LEISURE WORLD COMMUNITY_REDACTED.PDF
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MARICOPA COUNTY BOARD OF SUPERVISORS 301 West Jefferson Street, 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 Street, 10" Floor, Phoenix, 85003 (602-506-3766) at least 30 days prior to the event date. All applications must have the following documentation attached: 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. EVENT INFORMATION Name/Organization: — Leisure World Community Name of Event: Community Event Event Address: 908 S Power Rd. Mesa AZ 85206 Date and Time of Event: Wednesday, November 11, at approx 8:30 pm DISPLAY DIRECTOR (permit will be issued to the following) Name: Cody Welty 480-466-6705 Phone: Address: 17034 S 54th St. Chandler AZ 85226 Emi: i SUBMIT APPLICATION AND REQUIRED DOCUMENTATION TO: Maricopa County Clerk of the Board of Supervisors Email: ClerkBoard@mail.maricopa.gov 301 W. Jefferson Street, 10" Floor Fax: 602-506-6402 Phoenix, Arizona 85003 RECEIV For questions, please call the Clerk of the Board of Supervisors OCT 0 6 2026 MARICOPA COUNTY BOARD OF SUPERVISORS CLERK FIREWORKS DISPLAY SITE MAP Indicate the following: > North direction Fire department access Distance from firing area to impact/fallout area Soe Hydrants PON Spectator location Distance to structures Storage area Pe Overhead lines (North) FOR DEPARMENT USE ONLY: SHERIFF’S OFFICE RECOMMENDATION The State Fire Marshal or local fire chief has reviewed 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 having been filed pursuant to A.R.S. § 36-1603, together with other proper documentation; permission is granted to the above-named applicant to conduct a fireworks display on the dates set forth in the application. INTHE EVENT OF POSTPONEMENT OF SAID SHOW, the display will be given not later than one (1) week from the date specified above. Approved by the Maricopa County Board of Supervisors: DATED this day of 20 Clerk of the Board, authorized signature ACORD DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE apts 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 have ADDITIONAL INSURED provisions or 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 COREACT Acrisure Midwest Insurance Services, LLC roe FAX a i | 223 West Grand River Ave #1 ; (A/C, No arr Howell MI 48843 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Property Casualty Company of America 25674 INSURED meveene : Third Coast Insurance Compan pany 10713 . FPA, Ltd, DBA: Fireworks Productions of Arizona insuRER C: Allianz Global Corporate & Specialty SE 17034 S 54th St Chandler AZ 85226 INSURER D: Everest Indemnity Insurance Company 10851 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 642304048 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. LIMITS SHOWN ARE INCLUSIVE OF AMOUNTS REQUESTED BY THE CERTIFICATE HOLDER AND MAY NOT REFLECT POLICY LIMIT AMOUNTS IN EXCESS OF THOSE REQUESTED. *Not Applicable in WY INSR ADDL|SUBR] POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INsD | wD POLICY NUMBER (MM/DDIYYYY) | (MM/DD/VYYY) LIMITS B | X | COMMERCIAL GENERAL LIABILITY PYTP0000013-01 10/9/2026 10/9/2027 | eEacH OCCURRENCE $ 1,000,000 DAMAGE 5 1 57 1 3 2 1852 1362 31 40 95.365509 TO 5 1 57 1 3 3 1899 1369 94 23 95.365509 RENTED 4 1 