20170122 Permit Pkg 02132017City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458 -3144
Applicant:
Name: AMERICAN PROMOTIONAL EVENTS NW
Address: 2120 MILWAUKEE WAY
TACOMA WA 98421
Property Information:
Site Address: 1109 YELM AVE E
Permit No.: 20170122
Issue Date: 2/1312017
(Work must be completed within 180 days)
Phone: 253 - 922 -0800
Owner: JESUS NAME PENTECOSTAL
CHURCH
Assessor Parcel No.: 85810000100 Subdivision: N/A
Contractor Information:
Name: AMERICAN PROMOTIONAL EVENTS NW Phone:
Address:
2120 MILWAUKEE WAY
TACOMA WA 98421
Contractor License No.: Expires: 12/31/2017
Project Information:
Project: FIRE WORKS
Description of Work: JUNE 28 THRU JULY 4, 2017
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item Contractor
FIRE AMERICAN PROMOTIONAL EVENTS NW
TOTAL FEES:
Applicant's Affidavit:
I certify that have read and examined the information contained within the application and know the same
to be true a rrect. I a certify that the proposed structure is in conformity with all applicable City of
Yelm regula ions including t ose governing zoning and land subdivision, and in addition, all covenants,
easements nd restnctio of record. If applying as a contractor, I further certify that I am currently
registered i th Slnkku� ngton.
Signature Date
.. n
Firm
Lot: N/A
Fees
$ 30.00
$ 30.00
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
Cite of Yelm
(361) 458 -3244
RECQ 00259487 2/13/2017 10:00 AM
OPER: CO TERM: 001
REF #: 30047800
PAID BY:
IRAN: 33.0000 BUILDING 30,OCCRII'
20170122
AMERICAN PROMOTIONAL EVENTS NW
1109 YELM AVE E
FIRE 30,OCCR
TENDERED: 30.00 CHECK.
APPLIED: 30,00-
CHANGE: 0.00
January 26, 2017
Community Development
City of Yelm
105 Yelm Avenue West
Yelm, WA 98597
Community Development Official,
201"10! -a-�
In preparation for the upcoming 2017 4t" of July season, please find enclosed
with this letter all the documents to apply for (2) stand /tent fireworks permit.
Included with the paperwork are the City of Yelm permitting fees.
If you have an r questions, please feel free to contact me at (253) 922 -0800,
thank you.
Si�nc&el
Liz L si .cV&e-rfl[�!
lisici hl wo ks.c
s-r t s
Amer ican Promotional
Enclosure(s)
Events, Inc. - Northwest
AMERICAN PROMOTIONAL EVENTS, INC.
2120 MILWAUKEE WAY • TACOMA, WA 98421
TACOMA (253) 922 -0800 • FAX (253) 830 -2930
www.tntfireworks.com
F CB 0
13 1 i eff � W lRt /� #Rf� l
!. 4 *$N\NGTON Sf4fF
Washington State Patrol Fire Protection Bureau
Office of the State Fire Marshal
CONSUMER FIREWORKS RETAIL SALES (CFRS) FACILITY LICENSE
.... �igF�4RSMAt`54F`4v.
Licensee Data
American Promotional Events, Inc.
ILL bw2120 Milwaukee Way
Tacoma, WA 98421
License Number: WSPFL -02766
Phone Number: (253) 922 -0800 ,jill
Stand Number: SN -11
Operational Data
Wholesaler: TNT Firework
County of Operation: Thurston
Operates For: Yelm Jesus Name
Stand Operated By: Greg Mattocks;;
Date of Issue - January 17, 2017 Date of Expiration: January 31, 2018 "
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
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
muss FIRE PROTECTION BUREAU
FIREWORKS LICENSING PROGRAM
PO Box 42600
Olympia WA 98504 -2600
(360) 596 -3914 FAX: (360) 596 -3934
APPLICATION
FOR RETAIL FIREWORKS STAND PERMIT
lr.
WWT7105
TO
Governing body of city, town, or county in which
DATE OF
fireworks stand will be located.
