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HomeMy WebLinkAboutTwo Special Event Applications from Rich Hoyt Sporting Clay & Cascade Challengep� Kittitas County Office Of The Treasurer . Amy Cziske, Treasurer 205% W -A& Avenue, Suitt lua Ellensburg, Wa 98926 Phone (509) 962-7535 Fax (509) 933-8212 Cash Receipts Receipt Number: 2019-5176 Date: 09/25/2019 Received From: MANDY BUCHHOLZ DEPUTY CLERK OF THE BOARD Check Amount: $400.00 Cash Amount: $0.00 Other Amount: $0.00 Total Amount: $400.00 Deputy: JENN Receipt Type: CHK Template: Comments: CSR 2019-3668 TWO SPECIAL EVENT APPLICATIONS FROM RICH HOYT FOR THE 2020 WASHINGTON STATE SPORTING CLAY CHAMPIONSHIPS EVENT AND THE 2020 CASCADE CHALLENGE FundCode GlCode Description Amount 001 1632171 SPECIAL EVENTS FEE $400.00 Total Amount: $400.00 Kittitas County Treasurer's Office Submitted By: Jennifer Golladay (c) 2002 Cashtax All Rights Reserved 09/25/2019 15:01:04 JENN � ' j ►.�rerr�y Kittitas County, Washington BOARD of COUNTY COMMISSIONERS EVENT APPLICATION Thank you for your interest in holding a special event in Kittitas County. Please complete and return this application along with any other materials to the Kittitas County Board of Commissioners at least 60 days prior to the day upon the event is scheduled. Any misrepresentation in the application materials or deviation from the final agreed upon route and/or method of operation described may result in the immediate revocation of an issued permit. Specifics outlining Event Permits can be viewed ath!!R:/Jwww.co.kittitas.wa.us/`boc/counlycodeZtitleO5.asl2 Event Information Name of event: 1 ��`+c�'� �r 'p CDp►I)yVS1"4S Date(s) of event:�- .l '2- 40C) , Hours of operation: 7 r d 0Qrn " Description of the event: \ (ILA Has this event taken place before? Yes ,j No Dates: I - 9D - Ii( -6 q " a 3- ) $ �- Estimated attendance: abQ _ How is your event being publicized? �o�rA mo Please attach any flyers, posters, etc. with your application submission. Contact Information r7 Name of the organizer/ contact person: ' ln(n I Address: �� 1101 IfYI W Phone number(s): 4 arD' _ay�- O- - l �L�r Email address: �(WCJ=1 � OV -1 Date of birth of applicant: SEP 2 5 2019 KITTITAS COUNTY COURTHOUSE • 205 WEST 5", SUITE 108 - ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www.colittitas.wa.us If the application is made on behalf of a partnership, please submit full names with their residence and post office address for a period of six months prior to the date of application together with the location of principal office or place of business of such corporation. Emergency contact name(s) and phone number(s) that can be contacted during the !Trtt-)at,Lv-A ��U t cif i � ),�; - 2-&t - 01 Y19 Name Phone Number S Name Phone Number WRITTEN PERMISSION TO ENTER EVENT SITE I/We hereby permit law enforcement and/or County officials to enter the site for which the Event Application has been granted at the time of the event and up to five days prior to the event for the purposes of inspecting and enforcement of County Code and other applicable laws, and pursuant to my agreement and representations made in connection with this Event Application. SWORN STATEMENT OF COMPLIANCE I/We hereby acknowledge that I/We have read Kittitas County Code, have familiarized myself with County requirements. I/We agree that either my designated agent or I/we shall be on site at all times and shall be responsible for the operation of the event and for compliance with all legal requirements in connection with this event. I/ We understand that failure to comply with the rules, regulations and conditions set forth in Code may be deemed a gross misdemeanor and that drug or narcotics violations are crimes un er RCW. C 1, C V�a J, 4tm� Applicant Name (Print) Applicant Signature Applicant Name (Print) Applicant Signature KITTITAS COUNTY COURTHOUSE • 205 WEST 5th, SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www.colittitasma.us Kittitas County, Washington BOARD of COUNTY COMMISSIONERS Fire Safety and Protection If more than 50 people are expected at your event, you must complete a separate application process which can be obtained