Independence Day Fireworks Display Agreement:NDEPENDENCE DAY FIREWORKS DISPLAY AGREEMENT
THS AGREEMENT cttgreme膚 りもetteЮ d hb hも 圧ty:
and is by and betteen M:AND:NC.DBA MAD 30MBER F:REWORKS PRODUCT10NS,an
lndiana corporation ("Confrac(o/'), and the VILLAGE OF OAK BROOK, an lllinois municipal
corporation (" Villagel' ).
lN CONSIDERATION OF the recitals and the mutual covenants and agreements set
forth in this Agreement, and pursuant to the Village's statutory powers, the Contractor and the
Village hereby agree as follows:
SECTION ONE: TIME AND PLACE OF DISPLAY. The Contractor shall provide a
hventy ihree (23) minute continuous aerial fireworks display ("Display') at that certain location
within the Village's sports core designated by the Village ('site'). The Display shall begin at
approximately 9:15 p.m. at the annual Taste of oak Brook celebration hosted by the Village,
scheduled for Sunday, July 3,2022 ("Display Dafe"), and shall continue thereafter for no less
than twenty three (23) minutes with no lags between firing of the individual fireworks devices
("Time of Performance'). The Contractor shall be responsible for completion of all work within
ihe Time of performance, notwithstanding any strike or other work stoppage by employees of
either Contractor or of the Village.
SECTION TWO: @. The Contraclor shall be obligated to
perform the following:
A. The Contractor shall furnish all labor, equipment, supplies, personnel and
supervision necessary to provide the Display, as set forth on the proposal attached as Exhibit A
to this Agreemenl (',Proposal'); provided, however, that the contractor may, at its discretion,
substitute fireworks devices of equal or greater value and duration than those devices set forth
on Proposal;
B. The Contractor shall, at its sole cost and expense, ensure that all personnel
involved in the set-up, operation, removal, and disposal of all fireworks devices involved in the
Display be experienced pyrotechnic operators licensed to perform such work under the laws of
the State of lllinois;
C. The Contractor shall deliver, set up, and execute the Display at the Time of
Performance;
D. The Contractor shall, upon completion of the Display, cause all equipment
associated with the Display to be removed from the Site, and shall remove and properly dispose
of all unfired or unexploded material; and
E. The Contractor shall conduct the Display in accordance with National Fire
Protection Association standards and guidelines for safety.
SECTION THREE: ]l!ttAgE-94!.gAL!.9N,' The Village shall be obligated to
perform the following:
A. The Village shall furnish an area adequate for the parking of automobiles by
spectators of the Display;
B. The Village shall, at its sole cost and expense, provide personnel for the purpose
of establishing crowd control in the general area of the Site;
C. The Village shall, at its sole cost and expense, provide a fire guard during the
Contractor's clearing of debris from the Site immediately following the conclusion of the Display;
D. The Village shall establish a sufficient area for the safe operation of the Display,
including, without limitation, establishmenl of a spectator safety area ("spectato r safety
AreaJ, which Spectator Safety Area shall include all points within 700 feet of the Site, and
which shall be marked with rope or other suitable materials to prevent spectators from entering
the Spectator Safety Area. The Village shall also provide adequate police protection to prevent
spectators from entering the Spectator Safety Area; and
E. The Village shall conduct a search of the fallout area the morning after the
Display is conducted to remove all debris resulting from the Display.
sEcTloN FouR: INToXICATED EMPLOYEES. The Contractor shall cause any of its
employees ,,vho are int,oxicated or under the influence of a controlled substance to be removed
immediately from the site, and shall prohibit any such employee from performing any work on
the Display or at the Site.
SECTION FIVE: !EBU!EL!.9,N-B!.9EI9. The Contractor shall have the right, but not
tne oUtigetion, to terminate tne Display in the event that unauthorized persons enter the
Spectator Safety Area and the Village is unable or unwilling to satisfy its obligations pursuant to
Section 3 of this Agreement.
EL!ON!X: PAYMENT. The Village shall pay the Contractor the sum of $32,500'00
1"ree") ror tne oisptay within ao days after the date of performance of the Display. The Fee
includes all applicable federal, state, and Village taxes of every kind and nature applicable to the
Display. Contiactor may charge the Village a service fee equal to 1.5% of the Fee per month if
the Viliage fails to pay the Fee within 60 days after the Contractor conducts the Display.
SECTION SEVEN: CANCELLATION: RESCHEDULING OF DISPLAY'
A. Cancellation bv Contractor. The Contractor shall have, in its sole and absolute
discretion, the right to make a determination that the Display should be cancelled due to
inclement o1. unsjfe weather conditions- ln the event the Display is cancelled by the Contractor
due to inclemenl or unsafe weather conditions, the Display shall be on July 4,2022 at 9:15 p.m.
(,,Rain Date,). lf inclement or unsafe weather conditions prevent the contractor from
performing the Display on either the Display Date or the Rain Date, the Parties shall confer and
agree to -a mutually convenient alternate dale (" Atternate Display Date"), no later than six
m-onths after the original Display Date set forth herein to conduct the Display. ln the event the
Village does not choose to reschedule another date or cannot agree to a mutually convenient
date, Village shall pay to contractor an amount equal to 40% of the Fee as full payment and
settlement for the Contractor's costs, damages and expenses.
B. Cancellation bv Villaqe. ln the event the Display is cancelled by the Village prior
to the Display bate, the Village shall pay to the Contractor an amount equal to Conlractor's
actual expenses incurred in preparation for the Display, including, but not limited to, material
purchases, preparation and design costs, deposits, licenses and employee charges. contractor
will provide documentation of such expenses to the Village upon request for payment. Payment
of the Contractor's expenses pursuant to this Section 7.8 shall be the Contractor's sole remedy
for cancellation of the Display by the Village prior to the Display Date.
SECTION EIGHT: !N,UUE. The Contractor, at its sole cost and expense, shall
provide liabillty insurance in the amount of $10,000,000, which insurance shall include, without
iimitation, protection for the benefit of spectators from the time the Contractor arrives at the Site
until the residuals from the Display are removed therefrom. The limit of liability shall be
$1O,00o,ooo for bodily injury and $10,000,000 for property damage. The contractor shall cause
the Village to be named as an additional insured on the insurance policy required by this
Section. At least one week prior to the Display, the Contractor shall provide the Village with
either (a) a copy of the entire insurance policy, or (b) a Certificate of lnsurance along wilh a
letter fiom the broker issuing the insurance policy to the effect that the Certificate accurately
reflects the contents of the insurance policy.
SECTION NINE: !NpE!!Nlf[. The Contractor shall, and does hereby agree to' hold
harmless and indemnify the Village and all Village elected or appointed officials, officers,
employees, agents, representatives, engineers, and attorneys, from any and all claims that may
be asierted at any time against any of such parties in connection with the Display; provided,
however, the foregoing indemnity shall not apply to willful misconduct or gross negligence on
the part of the Village.
SECTION TEN: PERMITS: FEES. The Contractor shall, at its sole cost and expense,
obtain all permits, gtive all necessary notices, pay all license fees, and comply with all applicable
local, state, and federal rules, regulations, and ordinances
SEcTloN ELEVEN: !GH!98'. All vehicles utilized by the Contractor shall be
properly identified and licensed as required by the laws of the State of lllinois.
sEcTloN TWELVE: re. The contractor assumes complete and sole liability for
the payment of all applicable federal, state, and local taxes
sEcTloN THIRTEEN: 91p91re,. The contractor certifies hereby that it is not barred
trom niOOingffiis contract as iresult of violations of either Section 33E-3 or Section 33E-4 of
the lllinois Criminal Code.
SECTION FOURTEEN: WBNUENI. The Contractor certifies hereby that
it nas a vwitten sexuat narassment policy in place in full compliance with 775 ILCS 5/2-
105(AX4).
SECTION FIFTEEN: OPTION TO RENEW. The Village shall have four options to
renew this Agreement by delivering written notice to Contractor by December 15 of each year
for Contractor to provide a Display to the Village in 2023, 2024, 2025, and 2026 on the dates set
forth below:
Displav Date Rain Date
2023 July 3,2023 Julv 4,2023
2024 July 3,2024 」ulv 4,2024
2025 July 3,2025 July 4,2025
2026 Julv 3, 2026 Julv 4,2026
The Contractor must deliver in writing by October 15 of each year the amount of
increase (if any)for the following year.
lf the Village exercises either of its options to renew this Agreement, all of the terms of
this Agreement shall apply, including, without limitation, the updated Fee provision if there is an
amount increase, which amount will be included in an Amendment to this contract. The Village
shall have no obligation to exercise either of its options to renew this Agreement.
SECTION SIXTEEN: GENERAL PROVISIONS.
A. Relationship of the Parties. The Contractor shall act as an independent
contractor in providing and performing the Display. Nothing in, nor done pursuant to, this
Agreement shall be construed (i) to create the relationship of principal and agent, employer and
employee, partners, or joint venturers between the Village and Contractor; or (ii) to create any
relationship between the Village and any subcontractor of the Contractor.
B. Amendment. No amendment or modification to this Agreement shall be
effective unless and until such amendment or modification is in writing, properly approved in
accordance with applicable procedures, and executed.
C. Assiqnment. This Agreement may not be assigned by the Village or by the
Contractor without the prior written consent of the other party.
D. Bindinq Effect. The terms of this Agreement shall bind and inure to the benefit
of the Parties hereto and their agents, successors, and assigns.
E. Notice. Any notice or communication required or permitted to be given under
this Agreement shall be in writing and shall be delivered (i) personally, (ii) by a reputable
overnight courier, (iii) by mail, return receipt requested, and deposited in the U.S. Mail, postage
prepaid, or (iv) by email. Unless othenvise expressly provided in this Agreement, notices shall
be deemed received upon the earlier of (a) actual receipt; (b) one business day after deposit
with an overnight courier as evidenced by a receipt of deposit; or (c) five business days
following deposit in the U.S. mail, as evidenced by a return receipt. By notice complying with
the requirements of this Subsection, each Party shall have the right to change the address or
the addressee, or both, for all future notices and communications to such party, but no notice of
a change of addressee or address shall be effective until actually received.4
Notices and communications to the Village shall be addressed to, and delivered at, the following
address:
Village of Oak Brook
1200 Oak Brook Road
Oak Brook, lllinois 60523
Attention: Greg Summers, Village Manager
Email: osummers@oak-brook.oro
Notices and communications to the Contractor shall be addressed to, and delivered at,
the following address:
Miand lnc. DBA Mad Bomber Fireworks Productions
3999 E. Hupp Road
Building R-3-1
LaPorte, lN 46350
Attenlion: Andrew James, President
Email: andrew@madbomberfireworks.com
F. Provisions Severable. lf any term, covenant, condition, or provision of this
Agreement is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the
remainder of the provisions shall remain in full force and effect and shall in no way be affected,
impaired, or invalidated.
G. Time. Time is of the essence in the performance of this Agreement.
H. Governinq Law: Venue. This Agreement and any dispute arising out of or
relating to this Agreement shall be governed by and construed in accordance with the laws of
the State of lllinois, without reference to its conflict of law rules. All judicial actions relating to
any interpretation, enforcement, dispute resolution or any other aspect of this Agreement shall
be brought in the circuit court of the state of lllinois, DuPage County, lllinois. Any matter
brought pursuant to the jurisdiction of the federal courts shall be brought in the United States
District Court of the Northern District of lllinois.
l. Entire Aqreement. This Agreement constitutes the entire agreement between
the parties and supersedes any and all previous or contemporaneous oral or written
agreements and negotiations betvveen the Village and the Contractor with respect to the
services contemplated in this Agreement.
J. Waiver, No waiver of any provision of this Agreement shall be deemed to or
constitute a waiver of any other provision of this Agreement (whether or not similar) nor shall
any such waiver be deemed to or constitute a continuing waiver unless otherwise expressly
provided in this Agreement.
K. Riohts Cumulative. Unless expressly provided to the contrary in this
Agreement, each and every one of the rights, remedies, and benefits provided by this
Agreement shall be cumulative and shall not be exclusive of any other such rights, remedies,
and benefits allowed by law.
L. Exhibits. Exhibit A attached to this Agreement is, by this reference,
incorporated in and made a part of this Agreement. ln the event of a conflict belween an exhibit
and the text of lhis Agreement, the text of this Agreement shall control.
M. Conflicts of lnterest. Contractor represents and certifies that, to the best of its
knowledge: (1) no elected or appointed Village official, employee or agent has a personal
financial interest in the business of Contractor or in this Agreement, or has personally received
payment or other consideration for this Agreement; (2) as of the date of this Agreement, neilher
Contractor nor any person employed or associated with Contractor has any interest that would
conflict in any manner or degree with the performance of the obligations under this Agreement;
and (3) neither Contractor nor any person employed by or associated with Contractor shall al
any time dudng the term of this Agreement obtain or acquire any interest that would conflict in
any manner or degree with the performance of the obligations under this Agreement.
