ST. ROSE PHILIPPINE DUCHESNE CATHOLIC PARISH - 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 St. Rose Philippine Duchesne Catholic Parish
EVENT ADDRESS 2825 W. Rose Canyon Circle, Anthem AZ 85086
DATE AND TIME OF EVENT October 17, 2014 @ 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. 54 th Street, Chandler AZ 85226 Email:
_
W
Signatu e o Display 'rector 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.
Sheriffs 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

ME RC HAN -Mb\
BONDING COMPANY
2100 FLEUR DRIVE • DES MOINES, IOWA 50321-1158
(515) 243-8171 • (515) 243-3854 FAX
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, with its home office in the
City of Des Moines, Iowa, and duly authorized and licensed to do business in
the State of Arizona, as Surety, are firmly bound unto MARICOPACOUNTY
State of Arizona
in the sum of One Thousand Dollars DOLLARS (00)00.00
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.
1,PA, LTD dbaHRI:WORKS 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 OneThousamiDollars
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
MARI('OPA 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 4 6 ,
Arizona Legislative Session Laws of 1941, for a period from 12:01 A.M.
August 23, 2014 to 12:01 A. H. Augsst23,2015 then this
obligation to be void, and of no effect.
SIGNED, sealed and dated this 1st day of June 2014
1-'PA, LTD dba FIREWORKS PRODUCTIONS OF
ARIZONA . _
Principal
UTUAL)
LP 0265 AZ (12/99)

FIREWORKS DISPLAY SITE MAP
Indicate the following:
1. North direction 5. Fire department access
2. Distance from firing area to impact/fallout area 6. Hydrants
3. Spectator location 7. Distance to structures
4. Storage area 8. Overhead lines
(North)

--- 7 0
Acc•RD CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DONYYY)
4.------ 8/19/2014
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 (A/C. No. Esq.:216-658-71 00 INC, N01:216-658-7101
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
Fireworks Productions of Arizona Ltd. INSURER C Travelers 5606
170348 54th St INSURER D :Everest Indemnity Insurance Co. 10851
Chandler AZ 85226
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 365933952 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 ADM INSR SUER WVO POLICY NUMBER MMIODNYYTUMM/DD(TYYY) POLICY EFF POLICY EXP LIMITS
D GENERAL LIABILITY V SI8ML00014-141 0/9/2014 10/9/2015 EACH OCCURRENCE $1,000,000
DAMAGE TO RTNTED-
X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occ.tirrence) $300,000
CLAIMS-MADE X OCCUR MED EXP (Any one person} $
PERSONAL 8, ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $2,009,000
POLICY X TPET: LOG $
AU °MOBILE LIABILITY V SI8CA00008-141 101912014 0/9/2015 COMBINED (Ea accident) -SINGLE LIMIT $1,000,000
X ANY AUTO BODILY INJURY (Per person) $
AUTOS ALL OVVNED AUTOS SCHEDULED BODILY INJURY (Per accident) $
X HIRED AUTOS AUTOS NON-OWNED PROPERTY (Per accident) DAMAGE $
$
UMBRELLA LIAB X OCCUR r EXC6017189 -03 10/9/2014 0/9/2015 EACH OCCURRENCE $9,000,000
X EXCESS LIAB CLAIMS-MADE AGGREGATE $9,000,000
DED RETENTIONS $
WORKERS COMPENSATION 4864P073 10/9/2014 0/9/2015 X VVC STATLI OTH-
AND EMPLOYERS' LIABILITY Y I N TORY LIMITS ER
ANY OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? N I A ELL EACH ACC/DENT $500,000
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $500,000
If yes, describe under
DESCRIPTION OF OPERATIONS betow E.L. DISEASE - POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS ( LOCATIONS/ VEHICLES {Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Date of Display: October 17, 2014
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
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
St. Rose Philippine Duchesne ACCORDANCE WITH THE POLICY PROVISIONS.
2825 W. Rose Canyon Circle
Anthem AZ 85086 AUTHORIZED REPRESENTATIVE
4012.i4=,,
0 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD

info@fireworksaz.com
Aerial
2.5" 480-948-0090
Size:
Shell
Maximum
Arizona
of
rrocluctions
Map
Site rireworics

EXHIBIT A
St. Rose Philippine Duchesne Catholic Parish
Friday, October 17, 2014
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 1,4" - 4 EPA 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 for5t. KO5C Philippine Duchesne Catholic Parish
by: work5 Productions of Arizona

Phoenix Certificate of Fitness
Kendon Victor
Head Pyrotechnician
602-672-9313
mmlpuovN
.ondon S. Victor
•
THIS CERTIFICATE 15 NOT
TRANSFERABLE AND MAY BE
REVOKED FOR CAUSE
NOT TO BE USED OUTSIDE
CITY OF PHOENIX
Fireworks Productions of Arizona
1-877-948-0090...info@fireworksaz.com

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
on October 17th, 2014. 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 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.
Dave Nielsen
Fire Prevention Division Chief
Fire.Marshal@dmfd.org

rireworks rroductions of Arizona
im\Kr-lkiL
RECEIVED
September 3, 2014 SEP 5 2014
Clerk of the Board of Supervisors MARICOPA COUNTY
Maricopa County CLERK BOARD OF SUPERVISORS
301 W. Jefferson
Phoenix, AZ, 85003
To Whom It May Concern:
Attached is the permit application for St. Rose Philippine Duchesne Catholic
Parish Fireworks. 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: wwwfireworksaz.com