through the Kittitas County Fire Marshal's office. You may contact the Fire Marshal's office at 509-962-7000. Will there be a temporary structure erected for the event? Yes No If yes, you must attach a drawing including the dimensions. The structure may require an inspection by County staff prior to the event. Public Health/Environmental Health Will there be food served at the event? `iyes"? No If no food will be served at the event then, no permit or application is required. If yes, is the food and beverage that you intend on preparing and serving at the event exempt from permit requirements http:/ /www.co.kittitas.wa.us/health/food. as F? - If yes, please submit an a licativn for exam tion from permit and proof of food handlers training to the Kittitas County Public Health Department (KCPHD). If yes, and the food or beverage is not considered exempt from permit, then does the person or organization preparing and serving the food have a food service permit, temporary food service permit, or catering permit from KCPHD? - If yes, please provide a list of foods and beverages that you intend on having �/ prepared and served at the event along with the name and phone number(s) of /I_ the permitted person or organization. If yes, and the person or organization preparing and serving the food does not already have a food service permit. Then a temporary food service permit or catering permit will need to be acquired from KCPHD prior to the event. Please allow at least 2 weeks to complete the food service permitting process. -�tpA&A�NA-s �- � CC) ( Jot>,[S� ' Uc �, KITfITAS COUNTY COURTHOUSE • 205 WEST 5", SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www.co.kittitas.wa us Are there permanent or fixed bathroom facilities already available at the location of the event? Yes No If yes, please provide an estimated attendance for the event, a detailed map that identifies the name and address of the physical facility that will provide lavatory facilities for the event, quantity of toilette facilities available for each gender, and the distance from the event that patrons must walk. If no, please provide an estimated attendance for the event, specific information related to the number of portable restrooms that will be provided, the distance from the event that patrons must walk, and a service plan to ensure that sari -cans remain in a sanitary condition. You must include the location of the portable restrooms on a map/ diagram of the event. ccwu�A V� Ck'�L-e' Q16C7�1\c� VIA $ Sc -VL i caws. KITTITAS COUNTY COURTHOUSE • 205 WEST 5", SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www. co. kittitas. wa. us Kittitas County, Washington BOARD of COUNTY COMMISSIONERS Law Enforcemenf Securibff mergency Medical Services Will there be security on site during the event? Yes G� If yes, please provide a complete list of names and contact information for who will be providing the security. Will Emergency Medical Services (EMS) be on site during the event? Y • No If yes, please provide written verification from the providers. Will there be music, sound amplification or any other noise impacts? Yes N41 , If yes, Kittitas County has a noise ordinance in effect (see County Code for details). If your event is scheduled for outside of the allowed time, you must submit a written letter to the Board of County Commissioners requesting a waiver and it must be included with your application materials. Will you have traffic control?Ye No If yes, please provide documentation on how the traffic control will be addressed. Will there be off-site arkin ? Ye No l P g � �� �G� S c �__ If yes, please provide the location and a parking plan. U o � u--VAAee:X W kk \o�c v Ye- Will there be shuttle buses provided for attendees? Ye Na . If yes, provide a map of their route. Will there be alcohol served at the event? 