N. Force Maieure. No Party shall be liable or responsible to the other Party, nor be
deemed to have defaulted under or breached this Agreement, for any failure or delay in fulfilling
or performing any term of this Agreement (except for any obligations to make previously owed
payments to the other Party hereunder) when and to the extent such failure or delay is caused
by or results from acts beyond the impacted Party's ("lmpacted Party") reasonable control,
including, without limitation, the following force majeure events ("Force Majeure Event(s)") that
frustrates the purpose of this Agreement: (a) acts of God; (b) flood, fire, earthquake or
explosion; (c) war, invasion, hostilities (whether war is declared or not), terrorist threats or acts,
riot or other civil unrest; (d) government order or law; (e) actions, embargoes or blockades in
effect on or after the date of this Agreement; (f) action by any governmental authority; (g)
national or regional emergency; (h) strikes, labor stoppages or slowdowns or other industrial
disturbances; (i) epidemic, pandemic or similar influenza or bacterial infection (which is defined
by the United States Center for Disease Control as virulent human influenza or infection that
may cause global outbreak, or pandemic, or serious illness); (i) emergency state; (k) shortage of
adequate medical supplies and equipment; (l) shortage of power or transportation facilities; and
(m) other similar events beyond the reasonable control of the lmpacted Party.6
:NV口 TNESS WHEREOF.the parties hereto have affixed their signatures the date and
year lrst above wntten
ⅥLLAGE OF OAK BR00K,an∥inois municipal corporalon
M:AND iNC.DBA MAD BOMBER F:REWORKS PRODuCI:ONS,an:ndiana corpOra∥On
Ъ∥otte K Pruss,V∥age Clerk
, Mllage Manager
EXHIBIT A
Proposal8
VILLAGE OF OAK BR00K
l18『鵠 評瞬 認 XRI湯
Oak Brook,:L 60523
(630)368口 5164
REQUESttFOR PROPOSAL
November 2021
j:\worddoc\rfp\2021 rfp\independence day fi reworks.docx
lndependence Dav Fireworks Displav
TABLE OF CONTENTS
SECT:ONl.REQUEST FOR PROPOSALS.................2
A. Nortce - PosrED oN THE Vttmce WEBSITE Noverr/eeR 2' 2021 ...........'......2
B. PRoJEcr DescRtprtox '................"... 3
C GENERAL TERMS Rtto CoruolrloNs ............ '.'..".'.. 1
sEciloN 2. PROPOSAL INSTRUCTIONS..... .........".....9
A. Docutuerurs/lruroRunrtoN To BE SuaMtrreo '....... 9
B. PRoposAL... '...'........'...' 10
C. REFERENCES ........'...'..'. 11
E. CoNTRACTons CEnttrtcATloN.......... .'..............'.. 13
D. Sexut HARASSMENT Poltcv .""""" 15
SECTION 3. REVTEW PROCESS """"""" 16
EVALUATION OF PROPOSALS AND SCIECTIOru .'.''... 16
BASrs oFAWARD ............ .'........'....." 16
j:\worddoc\rfp\2O21 rfp\independence day fi reworks.docx
Section 1. Request for ProPosals
Notice - posted on the Village Website November 2, 2021
Village of Oak Brook
Request for Proposals
November 2021
The Village of oak Brook is soliciting proposals for lndependence Day Fireworks Display.
Proposals shall be addressed to:
Rania Serences
Senior Purchasing Assistant
Village of Oak Brook
1200 Oak Brook Road
Oak Brook, lL 60523
The closing date and time for receipt of proposals is Tuesday, November 16, 2021, at 3:00 P.M.
prevailingiime. proposals received after the submittal time will be rejected and returned unopened to
the sender.
A complete proposal package is on file for inspection and may be downloaded from the Village's website
,i-***"iilUrdor.ori or piiked up at the Butler covernment Center, '1200 oak Brook Road, oak Brook,
tttiniEGOESJEGEdn the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday. There is no charge
for the package.
The Village of Oak Brook reserves the right to reject any or all proposals, waive all technicalities, errors,
omissionl, erasures, alterations, and additions not called for, and to make an award which, in its
judgment, is the best and most favorable to the interests of the Village and the public.
Page 2
B. Proiect Descriqtion
lntroduction
The Village of Oak Brook will be hosting the Taste of Oak Brook followed by an lndependence
Day Fireiorks display on July 3,2022. The Taste of Oak Brook celebration kicks off in the
afternoon and will include food from some of Oak Brook's finest restaurants and children activities'
The Taste will conclude with fireworks beginning at approximately 9:15 p.m The rain date for
fireworks only is July 4,2022-
Scope of Services
Contractor shall furnish, erect, and fire under Village direction the Village of Oak Brook's July 3,
2022, fireworks display at the oak Brook Sports core Field #1 in oak Brook, lllinois.
Contractor shall provide through the field pyro technician, at the contractor's expense, one (1)
assistant chief pyro technician, and two (2) additional qualified pyro technician aides to assisl in
the erection andliring of the display. Each person shall be an employee of the contractor.
Contractor's personnel and materials shall report to the Oak Brook Sports Core in Oak Brook,
lllinois, (fireworks display site) no later than 9 a.m., July 3,2022, to begin setting up the fireworks
display.'The contractor;hall have the fireworks display material ready for show by 5 p.m., July 3,
21i2.'Conlractor will have the flexibility to set up J uly 2,2022. Cancellation or postponement due
10 inclement weather will be made at the discrimination of the Village of Oak Brook and the
contractor's representative.
Contractor shall perform tests before beginning the official program to make sure that.the winds
aloft will not distort the exhibition nor carry hot or burning matter where it can cause damage to
persons or proPerty.
Contractor shall provide for at all times in preparation of, during, and immediately after fireworks
display, a safe and clean operating environment at the fireworks display site in oak Brook.
Contractor shall provide for a fireworks display lasting twenty-three (23) minutes in duration and
fireworks display shall exhibit rapid, constant fire for the entire lwenty-three (23) minutes.
Rain date shall be July 4,2022. Times and arrangements shall be the same as outlined in the
pr"""Oing paragraphs of these specifications. Decision by the Village of Oak Brook to cancel the
event will be made by 7 p.m. on the date in question.
The closest building to the site of the fireworks display will be no closer than 1,200 feet. The
closest residential a-rea to the site of the fireworks display will be no closer than 1,200 feet. The
ilosest spectators to the site of the fireworks display will be no closer than 1,200 feet. The firing
location may be subground level; only aerial shells are to be incorporated into show.
pyrotechnic materials may arrive early for the Oak Brook.show if they are enclosed and secured
in a weather tight motor vehicle stored outdoors. The Village of Oak Brook will not assume the
responsibility or liability for the storage of pyrotechnical materials'
All pyrotechnic materials shall be too orade and have been factory tested by the manufacturer to
assure their individual quality, performance, and safety.
Contractor shall provide for his employees'and public safety at all times'
Page 3
3.
Contractor shall perform this agreement as an independent contractor and shall not be considered
an agent ofthe Village of Oak Brook, or shall any employees or agents of contractor be considered
an agent of the Village.
Show Design and Work
Contractor shall provide labor, material, and equipment for presentation of an innovative and
attractive aerial fireworks display on July 3,2022, at the Oak Brook Sports Core, Oak Brook,
lllinois. Program objective shall be to create a spectacular, continuous fire, aerial display visible
to an audience viewing from many area vantage points not immediately adjacent to the discharge
site and accompanied to music. At the conclusion of the fireworks display, the William Tell
Overture shall be played unless prior written direction is given by the Village Manager. To achieve
this objective, the contractor shall allow for appropriate layering and balance of the overall
program with no perceptible breaks or gaps in the display. Proposal must include patriotic music
selections with corresponding pyrotechnics. The proposed synchronized audio must be provided
via audio CD to the Village by July 1't. The following general parameters are provided for
accomplishment of the objective.
Length of Display: 23 minutes continuous firing
Pyrotechnics: Total display shall include approximalely 2,000 individual shells. Suggested
number of shells is provided as a guideline; therefore, innovation and creativity on the part of the
contractor is essential. Proposal shall be an aerial display only, which must include a riveting
opening, unique body, and dramatic finale (no set pieces). No parachute shells of any type shall
be allowed.
Substitutions: Contractor must perform show that was proposed Substitution(s) shall not be
made after award of contract unless approved by the village Manager 15 days prior to July 3,
2022. Failure to provide exact brand, size, and quantity of shell as submitted in final proposal
will result in reduction in payment.
Conduct of the DisPlaY
The display shall be conducted in accordance with National Fire Protection Association standard
1123-1995, code for the Outdoor Public Display of Fireworks published by the National Fire
Protection Association, lnc. The following modifications apply:
A. Construction of She//s
ln addition to the standard paper mache shells, shells with molded plastic casing shall be
permitted. However, mortars firing shells with plastic casings shall not be reloaded.
B. lnstallation of Moftars
Mortars shall be installed in mortar racks in accordance with NFPA standards and be properly
anchored to the ground.
C. Discharge Sifes
The discharge site shall be limited to the area specified by the village of oak Brook.
D. General Requirements
No aerial display may be fired when winds exceed 20 MPH, when unusually wet weather
presents other d;finite dangers, or when conditions are deemed unsafe by the Village of Oak
Brook.
The contractor shall be responsible for the complete installation and cleanup of the display and
supplying all necessary materials and equipment in connection therewith except as provided for
under Village Furnished ltems.4Page 4
ZThe contractor shall furnish qualified operators for se{-up, launch, and take down, and abide by
all Federal, State, and Local regulations that apply to handling pyrotechnics.
The contractor shall provide necessary safety equipment and materials, transportation, and
security for fireworks and launch site. Fire extinguishers shall be in plain view when any live loads
are on-site. Numbers of fire extinguishers shall be adequate to the size of the display.
The fireworks display is scheduled to commence at approximately 9:'15 p.m. The exact firing
command shall be given by the Village representatives at the launch site. ln the event that the
performance provided is delayed through any fault of the contractor, the contractor shall
reimburse the Village the amount of $500.00 per each 5 minute delay beyond the scheduled
starting time of the performance as noted above.
ln the event of inclement weather, the display will be rescheduled for July 4, 2022. fhe decision
to postpone displays shall be made by the Village representative.
The contractor shall be responsible for cleanup of the safety zone to include: cleanup of shell
fragments, bits of fusing, and any hazardous material; gathering any other trash and debris
generated by the contractor's personnel in appropriate trash containers.
Transportafion and Storage of Fireworks
The transportation of fireworks shall be in compliance with the regulations of the U.S. Department
of Transportation, 41 CFR, Part 170-189 and Part 390-399 and all state and local motor vehicle
laws applicable to the area through which fireworks are transported. All fireworks materials shall
be packaged and shipped in compliance with all applicable laws and ordinances (Federal, State,
and Local) for delivery and storage of fireworks and explosives. Packaging to be in sealed,
weather protected, heavy duty containers to completely prevent deterioration or diminution of fire
ability due to moisture and/or other contaminations. Vehicle operators will be responsible for the
safety of the fireworks and all related equipment, remaining with the vehicle(s) at all times.
Suppiemental site security will only be provided by the Village of Oak Brook during the evening
houis of the event and shall not relieve the contractor of this responsibility. The number of vehicles
allowed on site will be kept to a minimum.
Notification of Fire Department
The Fire Department will be notified of the Village's intent to have the fireworks display and will
request the appropriate fire apparatus be on site during the display and to relate the name and
address of the contractor.
Upon receipt of the contract, the contractor shall contact Chief Barry Liss of the Oak Brook Fire
Departmeni and arrange for review of the pyrotechnics set up plan and site inspection on the
event day. lt is the responsibility of the contractor to provide all required and relevant information.
Should ihe contractor require assistance with contacting the Fire Department, the Senior
purchasing Assistant shall provide assistance in providing a liaison with the Village of Oak Brook
Fire Department.
Qual ificati on of OPerators
The person in charge offiring the display (chief pyro technician) and one assistant (assistant chief
pyro technician) shall:
. Be at least 21 Years of age.
. Have a minimum of 4 years pyrotechnic experience.
. Have fired a minimum of 12 displays of the size and nature of the display proposed
herein.
. Possess a valid and current exptosive permit issued by the State of lllinois.
Page 5
ユ
The chief pyro technician must be licensed by the Office of the State Marshall. An out of state
contractor must have a person licensed under the Pyrotechnic Operator Licensing Act (225 ILCS
227) as the lead pyrotechnic operator supervising the display.
All other assistants shall be at least 18 years of age.
No other persons are permitted within fenced-off firing area.
8. Village Furnished ltems
. Protection of the display are by roping-off or similar facility
. Adequate police protection to prevent spectators from entering display area
9. Safety
Contractor shall submit prior to event a list of assigned employees. The only persons permitted
to be within the fenced-off firing area will be the authorized pyrotechnical staff and a Village
Representative. No exceptions will be made.
contractor shall submit with his proposal a loss run prepared by his insurance company, or
companies, for the period covering 5 years prior to the date ofthe proposal. This information shall
be submitted from any and all insurance companies used by the contractor during this s-year
period.
