LUKE AIR FORCE BASE_REDACTED .PDF

Maricopa County — Formal (2023-06-14)

Extracted text (via ocr_local) 14295 characters

MARICOPA COUNTY BOARD OF SUPERVISORS
301 West Jefferson Street, 10th Floor, Phoenix, Arizona 85003

APPLICATION FOR FIREWORKS DISPLAY

Arizona Revised Statutes § 36-1603 requires every display shall be handled by a competent operator, and shall
be of a character and located, discharged and fired so that it will not be hazardous to property or endanger any
person. Before a permit is granted, the operator, location and handling of the display shall be approved by the
sheriff of the county. After a permit is granted, the sale, possession, use and distribution of fireworks for the
display shall be lawful for that purpose only. Permits are not transferable or assignable.

Further, A.R.S. § 36-1604 requires that the governing body shall require each applicant to provide a satisfactory
bond of not less than $500, or a copy of the certificate of liability insurance in a principal amount usually not less
than $1 million, conditioned upon payment of all damages which may be caused to persons or property by
reason of the display.

Complete the following application and submit to the Clerk of the Board of Supervisors, 301 W. Jefferson Street,
10" Floor, Phoenix, 85003 (602-506-3766) at least 30 days prior to the event date.

All applications must have the following documentation attached:
1. Proof of appropriate bond or insurance payable to Maricopa County.
2. Map of display area.
3. List of fireworks to be discharged. The Director of Display for the fireworks company is expected to be
licensed and/or trained by the City of Phoenix or have other verification of expertise.
4. Verification from local fire department that they were notified of event, date, location and time.

EVENT INFORMATION

Name/Organization: Luke Air Force Base

Name of Event: Independence Celebration Fireworks display

Event Address: Empty Lot at 13803 W Northern Ave. Glendale AZ 85307
Date and Time of Event: June 30, 2023 @ 9pm

DISPLAY DIRECTOR (permit will be issued to the following)
Name: Cody Welty Phone: 480-466-6715

Business: _ Fireworks Productions of Arizona Fax:

Address: 17034 § 54th St. Chandler 85226 Email: FT

SUBMIT APPLICATION AND REQUIRED DOCUMENTATION TO:

Maricopa County Clerk of the Board of Supervisors Email: ClerkBoard@mail.maricopa.gov
301 W. Jefferson Street, 10" Floor Fax: 602-506-6402
Phoenix, Arizona 85003

For questions, please call the Clerk of the Board of Supervisors at: 602-506-3766. yw

RECEIVED

JUN 0.5 2023

MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

FIREWORKS DISPLAY SITE MAP

Indicate the following:

Fire department access
Hydrants

Distance to structures
Overhead lines

1. North direction

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

4. Storage area

(North)

é es email to Clerk of the Board

FOR DEPARMENT USE ONLY:

SHERIFF’S OFFICE RECOMMENDATION

The State Fire Marshal or local fire chief has reviewed the site and fireworks described by the applicant and
found them to be satisfactory.

Sheriff’s Office Signature Date

PERMIT FOR FIREWORKS DISPLAY

The above application having been filed pursuant to A.R.S. § 36-1603, together with other proper
documentation; permission is granted to the above-named applicant to conduct a fireworks display on the dates
set forth in the application. INTHE EVENT OF POSTPONEMENT OF SAID SHOW, the display will be given
not later than one (1) week from the date specified above.

Approved by the Maricopa County Board of Supervisors:

DATED this day of 20

Clerk of the Board, authorized signature

Display Site

Pas nos 2A Te SSuiiceu

Water. Fire Exinguistrers 7s
WI

| Luke Air Force Base
Off-Site Location

Site Map Maximum Shell Size: 6° Aerial
Fireworks Productions of Arizona 480-948-0090 info@fireworksaz.com

EXHIBIT A
LUKE AIR FORCE BASE

Friday, June 30, 2023

15 - 20 Minute Display
(3 second pace)

Total Aerial Shells 499

Opening:
Your show begins with an impressive series of brilliantly-colored shells and powerful

booms with flashing light to excite and thrill the audience.

Your Opening: 4 - 5” shells, 2 — 6” shells w/ 21 - 3” Titanium Salutes

Aerial Display:

A large assortment of brilliantly-colored shells, including Chrysanthemums, Waves, Crowns,
Peonies, Strobes, Brocade Crowns, Diadems, and Crossettes in gorgeous Reds, Yellows,
Blues, Greens, Silvers, and Golds.

