ANTHEM FIREWORKS DISPLAY-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 feast 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 INFORMATIONName/Organization: Anthem
Name of Event: July 3rd, 2026 Fireworks Display

Event Address:41130 N. Freedom Way, Phoenix, AZ. 85086
| Date and Time of Event: July 3rd, 2026 @ 9:00 PM

DISPLAY DIRECTOR (permit will be issued to the following}

Fs
; Name: Randy Reyman Phone

Business: Reyman Pyrotechniques/Any Pyro Fax:

SUBMIT APPLICATION AND REQUIRED DOCUMENTATION TO:

Maricopa County Clerk of the Board of Supervisors Email: ClerkBoard@maricopa.gov
301 W. Jefferson Street, 10" Floor Fax: 602-506-6402
Phoenix, AZ 85003

For questions, please call the Clerk of the Board of Supervisors at: 602-506-3766
FIREWORKS DISPLAY SITE MAP
indicate the following:
North direction
Distance from firing area to impact/fallout area

Spectator location
Storage area

Fire department access
Hydrants

Distance to structures
Overhead lines

RECEIVED

FEB 1 3 2026

PON ss
PN AA

MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

(North)

FOR DEPARTMENT 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 on:

DATED this day of 20

Clerk of the Board, Authorized Signature

3
~ DATE (MMNDDIYYYY)

ACOR CERTIFICATE OF LIABILITY INSURANCE seuoom
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: ff the certificate holder is an ADDITIONAL INSURED, the policy(ies} must be endorsed. !f 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 endorsemant(s).

PRODUCER GORTACT ctw Wolfe
Ryder Rosacker McCue & Huston (MGD by Hull & Company) bnoNe . a PEAK re
609 W Koenig St IAC, Ho, Ext IAG,
Grand Isfand NE 68801 Aopress: a nee
INSURER(S) AFFORDING COVERAGE NAIC
INSURER A: SCOTTSDALE INS CO _. . _. 44297
INSURED INSURER B:
Reyman Pyrotechniques / Any Pyro — oe
INSURER C : nae oe
INSURER O we
WWSURERES
INSURER F |
COVERAGES CERTIFICATE NUMBER: 1844388335 REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO 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 ADDL SUBR POLICY EFF ~ POLICY EXP °
LIR TYPE OF INSURANCE INSR WyD POLICY HUMBER (MIDDAY YY): (MMUDDAVYYY) UUMITS

A GENERAL LIABILITY CP17222661 6/2025 a92026 y
; EACH OCCURRENCE § 2,000,000
OAMAGE TO RENTEO
x _ COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $100,000.
cLaims-MaoE =X cecur MED EXP (Anyone person) $6,000
PERSONAL & ADV INJUF
| GENERAL AGGREGATE 0.0
GENT AGGREGATE LIMIT APELIES HER | PRODUCTS - COMP/OP AGG . § 2,000,000 J
X_roucy ERO Loc $
T COMBINED SINGLE LIMIT
AUTOMOBILE LIAGILITY ) (Ea acadant) oj
ANY AUTO BODILY INJURY (Perperson) |S
ALL OBNEO Sgymguteo GODILY INJURY (Per accident} $
NON-OWHED PROPERTY DAMAGE “Ss ~
HIRE AUTOS AUTOS (Per ncedent) _. .
$
UMBRELLA LIAB OCCUR _ EACH OCCURRENCE $
EXCESS UAB CLAIMS-MADE _ AGGREGATE .
beD RETENTION $ : $
WORKERS COMPENSATION j Vic STATU- OTH
ANO EMPLOYERS’ LIABILITY yn 1 ETORY LIMITS, ..___ER_
ANY PROPRIETORPARTNER EXECUTIVE [—— € L. EACH ACCIDENT $
OF MOL RE MBER FXCLUDED? [ | NIA i ~~ :
{Mandatory in HH) aa EL. DISEASE - EA EMPLOYEE $
Wyos. du cnbe under | “A EMPLOY!
DESCRIBTION OF OPERATIONS buon | E.L DISEASE - POLICY LIMIT. §

DESCRIPTION OF OPERATIONS | LOCATIONS / VEHICLES (Attach ACORD 101. Additionat Romarks Schaduta, If more space is required)

Regarding the General Liability coverage, Primary and Non-Coninbulory coverage applies to the entities listed below per allached form CG 20 04 when
fequired by weilten agreement.

