLAIMS. POLICY EXP MM/DDIYYYY WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS. - LIMITS INSR LTR 2115/2026 EACH OCCURRENCE $1,000,000 B GENERAL LIABILITY X RAL LIABILITY COMCLAIMS•MADEE.� OCCUR 052115105 MA E REN 0 PREMISES Ea occurrence _ $ 500.000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000.000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,non GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X LOC POLICY COMBINED SINGLE LI IT $ AUTOMOBILE LIABILITY Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A UMBRELLA LIAR X OCCUR UXPI037038-05 2/15/2025 2/16/2026 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1.000.000 X Is DED RETENTION $ WC STATU- O WORKERS COMPENSATION R E.L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY ANY PROPRIETOR'PARTNER/EXECUTIVE Y� E.L. DISEASE - EA EMPLOYE $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes. describe under DESCRIPTION OF OPERATIONS below N / A E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Sales Location: 16628 State Route 507 SE, Yelm, WA 98597; Land Owner: Tim Baublits; Ken Kersey, P.O Box 1106, McKenna, WA 98558; City of Yelm and all it's employees, 105 W. Yelm Ave., Yelm, WA 98597, Christensen's Furniture and all it's employees Term: February 15, 2025 through February 14, 2026; The Certificate Holder and the above listed are Additional Insureds with respects to General Liability policy as required by written contract. 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. Ken Kersey PO Box 1106 AUTHORIZED UPRESENTATIVE McKenna WA 98558 yA10— . © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD a, Y�r w i r4- H-kJ4