BOULDER CREEK HIGH SCHOOL- SHERIFFS SIGNATURE

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.
NAMEIORGANIZATION Boulder Creek High School
EVENT ADDRESS 40404 N. Gavilan Peak Parkway, Anthem AZ 85086
DATE AND TIME OF EVENT October 14, 2016 @ approx. 6:45pm - 10:00pm
DISPLAY DIRECTOR (permit will be issued to the following)
Name: Sarah Harris Phone: 480-948-0090
Business: Fireworks Productions of Arizona Fax: 480-423-5430
Address: 17034 S. 54 th Street, Chandler AZ 85226 Email:
_ sarah@fireworksaz.com
Signature of DietplaNYre ate
SHERIFF'S OFFICE RECOMMENDATION
The State Fire Marshal has inspected the site and fireworks described by thialpplicant and found them to be satisfactory.
/ iee
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

MERCHANITIa\
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. AZ 411797
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
bound unto MARICOPA COUNTY
State of Arizona
in the sum of One Thousand Dollars DOLLARS ($$1,000.00
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.
FPA, LTD. dba FIREWORKS PRODUCTIONS
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 OneThousandDollars
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. dba FIREWORKS PRODUCTIONS OF
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
MAR1COPA 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, 2016 to 12:01 A.M. August23,2017 then this
obligation to be void, and of no effect.
SIGNED, sealed and dated this 1M day of June , 2016
FPA, LTD. dba FIREWORKS PROAucTioNs OF
ARIZONA h a. _
Principal
BONE)ING CDMPANY (MUTUAL)
By
Attorn-dy-in-tact ng
LP 0265 AZ (2/15)

Daisy Mountain Fire Prevention
Stp1.9,21416
Mrs. Harris,
Thank you for the notification that Fireworks Productions of Arizona will be
conducting the fireworks display for the Boulder Creek High Schools
Football Homecoming event in Anthem on October 14th, 2016. As in the
past, once you have the required County permits, you can apply to the
Daisy Mountain Fire District for a site permit, inspection and stand-by units.
The preliminary site map you have submitted has been approved and when
the event is closer we would like to do a pre-site visit with your staff. We
look forward to working with you again. Please let us know if you need any
further information,
Respectfully,
D.Atzttte4,
Dave Nielsen
Fire Prevention Division Chief
Fire.Marshal@dmfd.org

EXHIBIT A
BOULDER CREEK HIGH SCHOOL
Anthem
Friday, October 14, 2016
HOMECOMING
Total Aerial Effects 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: 7 — 2.5" Aerial Shells
NATIONAL ANTHEM:
3 - 2.5" Red Aerial Shells for "Rockets Red Glare"
3 - 2.5" Aerial Shells for "Bombs Bursting"
7 - 2.5" Aerial Shells at the end
SCORE SHELLS: 3 - 2.5" Aerial Shells each Touchdown or Field Goal (30 Total)
KING & QUEEN (HALFTIME): 14 - 2.5" Aerial Shells
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 15oulder Creek 1118-A 5chool by: rreworks rrocluctions of Arizona

---- 1 0
ACCPRE) DATE (MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE
9/9/2016
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(les) 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:
Britton Gallagher PHONE IA/C, No. Ext):216-658-7100 FAX (A/C, No):
One Cleveland Center, Floor 30 E-MAIL
1375 East 9th Street ADDRESS:
Cleveland OH 44114 INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A :Everest National Insurance Company 10120
INSURED INSURER B :maxum Indemnity Company 26743
FPA, Ltd. INSURER c :Everest Indemnity Insurance Co. 10851
17034 S 54th S t INSURER D :Travelers Property Casualty Co. of
Chand ler AZ 85226
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 2110743551 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. NOTVVITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VVITH 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER (MM/DD/YYYY) POLICY EFF (MM/DDNYYY) POLICY EXP LIMITS
C GENERAL LIABILITY Y SI8ML00014-161 10/9/2016 10/9/2017 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES DAMAGE TO (Ea RENTED occurrence) $500,000
CLAIMS-MADE X OCCUR MED EXP (Any one person) $
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
POLICY X JECT PRO- LOC $
A AU OMOBILE LIABILITY Y SI8CA00008 -161 10/9/2016 10/9/2017 COMBINED (Ea accident) SINGLE LIMIT $1,000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
X HIRED AUTOS AUTOS NON-OWNED PROPERTY (Per accident) DAMAGE $
$
B UMBRELLA LIAB — X OCCUR Y EXC6017189-05 10/9/2016 10/9/2017 EACH OCCURRENCE $9,000,000
X EXCESS LIAB CLAIMS-MADE AGGREGATE $9,000,000
DED RETENTIONS $
D WORKERS COMPENSATION 6JUB-2E48371 -0-14 (AZ) 10/9/2016 10/9/2017 TORY WC STATU- LIMITS OTH- ER
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE N / A E.L. EACH ACCIDENT $500,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement.
Date of Display: October 14, 2016
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.
CERTIFICATE HOLDER CANCELLATION
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
© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD

HS AZ
Creek
Boulder Anthem,
info@fireworksaz.com
Shells
2.5"
Size: 480-948-0090
Shells
Maximum
Arizona
of
Productions
Map Fireworks
Site

rireworks rroductions of Arizona
September 9, 2016
Clerk of the Board of Supervisors
Maricopa County
301 W. Jefferson
Phoenix, AZ. 85003
To Whom It May Concern:
Attached is the permit application for Boulder Creek High School
homecoming fireworks scheduled for October 14, 2016. I have also included
a copy of the letter from Dave Nielsen of Daisy Mountain Fire Department
since they will be the responding Fire Department.
Once the permit has been approved with Maricopa County Board of
Supervisors please send me a copy either by mail or email to the following
address:
Fireworks Productions of Arizona
Attn: Sarah Harris
17034 S. 54th Street
Chandler, AZ. 85226
sarah@fireworksaz.com
If you have any questions or need any additional information please do not
hesitate to contact my office. Thank you very much!
Pyrotechnically Yours,
Sarah Harris
Pyro Office Manager
Pyrotechnician
17034 S. 54th Street • Chandler, Arizona 85226 • office (480) 948-0090 • fax (480) 423-5430 • toll free 1-877-948-0090
e-mail: info@fireworksaz.com • web: www.fireworksaz.com

MaLinda Johanning - SHERIFFX
From: Frederick Durham <FrederickDurham@forestryandfire.az.gov >
Sent: Tuesday, September 20, 2016 3:26 PM
To: MaLinda Johanning - SHERIFFX
Subject: Re: FW: Boulder Creek High School Fireworks Application
Looks good, approved by us.
Frederick Durham
Acting State Fire Marshal
frederickdurhamforestrvandfire.az.gov
520-338-4425
On Tue, Sep 20, 2016 at 2:28 PM -0700, "MaLinda Johanning - SHERIFFX"
<M Johanning@MCSO.maricopa.gov> wrote:
Hi Fred,
Have you had a chance to review the attached Firework Application?
Let me know if it has your approval.
Thanks
MaLinda Johanning #A9657
Administrative Assistant to
Chief Dave Trombi, Enforcement Operations Command
& Deputy Chief Joe Rodriquez, Patrol & Enforcement Support Bureau
(602) 876-1822 / Fax (602) 876-0076
The information contained in this e-mail and any files transmitted with it are confidential and/or privileged, and are intended solely for the use of the recipients listed above. If you are
not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of the transmitted information is strictly prohibited. If you have received this
transmission in error, please immediately notify the sender and delete and destroy all copies and attachments.
From: MaLinda Johanning - SHERIFFX
Sent: Thursday, September 15, 2016 10:09 AM
To: Fred.durham(adfbls.az.gov
Subject: FW: Boulder Creek High School Fireworks Application
Good Morning Fred,
Please review the attached Fireworks Application for Boulder Creek High School.
Everything is in order, request your approval.
Thanks
MaLinda Johanning #A9657
1

Administrative Assistant to
Chief Dave Trombi, Enforcement Operations Command
& Deputy Chief Joe Rodriquez, Patrol & Enforcement Support Bureau
(602) 876-1822 / Fax (602) 876-0076
The information contained in this e-mail and any files transmitted with it are confidential and/or privileged, and are intended solely for the use of the recipients listed above. If you are
not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of the transmitted information is strictly prohibited. If you have received this
transmission in error, please immediately notify the sender and delete and destroy all copies and attachments.
From: Amy Goodloe - COBX
Sent: Thursday, September 15, 2016 10:06 AM
To: MaLinda Johanning - SHERIFFX; Joe Rodriquez - SHERIFFX
Subject: Boulder Creek High School Fireworks Application
Good Morning, I have attached a Fireworks application for Boulder Creek High School. It will be interoffice to your office
as well for you to process. Thank you!
Respectfully,
Amy Goodloe
Clerk of the Board Specialist
Clerk of the Board of Supervisors
301 West Jefferson Street, 10th Floor
Phoenix, Arizona 85003
Telephone: 602-506-3579
Fax: 602-506-6402
Email: qoodloea(a.mail.maricoba.cov
2