ST ROSE PHILIPPINE SHERIFFS SIGNATURE.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.
NAME1ORGANIZATION St. Rose Philippine Duchesne Catholic Parish
EVENT ADDRESS 2825 W. Rose Canyon Circle, Anthem AZ 85086
DATE AND TIME OF EVENT October 15, 2016 @ approx. 9:00pm - 9:30pm
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. 54th Street, Chandler AZ 85226 Email:
_
SHERIFF'S OFFICE RECOMMENDATION
The State Fire Marshal has inspected the site and fi rks described by the applicant a 'd them to be satisfactory.
),(8
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

MERCHANTS
BONDING COMPANY„
MERCHANTS 80N DING COMPANY (MUTUAL) P.O. 1')OX 11198, DES MOINES', IA 50306-3498
(800) 678-8171 FAX: (515) 243-3854
FIREWORKS DISPLAY BOND
Bond No AZ 411797
['PA, LTD. dba FIREWORKS PRODUCTIONS OF ARIZONA
tnincipat, and MERMHAHTH PONITNM COMPANY MMDTUAln, a corporation
undbi sawn at rho Dhahe of igwa, and Juky authorized and
H3ed to do business in tile rlrate of Arizona, as Surety, are inirmly
MARICOPA COUNTY
bc ud uuto
State of Artsb, n.r:A
In the - .112 OnellmusandDollars DOLLARS 9; $1,000.00
or tho United Shatbs, to the payment:. of which L'AER, well and
rererly . c .2A.L., the Principal and Sac - era hind themselves, their and each
of their heirs, executors, admrtnistrators, successors and assigns, -jointly
and sbvbrally, Eirmly boy these btnnents.
ITA,I:MdbaFIRFAVORKSPRODUCHONS
WHEREAS the above bounden Prinbil ) (IF ARIZONA
des tsar co have a permit for y -ks Display and in order: to have such
blay it is nbeeksury tor said I PA, LTD. dba FIREWORKS PRODUCTIONS OF
ARIZONA
ty. . a surety bond in the sf. n a t One Thousand Dollars
$ $1,000.00 for the paymenc_ of all damages which may
Pe cs.nred ho persons or prober , / ason of the permihttr.d display as
provided in i1hapteL 16, Atizet . Haf.ive Session haws of 19 ,11.
FPA, 1 ,TD. dha FIREWORKS pRoDuctioNs OF
NOW, TH:122 t11:LC.f. , I_ he an 1 a ARIZONA
hr,H 1- 1 - 1 • , per, pertorm rind comply with all requirements,
Le ruts rid p Lf . t he t,) ihant:e s all ti'ie Boar ti of Su pe rv 1, sots of
NWMCOPA Counr.v, State of AL7i.r(Jh,'-'1,
bondihioned for the payment br all denhnt,res which may be caused he persbns (51',
property bv reE.1.3on (A1 (lie petmiLLed display as provided in ChapLer
Arizona (-3() niaLive Session 1, Lcd:2 of 1941, . for a period from 12:01 AN.
August 23, 2016 to 12:01 A.M. August 23, 2017 then hhrk
ol ligation to be void, anti of nonffect.
set-1'1.bn and dared thi.s IM Jay or June 2016
FPA, (lba FIREWORKS PROAUCTIONS OF
ARIZONA
CP,MPANY (MUTUAL)
By
At±o'ine in-tact D,
LP 0265 AZ (2/15)