Your Aerial Display will contain a total of 378 Aerial shells.
4” -180 Chinese Fancy’s & Specials
4” - 36 Designer Specials
5”- 72 Chinese Fancy’s & Specials
5”- 18 Pattern Specialty Shells
6” - 36 Chinese Fancy’s & Specials
6”- 18 Pattern Specialty Shells

Grand Finale:

Your celebration will close in spectacular excitement as multiple styles of brilliantly-colored
shells, rocket skyward growing and glowing in breath-taking Blues, Golds, Greens, Silvers,
Yellows, Purples and Red.

Your Grande Finale consists of 94 Aerial shells:
Your Grande Finale 35 - 3” shells, 32 - 4” shells, 6 - 6” shells

w/ 21 - 3” Titanium Salutes

Designed: for [ uke Air Force Base by: Fireworks Productions of Arizona

May 22, 2023

Clerk of the Board of Supervisors
Maricopa County

301 W. Jefferson

Phoenix, AZ. 85003

To Whom It May Concern:

Attached is the permit application for Luke AFB fireworks scheduled for June
30, 2023 at the empty lot north of Luke Elementary 7300 N Dysart Rd.,
Glendale. I have also included a letter from Luke AFB stating they will be the
responding fire department.

Once the permit has been approved with Maricopa County Board of
Supervisors please send me a copy either by mail or email to the following
address:

Fireworks Productions of Arizona
Attn: Cindy Herbel

17034 S. 54" Street

Chandler, AZ. 85226

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

Pyrotechnically Yours,

Cindy Herbel
Pyro Office Assistant

DEPARTMENT OF THE AIR FORCE

56TH FIGHTER WING (AETC)
LUKE AIR FORCE BASE AZ 85309-1629

18 May 2023

MEMORANDUM FOR KENDON VICTOR (Fireworks Productions of Arizona)
FROM: 56 CES/CEF
SUBJECT: Luke Fire Dept Support for Fireworks Display

1, Luke AFB Fire & Emergency Services (F&ES) will provide fire suppression/medical support
for the fire works display on 30 June 2023.

2. Luke AFB F&ES will assume responsibility pertaining to fire and emergency services for the
firework production personnel, residences, and spectators at the event. Luke AFB F&ES will
provide a Battalion Chief (Command & Control) and a fire suppression apparatus (Structural
Pumper) consisting of 4 personnel. If required, additional fire department resources will be
staged at Fire Station | on Luke AFB.

3. Any questions please contact Mr. Jason Haddock at 623-896-7425.

HADDOCK.JASO Digtaly signed by

IADDOCK.JASON.R.1187185714

N.R.1187185714 date: 2023.05.18 10:02:35 .07'00

JASON R. HADDOCK, CIV, DAF
Deputy Fire Chief

POLICY NUMBER: — SI8MLO2344221

COMMERCIAL GENERAL LIABILITY
ECG 20 592 05 09

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED — DESIGNATED
PERSON OR ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s)

ANY PERSON OR LEGAL ENTITY IN WHICH YOU HAVE A WRITTEN CONTRACT, AGREEMENT, OR
PERMIT WHICH REQUIRES THAT YOU NAME THE CONTRACTING PARTY AS AN ADDITIONAL INSURED.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section Il — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", “property
damage" or "personal and advertising injury" but
only to the extent caused, in whole or in part, by
your acts or omissions or the acts or omissions of
those acting on your behalf:

41. In the performance of your ongoing operations;
or

2. In connection with your premises owned by or
rented to you.

B. The insurance afforded to an additional insured
shall only include the insurance required by the
terms of the written agreement and shall not be
broader than the coverage provided within the
terms of the Coverage Part.

ECG 20 592 05 09

C. The Limits of Insurance afforded to an additional

insured shall be the lesser of the following:

1. The Limits of Insurance required by the written
agreement between the parties; or

2. The Limits of Insurance provided by this Cov-
erage Part.

. With respect to the insurance afforded to an addi-

tional insured, the following additional exclusion
applies:

This insurance does not apply to “bodily injury’,
"property damage" or "personal and advertising in-
jury" arising out of any act or omission of an addi-
tional insured or any of its employees.

Page 1 of 1

Includes copyrighted material of Insurance Services Office, Inc., used
with its permission.

