AMERICAN LEADERSHIP ACADEMY - WEST FOOTHILLS 7-12_REDACTED.PDF

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: | American Leadership Academy - West Foothills 7-12

Name of Event: Graduation
Event Address: 17608 W Olive Ave. Waddell, AZ 85355

Date and Time of Event: Tuesday, May 19, 2026 at then end of graduation approximate! 8:30pm

DISPLAY DIRECTOR (permit will be issued to the following)

Name: Kendon Victor Phone: | sgX

Business: Fireworks Productions of Arizona Fax:

Address: 17034 S 54th St. Chandler AZ 85226 Email:

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

For questions, please call the Clerk of the Board of Supervisors at: oobRtee Kes = IVED
MAR 17 2026

ARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

FIREWORKS DISPLAY SITE MAP

Indicate the following:

Fire department access
Hydrants

Distance to structures
Overhead lines

North direction

Distance from firing area to impact/fallout area
Spectator location

Storage area

PeNs
PN HOH

(North)

f ea email to Clerk of the Board

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. IN THE 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

2 Vo
ACORD
.—

CERTIFICATE OF LIABILITY INSURANCE

DATE (MMIDDIYYYY)
2/26/2026

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.
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).

If SUBROGATION IS WAIVED, subject to

PRODUCER

Acrisure Great Lakes Partners Insurance Services
223 West Grand River Ave #1

Howell MI 48843

CORTACY

PHONE

INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Travelers Property Casualty Company of America 25674
EPA, Ltd, DBA: Fireworks Productions of Arizona INSURERS: Third! Coast Insurance Company /oma
17034 S 54th St INSURER C : Allianz Global Corporate & Specialty SE
Chandler AZ 85226 INSURER D : Everest Indemnity Insurance Company 10851
LINSURERE:
INSURER F ;

COVERAGES CERTIFICATE NUMBER; 3233573

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.

1NSR ADDL |SUBR)
LTR TYPE OF INSURANCE INSR| WvD POLICY NUMBER (MOBY) (MIIOBYYYY) LIMITS
B | GENERAL LIABILITY PYTP0000013-00 101972025 1019/2026 | EACH OCCURRENCE $1,000,000
a (AGE TO RENTED
X_| COMMERCIAL GENERAL LIABILITY PREMISES (ea occurrence) _| $ 500,000
| cLams.mane OccuR MED EXP (Any one person) | $
PERSONAL & ADV INJURY _| $ 1,000,000
GENERAL AGGREGATE $2,000,000 |
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - C AGG | $2,000,000
PI
pouicy | X | 58% | X | toc s
COMBINED SINGLE LIMIT
B | AUTOMOBILE LIABILITY PYTA0000000-00 4010/2025 torerao2s | COMBINED § $4,000,000
X | any AuTo BODILY INJURY (Per person) | $
ALL OWNED SCHEDULED :
X | uirevautos |X | autos (Per accident) s
$
c UMBRELLALIAB | X | occur 25ABEXO150 4019/2025 40/9/2026 | EACH OCCURRENCE $ 4,000,000
X | EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000
op |_| retentions $
‘A_| WORKERS COMPENSATION 6JUB-1W1 1898-8-25(AZ) 10/9/2025 40/9/2026 |X 1s ain ve] Ng
AND EMPLOYERS’ LIABILITY YIN
ANY PROPRIETORIPARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? NIA ~y
(Mandatory in NA E.L. DISEASE - EA EMPLOYER] $ 1,000,000
If yas, describe u
DESERISTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 1,000,000
D | 2nd Excess GC10010017-251 40/9/2026 40/9/2026 | Each Occurrence 5,000,000
Aggregate 5,000,000

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 and Auto Liability policies where required by written agreement.
026

Date of Display: May 19, 2
Location of Display: ‘ALA West Foothills 7-12 Waddell AZ

Additional Insured(s): State of Arizona; Maricopa County; Rural-Metro Fire Department; American Leadership Academy West Foothills 7-12.

CERTIFICATE HOLDER

CANCELLATION

American Leadership Academy West Foothills 7-12
17608 W Olive Ave

Waddell AZ 85355

USA

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.

Ly | REPRESENTATIVE

ACORD 25 (2010/05)

a 1988-2010 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

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EXHIBIT A

AMERICAN LEADERSHIP

ACADEMY- WEST FOOTHILLS
WADDELL

Tuesday, May 19, 2026
Graduation
2 minute display
Total Aerial Effects 182

In celebration of the Class of 2026 Seniors, a spectacular display of
fiery Red, White and Blue in the sky following graduation.

Opening: 2 -— 100mm Colored Mines
Aerial Display:
64 — Comets will rise up as individual fiery balls of color.
86 — Crossettes criss-crossing in the air bursting into a multitude of
Red, Silver and Blue colors.
Bombettes will fire in multiple volleys of glowing color.

8 aad
2 -— Large Color Mines burn brightly, high into the sky.

Grand Finale:
2 — Large Color Mines
16 — Color Crossettes

2 —- Large Glitter Crackle Mines

Designed for American Leadership Academy by: Fireworks Productions of Arizona

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City of Phoenix
FIRE DEPARTMENT
FIRE PREVENTION SECTION

Pyrotechnician
Certificate of Fitness

Kendon Victor

PY-00215

Expiration Date: 04/05/2027

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.

ny

John Mertens
City of Phoenix Fire Marshal

Callie Hunt (COB)

= Seer ne Serie 2 ee
From: Kenneth Diamond
Sent: Tuesday, March 17, 2026 1:02 PM
To: Cindy Herbel
Subject: Re: Fireworks - May 19 - ALA Westfoothills

Hello There

| have no issues with this display. | am aware of your fireworks shoot and | approve.

Kenneth Diamond
Fire Marshal
Fire Plans Examiner

@ ihetho

www.ruralmetrofire.com

Sent: Tuesday, March 17, 2026 12:50 PM
To: Kenneth Diamond
Subject: [EXTERNAL] Fireworks - May 19 - ALA Westfoothills

| aaa

Hello there!
One more graduation and because you are the guy for all of the valley — here you go! ©
Attached is the following for a graduation display American Leadership Academy West Foothills in
Waddell AZ on Tuesday, May 19:
e¢ Rural Metro Notification
e Show Program
e Site Map
e COl

When you get a chance please let me know if you have any questions or objections to this display so |
can submit to Maricopa County.

Thank you and have a great weekend!

Cindy Herlel

Pyro Administrative

Assistant / Fireworks
Productions
of Arizona y
480-948-0090 (office)
480-423-5430 (fax)
1-877-948-0090 (toll-free)

17034 S, 54th Street, Chandler, AZ 85226

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