MERCHANT
BONDING COMPANY„ 11011 d it: AZ 411797
POWER OF ATTORNEY
for Company Employees
Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING,
INC., both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint
the following company employees, individually.
Dan Lengeling
(heir true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver on behalf of the Companies, as Surety, bonds, undertakings
and other written obligations in the nature thereof, subject to the limitation that any such instrument shall not exceed the amount of:
Unlimited
This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the
Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and adopted by the Board of Directors of Merchants
National Bonding, Inc., on October 24, 2011.
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and
authority to appoint Attorneys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company
thereto, bonds and undertakings. recognizances, contracts of indemnity and other writings obligatory in the nature thereof."
The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of
Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship
obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually Fixed
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given
to the Attorney-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and
construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the Stale of Florida
Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company
of any of its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given
to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner-
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 14th day of August 2015
MERCHANTS BONDING COMPANY (MUTUAL)
..... • . MERCHANTS NATIONAL BONDING, INC.
OCt" (:)4 • 1 -.•
'-0-
2003
By
7741-
'4/z/7
STATE OF IOWA
COUNTY OF DALLAS ss President
On this 14th day of August 2015, before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say
that he is President of the MERCHANTS BONDING COMPANY (MUTUAL.) and MERCHANTS NATIONAL BONDING, INC., and lhat the seals
affixed to the foregoing instrument are the Corporate Seals of the Companies: arid that the said instrument was signed and sealed in behalf of the
Companies by authority of their respective Board of Directors.
WENDY WOODY
78.1654
E.KplfeS
20. 2017
Notary PubliZ".--gorif County, Iowa
(Expiration of notary's commission
does not invalidate this instrument)
I. William Warner, Jr., Secretary of Ilie MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC..
do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies,
which is still in full force and effect and has not been amended or revoked,
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 1st day of June , 2016
• -\ttG CO **
• • C) \-\: 1-*' Sk • PO • • ".•41.
; or) • • 0 4 •
• • : • - - co • •
• Z—• t=3 • -- • Secretary
° •11. 1933
• (),.• • c.‘ • •
° • • 0 °
POA 0015 (6/15)

Daisy Mountain Fire Prevention
Mrs. Harris,
Thank you for the notification that Fireworks Productions of Arizona will be
conducting the firework display for the St. Rose Philippine Duchesne Parish
event in Anthem on October 15th, 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. This site has been approved
in the previous years and we look forward to working with you again.
Please let us know if you need any further information or if there will be a
major change to the site from last year.
Respectfully,
D.At4424.,
Dave Nielsen
Fire Prevention Division Chief
Fire.Marshal@dmfd.org

Phoenix Certificate of Fitness
August (Fielding) Heckendorf
Head Pyrotechnician
602-403-6307
Certificate of Fitness for Pyrotechnics
(ii ,,t Intont I t ir IN:pannwrit
AUGUST HECKENDORF
FIRE DEPT EMMA FE
Certificate of fitness is not transferable and may be revoked 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
Cardholder signature
Fire Marshal
Fireworks Productions of Arizona
1-877-948-0090...info@fireworksaz.com

EXHIBIT A
St. Rose Philippine Duchesne Catholic Parish
Saturday, October 15, 2016
10 minute display
Total Aerial Effects 650
Total Shells 250 Total Effects in Basins 400
Opening:
The celebration of this special evening begins with a beautiful burst of fiery color.
10 — 2.5" Chinese Fancy Color Shells
Aerial Display:
A gorgeous assortment of brilliantly-colored shells, including Chrysanthemums,
Waves, Crowns, Peonies, Strobes, Diadems, and Crossettes in gorgeous Reds,
Yellows, Blues, Greens, Silvers, and Golds.
Your Aerial Display will contain a total of 200 aerial shells and 400 basin effects.
1 1/2" - 4 FPA Premier Specialty Basin
2.5" - 200 Chinese Fancy's & Specials
GRANDE FINALE:
Your celebration will close in spectacular excitement as multiple styles of brilliantly-
colored shells, rocket skyward growing and glowing in breath-taking Blues, Golds,
Greens, Silvers, Yellows, Purples and Red.
Your Grande Finale consists of 40 aerial shells:
Your Grande Finale: 40 — 2.5" shells
DeSigned fOr 5t. Nose rial-ppine DucAesne Catholic farisb
L 9: [Ire works froductions of Arizona