0yes No If yes, a State permit is required from the WA State Liquor Control Board and must submitted with your application materials. KFMTAS COUNTY COURTHOUSE • 205 WEST 5h, SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www.co.kittitas.wa.us Kittitas County, Washington BOARD of COUNTY COMMISSIONERS Public Roads Will the event obstruct, interfere or re.7NO e-the closure and free use of any public road, street or right-of-way? YesS If yes, please provide a detailed adequate traffic and detour plans at the time of submission of the application. Will there need to be road closure or detour signs posted? YesNo KITTTTAS COUNTY COURTHOUSE • 205 WEST 5h, SUITE I08 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www.colittitas.wa.us Kittitas County, Washington BOARD of COUNTY COMMISSIONERS Garbage/Recycling Do you have a plan for garbage and recycling? Yes No A written plan for garbage and recycling must be attached to your application materials. For questions or assistance contact the Kittitas County Solid Waste Department at 509-962-7542. Insurance Have you obtained a Certificate of Insurance dorsernents, specifically naming "Kittitas County" as an insured? Yes No A copy of the Certificate of Insurance amd endorsements must be included with your application materials. Kittitas County must be named as an additional insured in the amount of $7.,000,000.00 per occurrence and $2,000,000.00 aggregate coverage. This insurance must apply First and on a primary non-contributing basis in relation to any other insurance or self-insurance available to Kittitas County. Penal Bond - Bond of Indemnity A $5,000.00 Penal Bond - Bond of Indemnity is required to be deposited with the County Treasurer to save and protect the streets, pavements, bridges, etc. from damage. The deposit or its balance will be returned once the event has been held and the Board of County Commissioners has certified no damage has been done and that the County has not incurred additional expenses Are you submitti a-$ 0.00 P and -» Bond of Indemnity with your Event Application? s No s.t� If no, you must request a letter in writing to the Board of County Commissioners requesting a waiver to the Penal Bond - Bond of Indemnity and outline the specific reasons why it should not be required of your event, Co_unfy Filings and Registration Is there a cost to attend the event? ryes J No How much are you charging to attend your event? KrMTAS COUNTY COURTHOUSE • 205 WEST 5", SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www.colittitasma.us '] Washington State Liquor and Cannabis Board Washington State Liquor Cannabis Board BANQUET PERMIT Document Number: LCB-BP192434 (Does Not Authorize Sale of Alcohol) Name of Organization (if applicable): Lost Pair Ranch Start Date of Event: Sep 19, 2020 Applicants Name: Richard Hoyt no Number: 4252810749 Event Start Time: 5:00 PM Applicants Home Address: 3900 Pasco Rd Cie Elum WA 98922 Event End Time: 8:00 PM Name of Building or Location: Clubhouse Room or Area Held: Shop Number of Event Days: 1 Street Address of Building or Location: 3900 Pasco Rd City of Building or Location: CLE ELUM County of Building or Location: Kittitas Purpose of Occasion (be specific): Sporting Clay Championship Banquet Number of Persons to Attend: 200 Number of Persons Under 21 Years of Age That WIII Attend: 25 Attendees WILL NOT bring their own Alcohol. Name of Caterer: Address: Phone: I have accepted this permit subject to following conditions: • THE EVENT WILL NOT BE OPEN TO THE PUBLIC. No advance sale of tickets will be made to general public and no advertising will be directed to the general public. • Llauor will not be sold for cash, scrip, tickets or any other manner whatsoever. ■ This permit is not valid on liquor -licensed premises while the liquor license is suspended. • All liquor served will be purchased in Washington State from an authorized liquor retailer. • This permit will be conspicuously posted in the banquet area. • Liquor will be served and consumed only in the portion of the Building or Location described. • Liquor will be served only to members and invited guests who are 21 years of age or older. • Legal hours for service and consumption of liquor are 6:00 a.m to 2:00 a.m daily • The event and the premises for which the permit is issued will be subject to inspection by any liquor control officer or law enforcement officer. WAC 314-18-070 states that no banquet permittee or employee of