City of Phoenix

Fire Department

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FIRE PERMIT

150 South 12th Street

To find out about Phoenix construction code adoption

nevis anf eseach your parm or projets, please Phoenix, Arizona 85034 POST THIS PERMIT ON JOB SITE
Visi ip:fwer phoarix gowiPD General Information (602)262-6771
Permit # | F702 2008438 | Issue Date 19-FEB-2020 Expires 31-MAY-2023

Permit Description CODY WELTY - PYROTECHNIC CERT OF FITNESS
Project 20-668
| Address NOT FOUND Zoning

Description/Scope of Work: FIREWORKS/PYRO NEW CERT OF FITNESS CARD

PERMIT TO CONDUCT FIREWORKS SHOWS IN THE CITY OF PHOENIX

OUTDOOR FIREWORKS CARD HOLDER:

-_ L _

EMPLOYED BY:

FIREWORKS PRODUCTIONS OF ARIZONA, LTD.
17034 S. 54th Street

Chandler, AZ 85226

480-948-0090

Valuation: $0
Owner Information

Certificate of
Name Occupancy Type: COFC

Address
Contractor Information

. Permit Issued By CMCC Entered By CMCC
Instructions and Comments

| inspections Required: FIRE-GEN

bprp01fd

DATE (MMI/DD/YYYY)

—
ACORD CERTIFICATE OF LIABILITY INSURANCE Femina

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: [If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).

PRODUCER GONTACT janet Nau
The Partners Group Ltd PHONE - FAX 495-455-672
411225 SE 6th St., Suite 110 {AIG No, (AIC, No}: 425-455-6727
Bellevue WA 98004 ADDRESS;
INSURER(S) AFFORDING COVERAGE NAIC #
__ INSURER A: Everest Indemnity Insurance Co 10851
INSURED 16021) iwsureR B: Everest Denali Insurance Company 16044
FPA, LTD 7 -
Fireworks Productions of Arizona INSURER C : AXIS Surplus Lines Insurance Company 26620
17034 S. 54th Street INSURER D: Travelers Property Casualty Co of America 25674
Chandler AZ 85226 INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: 1140068795 REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

ie TYPE OF INSURANCE Nal wn POLICY NUMBER (AMERY) | (MMIDDIYYYY) LIMITS
A GENERAL LIABILITY Y SI8ML02344221 10/9/2022 40/9/2023 EACH OCCURRENCE $1,000,000
x COMMERCIAL GENERAL LIABILITY Ce EE Oe cwaurence) $500,000
| CLAIMS-MADE OCCUR MED EXP (Any one person) SIA
|_| PERSONAL & ADV INJURY, $ 1,000,000
|_| GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $2,000,000.

|_| pouicy | X | REO: [_|toc 8

COMBINED SINGLE LIMIT

B_ | AUTOMOBILE LIABILITY $18CA00258221 40/9/2022 yosi2023 | FOMBINED s $1,000,000
X | any auto BODILY INJURY (Per person) | $
ALL OWNED SCHEDULED 5
ALL OM [ SCHED BODILY INJURY (Per accident) | $
X X | NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS (Per accident)
$
c UMBRELLA LIAB X | occur P00100089169702 10/9/2022 10/9/2023 | EACH OCCURRENCE $ 4,000,000
X | EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000
DED | | RETENTION $ $
D_ | WORKERS COMPENSATION 6R08411 40/9/2022 40/9/2023 |X | _WCSTATU- OTH
AND EMPLOYERS! LIABILITY YIN TORY LIMITS. ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE} $ 1,000,000
Ifyes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $4,000,000
A_ | General Liability & SI8EX01790221 10/9/2022 10/9/2023 | Each Occurrence $5,000,000
Auto Excess over $4M Aggregate $5,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 104, Additional Remarks Schedule, if more space is required)
The following are included as Additional Insured on General Liability as their interest may appear as respects operations performed by or on behalf of the
Named Insured per form #ECG 20592 0509 Additional Insured-Designated Person or organization attached:

Date of Display: June 30, 2023

Location of Display: 7510 N. Dysart Rd., Glendale, AZ

Additional Insured(s): Luke Air Force Base; Community Center; State of Arizona; Maricopa County Board of Supervisors; City of Glendale; Glendale Fire
Department; Rural-Metro Fire Department; Miedema Produce, Inc.; Desert Leasing LLC..

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.

Luke Air Force Base - 56 Cons

14100 W. Eagle St. AUTHORIZED REPRESENTATIVE

Luke Air Force Base AZ 85309-1920
fom fall