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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 4 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, locatian 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
nat 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 Cily of Phoenix or have other verification of expertise.
4. Verification from local fire department that they were notified of event, date, location end time.
| EVENT INFORMATIONName/Organization: Anthem
i Name of Event: July 3rd.. 2025 Fireworks Display
| Event Address: 41130 N. Freedom Way, Phoenix, Adz. 85086
ik
i Date and Time of Event: July 3rd., 2025 @ 9:00 PM
DISPLAY DIRECTOR (permit will be issued to the following)
1 Name: Randy Reyman
| Business: Reyman Pyrotec niquesfAny Pyro
| Address: 12820 S 40th PL, Phoenix, AZ 85044
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 cali the Clerk of the Board of Supervisors at: 602-506-3766
FIREWORKS DISPLAY SITE MAP
Indicate the following:
1. North direction 5. Fire department access
2. Distance from firing area to impactifallout area 6. Hydrants
3. Spectator location 7. Distance to structures
4. Storage area 8. Overhead lin
RECEIVED
MAR 2 4 2025
MARICOPA
° Cou
LERK BOARD OF SUPERVISORG
(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
A ee rer fe me a a ame PRL IS i PP a a st
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
o als
—s" 3s DATE (MMDDVYYY}
ACORD CERTIFICATE OF LIABILITY INSURANCE eeuoonrey
THIS CERTIFIGATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO 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, tho policy{ias} must be endorsed, If SUBROGATION 1S WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this cortificate does not confer rights to the
certificate holder in lisu of such endorsement(s).
PRODUCER CONTACT fe
Ryder Rosacker McCue & Huston (MGD by Hull & Company) iw
908 W Koenig St
Grand tstand NE 68801
INSURED
Reyman Pyrotechniques / Any Pyro —
12820 S. 40th Place JSURER.G : seen
Phoenix AZ 85044 INSURER Bt _ eae
INSURER F : ‘
COVERAGES CERTIFICATE NUMBER: 458494778 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE (LISTED BELOW NAVE BEEN ISSUED TO THE INSUREO 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, IKE 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.
i
. ‘ADDS SUBR policy gee POLIGVEXP —
fi DPE OF INSURANCE ISR Wy POLICY NUMBER EQUNCDON YY) (MRD LnUTS
A: @LHERAL LIABILITY Crag z3ue Evesrs) 292025 EACH OCCURRENCE : § 2000.neo
ye “OAMAGE 10 RENTEC leans mn 7
X _ COAMERGIAL GENERAL LABILITY PASM SE ace) _3.109,005.
cams-stage | X | occur " $3.09
GEN AGGREGATE LIMIT APPLIES PER
PRE
JECT
X _poucy Loc } :
AUTOMOBILE UABILITY BE
Lo ANY AUTO ! IY (Fer persia) 8
ALLOWREO SCHEDULED ; $
a AUTOS AUTOS if a
__) RIRED AUTOS AUIS i § a |
i $
a UMBRELLALIAS = oncuR EACH GOCURRENCE {f
| EXCESS LAB | Cuasarae AGGRE if
OED |. RETENTIONS . we 3
WORK! TES ot
; WORKERS COMPENSATION wan Hrokv users. PgR ol
ANY PRCERIETOR- PAR INER EXECURYVE Ed. BACH ACCIDENT us
DEFICEHINIAER EXCLUDED? ina EL CISEASE - eA EMPLOYEE 5
Mandatory in . : E BASE +EAEMPLOVEE S$
Byes, Coprbe vader i
CASERETON GE OPERATIONS below i EL DISEASE POLICY UNIT | £
DESCRIPTION OF OPERATIONS | LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space fe required) ;
Regarding the Gonerat Liability coverage, Waiver of Subrogation applias to the entities listed below per attached form CG 24 04 when required by weitton
egreement. . .,
Ragardng the General Lisbility coverage, Blanket Additianat Insured applies to the entities listed below par attached form GLI-150s when required by wrilten
agreanent. .
Regarding the Generat Liability coverage, Primary and Non-Contibutory coverage applies to the entitles listed below par attached form CG 20 01 when
raquired by written agreement. | . . .
Addkional insureds: Anthem Community Council inc.; Anthem Parksice Community Assocation Inc,; Anthem Country Club Community Association Inc;
Maricopa County, State of Arizong, Daisy Mountain Fire Disviel.; AAMLLC, their respective and affiliated entitos and all of their respective directors. officers.
partners, membars, employees, and agenis are hereby named #5 additional insured. Insurance is primary and noncontributory. Display date Is July 3rd,2025
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICR WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Anthem Community Council
3701 W Anthem Way Ste 4201
Anthem AZ 85086
AUTHORIZED REPRESENTATIVE
SA reo re,
© 1988-2010 ACORD CORPORATION, All rights reserved.
ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD
Reyman Pyrotechniques/Any Pyro
Anthem 7/3/2025
Content of display
Following is the shell content of the display:
2 1/2 inch shells-40
3 inch shells-144
4 inch shells~144
5 inch shells-54
6 inch shells-36
Oe et
oe
Bo. snternationad its vuiniiong
st iy Sdternalivaal Assndialion
Yo Scape:
rn
MEMBER ID: 369241
RANDY L.