57 1 4 0 309 1388 1915 34 -1 5 1 57 1 4 1 309 1388 164 34 92.675095 CLAIMS-MADE 5 1 57 1 4 2 566 1394 88 19 96.455750 OCCUR 5 1 57 1 4 3 1746 1398 121 18 96.753662 PREMISES 5 1 57 1 4 4 1875 1398 36 23 96.378204 (Ea 5 1 57 1 4 5 1919 1397 127 22 96.029427 occurrence) 5 1 57 1 4 6 2106 1390 118 25 69.639633 $500,000 4 1 57 1 5 0 177 1440 1941 36 -1 5 1 57 1 5 1 177 1442 63 34 29.458323 ___| 5 1 57 1 5 2 1746 1442 51 19 95.819183 MED 5 1 57 1 5 3 1805 1441 45 20 96.363098 EXP 5 1 57 1 5 4 1859 1442 48 23 96.336662 (Any 5 1 57 1 5 5 1914 1446 40 15 96.656769 one 5 1 57 1 5 6 1962 1441 81 24 96.684212 person) 5 1 57 1 5 7 2106 1440 12 22 68.741798 $ 4 1 57 1 6 0 1746 1487 500 25 -1 5 1 57 1 6 1 1746 1490 128 20 91.702019 PERSONAL 5 1 57 1 6 2 1880 1489 16 20 91.702019 & 5 1 57 1 6 3 1902 1489 144 20 77.740227 ADVINJURY 5 1 57 1 6 4 2058 1479 38 40 62.550243 _| 5 1 57 1 6 5 2106 1487 140 25 73.741364 $1,000,000 4 1 57 1 7 0 194 1535 2052 55 -1 5 1 57 1 7 1 176 1529 14 42 92.681396 | 5 1 57 1 7 2 180 1539 81 28 69.804413 GEN'L 5 1 57 1 7 3 269 1539 150 20 96.379005 AGGREGATE 5 1 57 1 7 4 427 1539 59 51 52.465626 LIMIT 5 1 57 1 7 5 493 1539 101 20 96.939224 APPLIES 5 1 57 1 7 6 602 1539 53 20 96.346237 PER: 5 1 57 1 7 7 1746 1538 111 20 96.776016 GENERAL 5 1 57 1 7 8 1863 1538 153 20 96.486923 AGGREGATE 5 1 57 1 7 9 2105 1535 141 26 74.009567 $2,000,000 4 1 57 1 8 0 250 1559 1996 62 -1 5 1 57 1 8 1 250 1562 79 55 46.402760 pouicy 5 1 57 1 8 2 342 1588 1 19 93.284714 | 5 1 57 1 8 3 365 1562 14 55 91.725723 X 5 1 57 1 8 4 392 1566 14 47 96.877419 | 5 1 57 1 8 5 345 1559 16 62 91.846756 [ 5 1 57 1 8 6 370 1563 17 52 77.521339 x 5 1 57 1 8 7 401 1559 12 62 77.521339 ] 5 1 57 1 8 8 427 1559 54 62 51.135082 589: 5 1 57 1 8 9 423 1593 58 20 96.633110 JECT 5 1 57 1 8 10 516 1560 69 59 70.519440 [x] 5 1 57 1 8 11 596 1587 48 20 95.649254 Loc 5 1 57 1 8 12 1746 1587 130 19 93.215324 PRODUCTS 5 1 57 1 8 13 1884 1596 8 4 89.020294 - 5 1 57 1 8 14 1898 1587 114 19 86.894936 COMP/OP 5 1 57 1 8 15 2019 1587 54 19 95.796837 AGG 5 1 57 1 8 16 2076 1575 15 41 95.796837 | 5 1 57 1 8 17 2105 1584 141 25 80.649590 $2,000,000 4 1 57 1 9 0 250 1625 1867 42 -1 5 1 57 1 9 1 250 1625 88 42 96.688736 OTHER: 5 1 57 1 9 2 2105 1625 12 22 89.677582 $ 4 1 57 1 10 0 1744 1654 290 57 -1 5 1 57 1 10 1 1744 1654 127 57 91.151360 COMBINED 5 1 57 1 10 2 1878 1665 88 20 92.147110 SINGLE 5 1 57 1 10 3 1973 1665 61 19 92.147110 LIMIT 4 1 57 1 11 0 135 1662 2111 46 -1 5 1 57 1 11 1 135 1671 15 19 36.461987 B_ 5 1 57 1 11 2 167 1664 15 40 73.246185 | 5 1 57 1 11 3 192 1675 157 19 94.637589 AUTOMOBILE 5 1 57 1 11 4 356 1676 109 18 96.072647 LIABILITY 5 1 57 1 11 5 898 1663 216 40 36.256790 PYTA0000008-01 5 1 57 1 11 6 1388 1662 122 40 94.380600 40/9/2026 5 1 57 1 11 7 1576 1671 122 21 73.751884 10/9/2027 5 1 57 1 11 8 1722 1662 13 50 73.751884 | 5 1 57 1 11 9 1752 1688 117 19 75.960358 COMBINED 5 1 57 1 11 10 1871 1688 13 20 14.385843 § 5 1 57 1 11 11 2105 1674 12 21 93.075005 $ 5 1 57 1 11 12 2125 1672 121 24 96.310654 1,000,000 4 1 57 1 12 0 196 1719 1921 29 -1 5 1 57 1 12 1 196 1719 19 25 92.182396 X 5 1 57 1 12 2 229 1711 15 41 92.401527 | 5 1 57 1 12 3 248 1723 50 19 88.166756 ANY 5 1 57 1 12 4 304 1723 67 19 88.166756 AUTO 5 1 57 1 12 5 1744 1723 85 19 