a banquet permittee may knowingly permit. • The service of liquor to or consumption of liquor by any person under 21 years of age at the Banquet Permit event. • Any disorderly conduct to occur at the Banquet Permit event. • The service of liquor to or consumption of liquor by an apparently intoxicated person(s). By making this application and accepting the Banquet Permit -YOU J. REASSUMING FULL RESPONS1111M FQR TJjI,,ELIHf]]ON. A violation: could subject the violator to criminal prosecution, immediate cancellation of the permit and render the appilcatlon/premises ineligible for future permits. This permit is not valid unless signed, dated and posted at the event location. I am assuming full responsibility for the event and the compliance of Ilie rol at 'above c Sign your name to affirm the above conditions: _ _ ' _ _ _ Date: I — 25' 0_ LIQ 158 4/12 I Garhaze and RecyclinQ Plan We will have a 30 to 40 yard dumpster delivered for this event. There will be 35 to 40 trash cans placed around the property for the event. During intermissions they will be collected and dumped into the dumpster. Volunteers will be monitoring throughout the day to make sure it is kept clean. We will also have one 5 yard dumpster for Recycle only. CERTIFICATE OF LIABILITY INSURANCE °"��0;9°"'"Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEOATNELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certleoate holder Is an ADDITIONAL INSURED, tiro poticy(ioa� must he endnrsed. IT SUSROGATION IS WANED, subject to tho terms and conditions of the policy, certain policies may require an endorsomonL A statement on this cer cato does not confo-r rights to tho corbIRzto holder In lieu of ouch onftmornonQs). PRODUCER: CONTACT NAME: Leslie Casanova Sportsman's Insurance Agency, Inc. 1364 North US 1, Suite 503 PHONE: 800 925-7767 Ext 111 FAX: 366 677-3292 E-MAIL ADDRESS: lemanova@siai.net Ormond Beach, FL 32174 INSURED: LOSTINSURER LOST PAIR RANCH, LLC (S) AFFORDING COVERAGE P.O. BOX 814 INSURER A: T.H.E. INSURANCE COMPANY SOUTH CLE ELUM WA 98943-0814 INSURER B: INSURER C: COVERAGES THIS I TO CERT1 T?IAT THE POLE INSURANCE LIST1EDecLowmAvE8EENtSsu9oTOTHE INSURED NAMPO ABOVE FOR THE POLICY PER= INDICA D NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDfrlphl OF AM1fY CONTRACTOR OTHER 17OCUMiENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 0Ei ISSUE❑ OR MAY PERTAIN, FEE INSURANCE AFFORDED BYTHE POLICl 0 DEBCR(HED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDFCIONS OF SUCH P LILIES. LI iT H IAA HA E C ePAD CVOMS INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER (MhyDONM (MMNDONYYY) LIMITS A GENERAL LIABILITY FX 1 COMMERCIAL GENERAL LIABILITY E) OCCURRENCE ❑ CLAIMS MADE MASTER POLICY # GGLO1001 3/25/2019 3/25/2020 GENERAL AGGREGATE NONE PRODUCTS-COMP/OP AGG $1,000,000 PERSONAL & ADV. INJURY $1.000,000 E] PREMISEaIOPERATIONS CERTIFICATE # EACH OCCURRENCE 81.000.000 DAMAGE TO PREMISES RENTED TO YOU (A11Y Olkr� hses S 100.000 xl HIRED ALTO 8 NON-OWNED AUTO NGC 2917 -01 MED. EXP (Any One Person) $ 10,000 LIQUOR LIABILITY Each Common Cause ❑ OCCURRENCE Aggregate ❑ ExcESs LIABILITY EACH OCCURRENCE ❑MCURRENCE ❑ CLAIMS MADE Om ❑ RETENTION i AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ❑ WC STATU- ❑ OTHER TORY LIMITS E.L. EACH ACCIDENT YIN ANY PROPRIETOWPARTHER1EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT �ay6 das&b H DE&L�RIPTION OF OPERATIONS 6alaw E.L. DISEASE - EA EMPLOYEE DESCRLPT10N OF OPERAT1ONSILOCATTON&ISPECTAL ITEMS —CERTIFICATE HOLDER 18 ADDED AS AN ADDITIONAL INSURED -MANAGERS OR LESSORS OF PREMISES BUT ONLY WTH RESPECT TO THE OPERATIONS OF: LOST PAIR RANCH, LLC KITTITAS COUNTY IS ADDED AS ADDITIONAL INSURED ON A PRIMARY/NONCONTRIBUTORY BASIS, BUT ONLY WITH RESPECTS TO THE NAMED INSUREDS OPERATION. LIABILITY COVERAGE IS NOT EXTENDED FOR ANY OTHER ACTIVITIES. 