A loss run is defined as an itemization of all paid and reserved occurrences resulting from activities
associated with a fireworks display as defined under a general liability policy for the term of the
policy, which is the subject of the loss run. The loss run shall distinguish employee injuries from
speciator injuries and shall identify pending and closed cases. Loss run shall be accompanied by
sufficient evidence to indicate that the loss run is accurate and has been prepared by the
insurance company. The Villages hall be the sole judge as to whether the information provided
meets the specifications.
Failure to submit complete and accurale loss run information may result in rejection of proposal.
10. Contract
The successful contractor agrees that upon acceptance of its proposal by the Village of Oak Brook
this Request for Proposal, along with all instructions, conditions, and specifications attached
thereto, constitute a binding contract which may be enforced by the Village.
11. Contract Extension
At the conclusion of the 2022 fireworks display, the Village of Oak Brook reserves the right to
award an annual contract extension for each following years, not to exceed 4 yearc (2023,2024'
2025, and 2026), to the current contractor. Determination will be made annually solely by the
Village of Oak Brook with the concurrence of the contractor and will be determined no later than
'12 weeks following the display.
Page 6
General Terms and Conditions
1. Preparation and Submission of Proposals:
a) The proposal shall be submitted in an opaque sealed envelope on or before the time stated
and shall bear the name of the individual, firm, or corporation submitting the Proposal and
the Project Name: "lndependence Day Fireworks Display".
b) contractors may attach separate sheets to the proposal for the purpose of explanation,
exception, alternate proposal and to cover unit prices, if needed.
c) Contractors may withdraw their proposal either personally or by written request at any time
before the hour set for the proposal opening, and may resubmit it. No proposal may be
withdrawn or modified after the receipt of proposals except where the award of contract
has been delayed for a period of more than ninety (90) days.
d) ln submifting this proposal, the contractor further declares that the only person or party
interested in the proposal as principals are those named herein, and that the proposal is
made without collusion with any other person, firm or corporation.
e) The contractor further understands and agrees that if their proposal is accepted, the
individual/company is to furnish and provide all necessary materials and/or equipment and
other means to do all of the work and to furnish all of the materials specified in the contract,
except such materials as are to be furnished by the village (village), in the manner and at
the time therein prescribed, and in accordance with the requirements therein set forth.
f) The contractor further agrees to execute all documents within this Proposal Package,
obtain a Certificate of lnsurance for this work and present all of these documents to the
Village within fifteen (15) days after the receipt of the Notice of Award and the contract by
the company.
g) The contractor further agrees to begin work not later than ten (1 0) days after receipt of the
Notice to Proceed, unless otherwise provided, and to execute the work in such a manner
and with sufficient materials, equipment and labor.
h) By submitting a proposal, the contractor understands and agrees that, if the proposal is' 'accepted,lnd the contractor fails to enter into a contract forthwith, the company shall
be liable to the Village for any damages the Village may thereby suffer.
2. Conditions
a) The Village is exempt from Federal excise tax and the lllinois Retaile/s Occupation Tax.
This proposal cannot include any amounts of money for these taxes.
b) Any contract or agreement resulting from the acceptance of this proposal by the Village' sfritt Ue on formi either supplied by or approved by the Village's Legal Department.
The Village reserves the right to reject any agreement that does not conform to the
Request For Proposal and any Village requirements for agreements and contracts.
c) The Village reserves the right to request clarification of information submitted and
request additional information as neededC
4d) The requirements of this RFP shall be included in the contract with the selected
firm.
Payment
The Village authorizes the payment of invoices on the second and fourth Tuesday of the
month. For consideration on one of these dates, payment request mUSt be received no later
than fourteen (14) days prior to the second or fourth Tuesday of the month
lndemnification
The contractor shall protect, indemnify, save, defend and hold forever harmless the village
and/or its officers, officials, employees, volunteers and agents from and against all liabilities,
obligations, claims, damages, penalties, causes of action, costs and expenses, including
without limitation court costs, insurance deductibles and attorney's fees and expenses,
which the Village and/or its officers, officlals, employees, volunteers and agents may incur,
suffer or sustain, or for which the Village and/or its officers, employees and agents may
become obligated by reason for any accident, injury to or death of persons or loss of or
damage to pioperty, or civil and/or constitutional infringement of rights (specifically including
violations of the Federal Civil Right Statutes), arising indirectly or directly in connection with
or under, or as a result of, this or any Agreement by virtue of any act or omission of any of
the Contractot's ofticers, employees, subcontractors, and/or agents, provided that the
contractor shall not be liable for claims, obligations, damages, penalties, causes of action,
costs and expenses arising solely from any act or omission of the Village's officers, officials,
employees, volunteers and/or agents.
The contractor shall hotd the Village harmless for any and all claims for labor, material,
apparatus, equipment, filitures or machinery furnished to the contractor for the purpose of
performing the work under the contract; and the payment of all direct and indirect damages
io any p"rson, firm, company or corporation suffered or sustained on account of the
performance of such work during the time the contract is in force.
lnsurance
Certificates of lnsurance and Additional lnsured Endorsement shall be presented to the
village within fifteen (15) days after the receipt by the contractor of the Notice of Award and
the unexecuted contract, it being understood and agreed that the village will not approve
and execute the contract nor will the bid guarantee be returned until acceptable insurance
certificates are received and approved by the Village.
Each contractor performing any work pursuant to a contract with the Village and each
permittee working under a permit as required pursuant to the provisions of Title 1, chapter
b of the Code oiOrdinances of the Village (hereinafter referred to as "lnsured") shall be
required to carry Such insurance as specified herein. Such contractor and permittee Shall
procure and maintain for the duration of the contract or permit insurance against claims for
injuries to persons or damages to property which may arise from or in connection with the
performance of the work under the contract or permit, either by the contractor, permittee, or
their agents, representatives, employees or subcontractors.
A contractor or permittee shall maintain insurance with limits no less than:
a) General Liability - $10,000,000 combined single limit per occurrence for bodily injury,
personal injury and property damage, provided that when the estimated cost of the work in
question does not exceed $5,000 the required limit shall be $500,000;
b) Automobile Liability (if applicable) - $ 1,000,000 combined single limit per accident for
bodily injury and propertY damage;
c) Worker's Compensation and Employer's Liability - Worker's Compensation limits as
required by the Labor Code of the State of lllinois and Employer's Liability limits of
$1 ,000,000 per accident.
Any deductibles or self-insured retention must be declared to and approved by the Village.
At the option of the Village, either the insurer shall reduce or eliminate such deductible or
self-insured retention as respects the Village, its officers, officials, employees and
volunteers; orthe lnsured shall procure a bond guaranteeing payment of losses and related
investigations, claim administration and defense expenses to the extent of such deductible
or self-insured retention.
The policies shall contain, or be endorsed to contain, the following provisions:
d) General Liability and Automobile Liability Coverage -
l. The Village, its officers, officials, employees and volunteers are to be covered
as additional insureds as respects: liability arising out of activities performed
by or on behalf of the lnsured; premises owned, occupied or used by the
lnsured. The coverage shall contain no special limitations on the scope of
protection afforded to the Village, its officers, officials, employee's volunteers
or agents.
ll. The lnsured's insurance coverage shall be primary insurance as respects the
Village, its officers, officials, employees, volunteers and agents. Any
insurance or self-insurance maintained by the Village, its officers, officials,
employees, volunteers or agents shall be in excess of the lnsured's insurance
and shall not contribute with it.
lll. Any failure to comply with reporting provisions of the policies shall not affect
coverage provided to the Village, its ofiicers, officials, employees, volunteers
or agents.
lV. The lnsured's insurance shall apply separately to each covered party against
whom claim is made or suit is brought except with respect to the limits of the
insurer's liabilitY.
e) Worker's Compensation and Employer's Liability Coverage
The policy shall waive all rights of subrogation against the Village, its officers, officials,
empioyees, volunteers and agents for losses arising from work performed by the
insured for the Village.
Each insurance policy shall be endorsed to state that coverage shall not be
suspended, voided, canceled by either party, reduced in coverage or in limits except
after thirty (30) days prior written notice by certified mail has been given to the Village.
Each insurance policy shall name the Village, its officers, officials and employees,
volunteers and agents as additional lnsureds. lnsurance is to be placed with insurers
with a Best's rating of no less than A: Vll.
Each Insured shall furnish the Village with certificates of insurance and with original
endorsements effecting coverage required by this provision. The certificate and
endorsements for each insurance policy are to be signed by a person authorized by
that insurer to bind coverage on its behalf. The certificates and endorsements are to
be on forms approved by the Village and shall be subject to approval by the Village
Attorney before work commences. The Village reserves the right to require complete,
certified copies of all required tnsurance policies, at any time.
Each insured shall include all subcontractors as insureds under its policies or shall
furnish separate certificates and endorsements for each subcontractor. All
coverages for subcontractors shall be subject to all of the requirements stated herein.
6. Safety
The contractor and any subcontractors shall comply with all the provisions of the Federal
Occupational Safety and Health Act of 1970 (84 Stat. '1590), as amended.
Equal Opportunity
The Contractor will not discriminate against any employee or applicant for employment
because of race, color, religion, sex, ancestry, national origin, place of birth, age or handicap
unrelated to bona fide occupational qualifications.
Execution of Documents
The contractor, in signing his Proposal on the whole or on any portion of the work, shall
conform to the following requirements:
proposals signed by an individual other than the individual represented in the Proposal
documents shall have attached thereto a power of attorney evidencing authority to sign the
Proposal in the name of the person for whom it is signed.
proposals which are signed for a partnership shall be signed by all of the partners or by an
attorney-in-fact. lf signed by an attorney-in-fact, there shall be attached to the Proposal a
power of attorney evidencing authority to sign the proposal, executed by the partners
proposals which are signed for a corporation, shall have the correct corporate name thereof
and the signature of the President or other authorized officer of the corporation manually
written below the corporate name.
lf such Proposal is manually signed by an official other than the President of the Corporation,
a certified copy of a resolution of the board of directors evidencing the authority of such official
to sign the Proposal shall be attached to it. such Proposal shall also bear the attesting
signiture of the Secrelary of the corporation and the impression of the corporate seal'
The Contract shall be deemed as have been awarded when formal notice of award shall
have been duly served upon the intended awardee.4
9. Non-Discriminating
The Vendor, its employees and subcontractors, agrees not to commit unlawful discrimination
and agrees to comply with applicable provisions of the lllinois Human Rights Act, the U.S.
Civil Rights Act and Section 504 of the Federal Rehabilitation Act, and rules applicable to
each.
10. Negotiations
The Village reserves the right to negotiate specifications, terms, and conditions which may
be necessary or appropriate to the accomplishment of the purpose of the RFP. The Village
may require the entire proposal be made an integral part of the resulting contract. This implies
that all responses, supplemental information, and other submissions provided by the
contractor during discussions or negotiations will be held by the Village as mntractually
binding on the successful contractor.
11. lncurred Costs
The Village will not be liable in any way for any costs incurred by respondents in replying
to this RFP. Contractor agrees to comply with all laws, ordinances, and rules of the Village
and the State of lllinois.
12. Contractor Responsibilities
The selected Contractor will be required to assume responsibility for all services offered
in this proposal. The Village will consider the selected Contractor to be the sole point of
contact with regard to contractual matters, including payment of any and all charges
resulting from the contract.
13. Prevailing Wage
All wages paid by the Contractor and each subcontractor shall be in compliance with The
Prevailing Wage Act (820 ILCS 130), as amended, except where a prevailing wage
violates a federal law, order, or ruling, the rate conforming to the federal law, order, or
ruling shall govern. lf the Department of Labor revises the wage rates, the revised rate,
as made available on the Department's official website, shall apply to this contract and
the Contractor will not be allowed additional compensation on account of said revisions.
The Contractor shall be responsible to notify each subcontractor of the wage rates set
forth in this contract and any revisions thereto.
Contractor will comply with the lllinois prevailang wage law, as amended from time to time
and made available on the Department of Labof s official website. Not less than the
prevailing rate of wages as found by the lllinois Department of Labor shall be paid to all
laborers, workers and mechanics performing work under the Contract. lf the Department
of Labor revises the prevailing rate of wages to be paid laborers, workers or mechanics
under the Contract, the revised prevailing rate of wages shall apply to the Contract and
Contractor shall have the sole responsibility and duty to pay, and ensure that all
Subcontractors pay, the revised prevailing rate ofwages to each person to whom a revised
rate is applicable. Revision of the prevailing wages shall not result in an increase in the
Contract sum or other cost to Village of Oak Brook. Contractor shall indemnify, defend
and hold Village of Oak Brook harmless from any loss, including but not |imited to Village
of Oak Brook's attorney's fees, resulting from Contractor's failure to comply with this
prevailing wage clause. All bonds applicable to the Contract shall include a provision as
will guarintee the faithful performance of the obligation to pay the prevailing rate of wages.