96.726471 BODILY 5 1 57 1 12 6 1838 1723 85 19 96.192238 INJURY 5 1 57 1 12 7 1932 1723 45 24 95.091026 (Per 5 1 57 1 12 8 1984 1723 81 25 93.394112 person) 5 1 57 1 12 9 2080 1712 14 40 91.831795 | 5 1 57 1 12 10 2104 1722 13 21 90.829247 $ 4 1 57 1 13 0 249 1752 1776 40 -1 5 1 57 1 13 1 249 1763 91 19 96.619591 OWNED 5 1 57 1 13 2 521 1752 148 40 96.849358 SCHEDULED 5 1 57 1 13 3 2023 1772 2 3 7.263908 , 4 1 57 1 14 0 248 1756 1869 74 -1 5 1 57 1 14 1 248 1787 81 43 96.114021 AUTOS 5 1 57 1 14 2 338 1768 64 42 96.874100 ONLY 5 1 57 1 14 3 446 1756 58 54 27.030884 || 5 1 57 1 14 4 520 1787 82 19 96.330849 AUTOS 5 1 57 1 14 5 1744 1771 85 19 96.911797 BODILY 5 1 57 1 14 6 1838 1771 85 19 96.700729 INJURY 5 1 57 1 14 7 1932 1772 44 23 92.856407 (Per 5 1 57 1 14 8 1984 1771 97 24 11.909914 accident)} 5 1 57 1 14 9 2104 1770 13 21 89.064789 $ 4 1 57 1 15 0 195 1810 1921 31 -1 5 1 57 1 15 1 195 1816 19 25 83.086227 X 5 1 57 1 15 2 225 1799 16 46 57.158756 | 5 1 57 1 15 3 249 1811 40 19 57.158756 HIR 5 1 57 1 15 4 467 1816 19 25 91.044930 X 5 1 57 1 15 5 497 1799 16 46 96.390717 | 5 1 57 1 15 6 521 1810 153 20 96.017021 NON-OWNED 5 1 57 1 15 7 1744 1810 129 26 96.567528 PROPERTY 5 1 57 1 15 8 1880 1810 102 19 96.256516 DAMAGE 5 1 57 1 15 9 2104 1818 12 22 90.856331 $ 4 1 57 1 16 0 174 1812 1718 52 -1 5 1 57 1 16 1 174 1824 34 40 43.676460 |” 5 1 57 1 16 2 224 1824 14 40 88.278488 | 5 1 57 1 16 3 248 1812 81 42 87.511223 AUTOS 5 1 57 1 16 4 338 1824 63 40 96.977837 ONLY 5 1 57 1 16 5 520 1835 82 19 96.367851 AUTOS 5 1 57 1 16 6 611 1835 64 19 96.954521 ONLY 5 1 57 1 16 7 1744 1833 43 23 78.740646 (Per 5 1 57 1 16 8 1796 1832 96 21 78.740646 accident) 4 1 57 1 17 0 2104 1867 12 22 -1 5 1 57 1 17 1 2104 1867 12 22 90.043251 $ 4 1 57 1 18 0 131 1909 2113 37 -1 5 1 57 1 18 1 131 1913 18 19 84.900543 c 5 1 57 1 18 2 249 1917 130 20 96.646179 UMBRELLA 5 1 57 1 18 3 386 1917 52 20 96.180801 LIAB 5 1 57 1 18 4 509 1914 19 25 92.013359 X 5 1 57 1 18 5 541 1910 15 40 96.186272 | 5 1 57 1 18 6 562 1928 89 18 94.081932 occur 5 1 57 1 18 7 895 1914 166 22 91.807869 25ABEX0150 5 1 57 1 18 8 1387 1909 122 34 95.774307 10/9/2026 5 1 57 1 18 9 1575 1913 122 22 75.785103 10/9/2027 5 1 57 1 18 10 1719 1909 14 38 75.785103 | 5 1 57 1 18 11 1744 1925 63 18 52.975502 exact 5 1 57 1 18 12 1814 1924 171 19 89.454849 OCCURRENCE 5 1 57 1 18 13 2103 1921 141 25 67.730301 $4,000,000 4 1 57 1 19 0 177 1945 56 10 -1 5 1 57 1 19 1 177 1945 56 10 45.904617 +——_ 4 1 57 1 20 0 194 1962 2050 40 -1 5 1 57 1 20 1 194 1962 19 24 93.110458 X 5 1 57 1 20 2 223 1955 14 40 96.413025 | 5 1 57 1 20 3 248 1966 94 19 96.239220 EXCESS 5 1 57 1 20 4 350 1966 52 19 96.232140 LIAB 5 1 57 1 20 5 562 1962 166 40 91.853867 CLAIMS-MADE 5 1 57 1 20 6 1743 1973 149 19 96.396515 AGGREGATE 5 1 57 1 20 7 2103 1971 12 22 91.972733 $ 5 1 57 1 20 8 2122 1969 122 25 96.103477 4,000,000 4 1 57 1 21 0 248 2002 1867 44 -1 5 1 57 1 21 1 248 2024 50 18 96.005432 DED 5 1 57 1 21 2 317 2002 5 44 80.834282 | 5 1 57 1 21 3 374 2002 5 44 93.019524 | 5 1 57 1 21 4 392 2023 135 19 86.833008 RETENTION 5 1 57 1 21 5 533 2023 12 21 86.833008 $ 5 1 57 1 21 6 2103 2019 12 23 92.699844 $ 4 1 57 1 22 0 130 2052 1929 28 -1 5 1 57 1 22 1 130 2057 18 20 44.986977 A 5 1 57 1 22 2 170 2051 15 41 0.000000 | 5 1 57 1 22 3 183 2057 121 19 0.000000 WORKERS 5 1 57 1 22 4 312 2058 188 19 96.286591 COMPENSATION 5 1 57 1 22 5 894 2058 308 22 31.680517 6JUB-1W'11896-8-26(AZ 5 1 57 1 22 6 1387 2058 122 21 95.915886 10/9/2026 5 1 57 1 22 7 1529 2049 18 41 95.915886 | 5 1 57 1 22 8 1575 2058 121 22 95.344742 10/9/2027 5 1 57 1 22 9 1799 2052 48 18 88.990150 PER 5 1 57 1 22 10 2001 2052 58 18 91.045341 OTH- 4 1 57 1 23 0 183 2050 1851 65 -1 5 1 57 1 23 1 183 2085 50 19 93.265022 AND 5 1 57 1 23 2 241 2085 151 19 85.614159 EMPLOYERS' 5 1 57 1 23 3 400 2085 109 19 96.975166 LIABILITY 5 1 57 1 23 4 667 2095 52 20 83.456604 YIN 5 1 57 1 23 5 1159 2058 52 28 28.677683 (AZ) 5 1 57 1 23 6 1733 2059 17 25 75.525787 X_| 5 1 57 1 23 7 1799 2073 106 19 89.635201 statute 5 1 57 1 23 8 1984 2050 5 44 57.749802 | 5 1 57 1 23 9 2002 2073 32 19 96.954597 ER 4 1 57 1 24 0 178 2106 2065 58 -1 5 1 57 1 24 1 178 2106 458 58 56.368462 ANYPROPRIETOR/PARTNERIEXECUTIVE 5 1 57 1 24 2 1743 2117 39 20 84.849655 E.L. 5 1 57 1 24 3 1791 2117 64 20 96.996361 EACH 5 1 57 1 24 4 1862 2117 123 20 96.727104 ACCIDENT 5 1 57 1 24 5 2102 2116 13 22 93.131371 $ 5 1 57 1 24 6 2124 2115 119 24 96.690346 1,000,000 4 1 57 1 25 0 183 2135 615 26 -1 5 1 57 1 25 1 183 2141 317 20 91.277603 OFFICER/MEMBEREXCLUDE 5 1 57 1 25 2 746 2135 52 19 62.653053 NIA 4 1 57 1 26 0 183 2154 2060 62 -1 5 1 57 1 26 1 183 2165 134 31 96.336273 (Mandatory 5 1 57 1 26 2 319 2165 19 19 96.256554 in 5 1 57 1 26 3 346 2154 38 62 49.417072 NH) 5 1 57 1 26 4 1743 2166 38 20 85.869080 E.L. 5 1 57 1 26 5 1790 2166 102 20 92.973022 DISEASE 5 1 57 1 26 6 1899 2176 8 4 92.973022 - 5 1 57 1 26 7 1914 2166 32 19 96.791916 EA 5 1 57 1 26 8 1953 2166 131 19 87.481117 EMPLOYEE] 5 1 57 1 26 9 2102 2165 13 21 90.475998 $ 5 1 57 1 26 10 2123 2163 120 25 96.304352 1,000,000 4 1 57 1 27 0 216 2211 2027 27 -1 5 1 57 1 27 1 216 2208 129 28 89.769951 SCRIPTION 5 1 57 1 27 2 352 2197 32 39 94.775749 OF 5 1 57 1 27 3 392 2198 154 38 95.250671 OPERATIONS 5 1 57 1 27 4 554 2217 65 19 96.155861 below 5 1 57 1 27 5 1742 2215 39 19 84.960411 E.L. 5 1 57 1 27 6 1790 2215 102 19 92.830856 DISEASE 5 1 57 1 27 7 1899 2224 9 4 92.816017 - 5 1 57 1 27 8 1915 2215 87 19 94.405167 POLICY 5 1 57 1 27 9 2010 2215 61 18 95.186417 LIMIT 5 1 57 1 27 10 2081 2203 11 40 91.122070 | 5 1 57 1 27 11 2102 2214 13 21 66.828903 $ 5 1 57 1 27 12 2123 2211 120 27 93.131439 1,000,000 4 1 57 1 28 0 130 2244 2113 39 -1 5 1 57 1 28 1 130 2250 17 19 93.199051 D 5 1 57 1 28 2 160 2246 14 38 94.235558 | 5 1 57 1 28 3 188 2250 38 19 96.862289 2nd 5 1 57 1 28 4 235 2250 75 19 86.317619 Excess 5 1 57 1 28 5 893 2245 211 38 22.099094 GC1l0010017-261 5 1 57 1 28 6 1385 2244 123 37 93.163376 10/9/2026 5 1 57 1 28 7 1573 2250 122 22 77.225662 10/9/2027 5 1 57 1 28 8 1714 2242 17 38 71.068611 | 5 1 57 1 28 9 1738 2249 51 20 96.293991 Each 5 1 57 1 28 10 1796 2249 124 20 94.966362 Occurrence 5 1 57 1 28 11 2121 2246 122 24 89.782845 5,000,000 4 1 57 1 29 0 1736 2268 507 34 -1 5 1 57 1 29 1 1736 2268 109 34 94.591087 Aggregate 5 1 57 1 29 2 2121 2273 122 26 58.763321 5,000,000 2 1 58 0 0 0 1725 1273 9 1115 -1 3 1 58 1 0 0 1725 1273 9 1115 -1 4 1 58 1 1 0 1725 1273 9 1115 -1 5 1 58 1 1 1 1725 1273 9 1115 95.000000 2 1 59 0 0 0 1350 1272 9 1117 -1 3 