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APPLICATION – PUBIC FIREWORKS DISPLAY CITY AND COUNTY OF BROOMFIELD CITY CLERK’S OFFICE ONE DESCOMBES DRIVE BROOMFIELD, CO 80020-2495 [PHONE REDACTED] Name and address of person or organization sponsoring the display Email Address Date and time of day display will take place Address and description of the exact location planned for the display Names and addresses of the competent fireworks operators who are to supervise the discharge of the fireworks. Include as an attachment written evidence regarding their competency. At least two competent fireworks operators are to be provided. Type and Class of fireworks to be discharged. Include the number of set pieces, shells (specifying single or multiple break) and other items including experimental or model rockets or missiles. Describe the manner and place of storage of the fireworks prior to and during the display. Signature Date (SEE LIST OF REQUIRED ATTACHMENTS ON BACK SIDE) ---PAGE BREAK--- Include as attachments: 1. A diagram of the grounds on which the display is to be held showing the point at which the fireworks are to be discharged, the location of buildings and highway within the vicinity and the location of all nearby trees, telephone and utility lines or any other overhead obstructions. 2. Proof that satisfactory compensation insurance is carried by the applicant for all of the applicant’s employees who will be working at the display. 3. Proof that the applicant has public liability insurance with the limits and coverage set forth as follows: At least $100,000/$300,000 and a policy of property damage insurance in the amount of at least $50,000, all protecting from liability the applicant, the manufacturer, the supplier, the seller, the buyer, the property owner, the user, the fire district, and the city. Such proof will be reviewed and approved by the City and County Attorney before any permit can be issued. Upon receipt of this application, the City Clerk will submit copies to the Police Chief and Fire Chief for their investigations of the location proposed for the fireworks display. Upon completion of their investigations, they shall submit to the City and County Manager, their written reports including their recommendations for the granting or denial of the permit. The City Council will review the permit application for compliance with the provisions of Chapter 9-76-030, 040 and 050. After completing the review, the City Council will either grant the permit, grant the permit with conditions, deny the permit, or refer the permit application back to the applicant. Upon City Council’s approval of the permit, the City and County Manger will provide a written Public Fireworks Display Permit. The permit shall have included theron such conditions of approval as may have been established by the City Council, and such conditions are an integral part of the permit. PUBLIC FIREWORKS DISPLAY PERMITS ARE NOT TRANSFERABLE OR ASSIGNABLE The application shall be submitted to the City Clerk not less than thirty days in advance of the date of the fireworks display, and shall be accompanied by a nonrefundable application fee of $50.00 FOR OFFICE USE ONLY Fee Paid Date Check No. Broomfield Municipal Code – Chapter 9-76-010