The contractor and each subcontractor shall make and keep, for a period of not less than
3 years, records of all laborers, mechanics, and other workers employed by them on the
project; the records shall include each worker's name, address, telephone number when
av;ilable, last four digits of their social security number, gender, race, ethnicity, veteran
status, classification or classifications, the hourly wages paid in each period, the number
of hours worked each day, the starting and ending times of work each day, the worker's
hourly rate, the worker's hourly overtime wage rate, the worker's hourly fringe benefit
rates, the name and address of each fringe benefit fund, the plan sponsor of each fringe
benefit, if applicable, and the plan administrator of each fringe benefit. The contractor
and each subcontractor shall submit monthly, in person, by mail, or electronically a
certified payroll to the Department of Labor, or to the public body if the Department of
Labor has yet to activate the database created by section 5.1 of 820 ILCS 130. The
certified payroll shall consist of a complete copy of the records. The certified payroll shall
be accompanied by a statement signed by the contractor or subcontractor which states
that: (i) such records are true and accurate; (ii) the hourly rate paid to each worker is not
less tiian the general prevailing rate of hourly wages required; and (iii) the contractor or
subcontractor is aware that filing a certified payroll that he or she knows to be false is a
Class B misdemeanor.
Upon 7 business days' notice, the contractor and each subcontractor shall make
available for inspection and copying at a location within this state during reasonable
hours, the records to the public body in charge of the project, its officers and agents, and
to the Director of Labor and his deputies and agents The Contractor and each
subcontractor shall permit his/her employees to be interviewed on the job' during
working hours, by compliance investigators of the Department or the Department of
Labor.
14. Default
The contract may be canceled or annulled by the village in whole or in part by written
notice of default t,o the Contractor upon nonperformance or violation of contract terms' An
award may be made to another contractor wilh services similar to those so terminated.
Failure of ihe Contractor to deliver services within the time stipulated on his offer, unless
extended in writing by the Village, shall constitute contract default.
15. Force Maieure
A force majeure occurrence is an event or effect that cannot be reasonably anticipated
or controlled and is not due to the negligence or willful misconduct of the affected
Party.
unless otherwise agreed in the contract between the parties expressly or impliedly,
where a party to a contract fails to perform one or more of its contractual duties, the
consequences set out in this clause will follow if and to the extent that the party
proves: 1a; that its failure to perform was caused by an impediment beyond its
ieasonable control; (b) that it could not reasonably have been expected to have
taken the occurrence of the impediment into account at the time of the signing of
the contract; and (c) that it could not reasonably have avoided or overcome the
effects of the imPediment.6
A party invoking this clause shall be presumed to have established the conditions
described in the preceding paragraph in the case of the occurrence including, but
not limited to, one or more of the following impediments or other similar causes
beyond the control of the contractor or the Village in the performance of the contract
where non-performance, by exercise of reasonable diligence, cannot be prevented:
acts of God or natural disaster such as but not limited to violent storm, cyclone,
typhoon, hurricane, tornado, blizzard, earthquake, volcanic activity, landslide, tidal
wave, tsunami, flood, damage or destruction by lightning, drought;
acts of war (whether declared or not), armed conflict or the serious threat of the
same (including but not limited to hostile attack, blockade, military embargo),
hostilities, invasion, act of a foreign enemy, extensive military mobilization;
civil war, riot, rebellion, revolution, military or usurped power, insurrection, civil
commotion or disorder, mob violence, act of civil disobedience;
acts of public enemies, acts of terrorism, sabotage or piracy;
plague, epidemic, pandemic, outbreaks of infectious disease or any other
public health crisis, including quarantine or other employee restrictions;
act of authority whether lawful or unlav'rful, compliance with any law or
governmental order, rule, regulation or direction, curfew restriction, expropriation,
iompulsory acquisition, seizure of works, requisition, nationalization;
explosion, fire, destruction of machines, equipment, factories and of any kind of
installation, prolonged break-down of transport, telecommunication or electric
current;
general labor disturbance such as but not limited to boycott, strike and lock-out,
go-slow, occupation of factories and premises;
shortage or inability to obtain critical material or supplies to the extent not subject
to the reasonable control of the subiect Party.
The affected party shall provide the other party with written notice of any force
majeure occurrence as soon as the delay is known and provide the other party with a
wriiten contingency plan to address the force majeure occurrence. Furthermore, the
affected party shall use its commercially reasonable efforts to resume proper
performance within an appropriate period of time. Notwithstanding the foregoing, if the
iorce majeure condrtion continues beyond 30 days, the parties to the contract shall
jointly decide on an appropriate course of action that will permit fulfillment of the
parties' objectives under the contract.
contractor shall not be entitled to an adjustment in contract price or other non-price
related items caused by or within the control of contractor. Delay, disruption, and
interference attributable to and within the control of a subcontractor or supplier shall
be deemed to be within the control of contractor.7
1 6. lndependent Contractor
There is no employee/employer relationship between the contractor and the Village.
contractor is an independent contractor and not the Village's employee for all purposes,
including, but not limited to, the application of the Fair Labors Standards Act minimum
wage and overtime payments, Federal lnsurance contribution Act, the social security Act,
the Federal Unemployment Tax Act, the Worker's Compensation Act (820 ILCS 305/'l , et
seg.). The vILLAGE will not (i) provide any form of insurance coverage, including but not
timited to health, worker's compensation, professional liability insurance, or other
employee benefits, or (ii) deduct any taxes or related items from the monies paid to
Contractor. The performance of the services described herein shall not be construed as
creating any joint employment relationship between the contractor and the village, and
the Village is not and will not be liable for any obligations incurred by the contractor,
including but not limited to unpaid minimum wages and/or overtime premiums, nor does
there exist an agency relationshrp or partnership between the Village and the contractor.
17. Governing Law
The laws of the State of lllinois as to interpretation, performance and enforcement shall
govern this Agreement. The forum for resolving any disputes concerning the parties'
iespective performance or failure to perform under this Agreement shall be the Circuit
Court for the Eighteenth Judicial Circuit, DuPage County, lllinois'8
Section 2. Proposal lnstructions
Four (4) copies of the proposal shall be submitted in a sealed envelope to:
Rania Serences
Senior Purchasing Assistant
Village of Oak Brook
1200 Oak Brook Road
Oak Brook, lL 60523
and clearly marked on the outside of the envelope "lndependence Day Fireworks Display" on
or before Tuesday, November 16,202',1 at 3:00 p.m. prevailing time. Any proposal received
after this date and time will be rejected and returned unopened.
Lengthy, detailed proposals are not required. Proposals are intended to be an expression of
inteiesi in providing services for the project, as well as background information on the firm and on
its professional qualifi cations.
A. Documents/lnformation to be Submifted
Proposal Form (Section C below), Detailed cost Spreadsheet and Narrative
References (Section D below)
Contractors Certification (Section E below)
Sexual Harassment Policy (Section F below)
Statement of Qualificationso Provide background information on your firm including, but not limited to,
the age of the business, the number of employees, and pertinent financial
data that will permit the Village to determine the capability of the contractor
to meet all contractual requirements.
. List the abilities, qualifications, and experience of the persons who would
be assigned to the engagement and their experience on similar contracts.
Project Approach
o Terms and Conditions
List any terms and conditions which may apply to this contract and are
not included in this RFP.
. Additional lnformation and Comments
lnclude any other information you believe to be pertinent but not specifically
mentioned elsewhere.9
B. Proposal
ln compliance with this Request for Proposals, and subject to all conditions thereof, the
undersigned offers and agrees, if this proposal is accepted, to furnish the services as outlined
herein ior the Village of Oak Brook at the amount indicated, subject to modification through
negotiations. The time and material, not to exceed, cost proposed shall include all anticipated
expenses.
Perform the 2022 lndependence Day Fireworks Display
Not-to-Exceed Cost of $$32,50000
please provide a detailed list (size, amount, cost) of mortars and shells, etc. that will be used for the
display.
Firm Name:
Address:
DBA Mad Bomber Fireworks Productions
City, State,
Signature:
Name
Title:
Telephone: 2l Date: November 5, 2021
lf a Corporation:
ATTEST:
10
融 D BOMDEQ
F:REWORKS PRODuCT10NS
3999 E HUPP ROAD′BU LDING R-3-l LA PORTEIN 46350
PHONE(219)393-5051 TOLL FREE(877)623‐2662 FAX(219)393‐3177
Mad Bomber Fireworks Productions is in our Thirty-First year of producing professional fireworks
displays. ln the beginning we quickly earned the reputation as a company who catered to 'smaller'
clients that other fireworks companies tended to dictate terms to. We were often appreciated as a
firm that worked with our clients to ensure exPectations were met by both parties, lt was always
going above and beyond the norm that helped us compete with the big family companies that
dominated the fireworks industry. Many of whom had the benefit of generations of loyal customers.
we approached growth cautiously; while never losing siSht ofwhat had put us above the crowd for
our clients, now we enioy a strong and loyal clientele.
Today we produce approximately 5oo displays per year throughout the Midwest. our offerings
include traditional displays, electric fired, choreographed to music, computer fired, indoor and close
proximity displays. Our clientele ranges from high school homecomings to extravagant displays for
summer festivals and of course lndependence Day fare.
Andrew James, President, started Mad Bomber Fireworks in 1991. Due to his love of fireworks he
knew he wanted to build a company that provided the best displays as well as exceptional service. He
has produced thousands of displays over the years and has Srown the company into the premiere
display company in the Midwest.
Randy McCasland, Director of operations started working with his father on displays at a young a8e.
Having grown up in the industry, he provides an insight into display production paralleled by few. He
has been the lead operator on well over one thousand displays throughout fourteen states. Randy has
designed, produced and worked on displays for many industries, including professional baseball,
professional basketball, concert events, air shows, festivals, and cities and towns'
Mad Bomber Firework currently has eight full time employees. During the summer we bring on ten
to twelve college students full time to work preparing for the busy season. Many of whom return
season after season to work for the summer. Nearing the Fourth of July, we ramp up for our displays,
and we bring on 4OO-5OO workers producing displays throughout the Midwest. We pride ourselves on
the extensive training, skill and talent of our operators and crews.
C. References
Your Company Name:
(Please Print)
The Contractor shall list five (5) current references with needs similar to the Village of Oak Brook
for whom Contractor has provided comparable services. Please include company name, address,
telephone number, year(s) employed by referenced firms, contact person, and type of work you
performed for that entity.
1. Company Na me/Mu n icipa lity:Village ofBensenville
Miand Inc. DBA Mad Bomber Fireworks Productions
Address: 12 S Center St Bensenville, IL 60106
Phone' ( 630 \ 697'3439
Contact Person: Gary Thorsen
Type of Work and Date Performed: Iuly 4th Fireworks Displa],s
2. Company Name/Municipality: Westrnonl Park District
Address: 55 E Richmond St Westmont, IL 60559
Phone: ( 630 ) 969.8080
Contact Person: Bob Fleck
Type of Work and Date Performed: Iuly 4th Fireworks Displays
3. Company Name/Municipality: Village of Orland Hills
16553 S Haven Ave Orland Hills,IL 60487Address:
Phone: ( 70o ) 3497211
Contact Person: Glenn BYlina
Type of Work and Date Performed: Independence Dav Celebration
4. Company Name/Municipality: Citv of Waukegan
loo N Martin Luther )r Ave W
Phone: ( 847 \ j992521
Contact Person: David Motley
Type of Work and Date Performed: Juky 4th Fireworks Displav
5. Company Name/Municipality: Village of Woodridge
Address: 5 Plaza Dr νV oodridge IL 6051ラ _
Phone: ( 630 \ 7t9.470s
Contact Person:
Type of Work and Date Performed: Iuly 4th Fireworks Display
E. ContractorsCeftification
The undersigned, being first duly sworn an oath, deposes and states that he has the authority to
make this certification on behalf of the contractor for the construction, product, commodity, or service
briefly described as follows:
"lndependence Day Fireworks Display"
The undersigned certifies that, pursuant to Chapter 720, Section 5/33E of the lllinois
Compiled Statutes, 1993, the contractor is not barred from bidding on this contract as a result
of a conviction for the violation of State of lllinois laws prohibiting bid+igging or bid-rotating.
The undersigned states under oath that, pursuant to Chapter 65, Section 5/11-42.1-1 of the
lllinois Compiled Statutes, 1993, the contractor is not delinquent in the payment of any tax
administered by the lllinois Department of Revenue.
The undersigned certifies that, pursuant to Chapter 775, Section 512'105. of the lllinois
Compiled Statutes, 1993, the contractor has a written sexual harassment policy in place
including the following information:
a) An acknowledgment of the illegality of sexual harassment.
b) The definition of sexual harassment under State law.
c) A description of sexual harassment, utilizing examples.
d) The Consultant's internal complaint process including penalties.
e) The legal recourse, investigative and complaint process available through the lllinois
Department of Human Rights and the Human Rights Commission.
f) Directions on how to contact the Department or the Commission.
3)
This business firm is:
X Corporalon
Telephone:219-393-5051 ｀
(check one)
Partnership individual
R-3-1
Noveコnber 5,2021
City, State,
Signature:
Tlle:
13
Firm Name:
Address:
ATTES丁:KeLLEY ANr.t xrtrtelO fURLilrJottry Public . scal
視驚献12譜 w『需ノ串雷:担 穏明
'■',:29
‐SEAL―
14
D. Sexual Harassment PolicY
Miand Inc. DBA Mad Bomber Fireworks Productions hereinafter referred to as ,,Contractor,, having
to the Village of Oak
Brook, DuPage/Cook Counties, lllinois, hereby certifies that said Contractor has a written sexual
harassment policy in place in full compliance with 775 ILCS 5/2-105(AX4) including the following
information:
1)
2)
3)
4)
5)
An acknowledgment of the illegality of sexual harassment.
The definition of sexual harassment under State law.
A description of sexual harassment, utilizing examples.
The contractor's internal complaint process including penalties.
The legal recourse, investigative and complaint process available through the lllinois
Department of Human Rights and the Human Rights Commission.
Directions on how to contact the Department
provided in Section 6-
of Human RightsEach contractor must provide a copy of such written
upon request.
of Contractor
15
Section 3. Review Process
A. Evaluation of Proposals and Selection
The proposals received will be evaluated by the Village on the basis of professional qualifications,
previous experience on similar projects, key personnel assigned to the project, satisfaction of
previous clients on work performed for them, current billing rates of the firm, and the proposal that
best meets the needs of the Village. This proposal is not intended to be detailed; it is intended to
be an expression of interest in providing services for the project, as well as to provide background
information on the firm and its professional qualifications. Firms will be contacted during the
evaluation if further information is needed. The Village may choose to interview one or more firms
before final selection is made.
This Request for Proposal does not commit the Village to award a contract, to pay any costs
incurred in the preparation of a proposal based on this request, or to procure or contract for
services. All proposals submitted in response to this Request for Proposal become the property
of the Village. The Village reserves the right to accept or reject any or all proposals received as
a result of this request, to negotiate with qualified consultants, or to cancel in part or in its entirety
the Request for Proposal, if it is in the best interest of the Village to do so. The Village may require
the consultant selected to participate in negotiations concerning contract price or the nature and
extent of services to be provided. The results of such negotiations shall be incorporated into the
final contract between the Village and its consultant'
B. Basis of Award
Village staff will perform an evaluation of the proposals received. Appropriate finalist(s) may be
interviewed by the Village, after which a selection will be made-
The Village reserves the right to reject any or all proposals and to waive any informality or
technical6rror and to accept any proposal deemed most favorable to the interests of the Village.
The Village will review proposals based on the following criteria:
Compliance with RFP. Adherence to all conditions and requirements of the RFP.
understanding of the Project. The contractor's understanding of the engagement, the
Village's objectives, and the nature and scope of the work involved.
services to be Provided. The exact type and nature ofthe contractor's proposed services
and how they accomplish the objectives of the project.
Qualifications of the Contractor. The contractor's capability in all respects to perform fully
all contract requirements, and the integrity and reliability which will assure good faith
performance. This criterion includes:. The experience of the firm and its record on projects of a similar nature.
. Personnelto be assigned to the project, their education, qualifications, and experience
on similar projects.
. The availability of necessary personnel and other resources to Successfully complete
the project specified herein on a timely basis.
3)
4)
16
5) Costs. Proposed contract price.
6) Ability, capacity and skill to fulfill the contract as specified.
7) Ability to supply the commodities; provide the services or complete the construction
promptly, or within the time specified, without delay or interference.
8) Character, integrity, reputation, judgment, experience and efficiency.
9) Quality of performance on previous contracts.
10) Previous and existing compliance with laws and ordinances relating to the contract.
1 1 ) Sufficiency of financial resources.
12) Quality, availability and adaptability of the commodities, services or construction, in
relation to the Village's requirements.
13) Ability to provide future maintenance and service under the contract.
14) Number and scope of conditions attached to the proposal.
15) Record of payments for taxes, licenses or other monies due the Village.
17
Mro EoAtEEp
FIttWORKSPRODUCTIONS
3999 E HUPP RD R…3…l LAPORTE,IN 46350
PHONE(219)393…5051 Toll Free(877)MAD…BOMB
OAK BR00K
PROPOSAL
JULY 392022
FAX(219)393‐3177
MAD BOヽ IBER FIREWORKS PRODUCTIONSIS PLEASED TO PRESENT FOR YOUR
CONSIDERATION THIS EXCEPTIONAL PROPOSAL FOR A SPECTACULAR
FIREWORKS SHOW TO BE PRESENTED FOR YOURINDEPENDENCE DAY
CELEBRAT10N.
FIREWORKS SHOW
PROFESSIONAL PRESENTATION
$10,000,000 LIA131LITV INStJRANCE
POST DISPLAY CLEANUP
EARNEST MONEY DEPOSIT
BALANCE DUE AFTER PRESENTATION
Mad Bomber Fireworks will also supply the following:
1. We will secure all permits. Buyer will cover cost of permit'
2. CDL driver with a Hazmat endorsement.
3. Registered with the USDOT to haul hazmat. (mandatory by Federal Law)
4. Carry $5,000,000.00 auto insurance to haul hazmat. (mandatory by Federal Law)
5. Haul hazmatmaterial in a properly placarded vehicle.
BadalC
McCasland, Director of operations
$32,500,00
1NCLUDED
INCLUDED
INCLUDED
SWAⅣED
$32,500.00
MAD BOMBER
FIREWORKS PRODUCTIONS
AGREEMENT
This contract entered into this sth day of November , 2021 by and between Mad Bomber Fireworks
Productions of Kingsbury, Indiana hereinafter referred to as Seller, and
Villaee of Oak Brook
Herein after referred to as Buyer, of Oak Brook State: Illinois
Illinois
Witness: Seller agrees to provide and Buyer agrees to purchase a Fireworks Display in accordance with the program agreed
upon. Buyer will pay Seller a sum of $32.500.00 for Display. Upon acceptance of this agreement Buyer will pay Seller a sum of
Waived as an Earnest Money Deposit with the Balance due and payable within 30 days after the display date agreed upon. A late
charge of 1 %% per month will be assessed on accounts not paid within thirty days of display date. Buyer agrees to pay any and all
collection costs, including reasonable attorney's fees and court cost incnrred by Seller in the collection or attempted collection ofany
amount due under this agreement and invoice.
Both Seller and Buyer mutually agree to the following terms, conditions, and stipulations:
1. Seller will present said Fireworks Display on the evening of the 3rd Day of July ,2022, it being understood that
should there be inclement weather the day of the display the Seller has sole discretion to cancel display. An alternate display
date will be given within six months of the original display date agreeable to both the Seller and Buyer.
2.The Fee for cancellation for any reason of the Fireworks Display is 40% of the agreement price if Buyer chooses to not
select another display date within six montl.rs of the original display date.
3. Buyer will provide a sufficient area for the Display, including a minimum spectator set back of 560' feet at all points
from the discharge area. Buyer will provide protection of the display by roping-off or other suitable means. Buyer will
provide adequate police protection to prevent spectators from entering display area. Buyer agrees to search the fallout
area at first light following a night display.
4. Seller reserves the right to terminate the Display in the event that persons enter the secured Danger Zone ar,d Security is
unable to secure the Danger Zone.
5. Seller agrees to provide Qualified Technicians to take charge of and present said Display.
6. Seller agrees to provide Liability Insurance in the amount of $10,000,000.00 for the benefit of both the Buyer and Seller.
All individual entities listed on the Certificate of Insurance will be deemed an additional insured per this contract.
7. Mad Bomber Fireworks Productions retains the right to substitute product of equal or greater value in the event of
shortages or unavailability ofany particular item on the proposal.
8. Seller and Buyer agree to included Attachments, if any. See Attachments: none
Both Seller and Buyer hereto do mufually and severally guarantee terms, conditions, and payments of this contract, these articles to
be binding upon the parties, themselves, their heirs, executors, administrators, successors and assigns.
Mad Bomber Fireworks Productions BUYER
By By
Randy McCasland
Date
(Its duly authorized agent, who represents that he/she has full authority to
Bind the Buyer.)
Date
Print Name
Address
Ook Brook
Opening
36 2.5" Color Willows
24 3" Assorled Color Shells
6 4" Assorled Color Shells
2 5" Assorled Color Shells
1 6" Thousond Blooming Flowers
Mod Bomber
Fireworks Productions
Ook Brook
SPECiALTY BARRACES Dに ploved by pond
300 Shot Color Xsette ond Crockling
300 Shot Blooming Stors
200 Shot S & I Coconut w/Turbillion
170 Shot Chrys to Chrys (Crockling Chrysonthemums)
200 Shot Z Brocode Crown Blue Comet
400 Shot Color ond Solute
100 Shot Red Dohlio w/Red Toil
100 Shot Fon Red White ond Blue Crosseite
100 Shot Crockling Chrysonthemum
Mod Bomber
Fireworks Productions
36
Ook Brook
3INCH SHEttS
Three Shol Volleys
Coconut Polms
Purple Sky Mines
Silver Flying Fish
Green Strobe
White Strobe
Red White & Blue Ring w/Mine
Red Strobe
Red White & Blue w/Brocode Mine
Brocode w/Red White & Blue Mine
Turquoise Peony w/Polm Core
Peoch Flying Stors
Lemon PeonY
4 INCH SHEttS
Three Shol VolleYs
Red Green Blue SPorkling Roin
Green White Blue Clustering Strobe
Color Peont w/SPorkling Pistil
Cyon w/Mog Pistil
I /2 Red I /2 Silver
Oronge Glittering Woterfoll
Brocode w/Red Leoves
Ihree shells shol simulloneously ond
spreod ocross skY
Gold Komuro
Yellow Chrysonthemum w/Red Pistil
Silver PeonY w/oronge Pistil
Three Color Chonging
Cyon Peony w/Color Chonging Pisiil
Red White & Blue Rings
Violet Chrysonthemums
Blue Chrysonthemums
Purple Peony
Mog Green Peony
Mog Red PeonY
Mog Oronge Peony
Color Flying Stors
Silver Strobe
Hummer
Pixie Dust Willow
Glittering Silver
White Strobe Woterfoll
Brocode w/Roind\bow Dohlio
Mod Bomber
Fireworks Productions
30
Ook BrOOk
24 3" SPECIALTY SHEttS
3" Color Wolfs 3" Assorted Sky Mines
3" Silver Serpent w/Mogento 3" Peoch Flying Stors
3" Whistling w/Color Siors 3" Bonger Chortreuse
3" Red SkY Mines 3" Blue Comets
3,' Blue Sky Mines 3,'Diomond Screomer w/Color Stors
3" White Sky Mines 3" White Strobe Woterfoll
3" Smile Foce 3" oronge Strobe
3" Silver Turbulence w/RePort
I8 4'' SPECIALTY SHELTS
4"Cyon SkY Mine
4'Whistle Red Stors
4" Silver Flying Fish
4" Aquo w/Silver Turbulence
4" Forfollo w/Mogenio Stors
4' Assorted Color Wolfs
4" Multi Color FlYing Stors