ACCPRE) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DIDNYYY)
iiii..—.../ 8/19/2016
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(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:
Britton Gallagher PHONE FAX
One Cleveland Center, Floor 30 IA/C. E-MAIL No. Ext1:2 16-658-7100 (A/C, No):
1375 East 9th Street ADDRESS:
Cleveland OH 44114 INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A :Everest Nationa Insurance Company 10120
INSURED INSURER a :Maxum Indemni.y Company 26743
FPA, Ltd. INSURER c :Everest Indemnity Insurance Co 10851
17034 S 54th St INSURER o :Travelers Property Casualty Co. of
Chandler AZ 85226
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1252250751 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 LTR TYPE OF INSURANCE ADDL INSR SUBR VVVD POLICY NUMBER (MM/DDNYYY) POLICY EFF (MMIDD/YYYY) POLICY EXP LIMITS
C GENERAL LIABILITY Y SI8ML00014- 151 10/9/2015 10/9/2016 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES (Ea 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 128, LOC $
AU OMOBILE LIABILITY Y SI8CA00008-151 10/912015 10/9/2016 COMBINED (Ea accident) SINGLE LIMIT _S'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 $
$
UMBRELLA LIAB X OCCUR y EXC6017189-04 10/9/2015 10/9/2016 EACH OCCURRENCE 0,000,000
X EXCESS LIAB CLAIMS-MADE AGGREGATE $9,000,000
DED RETENT ON $ $
WORKERS COMPENSATION 6JUB-2E48371 -0-14 (AZ) 10/9/2015 10/9/2016 X WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y / N TORY UMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE N IA 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 15, 2016
Location of Display: St. Rose Parish
Additional Insured(s): State of Arizona; Maricopa County; Daisy Mountain Fire District; St. Rose Philippine Duchesne.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
St. Rose Philippine Duchesne THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
2825 W. Rose Canyon Circle ACCORDANCE WITH THE POLICY PROVISIONS.
Anthem AZ 85086
AUTHORIZED REPRESENTATIVE
© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD

rireworks Site
Map
rrocluctions
of
Arizona
Maximum
Shell
Size:
480-948-0090 2.5"
Aerial
info@fireworksaz.corn St.
Anthem Rose
Parish

MaLinda Johanning - SHERIFFX
From: Frederick Durham <I >
Sent: Wednesday, September 07, 2016 3:23 PM
To: MaLinda Johanning - SHERIFFX
Subject: RE: Emailing - St. Rose Philippine Firework.pdf
MaLinda,
This office has no objection to the issuance of a display permit to FPA for this event.
Frederick Durham
Acting State Fire Marshal
Arizona Department of Forestry and Fire Management
1110 West Washington, Suite 100
Phoenix, Arizona 85007
Office: 602-364-1090
Cell:
Original Message
From: MaLinda Johanning - SHERIFFX
Sent: Wednesday, September 07 2016 8:31 AM
To: Frederick Durham
Cc: MaLinda Johanning - SHERIFFX 1/111111 11.1-
Subject: FW: Emailing - St. Rose Philippine Firework.pdf
Good Morning Fred,
Attached is the complete Fireworks Application for St. Rose Philippine Duchesne Catholic
Parish.
Everything is in order, request your approval.
Thanks,
MaLinda Johanning #A9657
Administrative Assistant to
Chief Dave Trombi, Enforcement Operations & Deputy Chief Joe Rodriquez, Patrol Resources
Bureau
Fax (602) 876-0076
1

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.
Original Message
From: Laurinda Cook - COBX
Sent: Wednesday, September 07, 2016 8:26 AM
To: MaLinda Johanning - SHERIFFX
Subject: Emailing - St. Rose Philippine Firework.pdf
Malinda
I have attached the application for a Fireworks Display Permit for your review/approval as filed
by the following:
Company: Fireworks Productions of Arizona
Director of Display: Sarah Harris
Event Location: 2825 West Rose Canyon Circle
Anthem, Arizona 85086 Event Dates: October 15, 2016 at 9:00 PM
Please start the approval process for this application and the original application will be sent
interoffice to you today. The Fireworks Display Bond shows Salt River Pima Maricopa Indian
Community and I have requested a corrected copy.
The application is entered in SOLAR and scheduled to be approved by the BOS at the
September 21, 2016 Formal meeting.
Thank you for your assistance.
Laurinda R. Cook
Clerk of the Board Assistant
Maricopa County
Office of the Clerk of the Board of Supervisors
301 West Jefferson Street, 10th Floor
Phoenix, Arizona 85003
Direct Phone: 602-506-7947 Fax No: 602-506-6402
2