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Certificate of Insurance 8996 Issue Date: 2/25/2016 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF Professional Program Insurance Brokerage INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 371 Bel Mann Keys Blvd ., Suite #220 CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT Novato, California 94949 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE _ INSURED INSURER A: Underwriter's at Lloyd's, London Randy Reyman INSURER B: DBA: Any Pyro, DBA: Reyman Pyrotechniques 2937 N. 29th Street INSURER C: Phoenix, AZ 85016 INSURER D: .. COVERAGES: _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NAMED INSURED ABOVE FOR THE 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. '- CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (DD/MM/YY) DATE (DD/MM/YY) A CLAIMS GENERAL MADE LIABILITY PY/15-0173 11122/2015 11/22/2016 EACH ACCIDENT $1,000,000 MEDICAL EXP (any one person) FIRE LEGAL LIABILITY $50,000 GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/ OPS AGG DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder is additional insured as respects the following: Date(s) of Display: 7/3/2016 Location: Anthem Community Park - _ Additional Insured: Anthem Community Council, Inc.; Anthem Parkside Community Association,Inc.; Anthem Country Club Community Association,Inc.; State of Arizona; Maricopa County. , * Rain Date(s): 7/3/2016 subsection B, paragraph 1; this policy is issued by an insurer that does not possess a certificate of authority from the director of the Arizona Department of Insurance. If the insurer that issued this policy becomes Type of Display: Aerial Fireworks Display insolvent, insureds or claimants will not be eligible for - insurance guaranty fund protection pursuant to _ CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXIPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS Anthem Community Council, Inc. WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 3701 W. Anthem Way, Ste. 102 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, - Anthem, AZ. 85086 , : , • AUTHORIZED REPRESENTATIVE Anthem Comm Pa anthem shells Reyman Pyrotechniques/Any Pyro Anthem Display, 7/3/16 Content of display Following is the shell content of the display: 2 1/2 inch shells-70 3 inch shells-216 4 inch shells-210 5 inch shells-150 L a:sy Iviountain Fire Prevention 515 E. Carefree Highway PMB #385 Phoenix Az, 85085 623-465-7400 April 11, 2016 Mr. Reyman, Thank you for the notification that Reyman Pyro-techniques/Any Pyro will be conducting the firework display for the Anthem's July 3rd, 2016 Event. As in the past, once you have the required County permits, you can apply to Daisy Mountain Fire District for a site permit, inspection and stand-by units. This site has been approved in 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. Dave Nielsen, Fire Prevention Division Chief Fire.Marshal@dmfd.org 623-465-7400