REYMAN
REYMAN PYROTECHNICQUES
¥ City of Flagstaff Fire Department
211 W, Aspen Avonus
oe Flagstaff, AZ, 86001
Pyrotechnics Permit
Applicant, Randy Reyman
it
Pormit Holder: Randy Reymen
3233
Fite Inspector
4
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af Row Voobvinkans cd ES
BEA ee Oa Be dR RO eK Ee
8 OSC. Chapter 40)
Department of Justice
ut of Alcohol, Tobacco, Firearms and Explosives
sordanee with the provisions of Title XU, Organized Crime. Control Act of 1970, and the regulations issued thereunder 27 CFR Pant 555), you may engage in
tivity specified in this license or permit within the imitations of Ciupter 46, Title 18, Uitited States Code and the teguiations issued thereunder, until the
5 iS" on reverse,
ition date shown. sai F4 r m Uitte gd os .
1ATF ATE - Chief, FELC Licenseenmit
ssporicnee To 244 Needy Road Numby;
Martinsburg, WV 25405-9431
| Federal Bxplosives Licensing Centex (8LC) Expiration
LAR pH i, Date
REYMAN PYROTECHNIQUES/ANY PYRO
mises Address (Changes? Notify the PRLC at least 10 davs before the move.) |
12820 S$ 40TH PLACE
PHOENIX, AZ 85044-
of License or Permit
21-MANUFACTURER OF EXPLOSIVES
Puretiasing Certification Statement Mathng Addess (Changes? Notify the ELC of any changes.)
consee ey pemmiltve named above shall use a copy of this license us permil to assist a
wor of explosives to verify the identity and the liceased status of the Hoetsee or
tee as provided by 27 CFR Part 555, The signature un eseh copy sium be an original c 1 :
vg, A faxed, scanned or emailed copy of the license o¢ peimit with a signature REYMAN, RANDY
ed to be an original signature is acceptable. ‘The signatuse must De that of the Federal REYMAN PYROTECHNIQUES/ANY PYRO
sives Licensee (PEL) of a respeasible person of tho FEL. | certify thar this isa aue 12820 S 40TH PLACE
fa license or permit issued to the licensee or permittee named ahove tn engugy in the PHOE y .
88 OF operations specified sbaye under “Type of License a Permit,” OENIX, AZ 85044
a A e Px -
Ld Chrmsof fe tye (NOL
isee/Permittes Respovsible Person Signature Position/Title
Pras om “tee tet Aout (plzz 4
Printed Name —* Date ATF Ferra $400 1475400.15 Part |
Revised September 2011
WBditien is Chsolete arate, exsbearese econ tute asperg ar de bestest dogaad 1 RUE FARIA Ge HONS
Federal Explosives License (FEL) Customer Service information
al Explosives Lisensing Center (FELC) Toll-free Telephone Niuber: (877) 283-3352 ATF Homepage: wonw.arf gov
"eedy Road Fax Nanber: {304} 616-4464
asbura, WV 25405-9431 E-meil: FELCG@ati gov
geafAddress (27 CPR S535,54(@}(1)), Licenseus or permittees may during the teri of their current license or permit remove thelr business or operations to a
scation at which they intend regularly to cany on such business or operations. The licensee or permittees is required to give notification of the new lecation of the
385 or operations not less then 10 days prior to such removal with the Chief, Federal Explosives Licensing Center. The license or semmit will be valid for the
ader 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
rinit to the Director‘ of Industry Operations for denial in accordance with § 555.34.)
tof Succession (27 CFR 555.59), (a) Certain persons other than the licensee of permittee may seoue the right to carty on the same explosive materials
zss or operetions at the same address shown on, and for the remainder of the tem of, a euient leenge or permit. Such peisons are’ (2) The siuviving spouse
1d, or executor, administrator, or ather legal representative of a deceased Hoensee or permides, and (2) A reveiver or trustee banknuptey, oy an assignee for
it of creditors, (b) In order to secure the right provided by this section, the person or persous continuhig the business or operations shall furnish the license or
{ for for that business or operations for endorsement of such succession to te Chief, FELC, within 30 days from the date on which the suesessor begins to
on the business or operations,
{Continued on reverse side)
Here 2S
Federal Explosives License/Permit (FEL) Information Card
2ise/Permit Name: REYMAN, RANDY
ness Naive: REYMAN PYROTECHNIQUES/ANY PYRO
2use/Permit Type:21-MANUFACTURER OF EXPLOSIVES
tiration: August 1, 2025
i
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t
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|
1
|
. i
snse/Permit Number: 9-AZ-018-21-SH-09233 !
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5
$
i
se Note: Net Valid for the Sale or Other Dispasition of Explosives 1
I
Fire Marshal’s Office
41018 N Daisy Mountain Dr
Anthem, AZ 85086 DAISY MOUNTAIN
FIRE & MEDICAL
HONORABLE + COMPASSIONATE « EXCEPTIONAL
March 24, 2025
Mr. Randy Reyman
Any Pyro Pyrotechniques
RE: Annual-2025 pyro technique display at Anthem Community Park-
41703 N Gavilan Peak Pkwy, Anthem, AZ 85086
Mr. Reyman,
We have received your notice of intent to operate the annual fireworks (pyra techniques}
display at the Anthem Community Park on Thursday, July 3, 2025.
An Operational Permit will be required by Daisy Mountain Fire Department to include:
s Valid Maricopa Caunty permit
* Pyrotechnics shall not arrive onsite nor within DMFD jurisdiction prior to the day of
event unless coordinated and approved by DMFD,
® Detailed inventory
» Detailed site plan to include required: pubic areas, important structures, fire lanes,
shoot site, storage areas, fall-out area(s), ete.
e List and credentials of qualified “shooters” :
* Gertificate or Insurance to include Daisy Mountain Fire Department. Kg
* NFPA 1126 shall be the nationally recognized standard for this display é
We look forward to working with you, the Anthem community and its many visitors for this
celebration and fireworks display.
Thank you for the heads-up and please call or email if you have any questions.
Best regards, ; '
Tim Wills 4
Fire Marshal *
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