I APPLICATION
JANUARY 26, 2017
Applicant Name
Address, City, State
JESUS NAME PENTECOSTAL CHURCH
2120 MILWAUKEE WAY, TACOMA, WA. 98421
Sponsor (If other than applicant)
Address, City, State
GREG MATTOCKS
2120 MILWAUKEE WAY, TACOMA, WA 98421
Location of proposed fireworks stand (Enclose drawing of stand location]
1109 YELM AVE EAST - YELM WASHINGTON - SAFEWAY #1619
Manner and place of storage prior, during, and after sales dates
ON SITE WITH SECURITY
State - Licensed Fireworks Supplier
AMERICAN PROMOTIONAL EVENTS NW 2120 MILWAUKEE WAY, TACOMA, WA. 98421
FIREWORKS STAND PERMIT
For the Fireworks Sales Year of 2017
(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
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 July 4th Sales for December 313t
From: JUNE 28, 2017 From:
To: JULY 4, 2017
Sponsor GREG MATTOCKS
Location 11 YELM EAST - YE S F WAY #1619
/s/ /s
Nrii&ture of fficial Granting Pe t \Signa)u&ofApplic\4nt
Title 46y1z,0,A , Agenc
Date 2 ° /(> - I Permit
Licensee Name JESUS NAME PENTECOSTAL CHURCH License Number 17 -0119
3004420 -013 (R 3109)
FOR GREG MATTOCKS
AC'� ® DATE (MMIDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 11/1/2017 1 1/26/2017
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 have ADDITIONAL INSURED provisions or 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 Lockton Companies CONTACT
3280 Peachtree Road NE, Suite #250 PHONE -_ FAX
Atlanta GA 30305 E -MAIL EX : (Alc No):
(404) 460 -3600 ADDRESS:
INSURER A: Everest Indemnity Insurance Company 10851
INSURED American Promotional Events, Inc. INSURER B:
1359629 DBA TNT Fireworks, Inc. INSURER C :
P.O. BOX 1318 INSURER D:
4511 Helton Drive
Florence AL 35630 INSURER E :
INSURER F:
COVFRA - CFRTIFICATF KII IMRFR• 1 D2dMRA f?P\ /I¢Ir)M NII IMRFR- vvvvvvv
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.
IN SR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD I WVD POLICY NUMBER MM /DD/YYYY MM /DD/YYYY LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
r
CLAIMS -MADE X OCCUR
Y
N
SI8GL00242 -161
1 1/ 1 /2016
11/ 1 /2017
EACH OCCURRENCE
$ 1.000.000
DAMAGE TO
PREMISES (Ea occurrence)
$ 500,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 11000,000
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
GEN'L
POLICY F jE LOC
PRODUCTS - COMP /OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
NOT APPLICABLE
COMBINED SINGLE LIMIT
Ea accident
$ XXXXXXX
BODILY INJURY (Per person)
$ XXXXXXX
ANY AUTO
BODILY INJURY (Per accident)
$ XXXXXXX
OWNED
AUTOS ONLY AUTOSULED
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
$ X==
$XXXXXXX
UMBRELLA LIAB
OCCUR
NOT APPLICABLE
EACH OCCURRENCE
$ XXXXXXX
AGGREGATE
$ XXXXXXX
EXCESS LIAB
CLAIMS -MADE
DED 1 1 RETENTION $
$ XXXXXXX
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER /MEMBER EXCLUDED? ❑
N/A
NOT APPLICABLE
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ X==
E.L. DISEASE - EA EMPLOYEE
$ XXXXXXX
(Mandatory in NH)
If yes, describe under
E.L. DISEASE -POLICY LIMIT
$ XXXXXXX
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED.
Located at Safeway 1 109 Yelm Ave E, Yelm, WA (W WT7105) Certificate holder is an additional insured on the General Liability as required by written contract
subject to policy terms, conditions, and exclusions.
anr WFAAF � Ewlrar
12340084
City of Yelm
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Yelm Jesus Name Pentecostal Church
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
PO Box 479
ACCORDANCE WITH THE POLICY PROVISIONS.