4" Silver SerPents w/Mog Colors
IO 5'' SPECIATTY SHELTS
5" Forfollo w/Color
5" Multi Color Wolf
5" Mulii Color SkY Mine
5" Multi Color Poinsotte
5" Five Arm Cui Gloss
5" White Strobe Woterfoll
5" Gold Whirl io RePort
5" Silver Wove to Crockling Color
4" Whirlpool Green Xsette
4" Whirlpool Red Xsette
4" Green Sound Ring
4" Tourbillion w/Color Stors
4" Diomond Screomer w/Color Slors
4" Lemon Xsette w/Time Roin
4" Ti Serpent w/Red & Blue to Report
4" Ti Whistle Ring w/Lemon
5" Red Wove lo Xsette
5" Pixie Dust w/Stoin Gloss
5" Oronge Glittering Woterfoll w/Red Glitt
5" Glittering Xsetie
5" Whirl w/Blue Plstil
5" Color Chonging Ghost
5" Tourbillion to Color ond Report
5" Brocode to Thousond Green
Mod Bomber
Fireworks Productions
Ook Brook
Speciolty Stocks
Silver Slrobes
3"
Red, White ond Blue
3"
4"
5"
Colorlul Folling Leoves
3"
4"
5"
Differenl slze shells breoking ot multiple
heights creoling o slock.Mod Bomber
Fireworks Productions
Ook Brook
3 INCH SHELLS * main bodY
l8 Pheonix
Red PeonY w/Red Tail
Green & PurPle PeonY w/Tail
Green & Blue Chrysanthemum w/Tail
Glittering Big Willow
Five Pieces Willow
Red Stars w/1000Green w/Tail
Yellow to Crackling
Silver Crown to Red
Silver Crown to Yellow
18 Vulcan
Green PeonY w/Palm Core & Tail
Red PeonY w/Glitt Coco Core & Tail
Purple Peony w/Green Pistil & Pur Tail
Vareigated Chrysanthemum WBlue Tail
Spangle Chrysanthemum w/Red Tail
Crack Flower Chrys w/Crack Tail
1/2 Yellow 112 Blue w/Blue Tail
Orange to Blue Chrysanthemum
Gold Wave Green Strobe Chrys
12 Yung Feng
White Twinkling Chrysanthemum
Variegated CYcas Bloom
Green Chrysanthemum w/Crackling
Golden Silk Chrysanthemum
Red Cherry Blossom w/Tail
Nishiki Kamuro
Golden Gamboge to Blue
Golden Gamboge to Green
Silver Strobe
Brocade Crown to Red
Brocade Crown to Blue
Ripples to Red
Ripples to Blue
Red Peony w/Strobe Pistil
Color Flower Rain w/Silver Tail
Glitt Silver to Green to Red
Red and Spangle Chrysanthemum
Silver Strobe w/Strobe Tail
Multi Color Chrysanthemum
Yellow to Crackling WCrack Tail
Vareigated Color to Crack Flower
Ruby Red PeonY
Blue to Crackling Rain
Crackling Palm Tree w/Crackling Tail
Crackling Nishiki Kamuro
Golden Wave to Purple Chrysanthemum
Glittering Silver to Red Chrysanthemum
Reddish Gamboge to Silver Chrysanthemum
Nishiki Kamuro Niagra Falls
Silver Willow
Mad Bomber
Fireworks Productions
Oqk Brook
3 INCH SHEttS * moinbodv
72 Wizord Brond
Silver Strobe Glittering Sil to Red w/Blue Pistil w/Sil Toil
USA Style Titonium Whistle Connister Glittering Sil to Blue w/Red Pistil w/Sil Toil
Red io Crockling Chrysonthemum Bowtie w/Ring w/Sil Toil
Blue cycos w/ Gold Toil Green Peony w/Purple Pistil w/sil Toil
crockling spider to Yellow w/silver Toil Red chrys w/Blue Pistil w/Gold Toil
Silver to Green io Blue Peony w/Gold Toil Gliiiering coconut w/Glittering Toil
Red to Blue Peony w/Coco Pisiil w/ Sil. Toil New Roinbow Color Dohlio
Gold Silk w/Gold Toil Blue USA Style Connister
Purple chrys. w/coco Pistil w/Sil Toil RWB Peony to crock chrys w/Gold Toil
Green to Flosh w/Coco Pistil Glittering Silver to Blue
Blue to Red Flosh Yellow Chrys w/Coco Pistil w/Sil Toil
Brocode Crown w/Blue Pistil Mogento Peony w/Polm Core
RedCycosBlossoml/2Redll2BlueChrysonthemum
Purple Peony w/Gold Coco Pistil Red White & Blue Peony
Firefly Woterfoll w/Firefly Toil Red to Crockling
silver Potm Tree w/Silver Toil silver Peony w/Green Pistil
Green Peony w/Coco Pistil Gold Spongle w/Purple Pistil
Gittering Silver to voreigoted silver Fish w/BlueRing
6 Tilonium Scllule
3 1NCH SHELLS Mod Bomber
Fireworks Productions
24
Ook Brook
4 INCH SHEttS * moin bodY
Jinshon
Red Peony w/Red Toil
Red Chrysonthemum w/toil
Blue Chrysonihemum w/Toil
Glittering Big Willow
Five Pieces Willow
Red to Crockling
Yellow to Crockling
Silver Crown to Red
Silver Crown to Yellow
Guondu
Green Peony w/Polm Core & Toil
Red Peony w/Glitt Coco Core & Toil
Purple Peony w/Green Pistil & Pur Toil
Voreigoted Chrysonthemum w/Blue Toil
Spongle Chrysonthemum w/Red Toil
crock Flower chrys w/crock Toil
l/2 Yellow l 12Blue w/Blue Toil
Color Wove w/Silver Toil
Gold Wove Green Strobe Chrys
Golden Gomboge to Blue
Golden Gomboge to Green
Silver Strobe
Brocode Crown to Red
Brocode Crown to Blue
Ripples to Red
Ripples to Blue
Red Peony Wstrobe Pistil
Red Peony wCrockling Pistil
Glitt Silver to Green to Red
Red ond Spongle Chrysonthemum
Silver Strobe w/Strobe Toil
Brocode Crown to Crockling w/Crock Toil
Yellow to crockling w/crock Toil
Voreigoted Color to Crock Flower
Green Ring w/Green Toil
crockling willow w/Gold Toil
Crockling Polm Tree w/Crockling Toil
Mod Bomber
Fireworks Productions
24
Ook Brook
4 INCH SHETLS * moinbodv
36 Wizord Brond
Blue to Flosh w/coco Pistil Gliitering sil to Red w/Blue Pistil w/Sil Toil
Blue Cherry Blossom w/ Silver Toil Glitiering Sil to Blue w/Red Pistil w/Sil Toil
Brocode Crown w/Silver Toil Bowtie w/Ring w/Sil Toil
BlUeCycosw/GoldToilGreenPeonyw/PurplePistilw/SilToil
CrocklingSpidertoYelloww/SilverToilRedChrysw/BluePistilw/GoldToil
silver to Green to Blue Peony w/Gold Toil Gliltering coconut w/Glittering Toil
Red to Blue Peony w/coco Pistil w/ Sil. Toil New Roinbow color Dohlio
Gold Silk w/Gold Toil Blue USA Style Connisier
Purple chrys. w/coco Pistil w/sil Toil RWB Peony to crqck chrys w/Gold Toil
Green to Flosh w/Coco Plstil Gliitering Silver to Blue
Red cherry Blossom Yellow chrys w/Coco Pistil w/sil Toil
Brocode Crown w/Blue Pistil Mogento Peony w/Polm Core
RedCycosBlossoml/2Red|l29lvechrysonihemum
Purple Peony w/Gold Coco Pistil 3 Concentric Ring
Crockling Nishiki Komuro Red to Crockling
Silver Polm Tree Wsilver Toil Silver Peony w/Green Pistil
Green Peony w/Coco Pistil Gold Spongle w/Purple Pistil
Giitering Silver to Voreigoted Silver Fish w/BlueRing
Mod Bomber
Fireworks Productions
Ook Brook
5 INCH SHEttS * moin bodv
l8 Jlnsheng
Chrys w/Rthree Section Time Roin w/Coco Pistil Blue Peony to Brocde w/Polm Core
Red Strobe w/Blue sky w/Rising Toil Flower wove to Purple w/Rising Toil
silver coconut w/ Glittering Glittering silver to Blue to Green
Sun Ring w/ Rising Toil Green Cherry Blossom
Double Holf Red to Red Red Peony w/Rising Toil
YellowCycosw/RisingToilYellowPeonyw/GreenPistil
Red to Green Crossette Ring Green to Flickering
SilverWovew/SpeciolGreenStrobeRingw/MultiColorFlower
ThousondRedw/TimeRqinKoleidoscopew/Woterfoll
l8 Dominolor
Color Diodem w/Gold Toil Eight Heorts w/Rising Purple Flowers
Gold Silk Chrysonthemum Revolving Drogons w/Blooms
Golden willow w/Flore Moons Thousond color Titonium solutes
ColorPolmTreew/CrownFlowerssilverCrossetteinRed&BlUePeony
NishikiKomurow/ColorTipsNishikiKomurow/NiogroFolls
Mod Bomber
Fireworks Productions
Oqk Brook
5 INCH SHEttS * moinbodv
36 Wizord
Glitt Sil io Red w/Blue Pistil Ti Whistle Ring w/Red & Blue Connister Shell
Red crossette Polm Tree w/toil Glitt Sil to Blue chrys w/Broc Red Pistil
Sitver Crossette Polm Tree w/Toil Brocode woterfoll w/Silver Leoves
Gold crossette Polm Tree w/Toil Gold coconut io Green Flowers
Giont Brocode Crosseite Polm Tree Giont Gold Octopus w/Red Eyes & Bro Ring
Five concentri Ring Giont Green Peony wBrocode Ring
Gold Strobes w/toil Gold Chrys w/Roinbow Ring
l/2 Red l12Blue chrysw/ Broc cross Pistil Gold crossette Polm w/Trunk
Soturn Gioni Red Peony w/Brocode Ring Gliltering Silver
Sil to Blue Chrys w/Red Pistil Red Peony w/Blue Pistil
Blue to Green Peony w/coco Pistil Red to Blue Peony w/Coco Pisiil
Three Ring w/Pistil Brocode to Red to BIue Chrys
Schreecher Connister Gold Peony w/Blue Pistil
RWB Peony w/Coco Pistil Red Strobes w/Toil
Green Strobes w/Toil Giont Z Willow Polm w/Z Willow Toil
Gold Crossette w/Gold Sirobe Pistil Glitt Sil to Blue Chrys w/Brocode Pistil
Gold willow to Purple w/Peony Cenier Giont Golden ociopus w/Toil
Green Peony w/crockling Pistil Brocode crown w/Broc crossette Pistil
12 Phoenix
Chrysw/RedtoGreenRingsilverCrownw/SmollRedFlowers
Silver Crockling Polm Tree Ripples to Voreigoted Wove
Purple Wove Crockling to Sil Crossette
Red Flower Roin Chino Storm
Gold Wove to Aquo White Strobing
Smiley Foce Yellow PeonY
Brocode Butterfly Red to Purple to Green Peony
Seo Blue ond Lemon Dohlios Red Peony w/Glitt Gold Polm Tree Core
Blue Polm Tree Gold Wove to Red to Green
Blue Peony w/Silver core Green to Yellow w/Yellow to Green Pist
Gold Diodem Willow Yellow Peony w/Blue Polm Tree Core
Gold wove to Purple to Green silver Wove to Green to crockling
Mod Bomber
Ook Brook
6 INCH SHEttS * moin bodY
9 New Yeor
coscoding corollo Yellow to Green to Yellow w/Green Pisiil
Green w/Yellow Pistil ond Rising Flowers Corollo w/Blue to Red Pistil
Multi Color cycos w/Rising Siem silver Glittering w/Red to Blue Pistil
Red Chrys to Corollo WRising Toil Blue Chrys to White Strobe
Blue to Red with Silver Pistil Red Chrys to White Strobe
9 Yuon Yeng
Oronge Chrysonthemum
Gold Brocode Crosseite
Red ChrYsonthemum
Blue Chrysonthemum
Green Chrysonthemum
I Konlo
Red ond Yellow Sunflower
Silver Polm w/Rising Toil
Forfollo w/Multi Color
Multi Color Howling Wolf
Red ond Blue w/Rising Toil
Silver Chrysonlhemum
Yellow Chrysonthemum
Red to Blue to White Peony
Yellow ond Green PeonY
Glitiering Oronge Woteroll
Multi Color Poinsetto
Silver Wove to Crockling Color
1/2Lemon i /2 Lime w/Toil
1 /2 Red 1 /2 Blue White Pistil
Violet w/Green Pistil
Mod Bomber
Fireworks Productions
Ook Brook
8 8 INCH SHETLS x moin body
Brocode Purple Flickering w/Gold Strobe Pistil
Brocode newNew color Pistil Gold Wove to Purple to Red w/Pistil
Gold crown w/Koleidescope Pist Crock Nishiki Komuro w/Pistil
color Koleidescope w/Glitt Pistil Eight Heorts w/Rising Leoves Purple
8:NCH SHELLS
Ook Brook
Finqle
144 2.5" Assorled Color Peonies
288 Silver Comels
288 3" Finole Shells
Domlnolor Color Finole
Dominolor SPecioltY Finole
Kqnlo Mog Color Finole
Konlo Comel ond Color Finole
Konlo Premium Color Finole
Wizord Color Finole
Wizord Speclolty Finole
Wizord Glitterlng Silver Flnole
Guondu Iilonlum Solules
12 4" Finqle Shells
Vulcon Color Finole
Wlzord Color Finole
Konlo Color Finole
8 S" Assorted Peonies ond Chrysonlhemums
4 6" Assorled Peonies ond Chrysonlhemums
6 5" Gold Nlshikl Komuro
2 6" Gold Nishiki Kqmuro
Mod Bomber
Fireworks Productions
Fづ I多 ヽ「%爾 ;bθF 7153-650-5
Fo aII Io l劇 犠 競 tた cSc Presents Sttaご J Come Crectご ngI
みルSSθ 予慟づナのSθ θ
“
lα 7 o/S協 オθO/油 θS協 惚o/1J″三雀θれ′ο力
`認
by
C′鷲稔洗αII α解ナたιたθι″θr o/ナ た`“εθだSO/滋 θ Dι ″αγtrt`π ι O/
B,sttι ss S`鬱 イcgs.I θcFオ稔 幾αオ
MIAND,INC.,INCORPORATED IN INDIANA AND LICENSED TO・ 1｀RANSACT BUSINESSIN
THIS STATE ON JANUARY 31,2018,APPEARS TO HAVE COWIPLIED WITH ALL THE
PROVIS10NS OF THE BUSINESS CORPORAT10N ACT O「TIIIS STATE,AND AS OF THTS
DATE,IS A FOREIGN C9RPORAT10N IN G00D STANDING AND AtJTHORIZED T0
TRANSACT BUSINESSIN THE STATE OFILLINOIS,
ルtinttBι irnonJ ttere9ん Iヵ
`“
オθ SCr
窮yた α“グタ筵′θα“
s`オ θわθ刀算χι′幾ιG“αtt S′αl o/
働θS協 オιo/111J“θお′滋IS 25TH
″αソげr FEBRUARIY A.D。 2021 。6Authentication#1 2105603678 VeHiab:●tlnti1 02/25/2022
Authenticalo at httptil螂 .cyberd“ve"綱 nOiS COm SECRETARY OF STATE
STATE OF ILLINOIS
OFFICE OF THE STATE FIRE MARSHAL
DIVIsloN OF FIRE PREVENT10N
1035 StevensOn Drive e sprin爵 lld,IL 627034259
Py/Orecヵ ″たoた 麟治"ね ″上たerse
PLANEtt PRODUCTlo‐NS/MAD BOMBER FIREWORKS
3999 E HUPP RD BLDG R-3‐1LA PORttE,IN 46350
IL06‐OF‐00o29 05ノ 15ノ2024
License #ISSUE DATE
OP
EXPIRATION DATE
This license may be revoked by
the Office of the State Fire Marshal
for failure to comply with the lawful
rules regulating this program.
