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Home My WebLink AboutBCOI-24-32 2025 The Commonwealth of Massachusetts Town of YARMOUTH New and Renewal Certification of Inspection In accordance with the Massachusetts State Building Code,Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name:Camp Wingate*Kirkland BCOI-24-32 Trade Name:Camp Wingate*Kirkland Identify property address including street number,name,city or town,and county Certificate Expiration Located at 79 WHITE ROCK RD April 1,2025 YARMOUTH PORT,MA02675 Use Group Classification(s) Floor Occupancy_ Use Group Other Other 675 R-2 Summer Camps for children Allowable Occupant Load Other 275 R-2 Summer Camps for children This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure,or portion thereof as herein specified has been inspected for general fire and line safety features.This certificate shall be framed behind clear glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned.Failure to post or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Chief Name of Municipal Building Mark I Date of Inspection �'I)', 7 Commissioner D Signature of Municipal Fire Signature of Municipal Building - Date of Issuance `�/�Z/Zb ZT Chief - Commissioner ri,t TOWN OF YARMOUTH ila y BUILDING DEPARTMENT w i D s „.." 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext.1260 APPLICATION FOR CERTIFICATE OF INSPECTION March 1,2024 PAYABLE UPON RECEIPT (X) Fee Required$180.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code,Section 110.7,I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 79 WHITE ROCK ROAD Name of Premises: CAMP WINGATE*KIRKLAND Tel: 508.362.3798 Purpose for which permit is used: CHILDRENS SUMMER CAMP License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency R E c E P V E D [MAR 08 2024 BUILD By. r Certificate to be issued to CAMP WINGATE*KIRKI AND Tel: 508 362 3798 Address: 79 WHITE ROCK ROAD Owner of Record of Building W INGATF KIRKI AND REAL ESTATE LW Address 20 I INNELLLANE YARMOUTH PORT,MA 02675 P ctHHIderofCertificate CAMP WINGATE*KIRKLAND ��,�� Owner&Director Signatttle of person to whom Title Cdctiflcate is issued or his agent MARCH 4,2024 Date Finail Address: HEYSANDY@CAMPWK.COM Instructions: Make check payable to: Town of Yarmouth 1146 Route 28,South Yarmouth,MA 02664 Return this application to: Building Inspector's Office Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. Application must be received before the certificate will be issued. The building official shall be notified within ten(10)days of any change in the above information. PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# B Cb/-c7(/-32._ 04/01/2024-04/01/2025 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YY) 2/13/2024 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). PRODUCER CONTACT NAME: AMSkier Agency,Inc. A.M.Skier Agency PHONE (NC,No,Ext): 570-226-4571;800-245-2666 FAX No): 570-226-1105 209 Main Avenue E-MAIL Hawley, PA 18428 ADDRESS: amskierlamskier.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:PMA Insurance Group INSURED INSURER B: Wingate Kirkland Operating LLC 79 White Rock Road INSURER C: Yarmouth Port, MA 02675 INSURER D: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MMIDDIYYYY) (MMIDD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Es occurrence) (CLAIMS MADE OCCUR ❑ ❑ MED EXP(Any one person) $ PERSONAL AND ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ —1POLICY JEOT- BLOC $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INURY(Per person) $ ALL OWNED SCHEDULED BODILY INURY(Per accident) $ AUTOS AUTOS ❑ ❑ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Deductible: $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE ❑ ❑ AGGREGATE $ DED RETENTION$ _ WORKERS COMPENSATION WC STATU- 'I 0TH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE YM EL EACH ACCIDENT $ 500,000 A OFFICE/MEMBEREXCLUDED7 N N/A ❑ 2024010291401Y 2/1/2024. 2/1/2025 (Mandatory in NH) EL DISEASE-EACH EWLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L. $ 500,000 DISEASE-POLICY LIMIT ❑ ❑ DESCRIPTION OF OPERATIONS/LOCATIONSNEHILCES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Confirmation of Coverage. CERTIFICATE HOLDER CANCELLATION W79Whiteh Kirklandock RoadOperating LLC I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 79 Rock Yarmouth Port,MA 02675 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVES HENRY M.SKIER President 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD