An original certificate of insurance shall be submitted to the City of Council. Please submit an insurance
certificate a minimum of thirty days prior to the date of the event for approval by the City Legal
Department. The following represents the City’s insurance requirements. Any exceptions to these
requirements must be specifically granted by the City Council and made known to the City Legal
1. An original certificate of insurance with the original penned signature of the agent writing the
certificate is required. (Stamped signatures are not accepted.)
2. The name, address and phone number of the agent signing the certificate shall be typed under the
3. Copy of a Power of Attorney or other document showing the agent’s authority to sign for the
insurance company shall be attached to the certificate (a copy of the agent’s insurance license will
4. “The City of Council Bluffs, Iowa, and its employees are named as additional insured” shall be
specifically indicated on the certificate.
5. The name and date of the event being covered shall be indicated on the certificate.
6. The minimum liability limit required by the City is one million dollars (must be occurrence form
general liability coverage).
7. All addresses on the certificate shall list a street address; P. O. Box addresses are not accepted.
Pyrotechnic Plan giving date, time, exact location, etc.
List and descriptions of all pyrotechnic devices to be used.
Qualifications and experience of the operator.
Diagrams showing placement of devices.
Proof of financial responsibility.
Material Safety Data Sheets (MSDS)
Flame retardency certifications of scenery if applicable.
Storage locations of pyrotechnic materials.
Live demonstration of materials to be used.
Agreement to provide a minimum of (2) two stand-by fire personnel on scene at the applicable
cost per hour.
Additional personnel and/or equipment may be required by the authority having jurisdiction.
Applicable laws include, but are not limited to: NFPA 1123, 1124, 1126,101, IFC and all local,
State and Federal laws.
Operators shall be at least 21 years old Assistants at least 18.
Provide copies of all licenses and certificates, resume of experience.