AMERCIAN 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 jess 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 a
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 20, 2025- following graduation approx 8:30pm

DISPLAY DIRECTOR (permit will be issued to the following)

Name: Kendon Victor Phone: | lcs

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 “RECEIVED

MAR 2 4 2025

MARICOPA GOUNTY
CLERK BOARD OF SUPERVISORS

FIREWORKS DISPLAY SITE MAP

Indicate the following:

Fire department access
Hydrants

Distance to structures
Overhead lines

1. North direction

2. Distance from firing area to impact/fallout area
3. Spectator location

4, Storage area

PNA A

(North)

*@4 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

aconit

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DDIYYYY)
2/27/2025

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

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

certificate holder in tleu of such endorsement(s).

IMPORTANT: if the certificate hofder 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 dces not confer rights to the

PRODUCER CONTACT
Acrisure Great Lakes Partners insurance Services PHONE
223 West Grand River Ave #1 rTUy
Howell MI 48843 ADDRESS: :
INSURER(S) AFFORDING COVERAGE ___NAt :
Co _ : Everest Indemnity Insurance Company 10851
INSURED 16044
FPA, Ltd, DBA: Fireworks Productions of Arizona 20
17034 § 54th St 286:
Chandler AZ 85226 INSURER D; Travelers Property Casualty Company of America 25874
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: 430161432 REVISION NUMBER;

THIS 1S 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 (AODLSUBR) POLICY EFF | POLICY EXP
LIR TYPE OF INSURANCE insR| wyp. POLICY NUMBER {MAVDDIYYYY) | (MM/DDIVYYY} CiMITS
A. | GENERAL LIABILITY GC10010016-241 sore2024 10792028 | EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
X | COMMERCIAL GENERAL LIABILITY _PREMISES (Ea occurence) __| $600,000
ciams.aade |X | occur MEO EXP (Any one person) | $
PERSONAL & ADVINJURY $1,000,000
GENERAL AGGREGATE $2,000,000
| GENL AGGREGATE LIMIT APPLIES PER: $2,000,000
poucy | X | 68% [| toc s
COMBINED SINGLE LIMIT
B | AUTOMOBILE LIABILITY GCD9010003-241 109972024 401972025 | GOMBINED s £1.000.000
X | any auto BODILY INJURY (Per person) | $
ALL OWNED SCHEDULED '
Lee ee neo PROPERTY BURGE Ts
X | wireo autos AUTOS (Pee accident) $
$
c UMBRELLA LIAS =| X | occuR P-001-000691697-04 sora/2024 40/9/2025 | EACH OCCURRENCE $ 4,000,000
X | EXCESS LIAB CLAIMS-MADE, AGGREGATE $
cep | | retennions $
D | WORKERS COMPENSATION 6JUB-1W1 1896-8-24(AZ} 1079/2024 soi2028 |X | WOSTATU. OTH
AND EMPLOYERS’ LIABILITY vr aaa) Lioey Lats ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE
IR yes, describe under ee
DESCRIPTION OF OPERATIONS below E.(_ DISEASE - POLICY LIMIT
A. | 2nd Excess GCH0040017-241 10/9/2024 10/9/2025 | Each Ocourrence
Aggregate

Date of Display: May 20, 2025
Location of Display: ALA West Foothills 7-12 Waddell AZ

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES {Attach ACORD 101, Additional Remarks Schedule, Hf more space Is required)
Additional Insured extension of coverage is provided by above referenced General Liability and Auto Liability polcies where required by written agreement.

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.

AUTHORIZED REPRESENTATIVE

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ACORD 25 (2010/05)

© 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 20, 2025
Graduation
2 minute display
Total Aerial Effects 182

In celebration of the Class of 2025 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.
8 — Bombettes will fire in multiple volleys of glowing color.
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

“a

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.

ory

John Mertens
City of Phoenix Fire Marshal

Callie Hunt (COB)

From: Diamond, Kennet ar

Sent: Tuesday, March 18, 2025 4:04 PM

To: Cindy Herbel

Subject: Re: Fireworks - May 20 - ALA West Foothills
Hi Cindy

lam aware and approve

Kenneth Diamond
Fire Marshal
Fire Plans Examiner

@& RURAL

www.ruralmetrofire.com

Sent: Tuesday, March 18, 2025 3:32 PM
To: Diamond, Kenneth|

Subject: EXT: Fireworks - May 20 - est FOO

ATTENTION: External.Email — Use Caution — Contact Phishing@gmr.net if suspicious.

Hello there!
One more graduation and because you are the guy for ail 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 20:
¢ Rural Metro Notification
¢ 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 Horbel

Pyro Administrative ee
Assistant /¢

fi Fireworks |
Productions
Of Arizona ff

480-948-0090 (office)
480-423-8430 (fax)

1-877-948-0090 (toll-free)
17034 S. 54th Street, Chandler, AZ 85226

March 18, 2025

Clerk of the Board of Supervisors
Maricopa County

301 W. Jefferson 10" Floor
Phoenix, AZ. 85003

To Whom It May Concern:

Attached is the permit application for American Leadership Academy — West
Foothills in Waddell for a graduation fireworks scheduled for Tuesday, May
20, 2025 . Rural Metro Fire District 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: Cindy Herbel

17034 S. 54" Street

Chandler, A7.. 85226

If you have any questions or need any additional information, please do not
hesitate to contact my office. Thank you very much!

Pyrotechnically Yours,

Cindy Herbel
Pyro Office Assistant