Yelm WA 98597
AUTHORIZED REPRESENTAA-TIIIVrE_ 6/-
v 19tst$ -ZU1Z ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
MASTER FIREWORKS AGREEMENT
THIS MASTER FIREWORKS AGREEMENT (this "Master Agreement ") is dated as of
March >L(t'Y; 2016, and is entered into by and between Albertsons Companies LLC, a Delaware
limited liability company ( "Albertson ") on behalf of itself and its subsidiaries and American
Promotional Events, Inc. - West, a California Corporation, dba TNT Fireworks ( "TNT ").
RECITALS:
A. Albertsons. Albertsons through the Companies operates grocery supermarkets in the
United States.
S. TNT. TNT desires to enter upon a portion of the parking lot of some of the Stores for
the sole purpose of selling fireworks on and around the 4t' of July and New Year's
Eve holidays.
AGREEMENT.
Now, therefore, for good and valuable consideration, the receipt and sufficiency
of which are acknowledged, the parties agree as follows:
1 Definitions.
1 Definitions. When used in this Master Agreement, the following terms shall have the
meanings set forth below.
"Company" shall mean each of Albertson LLC, a Delaware limited
liability company, New Albertson's Inc., an Ohio corporation, Safeway
Inc., a Delaware corporation, The Vons Companies, Inc., a Michigan
corporation, and Randall's Food and Drugs Market, LP, a Delaware
limited partnership (collectively "Companies ").
"Confidential Information" is defined in Section 7.
"Event" shall mean a single holiday fireworks sale occasion in connection
with the 4th of July or New Year's Eve. In that regard a single Store may
be the location of two (2) Events in a single year.
"Fireworks Wholesale Sales" is defined in Section 4.2.
"Individual Vendor" shall mean those nonprofit organizations or other
entities which contract with TNT to operate a fireworks stand on the
License Premises.
"License" shall mean the right to install and operate a fireworks stand in
the area of the parking lots of the Stores pursuant the Revocable License
Agreement, the form of which is attached as Exhibit A.
K: l3rdPartyTNK_DATA1FireworkslTNT MasterTinal DocumentsWbertsons Master Fireworks Agreement3_10_16 GD v FINAL doc.doc
"License Premises" shall mean the area of the parking lots licensed under
the Revocable License Agreement for the placement of the fireworks
stands.
"Store" shall mean a grocery supermarket operated by any Company.
2 Term.
2.1 Term of Master Agreement. The term of this Master Agreement shall commence on
the date of this Master Agreement as indicated above (the "Effective Date ") and shall
expire on September 15, 2018. There are no option terms to extend this Master
Agreement.
3 Agreement To Install Fireworks Stands.
3.1 Agreement To Install Fireworks Stands in Identified Stores. Albertsons has
provided (and will provide form time to time) TNT with a list of Stores which may
have space available for fireworks stands. TNT will identify in writing to Albertsons
on or before March 15th of each year this Master Agreement is in effect which Stores
it would like to have fireworks stands in for the 4a' of July holiday. TNT will identify
in writing to Albertsons on or before October 3 lst of each year this Master Agreement
is in effect which Stores it would like to have fireworks stands in for the New Year's
Eve holiday. Upon the parties agreement on a list of Stores for each Company for
fireworks stands, Albertsons shall prepare and the parties shall execute a Revocable
License Agreement for each Company listing the agreed upon Stores for fireworks
stands. TNT's right to install fireworks stands is limited to the Stores listed on the
Revocable License Agreements. Albertsons may place, or may contract with any
third party to place, any other fireworks stands on any Store not identified by TNT
and listed on the agreed stores list by March 15th or October 31St as applicable.
