BOULDER CREEK HIGH SCHOOL REDACTED.PDF

MARICOPA COUNTY BOARD OF SUPERVISORS
301 West Jefferson, 10th Floor, Phoenix, Arizona 85003
APPLICATION FOR FIREWORKS DISPLAY
Arizona Revised Statutes § 36-1603 requires every display shall be handled by a competent operator, and shall be of a
character and located, discharged and fired so that it will not be hazardous to property or endanger any person. Before a
permit is granted, the operator, location and handling of the display shall be approved by the sheriff of the county. After a
permit is granted, the sale, possession, use and distribution of fireworks for the display shall be lawful for that purpose only.
Permits are not transferable or assignable.
Further, A.R.S. § 36-1604 requires that the governing body shall require each applicant to provide a satisfactory bond of not
less than $500, or a copy of the certificate of liability insurance in a principal amount usually not less than $1 million,
conditioned upon payment of all damages which may be caused to persons or property by reason of the display.
Complete the following application and submit to the Clerk of the Board of Supervisors, 301 W. Jefferson, Phoenix, 85003
(602-506-2774) at least 30 days prior to the event date.
Include the following items with your application:
1. Proof of appropriate bond or insurance payable to Maricopa County.
2. Map of display area.
3. List of fireworks to be discharged. The Director of Display for the fireworks company is expected to be licensed
and/or trained by the City of Phoenix or have other verification of expertise.
4. Verification from local fire department that they were notified of event, date, location and time.
NAMEORGANIZATION Boulder Creek High School
EVENT ADDRESS 40404 N. Gavilan Peak Parkway, Anthem AZ 85086
DATE AND TIME OF EVENT September 28, 2017 @ approx. 6:45pm - 10:00pm
DISPLAY DIRECTOR (permit will be issued to the following)
Name: Sarah Harris Phone
Business: Fireworks Productions of Arizona Fax: 480-423-5430
Address: 17034S. 54th Street, Chandler AZ 85226 Email:
Signatu - , o Mlay D ctor Date
SHERIFF'S OFFICE RECOMMENDATION
The State Fire Marshal has inspected the site and fireworks described by the applicant and found them to be satisfactory.
Sheriff's Office Signature Date
PERMIT FOR FIREWORKS DISPLAY
The above application filed pursuant to A.R.S. § 36-1603, together with proper bond as provided by law, and having been
approved by the State Fire Marshall and Sheriff, permission is granted to the above-named applicant to conduct a fireworks
display on the dates set forth in the application. IN THE EVENT OF POSTPONEMENT OF SAID SHOW, the display will be
given not later than one (1) week from the date specified above.
DATED this day of 20
Clerk of the Board, authorized signature

MERC A TS
BONDING COMPANY.
MERCHANTS BONDING COMPANY (MUTUAL) P.O. BOX 14498, DES MOINES, IA 50306-3498
PHONE: (800) 678-8171 FAX: (515) 243-3854
FIREWORKS DISPLAY BOND
Bond No. AZ411797
KNOW ALL PERSONS BY THESE PRESENTS, that we
FPA, LTD. dba FIREWORKS PRODUCTIONS OF ARIZONA
as Principal, and MERCHANTS BONDING COMPANY (MUTUAL), a corporation
organized under the laws of the State of Iowa, and duly authorized and
licensed to do business in the State of Arizona, as Surety, are firmly
MARICOPA COUNTY
bound unto
State of Arizona
in the sum of One Thousand Dollars DOLLARS (01000.00
lawful money of the United States, to the payment of which sum, well and
truly to be made, the Principal and Surety bind themselves, their and each
of their heirs, executors, administrators, successors and assigns, jointly
and severally, firmly by these presents.
FMLTD.dmFMEWORKSPRODUCT1ONS
WHEREAS the above bounden Principal OF ARIZONA
desires to have a permit for Fireworks Display and in order to have such
display it is necessary for said FPA, LTD. dba FIREWORKS PRODUCTIONS OF
ARIZONA
to execute a surety bond in the amount of OneThousandDollam
Dollars ($ $1,000.00 ) conditioned for the payment of all damages which may
be caused to persons or property by reason of the permitted display as
provided in Chapter 46, Arizona Legislative Session Laws of 1941.
FPA,LTD.dbaFIREWORKSPRODUCTIONSOF
NOW, THEREFORE, if the said ARIZONA
well and truly observe, carry out, perform and comply with all requirements,
terms and provisions of the Ordinances of the Board of Supervisors of
MARICOPA COUNTY County, State of Arizona,
conditioned for the payment of all damages which may be caused to persons or
property by reason of the permitted display as provided in Chapter 46,
Arizona Legislative Session Laws of 1941, for a period from 12:01 A.M.
August 23, 2017 to 12:01 A.M. August 23, 2018 then this
obligation to be void, and of no effect.
SIGNED, sealed and dated this 15141 day of August 2017
FPA, LTD. dba FIREWORKS Plf0pUCTIONS OF
ARIZONA
MERCHANTS BONDING COMPANY (MUTUAL)
By Attorney-in-fact Debi Williams
LP 0265 AZ (2/15)

