OCCURRENCE REPORT:

Trade Name: Barb Petrea LLC, DBA All About Fun

Address: 604 Lancaster Rd. Selah WA 98942

Occurrence Date: May 1st 2019 Time of Occurrence: 2:30 PM PST

Incident Involves: Customer Injury

Location of occurrence: There were five units secured on the Zillah High School grass football field, address of facility is
1602 2nd Ave, Zillah, WA 98953

What happened:

The Zillah ASB was having a fun reward day for high school students. The units were delivered at 10:45 AM and set up on
the high school grass football/soccer field. The event started at 12:30 PM and was slated to end at 2:45 PM PST. The
wind at set up via siri was approximately six mph and was in the weather reports to stay under the ten mph through out
the day. After units were secured and cleaned. The All About Fun staff walked through safety instructions with the
person in charge of the event Grace Gabriel ASB leader and two other high school staff members. The day was beautiful
and kids were having fun. Our AAF Staff was on site in preparation of take down which was scheduled for 2:45PM. The
staff said they felt the truck and trailer shake and they saw a large dust devil go down into the field where the units were
set up. The Hippo Chow Down which was the unit involved Serial #AAF-015 LNI Electrical Department Serial Number
decal/permit # is 49665 was in the path of the dust devil, they said it ripped it out of the ground 10-15 feet in the air and
drug it approx. 250 feet. There were four students on the amusement ride. They had vests on and were playing the
game when the dust devil grabbed the unit. The incident happened so fast there wasn't time to turn off the unit, it took
the blower with it. The unit finally rested upside down as the dust devil left the field. Here is a link of a video someone
took of the incident.

https://www.yaktrinews.com/news/wind-flips-bounce-house-injuring-students-at-zillah-high-school/1074281709

Three of the students did not have life threatening injuries but were severely hurt the fourth who we now have learned
is , was not breathing and Zillah high school staff members began administering CPR for approximately 10
minutes until EMT's arrived on site. We believe it was decided at that time by EMT's that the student needed to be
airlifted to the hospital. It was requested that the units be moved so the helicopter could land. The AAF staff and
students began pulling stakes and clearing the field for the helicopter.

Who were the people involved: Our AAF staff was unable to get information on students that were injured as they are
minors. We do know however that the one student that was air lifted to Virginia Mason Memorial is and
is now at Harborview. The rest of the students are reported to the Zillah Police Department, Officer Andrew Giles 509-
829-6100 509-829-5605 andrew.giles@co.yakima.wa.us. He let me know that the report with the pictures that he took
would perhaps be available Monday May 6th.

If Incident involves an injury or illness:

What was the condition of the injured/ill party, when you arrived on the scene?

Three students were on the ground and one was being given CPR.

First Aid was administered by a school staff member and EMT's

From what we understand three students were taken in separate ambulances to Memorial Hospital 2811 Tieton Dr,
Yakima, WA 98902

Phone: (509) 575-8100 and the other student was airlifted to Memorial then sent to Harborview in
Seattle Address: 325 9th Ave, Seattle, WA 98104 206.744.3000

Medical attention was not declined by anyone. Zillah high school staff, EMT's, and paramedics were onsite.

The injuries were sustained while on the Hippo Chow Down. The injuries were called in by ZHS Staff.

Once I was alerted to the incident at 2:38 PM I called our insurance company at 2:44 PM PST, Cossio Insurance, our
representative is

Sonia Foster
Cossio Insurance Agency
sonia@cossioinsurance.com
Phone : (317) 641-7948
Fax : (864) 603-2348
www.cossioinsurance.com

The Hippo Chow Down was secured to the ground with 8, 5/8 "x 18" inch hooked stakes perpendicular into the ground
at least a 90% angle. The unit was placed on grass. The officer in charge has pictures of where the unit was and has
taken pictures of each hole that was left where the stakes came out of the ground. These pictures and the report he has
prepared may be available on Monday May 6th, 2019. He wasn't exactly sure when it would be completed

Preparer:

Bartara Petrea

Barb Petrea Owner, May 2, 2019, 509-930-0432

Also Attached to report is picture of unit, signed waiver, supervisor instruction sheet walked through verbally with Zillah
high school staff members.

CC: Department of L&I

Amusement Ride Certified Inspector

Cossio Insurace Agency

Thank you, prayers to all involved.