111411:191111114V KITTITAS COUNTY 205 W. 5TH, AVE. ELLENSBURG, WA 98926 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE I THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE FMPCO12011 072013 Includes copyrighted material of 1988-2010 ACORD CORPORATION POLICY NUMBER: GGLO1001 Certificate Number. NGC 2917-01 COMMERCIAL GENERAL LIABILITY CG 20110196 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): 2. Name of Perso yr Organization (Additional Insured): KITTITAS COUNTY 205 W. 5TH, AVE. 3. Additional Premium: (Included) ELLENSBURG, WA 98926 (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2: Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. CG 20 11 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 Kittitas County, Washington BOARD of COUNTY COMMISSIONERS EVENT APPLICATION Thank you for your interest in holding a special event in Kittitas County. Please complete and return this application along with any other materials to the Kittitas County Board of Commissioners at least 60 days prior to the day upon the event is scheduled. Any misrepresentation in the application materials or deviation from the final agreed upon route and/or method of operation described may result in the immediate revocation of an issued permit. Specifics outlining Event Permits can be viewed at httD://www.co.kittitas.wa.us/boc/countvcode/tifleO5-asn Event Information Name of Date(s) of event: `1 `5 t - a C-) - g - r;� , - ACS Hours of operation:. - (:Q6- y,\ Description of the Has this event taken place before? Qi)No Dates: Q0 - a - I c� .0 ?--�' " Ll -1� Estimated attendance: c o o How is your event being publicized? eryf ccll 1 'a!t� MIL' Qw s Please attach any flyers, posters, etc. with your application submission. Contact Information Name of the organizer/ contact S. Phone number(s): 4Z9- r Q-�6 1 , 0-1 L Email address: 10 ( � Date of birth of applicant:)c�?' M" a- r CU -Com SEP Z 5 zais KITTITAS COUNTY COURTHOUSE - 205 WEST 5", SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 - FAX (509) 962-7679 www.coliftitasma.us If the application is made on behalf of a partnership, please submit full names with their residence and post office address for a period of six months prior to the date of application together with the location of principal office or place of business of such corporation. Emergency contact name(s) and phone number(s) that can be contacted during the V� t A --� �;- amePhone Number V � - a Name J Phone Number WRITTEN PERMISSION TO ENTER EVENT SITE I/We hereby permit law enforcement and/or County officials to enter the site for which the Event Application has been granted at the time of the event and up to five days prior to the event for the purposes of inspecting and enforcement of County Code and other applicable laws, and pursuant to my agreement and representations made in connection with this Event Application. SWORN STATEMENT OF COMPLIANCE I/We hereby acknowledge that I/We have read Kittitas County Code, have familiarized myself with County requirements. I/We agree that either my designated agent or I/we shall be on site at all times and shall be responsible for the operation of the event and for compliance with all legal requirements in connection with this event. I/ We understand that failure to comply with the rules, regulations and conditions set forth in Code may be deemed a gross misdemeanor and that drug or narcotics vinlatinnc arP rrimPc 11ndpr RC'W R c accd .1 Applicant Name (Print) Applicant Name (Print) /4/ Applicant Signature Applicant Signature =ITAS COUNTY COURTHOUSE • 205 WEST 5'", SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www. co, kittitas.wa. us Kittitas County, Washington BOARD of COUNTY COMMISSIONERS Fire Safe and Protection If more than 50 people are expected at your event, you must complete a separate application process which can be obtained through the Kittitas County Fire Marshal's office. You may contact the Fire Marshal's office at 509-962-7000. Will there be a temporary structure erected for the event? Yes (No If yes, you must attach a drawing including the dimensions. The structure may require an inspection by County staff prior to the event. Public Healtb Environmental Health Will there be food served at the event? [`yes No If no food will be served at the event then, no permit or application is required. If yes, is the food and beverage that you intend on preparing and serving at the event exempt from permit requirements http_1_/www_.c_o,kittitas.wa.us/liealth/food.asp? - If yes, please submit an aRplication for exemption from permit and proof of food handlers training to the Kittitas County Public Health Department (KCPHD). If yes, and the food or beverage is not considered exempt from permit, then does the person or organization preparing and serving the food have a food service permit, temporary food service permit, or catering permit from KCPHD? - If yes, please provide a list of foods and beverages that you intend on having prepared and served at the event along with the name and phone number(s) of the permitted person or organization. If yes, and the person or organization preparing and serving the food does not already have a food service permit. - Then a temporary food service permit or catering permit will need to be acquired from KCPHD prior to the event. Please allow at least 2 weeks to complete the food service permitting process. -,y "11� I C V Pj Lt K wo" KITTITAS COUNTY COURTHOUSE • 205 WEST 5h, SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 , FAX (509) 962-7679 wwwxo. kittitas. wa. us Are there permanent or fixed bathroom facilities already available at the location of the event? Yes 6—D If yes, please provide an estimated attendance for the event, a detailed map that identifies the name and address of the physical facility that will provide lavatory facilities for the event, quantity of toilette facilities available for each gender, and the distance from the event that patrons must walk. If no, please provide an estimated attendance for the event, specific information related to the number of portable restrooms that will be provided, the distance from the event that patrons must walk, and a service plan to ensure that sari -cans remain in a sanitary condition. You must include the location of the portable restrooms on a map/ diagram of the event. �J'e U3,\ �\"P % ���� Cck'-vVS . KITTITAS COUNTY COURTHOUSE • 205 WEST 5", SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www. co. kittitas.wa. us Kittitas County, Washington BOARD OF COUNTY COMMISSIONERS Law Enforcemen. Securritfinergency Medical Services Will there be security on site during the event? Yes oNq If yes, please provide a complete list of names and contact information for who will be providing the security. Will Emergency Medical Services (EMS) be on site during the event? Ye No If yes, please provide written verification from the providers. Will there be music, sound amplification or any other noise impacts? Yes No If yes, Kittitas County has a noise ordinance in effect (see County Code for details). If your event is scheduled for outside of the allowed time, you must submit a written letter to the Board of County Commissioners requesting a waiver and it must be included with your application materials. Will you have traffic control? �Ye No If yes, please provide documentation on how the traffic control will be addressed. --v0-Y \4A_:-. _ Will there be off-site parking?Yes No V6c� CA4T2ti If yes, please provide the location and a �'arking plan. ` V>e CA� Will there be shuttle buses provided for attendees? Yes If yes, provide a map of their route. Will there be alcohol served at the event? Yc No If yes, a State permit is required from the WA State Liquor Control Board and must submitted with your application materials. KrMTAS COUNTY COURTHOUSE • 205 WEST 5", SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 • FAX(509)962-7679 www.co.kjttitas,wa.us Kittitas County, Washington BOARD of COUNTY COMMISSIONERS Public Roads Will the event obstruct, interfere or re ire a closure and free use of any public road, street or right-of-way? YYes i� If yes, please provide a detailed adequate traffic and detour plans at the time of submission of the application. Will there need to be road closure or detour signs posted? Yes 5 KrMTAS COUNTY COURTHOUSE - 205 WEST 5", SUITE 108 • ELLENSBURG, WA 98926 (509) 962-7508 - FAX (509) 962-7679 www.co.kittitas.wa.us Kittitas County, Washington BOARD of COUNTY COMMISSIONERS Garbage/Recycling Do you have a plan for garbage and recycling? Yes No A written plan for garbage and recycling