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: Homecoming/Senior night footbail game
Event Address: 17608 W Olive Ave. Waddell, AZ 85355

Date and Time of Event: —_ Friday, September 19, 2025 - 645pm through end of game approximately 9:30pm

DISPLAY DIRECTOR (permit will be issued to the following)

Name: Mike Kreidel Phone:

Business: Fireworks Productions of Arizona Fax:

Address: —_ 17034 S 54th St. Chandler AZ 85226 Email: | = (<a<Ga&;,

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: 602-506-3766,

RECEIVED

AUG 1 2 2025

MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

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

PONS
PND

(North)

email to Clerk of the Board

FOR DEPARMENT USE ONLY:

SHERIFF'S OFFICE RECOMMENDATION

The State Fire Marshal or focal 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

@
ACCORD
Qe

CERTIFICATE OF LIABILITY INSURANCE

DATE (MMIDDIYYYY}
6/18/2025

THIS CERTIFICATE 1S 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(les) 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 does not confer rights to the

certificate holder in lieu of such endorsement(s),

PRODUCER GONpACT
Acrisure Great Lakes Partners Insurance Services it) i ee |
223 West Grand River Ave #1 {AiG No. Exth
Howell Mi 48843 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC &
insurer A: Everest Indemnity Insurance Company 40851
INSURED ns . . isurer b : Everest Denali Insurance Company 46044
PPA ba, DBA. Fireworks Productions of Arizona INSURER ¢: AXIS Surplus Insurance Company 26620
Chandler AZ 85226 INSURER D: Travelers Property Casualty Company of America 25674
INSURER E>
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1850468714 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.

SR [ADDL [SUBR] POLIGVEFF | POLICY EXP
LTR TYPE OF INSURANCE INSRIWVD POLICY NUMBER {MMVDDIVYYY) | MMIDDIYYYY) LIMITS
A | GENERAL LIABILITY GC10010015-241 40/972024 10192025 | EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
X_| COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) _ | $ 500,000
| CLAIMS-MADE OCCUR MED EXP (Any one person) | $
PERSONAL &ADVINJURY | $ 1,000,000
GENERAL AGGREGATE $2,000,000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | § 2,000,000
pouicy | X | FBO: Loc 8
COMBINED SINGLE Liat
B | AUTOMOBILE LIABILITY GCDe010003-241 10/9/2024 torezozs | COMBINED § § 1.000.000
X | any AUTO BODILY INJURY (Per person) | §
ALL OWNED [|] SCHEQULED BODILY INJURY (Per accident) | §
NON-OWNED PROPERTY DAMAGE
X | uirep autos AUTOS {Per accident) §
s
c UMBRELLALIAB | X | gccuR P-001-000891697-04 10/9/2024 101972025 | cach OCCURRENCE $4,000,000
X | EXcess LIAB CLAIMS-MADE AGGREGATE $
DED | [ RETENTIONS $
D | WORKERS COMPENSATION 6JUB-1W11896-8-24(AZ) 10/9/2024 tore2025 |X | WOSTATU- | OTH.
AND EMPLOYERS’ LIABILITY YIN TORY LIMITS. ER
ANY PROPRIETOR/PAR TNER/EXECUTIVE E.L_ EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) £.L, DISEASE - EA EMPLOYEE] $ 1,000,000
Ityes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | § 1,000,000
A | 2nd Excess GC10010017-244 40/8/2024 1019/2025 | Each Occurrence 5,000,000
Aggregate 5,009,000,

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 polcies where required by written agreement.

Date of Display: September 19, 2025

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.

AUTHORIZED REPRESENTATIVE

WAY

ACORD 25 (2010/05)

© 1988-2010 ACORD CORPORATION. Ail rights reserved.