Phoenix Certificate of Fitness
Steve Heck
Head Pyrotechnician
Certificate of Fitness for Pyrotechnics
:r 1: Ar
STEVEN HECK
Certificate of fitness is not transferable and may be ret4oked and or
suspended for any misuse of the card The card is the property of
the City of Phoenix and shall be surrendered upon request by any
local government or federal agency.
The card identifies but does not recommend the bearer The City
of Phoenix assumes no liability for activities performed by the
cardholder.
Fireworks Productions of Arizona
1-877-948-0090...info@fireworksaz.com

Daisy Mountain Fire Prevention
515 E. Carefree Highway PMB #385 Phoenix Az. 85085 623-465-7400 August 17, 2017
Thank you for the application from Fireworks Productions of AZ which will be
conducting a firework display/show for the Boulder Creek football event on Sept. 28'
2017. Your site, operator, and display plan is approved and DMFD has issued permit
#000760 for this event. A valid County permit shall be obtained and DMFD standby
personnel will be required on the day of the event. We look forward to working with
you again. Please let us know if you need-any furtherinformation.
Sincerely,
Da/V& ru,&6,e„kt,
Dave Nielsen — Division Chief
Fire Prevention 623-465-7400
www..1.)asiyMotai -at it re .org

EXHIBIT A
BOULDER CREEK HIGH SCHOOL
Anthem
Thursday, September 28, 2017
Total Aerial Shells 85
Boulder Creek High School's Homecoming will contain a multitude of fantastic
shells in beautiful colors to celebrate this year's homecoming and Royal Court.
Aerial Display:
A large assortment of brilliantly-colored shells, including Chrysanthemums, Crowns,
Peonies and Diadems in gorgeous Reds, Yellows, Blues, Greens, Silvers, and Golds.
Your Aerial Display will contain a total of 85 aerial shells shot during important moments
of the evening to excite the home crowd and celebrate the Jaguars' accomplishments.
2.5" - 85 Chinese Fancy's & Specials
Boulder Creek High School's show to consist of:
TEAM INTRO: 14 — 2.5" Aerial Shells
NATIONAL ANTHEM:
3 - 2.5" Red Aerial Shells for "Rockets Red Glare"
3 - 2.5" Aerial Shells for "Bombs Bursting"
14 - 2.5" Aerial Shells at the end
SCORE SHELLS: 3 - 2.5" Aerial Shells each Touchdown or Field Goal (30 Total)
TEAM INTRO AT END OF HALF-TIME: 7 - 2.5" Aerial Shells
END OF GAME: 14 - 2.5" Aerial Shells
(Any remaining Score Shells shot at end of game)
Designed for 5oulder Creek 1-1W7 ,5c1700/ by: hreworks froductions of Arizona

----- --1 0
DATE (MM/DDIYYYY)
ACCIR) E CERTIFICATE OF LIABILITY INSURANCE
4.----- 8/17/2017
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 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: Janet Nau
The Partners Group Ltd (NC. PHONE No. Ext1:425-455-5640 FAX (NC, No:425-455-6727
11225 SE 6th St., Suite 110 E-MAIL ,nauetpg
Bellevue WA 98004 ADDRESS:J rp.com
INSURER(S) AFFORDING COVERAGE NAIC tt
INSURER A :T.H.E. Insurance Company 12866
INSURED INSURER B :
Fireworks Productions of Arizona INSURER C :
17034 S. 54th Street INSURER D :
Chandler AZ 85226
INSURER E:
INSURER F :
CERTIFICATE CERTIFICATE NUMBER: NUMBER: REVISION REVISION NUMBER: 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 SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSR VVVD POLICY NUMBER (MMIDD/YYYY) IMM/DDIYYYY1
A GENERAL LIABILITY CPP010586200 10/9/2016 10/9/2017 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES TO (Ea RENTED occurrence $500,000
CLAIMS-MADE X OCCUR MED EXP (Any one person) $N/A
$2,000Deductible PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $N/A
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
POLICY X 78- ILOC
AUTOMOBILE LIABILITY CPP010586200 10/9/2016 10/9/2017 COMBINED Ea accident 1,000,000
ANY AUTO BODILY INJURY (Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident)
AUTOS AUTOS NON-OWNED PROPERTY DAMAGE
X HIRED AUTOS AUTOS (Per accident)
UMBRELLA LIAB X OCCUR ELP001232900 10/9/2016 10/9/2017 EACH OCCURRENCE $9,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $9,000,000
DED RETENTION S
WORKERS COMPENSATION WCP0005328001 10/9/2016 10/9/2017 x WC TORY STATU- LIMIT' OTH- ER
AND EMPLOYERS LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE l EL. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $1,000,000
If DESCRIPTION yes, describe under OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The following are Additional Insured on General Liability as their interest may appear as respects to operations performed by or on behalf of
the Named Insured, as required by written contract:
Date of Display: September 28, 2017
Location of Display: Boulder Creek High School, Anthem, AZ
Additional Insured(s):State of Arizona; Maricopa County; Daisy Mountain Fire District; Deer Valley Unified School District #97; Boulder Creek
High School; Boulder Creek Football Foundation.
--......—... _ ..____._
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Deer Valley Unified School District #97 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
18424 N. 51st Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Glendale AZ 85308
AUTHORIZED REPRESENTATIVE
I
© 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD

HS
Creek AZ
Anthem,
Boulder
info@fireworksaz.com
Pressurized Extinguishers Shells
2-A Fire 2.5"
Class 2 Water
Size: 480-948-0090
Shells
Spectators
Maximum
Arizona
of
Site Productions
Display
Map Fireworks
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