4 Payment for Fireworks Stands.
4.1 Fixed Payment. In consideration for having up to a total of'
(305) Events in each calendar year, TNT shall pay Albertsons the amounts set forth
below on the dates set forth below to such payees, in such increments and to such
lock boxes as Albertsons shall designate ( "Fixed Payments "):
K:\3rdParty\BNK_DATA\Fireworks \TNT Master\Final DocumentsWbertsons Master Fireworks Agreement3l0_16 GD v FINAL doc.doc
this Master Agreement may be disclosed for valid business purposes provided,
however, that a party shall notify the other in writing at least ten (10) days prior to
disclosure and confer with the other concerning means of maintaining the
confidentiality of the terms of this Master Agreement. Prior to such disclosure, the
disclosing party shall obtain the recipient's agreement to keep such information
confidential
7.3 Survival. The confidentiality obligations set forth in this Section 7 shall survive the
expiration or termination of this Master Agreement. When this Master Agreement is
terminated or expires, each party's Confidential Information and any copies thereof
shall be returned to that party except as may reasonably be required for the other
party's records.
8 Assignment
8.1 Assignment. TNT may not transfer, assign or sublicense this Master Agreement or
any interest therein, and any such assignment shall be deemed null and void and of no
force or effect. Nothing herein shall limit Albertsons ability to transfer, assign or
sublease its interest in any or all of the Stores or this Master Agreement.
9 Notices.
9.1 Notices. Any notice required or permitted by this Master Agreement to be provided
to either party by the other party shall be in writing and signed by a duly authorized
representative, and shall be deemed duly given (i) when personally delivered, (ii)
when delivery is made or attempted on a business day by Federal Express or similar
overnight delivery service, or (iii) three (3) business days after deposit in the United
States mail, sent certified or registered mail return receipt requested, with first -class
postage prepaid, (or any combination of the methods listed above), and addressed as
follows:
If to Albertsons:
Albertsons Companies, LLC.
Attn: Legal Department Real Estate
250 Parkcenter Blvd.
Boise, ID 83706
With a copies to:
Albertsons Companies LLC.
Attn: Real Estate Law
5918 Stoneridge Mall Road
Pleasanton, CA 94588
Albertsons Companies, LLC.
Attn: Property Management Department
250 Parkcenter Blvd.
Boise, ID 83706
K: \3rdParty\BNK_DATA\Fireworks \TNT Master\Final DocumentsWbertsons Master Fireworks Agreement3_10_16 GD v FINAL doc.doc
IN WITNESS WHEREOF, the parties hereto have executed this Master Agreement as of the
year and date written above.
ALBERTSONS COMPANIES LLC.,
a Delaware limited liability company
i
Marilyn K. Beardsley
Title: Vice President
Form Approv ed:
American Promotional Events, Inc. -
West, a California Corporation
By: v(
Title:P�l
K:\3rdPart7y\3NK_DATA \Fireworks \TNT MasterTinal Documents\Albertsons Master Fireworks Agreement3_1 D_16 GD v FINAL doc.doc
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o�+w REGISTERED ISSUED BY: Date treated or
o� AePUCarroN AZTEC TENTS manufactured
s CONCERN NO,
490 ALASKA AVENUE
=3 �*s� f►� CAL COMB F- 419.09 TQ�IifRA� 328 5060 90503
0512006
This is to certify that the materials described below hereof have been flame retardant treated (or are inher-
ently nonflammable).
' Fos ABC PARTYRENTALS ADDRESS 4333 HARBOUR POINTE BLVD. SW
.. I CITY MUKILTEO STATE WA, 98275
=j Certification is hereby made that: (Check "a" or "'b
(a) The articles described bebw this cer6Ficate have been treated with a flare retardant chemical approved
and registered by the State Fire Marshal and that the application of said chemical was done in confor-
El mance with the .. a of the State of California and the Rules and Regulations of the Slate Fire Marsha!_
> f Name of chemical used ............. ............................... Chem. Reg. No.........................
.w
Meathod of application
CQ (b) The articles described below hereof are (made from a flame - resistant fabric or material registered and
approved by the State Fire Marshal for such use; Fabric has been tested and passes NFPA701 -96-
Trade name of flame - resistant fabric or material used.. Laminated Fabric . Reg. No....... 419 01..._
The Flame Retardant Process Used 1LA_. N0T .... Be Removed by Washing
(Well or Will not).