The ACORD name and logo are registered marks of ACORD

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Site Map Maximum Shell Size:

Fireworks Productions of Arizona

480-948-

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| West Foothills

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info@fireworksaz.com

EXHIBIT A

AMERICAN LEADERSHIP

ACADEMY- WEST FOOTHILLS
WADDELL

Friday, September 19, 2025

Homecoming/Senior Night
Total Aerial Effects 132

Aerial Display of Close Proximity Pyrotechnics:

Your Aerial Display will contain a total of 132 Aerial Effects.

American Leadership Academy - West Foothill’s show to consist of:

TEAM INTRO (TEAM ENTRANCE IS 6:40ISH)

2 - 8 SHOT X 6 SEC. FINALE BOMBETTE BOARDS (RED & BLUE)
2 - 8 SHOT X 6 SEC. FINALE CRACKLE COMET BOARDS

NATIONAL ANTHEM
2 - LARGE MINES (RED)
ROCKETS’ RED GLARE
2-1 SHOT RED BOMBETTE
BOMBS BURSTING
2 - 8 SHOT X 6 SEC. FINALE BOMBETTE BOARDS (RED/WHITE/BLUE)

HALF-TIME KING & QUEEN
2 - 8 SHOT X 6 SEC. FINALE BOMBETTE BOARDS (BLUE & RED)
KING, THEN QUEEN, FIRE AFTER QUEEN

SCORE SHELLS
4-3 SHOT FAN CROSSETTE BOARD
(RED/BLUE/RED) (10 Scores TOTAL)

END OF GAME
2 - 8 SHOT X 6 SEC. FINALE BOMBETTE BOARD (RED & BLUE)
2 - 8 SHOT X 6 SEC. FINALE CRACKLE COMET BOARD
2 - LARGE MINES (RED/BLUE)
(All remaining score shells fired at end of game)

Designed for American Leadership Academy by: Fireworks Productions of, ‘Arizona

@

City of Phoenix
FIRE DEPARTMENT
FIRE PREVENTION SECTION

Pyrotechnician
Certificate of Fitness

Michael Kreidel

R2300049

Expiration Date: 05/04/2026

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.

ey

John Mertens
City of Phoenix Fire Marshal

Mia Vargas (COB)

ann a ne emeaanaaes
From: Cindy Herbel
Sent: Wednesday, August 20, 2025 3:38 PM
To: Mia Vargas (COB)
Subject: FW: Fireworks - Sept 19 - ALA West Foothills
Follow Up Flag: Follow up
Flag Status: Flagged

This Message Is From an External Sender
This message came from outside your organization. Please use caution when corresponding outside the county,

Hello Mia,
Below is Rural Metro’s notification that they are aware of and don’t object to the ALA West Foothills display.

Thank you for your patience.

Cindy Herbel

Pyro Administrative
Assistant /

‘Fireworks’
Productions §
of Arizona

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

From: Kenneth Diamond J

Sent: Wednesday, August 20, 2025 3:36 PM

To: Cindy Herbe| Ea

Subject: Re: Fireworks - Sept 19 - ALA West Foothills

lam aware and have no objections. Approved

Thank you

Kenneth Diamond
Fire Marshal
Fire Plans Examiner

METRO

Central Arizona Fire Operations

www.ruralmetrofire.com

From: Cindy Herbe| Zn

Sent: Wednesday, August 20, 2025 3:20:40 PM

Subject: [EXTERNAL] FW: Fireworks - Sep’ - est Foothills

*** WARNING: Email originated from outside the organization. Do not click links or open attachments
untess sender is verified. ***

Hello there,
?'m just needing your ‘I’m aware and no objection’ email {if that is the case) for the Sept 19 for the ALA West
Foothills football game display. I’ve attached the following for your review:
¢ §=6Notification letter

« Site Map
e Show Program
« Col

Please let me know if you need anything else at this time. Will be submitting permit through Maricopa County
once | receive your no objection.
Thank you and | hope you are having a safe summer.

Cindy Herbel

Pyro Administrative
Assistant

"Elreworks
Productions
of Arizona

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

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