must be attached to your application materials. For questions or assistance contact the Kittitas County Solid Waste Department at 509-962-7542. Insurance Have you obtained a Certificate of Insurance 4nt4ndorsements, specifically naming "Kittitas County" as an insured? Yes No A copy of the Certificate of Insurance amd endorsements must be included with your application materials. Kittitas County must be named as an additional insured in the amount of $1.,000,000.00 per occurrence and $2,000,000.00 aggregate coverage. This insurance must apply first and on a primary non-contributing basis in relation to any other insurance or self-insurance available to Kittitas County. Penal Bond - Bond of Indemnitv A $5,000.00 Penal Bond - Bond of Indemnity is required to be deposited with the County Treasurer to save and protect the streets, pavements, bridges, etc. from damage. The deposit or its balance will be returned once the event has been held and the Board of County Commissioners has certified no damage has been done and that the County has not incurred additional expenses Are you submittin 000.00 P and - Bond of Indemnity with your Event Application? Nv. �-L—v xx � VevLl yl(Uft If no, you must request a letter in writing to the Board of County Commissioners requesting a waiver to the Penal Bond - Bond of Indemnity and outline the specific reasons why it should not be required of your event. County Filings and Registration Is there a cost to attend the event? Yes No How much are you charging to attend your event? \( O -N 2 S KTTTTTAS COUNTY COURTHOUSE • 205 WEST 5'h, SUITE in • ELLENSBURG, WA 98926 (509) 962-7508 • FAX (509) 962-7679 www, co. kittitas.wa. us Washington State Liquor and Cannabis Board Washington State Liquor Cannabis Board BANQUET PERMIT Document Number: LCB-BP192430 (Does Not Authorize Sale of Alcohol) Name of Organization (if applicable): Lost Pair Ranch Start Date of Event: Aug 01, 2020 Applicants Name: Phone Number: Richard Hoyt 425-281-0749 Event Start Time: 5:00 PM Applicants Home Address: 3900 Pasco Rd Cie Elum WA 98922 Event End Time: 8:00 PM Name of Building or Location: Clubhouse Room or Area Held: Shop Number of Event Days: 1 Street Address of Building or Location: 3900 Pasco Rd City of Building or Location: CLE ELUM County of Building or Location: Kittitas Purpose of Occasion (be specific): Sporting Clay Banquet Number of Persons to Attend: 200 Number of Persons Under 21 Years of Age That WIII Attend: 25 Attendees WILL NOT bring their own Alcohol. Name of Caterer: Address: Phone: I have accepted this permit subject to following conditions: • THE EVENT WILL NOT BE OPEN TO THE PUBLIC. No advance sale of tickets will be made to general public and no advertising will be directed to the general public. • Liquor will not be sofd for cash, scrip, tickets or any other manner whatsoever. • This permit is not valid on liquor -licensed premises while the liquor license is suspended. • All liquor served will be purchased in Washington State from an authorized liquor retailer. • This permit will be conspicuously posted in the banquet area. • Liquor will be served and consumed only in the portion of the Building or Location described. • Liquor will be served only to members and invited guests who are 21 years of age or older. • Legal hours for service and consumption of liquor are 6:00 a.m to 2:00 a.m daily • The event and the premises for which the permit is issued will be subject to inspection by any liquor control officer or law enforcement officer. Warning: WAC 314-18-070 states that no banquet permittee or employee of a banquet permittee may knowingly permit. • The service of liquor to or consumption of liquor by any person under 21 years of age at the Banquet Permit event. • Any disorderly conduct to occur at the Banquet Permit event. • The service of liquor to or consumption of liquor by an apparently intoxicated person(s). By making this application and accopting the Banquet Permit Y-QMA€ E -AU- M1N-Q-FULLA PS) 51BILTY FOR THIS FUNCTION. A violation could subject the violator to criminal prosecution, Immadlate cancellation of the permit and render the applfcationlpremises