PA
David Bradley
Name of ApPl.cator or Protluchon Superin!enden:
nV2� -
+,. •p�r.l:r:;;i...rir ;�rra'f:yr�iti:.a�n:�: is .,...
:.i ?t" ?1:j; :,+�,',' 'aR.S• . i� � �u ' e^•'� t�:. ••
CUSTOMER ORDER NO. R160322
ITEMS MANUFACTURED:
2- 40 x4O' (2 PC.) JUMBOTRAC TOP ONLY ULTRA WHITE
3- 40 x2a' JUMBOTRAC MIDDLE TOP ONLY ULTRA WHITE
2- 40x10'JUMB0TRAC MIDDLE TOP OIVLY ULTRA WHITE
2- 30x3O' (2 PC.) JUMBOTRAC TOP ONLY ULTRA WHITE
2- 30 x20' JUMBOTRAC MIDDLE TOP ONLY- ULTRA WHITE
2- 30 x10' JUMBOTRAC MIDDLE TOP ONL Y- ULTRA WHITE
31- 10'x10'(1 PC.) FESTIVAL TOP ONLY- ULTRA mgjTE
8- 10'x20'(1 PC.) FESTIVAL TOP ONLY- ULTRA Wr _jjTf_
Chuck Miller - President
6'd ZZZlc6ts9 t She }ue'd ivaA3 jeioadS aqV d80 C0 80 9Z unr
RE: Tent Security, Flame Resistance
• The certificates of flame resistance. There is one for the
red material and one for the white material used in the tent.
Each of the tents will also have a tag attached noting that it
is flame resistant.
• As for security, when the tent is not open for business,
there will be at least two people at each tent throughout the
night. THEY WILL NOT BE SLEEPING. They will have a cell
phone as well as an air horn to scare anyone who may
attempt to break in. These tents will also remain lit -up
throughout the night. There will not be a fence around the
tent, but we do rope off 20ft. away from the tent all the way
around the tent, with bright colored pennants.
o This plan is valid for all 20x30, 20x40, 30x50, and
40x60 tents.
ate of
,bm9 pc REGISTERED) ISSUED BY
Fabric No. Uafa 11 2�.- 20-9 5
:y o? Pieridian Manuface`rring �anufaepurad
or.ca'' 5050 POPI;Ur dive
C'pg�ysP F'- 306,0' , See. 143'l.
°! McMnhis, TN 38157
This is to cerfify that the McfG6013 described on the reverse side hereof hbre beer, ftame-
retardant treated (or are inherently nonflammable,
FO KP Mant' fzcr Ur i ne S Rental
CiT1 Srpoks ADDRESS 5030 Rock dalF.St NE
STATE i?
Certification is hereby made that: (Chock "a" or "bof -" - --
(a) The articles dos4ri6ed on the reverse side of 'his Certi COte hove been treated wish a floma.retar
ehemiccl approved and registered by the State Fire Marshal n7
end 'hot the opplicarion of sand [hemie da
th® w
e Stets Fire Marshal. darts in conformance with the Iaws of the State of California and the Rules and Rogularions of
the
Nome of chemical used.._.,, -
Method of application ..... ........... ...... ....... - Chern_ Rag. No.,,... -............. .....
o
(b) rtiela$ described ert the rormtze side hereof a ..........................
rotitstgre.d grad a are n+odm from o flaw- r®sirtont fabric or naaterior
PProvvd by the State Fire Marshal for ameh u ,
Trades horn of Horne-resistant fabric .. _• •, -. Group 1
N ®. -M 1 1605
The Flame Retardant Process Used...y.i.x.I.. roc _.,.....,
a�.u,w4i- .:�... Be �® Removed �y asl�rr,g
- TINPIIE ROBEPTSON
Ne+ee co1 AgbJdc+0 or or PTUdverdan Sdg+iinrandonr 6
r;rjv
CONTROL NO.— 14924
CUSTOMER ORDER No, 4 2 2 7
CUSTOMER INVOICE NO. 80222
YARDS OR QUANTITY 760 yards -
COLOR red
STYLP Apex II Chrome
9DATE P ROCESaE® 8- 1 1 -96