1 59 1 0 0 1350 1272 9 1117 -1 4 1 59 1 1 0 1350 1272 9 1117 -1 5 1 59 1 1 1 1350 1272 9 1117 95.000000 2 1 60 0 0 0 1539 1273 9 1115 -1 3 1 60 1 0 0 1539 1273 9 1115 -1 4 1 60 1 1 0 1539 1273 9 1115 -1 5 1 60 1 1 1 1539 1273 9 1115 95.000000 2 1 61 0 0 0 173 1273 9 1116 -1 3 1 61 1 0 0 173 1273 9 1116 -1 4 1 61 1 1 0 173 1273 9 1116 -1 5 1 61 1 1 1 173 1273 9 1116 95.000000 2 1 62 0 0 0 733 1274 9 1115 -1 3 1 62 1 0 0 733 1274 9 1115 -1 4 1 62 1 1 0 733 1274 9 1115 -1 5 1 62 1 1 1 733 1274 9 1115 95.000000 2 1 63 0 0 0 805 1294 9 1095 -1 3 1 63 1 0 0 805 1294 9 1095 -1 4 1 63 1 1 0 805 1294 9 1095 -1 5 1 63 1 1 1 805 1294 9 1095 95.000000 2 1 64 0 0 0 876 1294 9 1095 -1 3 1 64 1 0 0 876 1294 9 1095 -1 4 1 64 1 1 0 876 1294 9 1095 -1 5 1 64 1 1 1 876 1294 9 1095 95.000000 2 1 65 0 0 0 2085 1321 9 1067 -1 3 1 65 1 0 0 2085 1321 9 1067 -1 4 1 65 1 1 0 2085 1321 9 1067 -1 5 1 65 1 1 1 2085 1321 9 1067 95.000000 2 1 66 0 0 0 98 2373 2307 23 -1 3 1 66 1 0 0 98 2373 2307 23 -1 4 1 66 1 1 0 98 2373 2307 23 -1 5 1 66 1 1 1 98 2373 2307 23 95.000000 2 1 67 0 0 0 115 2399 2187 152 -1 3 1 67 1 0 0 115 2399 1640 29 -1 4 1 67 1 1 0 115 2399 1640 29 -1 5 1 67 1 1 1 115 2400 160 19 96.430626 DESCRIPTION 5 1 67 1 1 2 284 2400 32 19 96.227509 OF 5 1 67 1 1 3 323 2400 152 19 93.157173 OPERATIONS 5 1 67 1 1 4 483 2400 7 19 92.492569 / 5 1 67 1 1 5 496 2400 139 19 92.700363 LOCATIONS 5 1 67 1 1 6 642 2401 7 18 92.549057 / 5 1 67 1 1 7 655 2400 117 28 93.280342 VEHICLES 5 1 67 1 1 8 785 2400 92 23 73.284180 (ACORD 5 1 67 1 1 9 885 2400 44 21 83.839775 101, 5 1 67 1 1 10 936 2400 114 19 96.452248 Additional 5 1 67 1 1 11 1059 2400 99 19 96.576721 Remarks 5 1 67 1 1 12 1166 2400 109 21 96.996750 Schedule, 5 1 67 1 1 13 1283 2405 44 23 96.630455 may 5 1 67 1 1 14 1335 2400 25 19 96.630455 be 5 1 67 1 1 15 1368 2400 95 19 96.678513 attached 5 1 67 1 1 16 1471 2400 15 19 96.113258 if 5 1 67 1 1 17 1493 2404 56 15 97.002174 more 5 1 67 1 1 18 1556 2404 67 18 96.963821 space 5 1 67 1 1 19 1631 2399 18 20 83.343040 is 5 1 67 1 1 20 1656 2399 99 28 96.835892 required) 3 1 67 2 0 0 119 2421 2183 66 -1 4 1 67 2 1 0 119 2421 2183 34 -1 5 1 67 2 1 1 119 2423 142 25 86.075691 Additional 5 1 67 2 1 2 273 2423 102 25 96.784325 Insured 5 1 67 2 1 3 387 2423 133 25 96.921295 extension 5 1 67 2 1 4 531 2423 27 25 96.997986 of 5 1 67 2 1 5 567 2430 131 25 96.943443 coverage 5 1 67 2 1 6 709 2423 20 25 96.988670 is 5 1 67 2 1 7 741 2423 119 31 96.704025 provided 5 1 67 2 1 8 871 2423 33 32 96.704025 by 5 1 67 2 1 9 914 2415 84 33 96.928169 above 5 1 67 2 1 10 1009 2423 152 25 96.732971 referenced 5 1 67 2 1 11 1173 2415 111 33 96.826958 General 5 1 67 2 1 12 1296 2421 103 34 96.818153 Liability 5 1 67 2 1 13 1408 2423 51 25 96.471596 and 5 1 67 2 1 14 1470 2423 66 25 96.453590 Auto 5 1 67 2 1 15 1548 2422 104 33 96.453590 Liability 5 1 67 2 1 16 1663 2422 103 32 95.705353 policies 5 1 67 2 1 17 1775 2422 86 25 96.751129 where 5 1 67 2 1 18 1873 2422 115 32 96.751129 required 5 1 67 2 1 19 2000 2421 32 33 97.011124 by 5 1 67 2 1 20 2041 2421 93 26 95.712929 written 5 1 67 2 1 21 2146 2422 156 31 95.940933 agreement. 