ineligible for future permits. This permit is not valid unless signed, dated and posted at the event location. I am assuming full responsibility for the event and the compliance of the rule st above. Sign your name to affirm the above conditions: _ Date: LIQ 158 4/12 Tr oF Garbage and Recyclint! Plan We will have a 30 to 40 yard dumpster delivered for this event. There will be 35 to 40 trash cans placed around the property for the event. During intermissions they will be collected and dumped into the dumpster. Volunteers will be monitoring throughout the day to make sure it is kept clean. We will also have one 5 yard dumpster for Recycle only. CERTIFICATE OF LIABILITY INSURANCE DA� OMIYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIG TS UPON THE CE:RTTF(CATE 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 THY ISSUING INSURER(S), AUTHORIZED RI_PRESMATTVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: 9the certificate holder Is an ADDITIONAL INSURED, the pollcy(I" must be ondom d. It SUBROGATION IS WAIVED, subject W the tonne and conditions of the policy, certain pollcles may requirean ondoreoment A state ment on this cent tate loon not confer rights to the cortiilceto holder In Ileo of such endomement(a). PRODUCER: CONTACT NAME: Leslie Casanova Sportsman's Insurance Agency, Inc. 1364 North US 1, Suite 503 PHONE: 800 925-7767 Ext 111 FAX: 386677-3292 Ormond Beach, FL 32174 E-MAIL ADDRESS: IcasanoveCsiai.net INSURED: LOST PAIR RANCH, LLC LOST INSURERS AFFORDING COVERAGE INSURER A: T.H.E. INSURANCE COMPANY P.O. BOX 814 SOUTH CLE ELUM WA 98943-0814 INSURER B: INSURER C: COVERAGES THIS ISTO CEWIFY THATTHE F5LIC1198 OF INISORANCE LI$TED B L w HAVE BEEN I U O THE INSURED NAMED ABOVE FOR THE P PERIOD INOICATt� NOTWITHSTAN NNG ANY REQUIREMENT TERh1 OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY OF ISSUED OR MAY PERTAIN, NE INSURANCE AFFORDED BY THE POLECI 8 DESCRIBED HrREIN IS SUBJECT TU ALL THE TERMS. EXCLUSIONS AND CONDIT*N8 UFS H LICfES.! iT Y VF x U Y 10 CLAIMS INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER (MNMDDIYYYY) (MMODNYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LLNNLrrY M OCCURRENCE [:]CLAM MADE MASTER POLICY # GGL01001 3/25/2019 3/25/2020 GENERAL AGGREGATE NONE PRODUCTS-COMPIOP AGG $ 1,000,000 PERSONAL & ADV. INJURY $ 1,000,000 M PREMISESIOPERATIONS CERTIFICATE # EACH OCCURRENCE S 1.000 000 DAMAGE TO PREMISES RENTED TO YOU (Any $ 100,000 M HIRED AUTO a NON-OMED AUTO NGC 2917 -01 MED. EXP (Any One Pelson) S 10,000 LIQUOR LIABILITY Each Common Cause ❑ OCCURRENCE Aggregate ❑ EXCESS LIABILITY EACH OCCURRENCE 13OCCURRENCE 0 CLAIMS MADE ❑ RETENTION a AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ❑ WC STATU- ❑ OTHER TORY LIMITS E.L. EACH ACCIDENT ANY PROPRIEtORIPARTNERIEXECUTNE YM OFFICERIMFMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT �M�"o'sld" In HH) DMAdIMMO'WHH D XERATI0Ns hekW E.L. DISEASE - EA EMPLOYEE DESCRIPTION OF OPERA7iDN8ROCA nt1NSISPECIAL ITEMS — CERTIRCATE HOLDER IS ADDED AS AN ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES 9UT ONLY trMTN rTO711E0PER 7122OYr: MU LOST PAIR RANCH, LLC KITTITAS COUNTY IS ADDED AS ADDITIONAL INSURED ON A PRIMARY/NONCONTRIBUTORY BASIS, BUT ONLY WITH RESPECTS TO THE NAMED INSUREDS OPERATION. LIABILITY COVERAGE IS NOT EXTENDED FOR ANY OTHER ACTIVITIES. &^ wPTivtr_ATr- mini nr-R CANCELLATION FMPCO12011 072013 Includes copyrighted material of 1988.2010 ACORD CORPORATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE VATH KITTITAS COUNTY THE POLICY PROVISIONS. 205 W. 5TH, AVE. ELLENSBURG, WA 98926 AUTHORIZED REPRESENTATIVE FMPCO12011 072013 Includes copyrighted material of 1988.2010 ACORD CORPORATION POLICY NUMBER: GGL01001 Certificate Number. NGC 2917-01 COMMERCIAL GENERAL LIABILITY CG 20 11 0196 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): 2. Name of Person or Organization (Additional Insured): KITTITAS COUNTY 205 W. 5TH, AVE. 3. Additional Premium: (Included) ELLENSBURG, WA 98926 (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2: Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. CG 20 11 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1