Reyarging the General Liability coveraye, Waiver of Subrogation applies to the entities listed below per attached form CG 24 53 when required by written
Agremem

Regarding the General Liability coverage. Blanket Additional Insured applies to the entities listed below per atlached form GLS-150s when required by writen.
ayrecatent,

Additional tasuteds: Anthem Gommunily Councit Inc.: Anthem Parkside Community Association Inc.: Anthem Country Club Community Association Inc.;
Maricopa County, State of Arizona, Daisy Mountain Fire District.; AAMLLC, their respective and affitiated entities and all of their respective directors, officers,
Pariners, members, employees, and agents are hereby named as additional insured. Insurance is primary and noncontributory.

CERTIFICATE HOLDER CANCELLATION

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

Anthem Community Council
3701 W Anthem Way Ste #201
Anthem AZ 85086

AUTHORIZEO REPRESENTATIVE

© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD

Reyman Pyrotechniques/Any Pyro

Anthem 7/3/2026

Content of display

Following is the shell content of the display:
2 1/2 inch shells-46

3 inch shells-144

4 inch shells-144

5 inch shells-54

6 inch shells-36

of Roo Hoetriylans
tt Tayestivatons

MEMBER 1D:

RANDY L.
REY WAN

BS

KSSOGIAn™ Roatan: L-

OPI,

a > City of Flagstaff Fire Departrnent
211 W. Asien Avenue
Flagstaff, AZ, 86004

Tic ae

Pyrotechnics Permit

Randy Reyman

Pormit Holder;
BAZ 103233

Fire Inspector

|
Dato Issued: C2 Ej

U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives

Federal Explosives License/Permit
(18 U.S.C. Chapter 40)

TAN ore Eee TEL TE CTA TTT

In accordance with the provisions of Title X1, Organized Crime Control Act of 1970, and the regulations issued thereunder (27 CFR Part 555), you may engage in
the activity specified in this license or permit within the limitations of Chapter 40, Title 18, United States Code and the regulations issued thereunder, until the
expiration date shown, THIS LICENSE IS NOT TRANSFERABLE UNDER 27 CFR 555.53. See "WARNINGS" and "NOTICES" on reverse.

Direct ATF ATE - Chief, FELC License/Permit
Correspondence To 244 Needy Road Number 9-AZ-01 3-21 -8H-03283
Martinsburg, WV 25405-9431 :
Chief, Federal Explosives Licensing Center (FELC) Expiration
“0 Tp. yf — Date August 1, 2028

Name
REYMAN PYROTECHNIQUES/ANY PYRO

Premises Address (Changes? Notify the FELC at least 10 days before the move.)

Type of License or Permit

21-MANUFACTURER OF EXPLOSIVES

Purchasing Certification Statement
The licensee or permittee named above shall use a copy of this license or pennit to assist a
transferor of explosives to verify the identity and the licensed status of the Jicensze or
permittee as provided by 27 CFR Part 555. ‘The signature on each copy must be an original

signature, A faxed, scanned or e-mailed copy of the license or permit with a signature
intended to be an original signature is acceptable. The signature must be that of the Federal
Explosives Licensee (FEL) or a responsible person of the FEL. I certify that this is a true
copy of a license or pennit issued to the licensee or permittee named above to engage in the

wee * specified ye under “Type of License or Permil."
bart) [PL bo~ OW wtr

Licetsed/Permittee Respbfisjble Pérson Signature Position Title
Rau, Key mAw ¢) Jame
Date

Prifted Name

Previous Edition is Obsolete

EYMAN, PANDY:12020 § AITH PLOCE 85040 AZ 412-21-24-03291 Aopen 1, 2028.21-MANUEACTUBEA OF EXPLOSYES

Mailing Address (Changes? Notify the FELC of any changes.)