STATE F,RE MARSHAL
Matt perez
lllinois
Department of
Natural Resources
Oper #: 2166
PLANET
3999
HAS PAID ttHE
・ ‐1.｀
EfFective
Certificate No.18866
Last day of February,2A22
Office of Minea and Minerals
and Minerals
uNrrE》駐 ATES OIF AMERICA ・
DEPARTMENT OF TRANSPOnTATIOIN
PIPELtt AND EAZARDOUS MATEttLSSAFETY AD―STRAT10N
HAZARDOUS MATERIALS
CERttCATE OF RECISTRAT10N
FOR REGISTRAT10N YEAR(S)2019‐2022
Rryistrrnt: MIAI{D INC DBA PLANET PRODUCTIONS
ATTN: Kelley Hatfiold TurleY
3999 HUPP ROAD, BUILDING R.3.1
LA PORTE,IN 46350
This ccrtifics t}at tho r*gistraat is registered with the U.S. Deporment of Trarsportstion as reguired by
49 CFR Part 10?, Subpart G'
l1is certi$csfe is issilsd rmder thE au&ority of 49 U.$.C. 5i08. It is rmlawfirl to alttr or falsify this
document.
Rcg. No: ffi24195502318p Effective: July 1,2S19 Expiresr Ja5re30,2ffi
HM Comprny Itrr 38f54
[ceord K*piag R*quiremcdr for thc Begirtrrti*n Progrrna
Thc followiag mrr6t bs maintained at the principal place of bugincss for a pcriod of three years from tIrc
da*e of issuxrce of tlis Certifieatc ofRqistrdion:
(1) A aofv of &e registatioo stetcln€nt filsd wi& PHMfiA; and
(2) fhis Ccrtificate of Rsgistration
Eaclr peison subjed b the regisEation requircmcnt must fumish &at person's Cortificats of Registntion
(or a mpy) and atl odrer rerords and information portaining to the information oontained in dre
rcgistratiorr stmmefit to an aufhorizd represqltativp or special ageirt of thc U. S. Departnsrt of
Transportcion upon requs$t.
Each motm carrier {privato or for.hire) and cach vessel operatot subject to &t registration requiremant
must kep a Eopy ofthc ounent Ccrtifiom of Rcgistration or aaother doounrcnt bearing thc rcgisaation
nuraber identifiad as thc .U.S. DOT llsrsnat ltcg. No.* in eseh truak and truck tractor or vcssel (trailcrs
aad serni-trailc$ rot iaoludcd) used ro transport hiz8rdous matErials eubject to the registration
requirunerrt. The Cortificate ofRrgistration or dooument bearing the rcgisfation numbcr must be madc
anailable, upon rcqu€st, tio enbrEcment personnel'
Fsr information, coqtad the llaeardous ldattrials Rogi*ration lvlanager, PH!I-SZ, Pipcline and
Haadous Matc.rials Safcry Adrninistration, U.S. Departmsnt of Trarsporution, 1200 Ncw Jerscy
Averrue; 38, Washington, DC 20590, talephone (202) 366-4109'
ー
U. S. Departnent of Justice
TnS and Expl軸 澪 響 要型 OJV∝L軸 se/Pem鸞
FCd,口 取
,wv 25405‐9411(FEr.c) ----::
PLANET PRoD/MAD 8oM,F轟
Ⅲ熟 111轟 TM^I DIs:
ヵpeoru颯 1撻 。rpenm壽
5,I-IMPOETER OF EXFL
Orthe Feda餞i
a ttue
PIntcd面
:鳳 n略 壼脱趙 v::絆 15 Ptt I
ofany changes.)
Client Name
Report Name
As of Date
T.H.E. lnsurance Company
Carrier Loss Run
11-07-2021
鑢
sedgwick、
As of Date:11-07-2021 F∥ter Name:MIAND INC Run Date:11‐08‐2021
T,H.E.:NSURANCE COMPANY
Carrier Loss Run
Clmt Name
(LasLFirst)
WC Cim Type
File Num Date of Loss
Clm Stat Desc Date Rep to lnsured
Cause Cd Desc
Nature/Result Desc
Pd:nd
Fut Res!nd
Pd Med
Fut Res Med
Pd Exp/oth
Fut Res Exp
Tot Paid
Tot Fut Reserves
Tot lncDate Clm Closed Date Reo to Sedqwick State/Province of Loss Tot Recov lnc lnd lnc Med lnc Exp
Po:icy Number‐Carrier Namell■sured Name CPP010529901‐T.H.E:NSURANCE COMPANY,MlAND,:NC.
Carrier Policy Period 20170204(02r04′2017T002′04r2018)
175884‐1lPD-1 07/05′2017
Closed 07/27′2017
08/22′2017 07/27ノ 2017
178613‐1lPD-1 07/04/2017
Closed 03/09/2018
09ノ26′2019 03′09/2018
20170204(0204r2017T002r04r2018)TotalS
CPP010529901‐TH.E:NSURANCE COMPANY,MIAND,:NC.Totals
176002‐1181-1 08′01/2017
Closed 08′02/2017
03/10/2018 08′02′2017 1N
MISCELLANEOUS BVPD
Not Provided/NOC/lnsufrlcient Data
Not Provided/NOCЛ nsuf「lcient Data
Not P「ovidedノ NOCノ insufrcient Data
M:
M:SCELLANEOuS BrPD
Not Providedノ NOC/1nsuttcient Data
lN
SPASOFF,NICK
000
」OHNSON,DAWN
000
MAIDENBERG
ASSOC:ATES LLC
000
000
000
000
000
000
2,93095
000
2,93095
000
000
000
2,930.95
0.00
2,930.95
2,930.95
000
2,930.95
000
000
000
000
000
000
000
000
000
000
0.00
0.00
0.00
0.00
0.00
000
000
000
000
000
000
000
000
000
COUNT:
0.00
0.00
0.00
COUNT:
0.00
0.00
0.00
000
000
000
2,93095
000
2,93095
000
000
000
2,930.95
0.00
2,93095
2,930.95
0.00
2,930.95
Confidential lnfomation. Any a@essing, acquisition, eview, retEnsmission, dissemination or other use of, or taking of any
action in reliance upon the Sensitive lnfomation by peFons or entities other than an Authorized Recipient is stdctly prchibited.
Page 3 Of
T.H.E.:NSURANCE COMPANY
Carrier Loss Run
As of Date:11‐07‐2021 F∥ter Name:MIAND INC Run Date:11‐08-2021
鶴
sedgwick.
F∥e Num Date of Loss
Clm Stat Desc Date Rep to lnsured
Cause Cd Desc
Nature/Result Desc
Clmt Name
(LasLFirst)
WC Clm Type
Pd ind
Fut Res ind
Pd Med
Fut Res Med
Pd Exp/Oth
Fut Res Exp
Tot Paid
Tot Fut Reserves
ict slrL/PDnBolLo!! TolR@ lnclnd lncE Tol hc
Po:icy Number‐Carrier Name,lnsured Name CPP0105299021T.H.EINSURANCE COMPANY,MiAND,:NC.
Carrier Po∥cy period 20180204(02′04r2018T002′04r2019)
181646‐51CL‐1 02′01/2019
Closed 02/12/2019
04ノ23/2020 02ノ 12/2019
179859-51CL‐1 07′20ノ2018
CIosed 07/23/2018
06′25′2020 07/23ノ 2018
179859‐1lPD‐2 07/20/2018
Closed 07/23/2018
06/25/2020 07ノ 23/2018
20180204(02r04′2018T002f042019)TOta:s
Damaged Vehicle
D€nted
IN
Damaged Vehicle
Dented
OH
Damaged Vehicle
Cracked
OH
MIAND INC
MiAND INC
0.00
Geico lnsurance
000
0.00
000
000
000
86800
000
86800
1,52575
000
1,52575
COUNT:
2,393.75
0.00
2,393.75
COUNT:
2,393.75
0.00
2,393.75
99433
000
99433
86800
000
86800
8,64575
000
8,64575
10,508.08
0.00
10,503.08
10,508.08
0.00
10,508.08
99433
000
99433
000
000
000
7,12000
000
7,12000
8,114.33
0.00
8,114.33
8,114.33
0.00
8,114.33
000
000
000
000
000
000
000
000
000
0.00
0.00
0.00
0.00
0.00
0.00
CPP010529902‐T.H.E:NSURANCE COMPANY,MIAND,:NC Tota:s
Confidential lniomation. Any a@$ing, acquisition, Eview, .etEnsmission, dissemination or othor u$ of, or taking of any
aclion in reliane upon tha Sonsiiive lnfomation by pemns or entities other lhan an Authorized Reclpient is stic-tly prchibiled.
Page 4
TH.E.lNSURANCE COMPANY
Carrier Loss Run
総
sedgwick.
Name:MIAND
File Num Date of Loss
Clm Stat Desc Date ReP to lnsured
Cause Cd Desc
Nature/Result Desc
Clmt Name
(LastFirst)
WC Clm Typ€
Pd lnd
Fut Res ind
Pd Med
Fut Res Med
Pd Exp′oth
Fut Res Exp
Tot Pald
Tot Fut Reserves
naぃ c:m c10sed Date Reo to Sedowick Stateノ Province of Loss TOt Recov :nc lnd inc Med inc Exp Tot inc
Po∥cy Number‐Carrier Name,lnsuredlName ELP001210400‐TH.EINSURANCE COMPANY,MIAND,lNC.
Carrier Po:icy Period 20160204(02/04r2016T00″04/2017)
No records found
20160204(0204r2016T00204r2017)TotaiS
ELP001210400‐T.H.EINSURANCE COMPANY,M:AND,lNC.Tota:s
0100
0.00
0.00
0.00
0.00
0.00
0:00
000
0.00
0t00
0.00
0.00
0.00
000
COUNT:
0.00
0.00
0.00
COUNT:
0.00
000
0.00
0.00
000
0、000
0.00
0.00
0.00
Conlidential lnlomation. Any accessing, acquisition, 6view, ret€nsmission, disseminatlon or other use of, or taking of any
action in reliance upon the Sensitive lnfomalion by peEons or entilies other lhan an Authorized Recipient is strictly prohibited
Page 5 Of
TH.E.INSURANCE COMPANY
Carrler Loss Run
As of Date:11‐07‐2021 F∥ter Namel M:AND:NC Run Date:11‐08‐2021
F∥e Num Date of Loss
Clm Stat Desc Date Rep to lnsured
Cause Cd Desc
Nature/Result Desc
Cimt Name
(LastFirst)
WC Clm Type
Pd lnd
Fut Res ind
Pd Med
Fut Res Med
Pd Exp/Oth Tot Pald
Fut Res Exp Tot Fut Reserves
sr.i.,P6!in60rl6 rorR@ hcMod hcEo te! lrc
Po∥oy Number‐Carrier Name,lnsured Name EL'001210401‐T.H.EINSURANCE COMPANY,M:AND,INC.
Carrier P01'Cy period 20170204(02ノ 04r2017T00204/2018)
No records found
20170204(02f04′2017T002r0412018)TotalS
0.00
000
0100
000
000
0.00
0.00
0.00
0:00
0.00
0.00
0.00
COUNT:
0.00
000
0.00
COUNT:
0.00
0.00
0.00
000
0.00
0.00
0.00
0.00
0.00
ELP001210401‐T.H EINSURANCE COMPANY,M:AND,:NC.Totals
0.00
Confidential lntomation. Any accessing, acquisition, review, retGnsmission, dissemination or other use ot, or taking of any
action in relian@ upon the Sensitive lnfomation by pecons or entities other than an Aulhorized Recipient is stric{y pohibited.