4 1 67 2 2 0 121 2456 515 31 -1 5 1 67 2 2 1 121 2456 67 25 96.661736 Date 5 1 67 2 2 2 198 2456 29 24 96.803535 of 5 1 67 2 2 3 235 2456 110 31 96.804306 Display: 5 1 67 2 2 4 357 2456 145 25 96.553612 November 5 1 67 2 2 5 513 2456 39 28 96.540436 11, 5 1 67 2 2 6 564 2456 72 25 96.422562 2026 3 1 67 3 0 0 121 2487 1049 33 -1 4 1 67 3 1 0 121 2487 1049 33 -1 5 1 67 3 1 1 121 2488 120 25 96.286690 Location 5 1 67 3 1 2 252 2488 27 25 96.286690 of 5 1 67 3 1 3 289 2487 109 33 96.153175 Display: 5 1 67 3 1 4 410 2488 97 31 96.358475 Coyote 5 1 67 3 1 5 519 2476 56 37 96.929146 Run 5 1 67 3 1 6 588 2487 60 26 96.958237 Golf 5 1 67 3 1 7 655 2488 101 25 96.048965 Course 5 1 67 3 1 8 767 2489 25 24 96.504120 at 5 1 67 3 1 9 803 2488 101 25 96.642067 Leisure 5 1 67 3 1 10 914 2487 81 26 96.476509 World 5 1 67 3 1 11 1006 2487 164 32 95.096611 Community 3 1 67 4 0 0 119 2519 2154 32 -1 4 1 67 4 1 0 119 2519 2154 32 -1 5 1 67 4 1 1 119 2519 141 26 92.265121 Additional 5 1 67 4 1 2 273 2520 148 31 88.944763 Insured(s): 5 1 67 4 1 3 432 2520 72 25 96.699059 State 5 1 67 4 1 4 515 2520 27 25 97.017952 of 5 1 67 4 1 5 549 2520 117 28 96.224098 Arizona; 5 1 67 4 1 6 679 2520 128 30 96.709358 Maricopa 5 1 67 4 1 7 818 2520 106 31 96.605682 County; 5 1 67 4 1 8 937 2519 72 26 96.647400 Rural 5 1 67 4 1 9 1021 2519 81 26 96.299614 Metro 5 1 67 4 1 10 1114 2519 53 25 96.476715 Fire 5 1 67 4 1 11 1178 2520 170 30 96.708252 Department; 5 1 67 4 1 12 1360 2519 102 25 96.453682 Leisure 5 1 67 4 1 13 1473 2519 83 25 96.376396 World 5 1 67 4 1 14 1567 2519 160 31 96.319618 Community 5 1 67 4 1 15 1737 2519 168 28 94.547974 Association; 5 1 67 4 1 16 1918 2519 100 31 96.724724 Coyote 5 1 67 4 1 17 2030 2519 56 25 96.687721 Run 5 1 67 4 1 18 2098 2519 58 25 96.848541 Golf 5 1 67 4 1 19 2164 2519 109 24 84.706635 Course. 2 1 68 0 0 0 96 2662 2307 23 -1 3 1 68 1 0 0 96 2662 2307 23 -1 4 1 68 1 1 0 96 2662 2307 23 -1 5 1 68 1 1 1 96 2662 2307 23 95.000000 2 1 69 0 0 0 113 2689 1414 27 -1 3 1 69 1 0 0 113 2689 1414 27 -1 4 1 69 1 1 0 113 2689 1414 27 -1 5 1 69 1 1 1 113 2690 222 26 95.830162 CERTIFICATE 5 1 69 1 1 2 349 2690 138 26 96.664146 HOLDER 5 1 69 1 1 3 1266 2689 261 26 96.910736 CANCELLATION 2 1 70 0 0 0 96 2710 2306 23 -1 3 1 70 1 0 0 96 2710 2306 23 -1 4 1 70 1 1 0 96 2710 2306 23 -1 5 1 70 1 1 1 96 2710 2306 23 95.000000 2 1 71 0 0 0 1293 2772 1063 60 -1 3 1 71 1 0 0 1293 2772 1063 60 -1 4 1 71 1 1 0 1294 2772 1062 24 -1 5 1 71 1 1 1 1294 2773 114 23 95.713417 SHOULD 5 1 71 1 1 2 1417 2773 58 23 96.579384 ANY 5 1 71 1 1 3 1485 2773 38 23 96.021957 OF 5 1 71 1 1 4 1531 2773 57 23 96.397835 THE 5 1 71 1 1 5 1597 2773 98 23 96.903336 ABOVE 5 1 71 1 1 6 1704 2773 160 23 96.229904 DESCRIBED 5 1 71 1 1 7 1874 2773 130 23 95.946251 POLICIES 5 1 71 1 1 8 2014 2773 37 23 96.961990 BE 5 1 71 1 1 9 2061 2772 171 24 96.355446 CANCELLED 5 1 71 1 1 10 2242 2772 114 23 96.163055 BEFORE 4 1 71 1 2 0 1293 2806 1062 26 -1 5 1 71 1 2 1 1293 2807 54 22 96.233971 THE 5 1 71 1 2 2 1375 2807 170 22 95.061684 EXPIRATION 5 1 71 1 2 3 1575 2807 75 22 94.782417 DATE 5 1 71 1 2 4 1678 2806 138 26 94.782417 THEREOF, 5 1 71 1 2 5 1846 2806 104 23 96.410446 NOTICE 5 1 71 1 2 6 1978 2806 70 22 96.410446 WILL 5 1 71 1 2 7 2076 2807 38 21 95.923798 BE 5 1 71 1 2 8 2142 2806 158 22 95.958786 DELIVERED 5 1 71 1 2 9 2329 2806 26 21 94.715622 IN 2 1 72 0 0 0 308 2840 1624 47 -1 3 1 72 1 0 0 308 