REYMAN, RANDY
REYMAN PYROTECHNIQUES/ANY PYRO

ATF Foun 3400.14/5400.15 Fan i
Revised September 2011

Federal Explosives License (FEL) Customer Service Information

Federal Explosives Licensing Center (FELC)
244 Needy Road
Martinsburg, WV 25405-9431

Fax Number:
E-mail: FELC@atf.gov

Toll-free Telephone Number:

(877) 283-3352
(304) 616-4401

ATF Homepage: www.atf£gov

Change of Address (27 CFR 555.54(a)(1)). Licensees or permittees may during the term of their current license or permit remove their business or operations to a
new location at which they intend regularly to carry on such business or operations. ‘he licensee or permittee is required to give notification of the new location of the
business or operations not less than 10 days prior to such removal with the Chief, Federal Explosives Licensing Center. The license or permit will be valid for the
remainder of the term of the original license or permit. (The Chief, FELC, shall, if the licensee or permittee is not qualified, refer the request for amended license
or permit to the Director of Industry Operations for denial in accordance with § 555.54.)

Right of Succession (27 CFR 555.59. (a) Certain persons other than the licensee or permittee may secure the right to carry on the same explosive materials
business or operations at the same address shown on, and for the remainder of the term of, a current license or permit. Such persons are; (1) The surviving spouse
or child, or executor, administrator, or other legal representative of a deceased licensee or permittee, and (2) A receiver or trustee in bankruptey, or an assignee for
benefit of creditors. (b) In order to scoure the right provided by this section, the person or persons continuing the business or operations shall furnish the license or
permit for for that business or operations for endorsement of such succession to the Chief, FELC, within 30 days trom the date on which the successor begins to

carry on the business or operations,

Cut Here 3¢

Federal Explosives License/Permit (FEL) Information Card
License/Permit Name: REYMAN, RANDY

Business Name: REYMAN PYROTECHNIQUES/ANY PYRO

License/Permit Number: 9-AZ-013-21-8H-03233

License/Permit Type:21-MANUFACTURER OF EXPLOSIVES

Expiration: August 1, 2028

Please Note: Not Valid for the Sale or Other Disposition of Explosives.

(Continued on reverse side)

Seu ing

Ss Honyv7

Fire Marshal’s Office

Anthem AZ S08 DAISY MOUNTAIN
FIRE & MEDICAL

623-465-7400 x 119 HONORABLE « COMPASSIONATE + EXCEPTIONAL.
To: Maricopa County Planning & Development

From: Tim Wills, Fire Marshal

Date: February 12, 2026

Subject: Anthem Community Independence Day Pyrotechnics Display 2026

Daisy Mountain Fire District has issued Special Event Permit #260008 for several Anthem Community
Council events that are scheduled throughout 2026 including the annual Independence Day Celebration
on Friday July 3, 2026. This event culminates with the fireworks display scheduled to shoot at 9pm. See
attached Special Event Permit 2600008 attached. This event will take place at the Anthem Community
Park, 41703 N Gavilan Peak Pkwy, Anthem, AZ 85086.

The pyrotechnics operator ACC has contracted with is Randy Rayman, of Reyman Pyrotechniques/Any
Pyro. Reyman Pyrotechniques will be required to apply for a Fireworks Display Permit with Daisy
Mountain Fire District in the coming months to address Fire Code requirements. This company has a

multi-year history with ACC and DMFD for these annual events.

We look forward to working with Reyman Pyrotecniques, ACC and Maricopa County again this year,

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