Page 6 Of
畿
sedgwick,
As of Date:11‐07‐2021 F∥ter Name:M:ANDINC Run Date:11-08‐2021
File Num
Clm Stat Desc Date Rep tO lnsured
DlbclmcLi..d Dai. R.D ti s€norrlc]( st t /PBinEorr4s TorR@ hclnd lnc M.d lrcEb Tol l.c
Date of Loss Cause Cd Desc
Nature/Result Desc
T.H.E.:NSURANCE COMPANY
Carier Loss Run
Clmt Name
(LastFirst)
WC Cim Type
Pd lnd
Fut Res lnd
Pd Med
Fut Res Med
Pd Exp/Oth
Fut Res Exp
Tot Pald
Tot Fut Reserves
Po∥cy Number‐Carrier Name,:nsured Name ELP001210402‐T.H.E:NSURANCE COMPANY,MIANp,:NC.
Carrier Policy period 20180204(02′0412018T002r04r201‐9)
No records found
20180204(0204′2018T002r04J2019)TOtals
ELP001210402‐T,H.ElNSURANCE COMPANY,MiAND,:NC.Totals
0.00
0100
0100
0.00
0:00
0.00
0100
0.00
000
0,00
0100
0100
COUNT:
0.00
0.00
0.00
00UNT:
0.00
0100
000
0.00
0.00
0.00
000
0.00
0.000_00
Confidential lnfomation. Any a@essing, acquisition, cview, relransmission, dissemination or other use of. or taking of any
action in reliance upon the Sensitive lnfomation by pereons or entities other than an Authorized Recipient is strictly prohibiled
Page 7
T.H.E.:NSURANCE COMPANY
Carrier Loss Run
翁
sedgwick,
As of Date:11‐07‐2021 F∥ter Name:MIAND:NC Run Date:11‐08-2021 中
―
File Num Date of Loss Cause Cd Desc Cimt Name Pd lnd Pd Med Pd Exp′cDth Tot Pald
Clm Stat Desc Date Rep to Insured Nature/Result Desc
(Last First)
WC Clm Type Fut Res lnd Fut Res Med Fut Res Exp Tot Fut Reserves
Date Cim Closed Date Rep tO sedgwick State/Province of Loss TOt Recov lnC lnd lnc Med lnc Exp Tot lnc
Grand Totals COUNT: 8
2,560.25 21,248.54
0.00 0.00
2,560.25 21,248.54
18,688.29
0.00
0.00 10,688129
0.00
0.00
0100
Confidential lnformaiion. Any accessing, acquisition, review, retransmission, dissemination or other use of. or taking of any
action in reliance upon the Sensitive lnfomation by peEons or enlities olher than an Authorized Recipient is strictly prohibiled.
Page 8 of 8
lnsured:
Policy Number:
Policy Period:
Cancel Date:
LOB:
MlAND:NC.DBA PLANEtt PRODUC丁
S:8GL01460
02ノ 04/2021¨02/04/2022
General Liab∥ity
EVEREST LOSS RUN
as of Oct15 2021
:録
塁ヽヽ.Rl:Sヽ
Claim Number
Claim Status
Closed Date
Date of Loss Description of Loss
Date Reported Cause of Loss
Days Between Loss State/Loc-Veh Num
Claimant Name
Driver/Class Cd
Loss Subline
lndemnity Paid Medical Paid
lndemnity Reserve Medical Reserve
lndemnity lncurred Medical lncurred
Expense Paid
Expense Reserve
Expense lncurred
Subrol Deductible/ Total Paid
Salvage Recovery Total Reserve
Total lncurred
A2128517/
4A2107322D
20001
0PEN
07ノ 04/2021
07ノ 21/2021
17
CLAIMANT HAS ALLEGED THAT DA∨iS,」ARED
HE SUSTAINED AN EYEIN」URY
AS A RESULT OF DE
lL/0000006
000
5,00000
5,00000
0.00
000
0.00
000
000
000
000
5,00000
5,00000Premises/Operations
Liabinty
A2128519/
4A
2107357140001
CLOSED
08/11/2021
07/04/2021
07/22/2021
18
CLAIMANT:S CLAIMiNG EYE
DAMAGES SUSTAiNED AS A
RESULT OF F!REWORK DEB
ILノ 0000006
DAViS,」ARED
Premises/Operalons
Liabi∥ty
000
000
000
000
000
000
000
000
000 000 000
000
000
000
SLrb Total for SubLine: Premises/Operations Liability : 2 000
5,00000
5,00000
000
000
000
000
000
000 000 000
000
5,00000
5,00000
Sub Total for Line Of Business: General Liability : 2 0.00
5,00000
5,000.00
000
000
000
0.00
0.00
000 000 000
000
5,00000
5,00000
Sub Total for Policy Number: S18GL01460-211 : 2 000
5,00000
5,00000
0.00
000
000
0.00
5,00000
5,00000
Run Date:11/2/2021 Page No 1 of 3
000 000
lnsured:
Policy Number:
Policy Period:
Cancel Date:
LOB:
MiAND iNC.DBA PLANET PRODUCT
Si8GL01460
02/04/2020-02/04/2021
EVttREST LOSS RUN
as of Oct15 2021 番VtR墨 :ヽ
Claim Number
Claim Status
Closed Date
Date of Loss Description of Loss
Date Reported Cause of Loss
Days Between Loss State/Loc-Veh Num
Claimant Name
Driver/Class Cd
Loss Subline
indemnity Paid Medical Paid
!ndemn"y Reserve Medical Reserve
indemnity incurred Medicai incurred
Expense Paid
Expense Reserve
Expense lncurred
Subro/ Deductible/ Total Paid
Salvage Recovery Total Reserve
Total lncurred
No Claims forthis Policy Pe“od 000
000
000
000
000
000
000
000
000 000
000
000
000
Sub Tctalfor SubLine:10 000
000
000
000
000
000
000
000
000
Sub Total for Line Of Business: : 0 000
000
000
000
0.00
000
000
000
000 000
Sub Totalfor Policy Numberi Si8GL01460-20110 000
000
000
000
000
000 000
000
000
000
Run Date,11/2/2021 Page No 2 of 3
000
000
000
lnsured:
Policy Number:
Policy Period:
Cancel Date:
LOB:
M:AND:NC DBA PLANET PRODUCT
Si3GL01460
02/04/2019-02/04/2020
EVEREST LOSS RUN
as of Oct15 2021 √/″R■Sヽ
Claim Number
Claim Status
Closed Date
Date of Loss Description of Loss
Date Reported Cause of Loss
Days Between Loss State/Loc-Veh Num
Claimant Name
Driver/Class Cd
Loss Subline
lndemnity Paid Medical Paid
lndemnity Reserve Medical Reserve
lndemnitylncurred Medicallncurred
Expense Paid
Expense Reserve
Expense lncurred
Subro/ Deductible/ Total Paid
Salvage Recovery Total Reserve
Total lncurred
No Ciaims forthis Policy Penod 000
000
000 000 000
000
000
000
Sub Totalfor SubL nei:0 000
000
000
000
000
000
000
000
000 000 000
000
000
000
Sub Total for Line Of Business: : 0 000
000
000
000
000
000
000
000
000 000 000
0.00
000
000
Sub Total for Policy Number: S18GL01460-191 : 0
000
000
000
0.00
000
000
000
Grand Total of Selected Years for Policy Number:S!8GL01460 1 2 000
5,00000
5,000.00
000
000
000
000
000
000
000
500000
5,00000
Run Date:11/2/2021 Page No 3 of 3
000
T.H.E.:NSURANCE COMPANY
Design Your Own 3‐Line Deta∥
As of Date:01‐04‐2021 F∥ter Name:Nl1426‐ MIAND LOSS RUNS
①
sedgwick゛
Acct Name
Line Desc
Policy Num
Event Desc
Struct Loc Code (03) File Num
State/Province of
Loss
Date of Loss Date Rep to Sedgwick Clm Stat Desc Date Clm Closed
Tot Pald Tol Fut Reserves Tot lnc
Carrier Po:icy Period 20180204{02J04′2018T002r04r2019)
Line Code And Coverage Code AL‐PD
M:AND,!NC
Auto Liab∥ity(3rd
Pa"y)
AL‐PD Totals
Line Code And Coverage Code AU-CL
M:AND,INC
Auto(l St Party)
MIAND,lNC
Auto(lSt PaⅢソ)AuCL Tota:s
CPP010529902 Nl1426
COLLIS10N DAMAGE OH
CPP010529902 Nl1426
COLL:S10N DAMACE OH
CPP010529902 Nl1426
COLLIS10N DAMAGE IN
COuNT:
COUNT:
COUNT:
COUNT:
179859‐1lPD‐2 07/20/2018 07r23/2018 Closed 06/25′2020
S 8,64575 S 000 S 8,64575
$ 8,645.75
3 0.00 S 8,645.75
07/23/2018 Closed 06/25/2020
S 86800 S 000 S 86800
02/1 212019 Closed 04/23/2020
$ 99433 S 000 S 99433
S l,862.33
179859‐51CL-1 07ノ 20/2018
181646‐51CL-1 02/01/2019
S O.00 S l,862.33
20180204(02′04′2018T002′04r2019)Totals
Grand Totals
S 10,508.08
S 21,24854
3 0.00 S 10,508.08
S O.00 S 21,248.54
Confidenlial lnformalion. Any accessing, acquisition, review, rgtEnsmission, dissemination or other use of, or taking of any
aclion in reliance upon the Sensitivs lntormation by peGons or entili€s other than an Authorized Recipient is stric{y prohibited.
Page4 of 4
T,H.E.:NSURANCE COMPANY
Design Your Own 3‐Line Deta∥
As of Date1 01‐04‐2021 Filter Name:Nl1426- MIAND LOSS RUNS
翁
sedgwickr
Acct Name
Line Oesc
Policy Num
Event Desc
Struct Loc Code(03) F∥e Num
State′Province of
Loss
Oate of Loss Date Rep to Sedgwick Clm Stat Desc Date Clm Closed
Tot Paid Tot Fut Reserves Tot lnc
Carrier Poiicy Per:od 20160204(0204f2016T002′0472017)
Line Code And Coverage Code AL‐PD
M:AND,INC
Auto Liab∥ity(3rd
Pa")
AL‐PD Totais
Line Code And Coverage Code AU4L
MIANO,lNC
Auto(lSt Party)
AuCL Totais
MIAND,:NC
Auto Liablity(3rd
Pa∥け)CPP010529900 Nl1426
1V DAMAGED CLMT :N
PROPERTY
CPP010529900 Nl1426
:V DAMAGED CLMT IN
PROPERTY
CPP010529901 Nl1426
1V DAMAGED CLMT MI
PROPERTY
171564‐1lPD-1 07′04/2016 07′14/2016 Closed 08/16′2016
S 3,27281 S 000 S 3,27281
S 3,272.81
COUNT:
COUNT:
COUNT:
3 0.00 S 3,272.81
171564‐41CL-2 07/04/2016 07/14′2016 Ciosed 12706′2016
20160204(02′04r2016T002J04r2017)TotalS
Carrier p。∥cy period 20170204(0204′2017T002′04r2018)
Line Code And Coverage Code AL‐PD
175884‐1lPD-1 07/05/2017
S 4,53670 0 000 S 4,53670
S 4,53670
S O.00 3 4,536.70
S 7,809.51
S O.00 3 7,809.51
07/27′2017 Closed 08/22/2017
S 2,93095 S 000 S 2,93095
Confidential lnfomation. Any accessing, acquisition, review, retEnsmission, dissemination or oth6r use of. or iaking of any
a6{ion in reliance upon the Sensitive lnformalion by peGons or entities other than an Authorized Recipient is stric-tly prohibited.
Page 2 of 4
T.H.E.:NSURANCE COMPANY
Design Your Own 3‐Line Deta∥
As of Date1 01‐04‐2021 Fi∥er Name:Nl1426-MIAND LOSS RUNS
Acct Name POlicy Num struct Loc Code(03) File Num Date of Loss Date Rep tO sedgwick Clm Stat Desc Date Clm Closed
Line Desc Event Desc State/Province of Tot Paid Tot Fut Reserues Tot lnc
@
sedgwick.
AL‐PD Totals
Line Code And Coverage Code GL-Bl
MIAND,:NC
Gene「al Liab∥ity
GL‐81 Totals
Line Code And Coverage Code GL-PD
MIAND,INC
General Liab∥ty
CL‐PD Tota:s
20170204(02′0412017T002′04/2018)Totals
CPP010529901 Nl1426
1N」URED/DAMAGE BY IN
FIREWORK
CPP010529901 Nl1426
1N」UREDノ DAMAGE BY :N
FIREWORK
COUNT:
COUNT:
COUNT:
176002‐1lB:-1 08/01/2017
07/04/2017
08′02/2017$03/09/2018S 2,930=95
0.00
0.00
2,93095S CIosedS
$
Closed
$
2,930.95
03/10/2018
$ 000S
09/26′2019$0.00
000
2,98095
000
000
000
0.00
0.00
178613-1lPD-1
COUNT:
Confid€ntial lnformation. Any accessing, acquisition, review, relransmission, dissemination or other usa of, or taking of any
action in reliance upon the Sensitive lnformation by persons or €ntities other than an Authorized Recipient is stricfly prohibited
Page 3