2840 1624 47 -1 4 1 72 1 1 0 308 2840 1624 47 -1 5 1 72 1 1 1 308 2851 114 29 96.128853 Leisure 5 1 72 1 1 2 432 2852 91 28 96.941933 World 5 1 72 1 1 3 536 2851 183 36 96.389641 Community 5 1 72 1 1 4 729 2851 181 29 95.977768 Association 5 1 72 1 1 5 1293 2840 200 22 96.062859 ACCORDANCE 5 1 72 1 1 6 1500 2840 71 22 96.575935 WITH 5 1 72 1 1 7 1579 2840 56 22 96.483719 THE 5 1 72 1 1 8 1644 2840 101 22 96.215187 POLICY 5 1 72 1 1 9 1753 2840 179 22 86.792007 PROVISIONS, 2 1 73 0 0 0 306 2888 1329 64 -1 3 1 73 1 0 0 306 2888 1329 64 -1 4 1 73 1 1 0 307 2888 324 35 -1 5 1 73 1 1 1 307 2888 124 28 96.139000 Finance 5 1 73 1 1 2 444 2888 187 35 96.139000 Department 4 1 73 1 2 0 306 2923 1329 29 -1 5 1 73 1 2 1 306 2925 57 27 93.297012 908 5 1 73 1 2 2 375 2923 29 29 92.436340 S. 5 1 73 1 2 3 421 2924 99 28 96.481941 Power 5 1 73 1 2 4 531 2923 84 29 96.902679 Road 5 1 73 1 2 5 1265 2929 151 19 96.496376 AUTHORIZED 5 1 73 1 2 6 1422 2929 213 19 96.147919 REPRESENTATIVE 2 1 74 0 0 0 306 2954 1156 94 -1 3 1 74 1 0 0 306 2954 1156 94 -1 4 1 74 1 1 0 306 2954 1156 94 -1 5 1 74 1 1 1 306 2960 84 28 96.215706 Mesa 5 1 74 1 1 2 402 2960 45 28 96.571487 AZ 5 1 74 1 1 3 458 2961 96 27 96.391609 85206 5 1 74 1 1 4 1308 2961 36 50 0.000000 / 5 1 74 1 1 5 1419 2954 43 94 0.000000 /. 2 1 75 0 0 0 1248 2907 1154 15 -1 3 1 75 1 0 0 1248 2907 1154 15 -1 4 1 75 1 1 0 1248 2907 1154 15 -1 5 1 75 1 1 1 1248 2907 1154 15 95.000000 2 1 76 0 0 0 2398 164 17 2897 -1 3 1 76 1 0 0 2398 164 17 2897 -1 4 1 76 1 1 0 2398 164 17 2897 -1 5 1 76 1 1 1 2398 164 17 2897 95.000000 2 1 77 0 0 0 1247 2720 6 343 -1 3 1 77 1 0 0 1247 2720 6 343 -1 4 1 77 1 1 0 1247 2720 6 343 -1 5 1 77 1 1 1 1247 2720 6 343 95.000000 2 1 78 0 0 0 1531 3052 871 13 -1 3 1 78 1 0 0 1531 3052 871 13 -1 4 1 78 1 1 0 1531 3052 871 13 -1 5 1 78 1 1 1 1531 3052 871 13 95.000000 2 1 79 0 0 0 94 3054 1168 13 -1 3 1 79 1 0 0 94 3054 1168 13 -1 4 1 79 1 1 0 94 3054 1168 13 -1 5 1 79 1 1 1 94 3054 1168 13 95.000000 2 1 80 0 0 0 110 3036 2273 115 -1 3 1 80 1 0 0 110 3036 2273 115 -1 4 1 80 1 1 0 298 3036 1224 22 -1 5 1 80 1 1 1 298 3036 4 22 64.786446 | 5 1 80 1 1 2 1518 3043 4 3 0.000000 ~ 4 1 80 1 2 0 110 3070 2273 34 -1 5 1 80 1 2 1 110 3071 124 27 91.636398 ACORD 5 1 80 1 2 2 246 3072 35 26 96.515999 25 5 1 80 1 2 3 292 3071 140 33 96.515999 (2025/12) 5 1 80 1 2 4 1466 3071 28 26 95.678673 © 5 1 80 1 2 5 1504 3071 158 26 93.078751 1988-2025 5 1 80 1 2 6 1673 3071 119 25 92.076622 ACORD 5 1 80 1 2 7 1803 3071 260 25 96.581360 CORPORATION. 5 1 80 1 2 8 2082 3071 42 25 89.446060 All 5 1 80 1 2 9 2135 3070 90 32 89.446060 rights 5 1 80 1 2 10 2237 3070 146 26 96.275620 reserved. 4 1 80 1 3 0 788 3119 948 32 -1 5 1 80 1 3 1 788 3120 60 26 89.464943 The 5 1 80 1 3 2 857 3119 120 27 89.464943 ACORD 5 1 80 1 3 3 990 3125 85 21 96.709053 name 5 1 80 1 3 4 1087 3119 58 27 95.989746 and 5 1 80 1 3 5 1158 3119 67 32 95.703056 logo 5 1 80 1 3 6 1236 3125 49 21 96.881752 are 5 1 80 1 3 7 1296 3119 156 31 93.979797 registered 5 1 80 1 3 8 1465 3119 98 27 95.855568 marks 5 1 80 1 3 9 1574 3119 33 27 93.180443 of 5 1 80 1 3 10 1615 3119 121 26 92.319748 ACORD Leisure World NMlesa 693 ee Lei World Site ; Map Maximum ' Shell Size: ‘ 1.5” Basins ‘ Fireworks Productions of Arizona 480-948-0090 info@fireworksaz.com EXHIBIT A LEISURE WORLD COMMUNITY Mesa Wednesday, November 11, 2026 5 —6 minute display 1,200 Basin Effects This celebration contains a combination of fiery color and sparkling fireworks to thrill and electrify the competitors, attendees and their guests. 5 -6 Minute Aerial Basin Display: Your Aerial Basin Display will contain a total of 1,200 aerial basin effects (including numerous Basins using Red, White and Blue effects) 1.5” - 12 FPA Premier Multi-shot Specialty Basins (5 - 10 seconds between basins; pause before the GF) (9 Multi-shot Basins fired one after another or together followed by 3 Multi-shot Basins fired simultaneously for the Grand Finale) Designed for the [ eisure World C ommunity by Fireworks Productions of Arizona ‘a City of Phoenix FIRE DEPARTMENT FIRE PREVENTION SECTION Pyrotechnician Certificate of Fitness Cody Welty PY-00297 Expiration Date: 05/04/2029 The above individual has been issued a Pyrotechnician Certificate of Fitness in accordance with the Phoenix Fire Code §105.11. This Certificate of Fitness is not transferable and expires on the date listed above. This Certificate of Fitness does not represent endorsement or employment by the Phoenix Fire Department or the City of Phoenix. John Mertens City of Phoenix Fire Marshal Callie Hunt (COB) From: Cindy Herbel <cindy@fireworksaz.com> Sent: Tuesday, October 6, 2026 11:01 AM To: Clerk of the Board of Supervisors - COBX Ce: Callie Hunt (COB) Subject: Fw: Fireworks - Nov 11 - Leisure World Community This Message Is From an Untrusted Sender You have not previously corresponded with this sender. Please use caution when you receive messages from new senders. Always validate the sender first. Hello, Below is the email from Rural Metro that they are aware of and approve the Nov 11 display at Leisure World. Let me know if you need anything else from me at this time. Thank you, Herbel Cindy Pyro Administrative 4 MH Assistant Fireworks # > Productions of Arizona 480-948-0090 (office) 480-423-5430 (fax) 1-877-948-0090 (toll-free) 17034 S. 54th Street, Chandler, AZ 85226 From: Kenneth Diamond <Kenneth.Diamond@ruralmetrofire.com> Sent: Tuesday, October 6, 2026 10:15 AM To: Cindy Herbel <cindy@fireworksaz.com> Subject: Re: Fireworks - Nov 11 - Leisure World Community Hi Cindy |am aware and approve of your plan. Thank you Kenneth Diamond Fire Marshal Fire Plans Examiner Central Arizona Fire Operations kenneth.diamond@ruralmetrofire.net (480) 869-2340 www.ruralmetrofire.com Certified Fire Plans From: Cindy Herbel <cindy@fireworksaz.com> Sent: Monday, October 5, 2026 3:05 PM To: Kenneth Diamond <kenneth.diamond@ruralmetrofire.com> Subject: [EXTERNAL] Fireworks - Nov 11 - Leisure World Community | maa Hello again, Attached is the following for a fireworks display for Leisure World — Veterans Day - Wednesday, Nov 11: e Notification letter e Show Program e Site Map e Col Please let me know if you have any questions or need anything else. If you have no objection, please let me know and | will include that response with our Maricopa County application. Herlel Cindy Pyro Administrative Assistant Fireworks |» Productions of Arizona 480-948-0090 (office) 480-423-5430 (fax) 1-877-948-0090 (toll-free) 17034 S. 54th Street, Chandler, AZ 85226